Tehnici de anestezie
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Transcript of Tehnici de anestezie
SPECIAL TECHNIQUESSPECIAL TECHNIQUES
Indication For Special TechniqueIndication For Special Technique
InfectionInfection
PathologyPathology
TrismusTrismus
TraumaTrauma
Nerve Block TechniquesNerve Block Techniques
Extraoral Maxillary Nerve BlockExtraoral Maxillary Nerve Block
Extraoral Infraorbital Nerve BlockExtraoral Infraorbital Nerve Block
Extraoral Mandibular Nerve BlockExtraoral Mandibular Nerve Block
Nerve Block TechniquesNerve Block Techniques
Gow-Gates Mandibular Nerve BlockGow-Gates Mandibular Nerve Block
Akinosi Closed Mouth Mandibular Nerve Akinosi Closed Mouth Mandibular Nerve BlockBlock
Infiltration TechniquesInfiltration Techniques
Periodontal LigamentPeriodontal Ligament
IntraosseousIntraosseous
Mylohyoid NerveMylohyoid Nerve
Gow-Gates Mandibular BlockGow-Gates Mandibular Block
Developed to improve success rateDeveloped to improve success rate
True mandibular nerve blockTrue mandibular nerve block
Has a lower rate of positive aspiration Has a lower rate of positive aspiration
(2% vs. 10%-15% for IAN)(2% vs. 10%-15% for IAN)
Technique dependentTechnique dependent
Indication For Special TechniqueIndication For Special Technique
Anatomic variationAnatomic variation
Complete nerve trunk Complete nerve trunk
Selective pulpal / soft tissue anesthesiaSelective pulpal / soft tissue anesthesia
Gow-Gates Mandibular BlockGow-Gates Mandibular Block
Target AreaTarget Area
Neck of condyle, below insertion of lateral Neck of condyle, below insertion of lateral pterygoid musclepterygoid muscle
Gow-Gates Mandibular BlockGow-Gates Mandibular Block
LandmarksLandmarks
Mesiolingual cusp of maxillary 2nd molarMesiolingual cusp of maxillary 2nd molar
Intertragic notchIntertragic notch
Corner of the mouthCorner of the mouth
Gow-Gates Mandibular BlockGow-Gates Mandibular Block
TechniqueTechnique
Coordinate intraoral & extraoral landmarksCoordinate intraoral & extraoral landmarks
Align barrel of syringe over premolars and Align barrel of syringe over premolars and with extraoral landmarkswith extraoral landmarks
Gow-Gates Mandibular BlockGow-Gates Mandibular Block
Technique (cont.)Technique (cont.)
Penetrate mucosa distil to 2nd molarPenetrate mucosa distil to 2nd molar
Advance needle to bone (avg. 25 mm)Advance needle to bone (avg. 25 mm)
Aspirate, deposit 1.8 ml of solution slowlyAspirate, deposit 1.8 ml of solution slowly
Gow-Gates Mandibular BlockGow-Gates Mandibular Block
Technique (cont.)Technique (cont.)
Patient’s mouth must be Patient’s mouth must be fullyfully open during open during injection and for 1-2 mins afterwardinjection and for 1-2 mins afterward
May require reinforcement with second May require reinforcement with second injectioninjection
Gow-Gates Mandibular BlockGow-Gates Mandibular Block
ComplicationsComplications
Hematoma (< 2%)Hematoma (< 2%)
TrismusTrismus
Akinosi Closed Mouth Akinosi Closed Mouth Mandibular BlockMandibular Block
Alternative for mandibular block when Alternative for mandibular block when limited opening is presentlimited opening is present
( eg. trismus, closed lock, etc..) ( eg. trismus, closed lock, etc..)
Akinosi Closed Mouth Akinosi Closed Mouth Mandibular BlockMandibular Block
AdvantagesAdvantages
Not necessary to open widelyNot necessary to open widely
High success rateHigh success rate
Relatively atraumaticRelatively atraumatic
Few complications, few positive aspirationsFew complications, few positive aspirations
Akinosi Closed Mouth Akinosi Closed Mouth Mandibular BlockMandibular Block
DisadvantagesDisadvantages
Visualization of path and depth of insertion Visualization of path and depth of insertion is difficultis difficult
No bony contactNo bony contact
Traumatic if needle hits periosteumTraumatic if needle hits periosteum
Akinosi Closed Mouth Akinosi Closed Mouth Mandibular BlockMandibular Block
Target AreaTarget Area
Soft tissue medial to ramusSoft tissue medial to ramus
Above foramen, below condyleAbove foramen, below condyle
LandmarksLandmarks
Mucogingival junction of maxillary 2nd or 3rd molarMucogingival junction of maxillary 2nd or 3rd molar
Maxillary tuberosity Maxillary tuberosity
Akinosi Closed Mouth Akinosi Closed Mouth Mandibular BlockMandibular Block
Area of insertionArea of insertion
Soft tissue overlying medial ramus, Soft tissue overlying medial ramus, adjacent to tuberosityadjacent to tuberosity
At height of mucogingival junction of At height of mucogingival junction of maxillary 2nd or 3rd molarmaxillary 2nd or 3rd molar
Akinosi Closed Mouth Akinosi Closed Mouth Mandibular BlockMandibular Block
TechniqueTechnique
Retract soft tissues, have patient occludeRetract soft tissues, have patient occlude
Apply topicalApply topical
Penetrate to 25 mm, parallel to maxillary Penetrate to 25 mm, parallel to maxillary occlusal plane, in a posterior and lateral occlusal plane, in a posterior and lateral directiondirection
Akinosi Closed Mouth Akinosi Closed Mouth Mandibular Block Mandibular Block
Technique (cont.)Technique (cont.)
Aspirate, deposit 1.8 ml slowlyAspirate, deposit 1.8 ml slowly
Motor paralysis will develop first, allowing Motor paralysis will develop first, allowing patient to open more widelypatient to open more widely
Akinosi Closed Mouth Akinosi Closed Mouth Mandibular BlockMandibular Block
ComplicationsComplications
Hematoma (<10%)Hematoma (<10%)
Facial nerve paralysis (Bell’s Palsy)Facial nerve paralysis (Bell’s Palsy)
Trismus (rare)Trismus (rare)
Akinosi Closed Mouth Akinosi Closed Mouth Mandibular BlockMandibular Block
Failures of anesthesiaFailures of anesthesia
Lateral flaring of mandibleLateral flaring of mandible
Insertion too lowInsertion too low
Penetration too deep or shallow (adjust for Penetration too deep or shallow (adjust for patient size)patient size)