Local anaesthesia II

hi Venus back here with the local anaesthesia part okay so before going into the topic okay so even if it is not a live class the most common things that I have encountered in the last one week in the phone calls and as well as in the messages is these two things okay so always pointing someone or some X apart from you for your failure okay last year I was not successful I did not clear my exam the reason was this okay now I'm not able to do the reason was this okay so I'm not going to talk about the X person the person can be anything sometimes can be a good friend sometimes can be your parents or your family members because I have seen many such cases where the main issue what you're pointing is just my parents are not allowing me to read they are not giving me the permission they are not giving me the scope okay so XY jet so my suggestion for all of you is whatever it may be okay whether you are with the best rank on the day of result or with the worst rank on the day of result the person who is going to get hundred percent is credit is you okay he if you feel that your parents or your your best friend or some good persons in your circle were spoil your preparation means it is you that is behind the particular individual for example your parents are not allowing you to study they're not allowing you to do ambience they're not happy with your preparation okay means that is you how to take a move to explain your parents or to explain the particular person that how important is the preparation for you okay how important is this exam for you professionally so that you will get into good college or I may get into good college I will get I'll be like this the stoy friends will be like this or the faeces will be like this if I get a free seat these are the consequences that - how and these are the benefits that we are going to have professionally and financially so it's you that how to explain everything to your parents okay because like I feel like only five percenters or like one to two percenters or the parents know what is really happening in the industry what is the scope of Dentistry rest most of us like 97 to 98 percentage of parents they don't know what is the scope and what is the liability of dentistry they just know that dentistry okay he treat us he treats the teeth or he's called as a dental doctor that most of her peers they don't they even the branches or even the subjects that were present in the dentistry okay it's you that you have to take some time explain the parents about the consequences and explain the patient explain the parents about the upcoming future in the dentistry so that the person who is going to stop you or prevent you from successfully is going to understand like what is really happening here okay so the main characters in the preparation according to me it's always you you are the only character whether you're successful you're the only character whether you're failure so that is the first note I want to make it very very clear don't don't don't throw the reason or your failure on some someone someone okay maybe him but it's always you behind them who are the primary reasons okay so the second factor that I'm going to discuss today is the fear factor okay I think today morning I got a call okay from the old student who is repeating the examination it's not the first call I used to get regular text messages from the old students and people who has this fear factor okay fear factor is the primary reason for most of us like fear of failure like why we study for the university exams most of us we study for the university exams including me last one month last ten days last one day last overnight I used to do hell of the work because it's not that I want to be the university topper it's not that I want to be the topper or a distinction candidate holder it's always the main factor is fear of failure I have a fear of failure and I take that as a primary concern I read duels and similarly I'm not talking about the people who has to start the preparation who have nowhere bothered about the preparation they don't worry about fear of failure because need exam is not mandatory Sam if you want to get updated to the next level this is one of the option and this is the best way of option but university exams which you give at the end of the year are mandatory and if you fail you will be separated from your batch mates right you will be separated from your respect to batch mates and that separation is the main reason of fear of failure and that is the primary theology why most of us like 90 percentage of us really I'm not talking about the 10 percentage of Distinction candidates are the people who treat from day one or college university stalkers or college toppers but I'm bothered about this 90 percent tears of the people in which I am included I have that fear of failure that I if I fail in this exam I'll be in the same year I my batch mates are going to get promoted so that fear of failure made me too ready for study for the University exams but it doesn't happen with me or with most of us in the need entrance or any sort of PG entrance exam okay so so if you have this fear of failure this fear is your driving force because there there should be some fear to drive you through the preparation okay so fear should be there because fear will drive you into the preparation will force you to work hard in the preparation but how to overcome and manage the fear fear like the few people who are psychologically feeling ill at the end of the day that whether I'm up to this mark or not whether I can etch you this or not so always there is a one-one saying of always when you are with MDS concur always think positive so universe is surrounded by lots of molecules if you think positive the positive will happen whatever you say is going to happen if you say good good will happen if you say bad bad will happen so taking this in words into consideration don't ever talk back about your preparation or about yourself let's talk good because good is going to happen definitely for sure okay so taking these two important notes into consideration this video I'm just going to move further into local anesthesia part two okay so I have already discussed about the classification the basic pharmacology classification which has divided it into esters and amides so it's just again divided into benzoic acid and paraben generic acid you can identify paraben tannic acid with throw and only stir which has to Isis this rest all oysters will have only one line coming to MIT amides easy way to identify this emerged always will have two eyes you can see all their meds will have two eyes so that's well I'm moving ahead okay yesterday I was discussing some stuff related to the medical emergencies where I have given few hints that endotracheal route is the most fastest route of activation right so the next comes is the if you if you see this is the time to reach the peak intravenous please do make a note about the angle of insertion of the injection for all this okay which was asked in 2017 question and which was done and they both whereas today's class right done I'm just moving ahead okay so so what happens we are done with the site of injection that site can be any of the modes like IV or anything but finally the product reaches the blood from blood it's going to distribute to all the areas so there is to two aspects of getting equilibrium one is the slow equilibrium and second one is the rapid decay so rapid equilibrium is mainly within the brain heart that is myocardium lungs and liver whereas the slow equilibrium is in the fat and the muscles note that which equilibrium everything right so what is slow slow comes which and where do the rapid equilibrium is going to come so I was talking like we need to talk about a few things about the half-lives right half life I hope you know the basic definition of half life half life is the amount of time required to decrease the product of 100 molecules 250 half of it okay so most of your questions will move around the highest and the lowest so already discuss the lowest is chloro propane and propane whose the lowest values and that's the reason by clora protein is most commonly used in children easy to remember it starts with C and it starts with C right and the maximum I have already discussed that is the Whoopi what kind okay what kind is the maximum with 3.5 3.5 hovers of half life okay so apart from this most commonly used buyers in the market right now is little kinds of to make an order but little friend values and ladokern is almost the same as pretty low kind okay so most of the values they move around one point six to one point and you can remember all these values right one point six to one point nine and the lowest and highest unmeritorious sometimes they can give half-life based questions by giving the value for example the half-life of a particular drug is this they can give you the chloro broken has a half-life of 0.1 over that is six minutes right zero point one over six minutes they can mention the half-life and in sometimes they will not mention the half-life value you have to remember the off life value and you have to solve the progress and all these problems will be a part of your general form of ecology okay don't worry about them we're going to discuss them in detail on the group but make a note but the half-life value of highest and lowest is important apart from that it is mandatory that you have to learn one two three and four for the sake of example so I'm done with the half-lives I'm moving ahead so this is I mean basically application based questions right application based question condition which are layer to be given which shall a to be avoided and everything so first of all I am going to discuss like as already discussed the contraindications can be categorized into two types absolute contraindication means you should never try relate to you can try with some sort of abnormality and some sort of risk so the two absolute contraindications are the one and two that is allergy is always an absolute contraindication you can see local anaesthetic allergy was documented nowadays documentation will be on the on the other on your like case sheet but previously we used to have some tattos you can see those tattos pictures on in your muhammad or they are going to give a brass light on which they are going to write about the ellipsis okay they're going to get write about the allergy so they're going to keep a tattoo on the body telling that this patient is a legit achter this okay nowadays we have the documentation so any sort of question can be given to you but make a note okay if there is a clear-cut documentation that the patient is a legit ik or the patient is having be sulphate allergic make sure it is absolute contraindication okay so absolute contraindication right so the next important point so the patient is a legit ik than all the local anesthetics in the same class for example if the patient is allergic to oysters then you can try emits if the patient is a legitimate then you can try mister right you can try the other class the solution is you can try the other class second one is bissell fatality okay sulfate allergy is mainly an ingredient that is present in the vas of chemists or that is present in the local anesthetics containing vasoconstrictor so it is it is mostly related to the vasoconstrictor so you go with LS without massive canister - that is a solution so next part is the relative contraindications these are the abnormalities or or the other or the pathophysiology that are present in the body okay the first one is a typical plasma mistress already discussed that Easter's are going to get metabolized in the plasma right whereas your amides are going to get metabolized in the form of liver right so plasma it is metabolized by an enzyme called s plasma cholinesterase so whenever you have an abnormality with the plasma colonists stress it is better to avoid Easter's right it's better to avoid Easter's then what what we have to do better to go with the leftover class that is emerge right so the next one I'm going to talk about is myth hemoglobin II me or idiopathic or congenital any sort of miss myth hemoglobin emia has already discussed it is mainly concerned with pre loci it's mainly concerned with brillig and so you can go with pre LOC and Antarctica and are also concerned with this abnormality so you can go with other unless okay the next one is liver dysfunction or liver diseases okay yes yeah I hope you have you had a note about a si is a classes class 1 class 2 class 3 class 4 classify classics what does it mean and what does it reflects is I get a most commonly asked question which will be dealing in the further classes but make a note if you have a liver problem then as I'd already discuss the Danites are going to get breakdown in the liver so I might should be avoided then you have to go further Easter's if you have a renal problem okay a renal problem is a condition where whatever it is like whether it it is metabolized in the plasma or whether it is metabolized in the liver the final output will be the kidney to eliminate it right so if you have a renal problem most of the local anesthetics are contraindicated and if it is mandatory that you have to go for the uses of local anesthesia then you need to plan some dialysis or anything to the patient to remove the remnants of LD so next course is the cardiac problem no I hope you have very familiar with this leg whenever you have hypertensive patient or whenever you have some cardiac problem patients the most common thing that you need to contraindicate is high doses high concentration of the vasoconstrictor then you need to go over either plain earlier or with the low doses of vasoconstrictor the same goes with hyper paradism hyperthyroidism of patients will have hypertension in the same go state whether it can be tired a toxicosis or anything right make a note that local anesthesia vasoconstrictor is avoided and you need to go for less level of basic constructs so these are the most commonly asked application based questions related to the contraindications of le okay so I'm going to move to the next one I hope you're very familiar with this what is e ml okay there's a full form make a note and if you want the definition make a note because this is again a common thing for your dental materials to make a note the melting point of this mixture is lower than the melting point of the individual components and the most commonly used product is this one that's 2.5 percentage of Lido kind plus 2.5 percentage of pillow kind is okay a few other things that you have to make a note about MLA which will be discussed on the Krypton where I'll be sharing the pic with clear underlining indications contraindications mode of action many other things which are very very important so before going before that and as already discussed in the morning note that there's one more classification which is based upon the biological action so categorized into a b c and so which is going to act which is going to act which is the most common thing apart from the definition of the each class is the examples biotoxins comes under a whereas your quaternary ammonium compound and a lots of judoka and scorpion venom comes into be and the most important thing are the last two allowed to ask questions on the last two that is your pincher kind comes and see and you were clinically used and as most of your clinically used Elias will come center of the class day so the questions are most of the clinically used Elias comes in to be Judith kind comes under Dean ok quaternary ammonium compounds which looks like a dog and comes under B okay so biotoxins comes under a so this biological side classification is again an important aspect that you have to make and not so I already told there is one more classification which is based upon the duration of action right so in which Elias are divided into shorter duration intermediate duration long duration shorter durations of 30 minutes that is pol pol anesthesia is approximately 30 minutes intermediate duration is 60 minutes and it is 90 minutes very simple to remember so most of the questions will be very simple you can see that shorter duration is mostly without any Vasa constructor right without any vessel constructor and this movie what kind is used in Pulp revascularization ok this 3% is a movie what kind is used in the pulp revascularization which is of shorter duration and make a note that this is the most commonly asked question right so of 0.5 percentage of boopie what kind is of longer duration of MVA okay no need of this but try to focus on this and this most common last ok we're done with this and moving ahead there okay there is something called a speaker value we have already discussed the pKa values the pKa values are the maximum okay the maximum for these two okay so the program pros are the maximum you can see all the pros okay Pro stands maximum with the PK value and you make a note about the minimum value minimum values been joke I've been jackin belongs to Class C biological side classification when Japan belongs to Class C so apart from this just make a note most of your values will move around seven point seven to eight point one if you don't know the answer and they're asking the PK value of a particular thing apart from the highest and the lowest most of the values we varam 7.7 to 8.1 just making or don't learn everything that's not smart preparation most of your questions will be on highest and lowest if not they will ask a little kind if not anything in the range of seven point seven to eight point one I'm done with PK values so next course with this Anatomy is very very important because we have multiple number of questions on this in most of the examinations it's very simple I don't want to make it complicated but just go through this there's more than sufficient solid there and almost all the basic mcq books okay the first one is no fiber very easy and which covers the no fiber is end honorarium okay your Indian medium is the one which covers the nerve fiber okay and a bundle of five hundred thousand no fibers now the no fibers combined they form classically the the one which covers the fasciculus is the perineum okay you can see the perineum here perineurium covering the fascicle a right so the innermost layer okay in the perineum which is the cover of the fasiq layer then the most layer is perry lemma okay don't get confused is completely out the innermost layer is perineum okay next one is epineurium okay epineurium is the annular connective tissue supporting the fascicle a and carrying the new vessels and the last one is AP AP neural shape this is the pin Ural sheet and this is the connector tissue you can see all the this everything this here here and here and everything you have a connector tissue that is epineurium and the covering outermost one is a pin you little right so I hope you're very clear please to make a note this is very very important they can ask this they can ask by giving this diagram directly from textbook by labeling or they can directly give it the simple definition so these factors which affects the early action are very very important we are already done with PK value we learn the highest lowest and ranges from 7.7 to 7.8 and it helps in onset of the early okay so lower the pKa value more rapid onset easterly don't don't go very deep lower is the PK value if you have low PK value the mode of onset will be very very fast the second one is the lipid solubility of LD okay so lipid solubility of any effects which factor anesthetic potency factor okay so increase lipid solubility increases the potency okay so I mean if the lipid solubility is more the potency of the L layer will be more right next the next one is a protein binding property so proteins if it is if it's have the ability to bind to the protein the duration it controls the duration so increasing in the protein binding allows the anaesthetic cation to be more firmly attached to the protein located at the receptor site thus the duration of the action increases so it wants or it holds for a longer duration of time whenever it holds the availability of it will be more and it will be for a longer duration of time okay then the non now as tissue diffusability it's also depends upon the onset okay it helps non set increasing in the diffusability decreases the onset like if it is able to diffuse into other tissues apart from the nerves means it's going to go away so the diffusability most moving away is going to decrease the time of onset okay next one is mass or delayed reaction so it it helps in controlling the anesthetic potency as well as the drug the greater the vasodilator action increases the blood flow to the to the region okay there will be more blood flow if the vasodilator action will be more so and apart from that it helps in whenever the drug well the main reason to compensate this we give a vasoconstrictor to hold it for a longer duration of time i hope most of the things are very interrelated i have seen a decent number of questions on this particular area so i have right so next comes is the antic on values and blood levels like one alia is overdoses so there will be few consequences which will be which I'm going to deal in the second slide next slide but making out this these values are important so anticonvulsant blood levels of local anesthetics so the anticonvulsant level will be seen at this value there is zero point five to four and the procedures and the same terms can be seen at four point five this is very important whenever the value goes and hits about seven point five new gram per ml the tone of chronic stress will be same okay so please do make a note ok these are the categories of sympathy emblematic and mines which are categorized into direct acting indirect acting and mixed acting so recently there was a question that is given in the aims exam very simple which of the following is indirectly Act and you need to pick the options so please don't make a note add to this notes do practice this there is high chances that you can encounter the same question so as already discussed the overdoses or failure what is going to happen what are the consequences so the overdoses can be categorized into two types that is a minimal to moderate doses there will be some signs and some symptoms and similar there will whenever it hits moderate to high doses then the complications will be more and more okay so we'll just have a look like when when the man it is minimal to moderate the page talkativeness so the patient I mean they may feel wanting sensation that will be sweating elevated blood pressure elevated heart rate elevated respiratory rate failure to follow the commands right this is important and these are all signs and coming to the symptoms the symptoms is restlessness nationís the metallic taste visual disturbances auditory disturbances loss of consciousness incoherent everything okay so but most important thing is moderate to high dosages that is tonic-clonic seizures have already discussed there will be generalized CNS system depression okay and there will be depress blood pressure I mean these are the late complications or the complications which are mainly concerned with high doses of local anaesthetic solution okay so so that's the you need to make anyone because they can ask you some questions okay so basing upon this limited knowledge you can easily pick the right answer okay so I'm just going to move to the next part that is you can see the bubble in the catalyst right so they can ask you the bubble size okay size is just one to two millimeters and the content this is the Nitro some cash okay nitrogen gas will be present in this okay sometimes in the clinical scenario you can see a condition where the stopper the stopper can be extruded and I mean that is basically when your catalyst this particular catalyst is stored inside the fridge nothing sometimes regularly the the size should be this one to two millimeters and sometimes unfortunately you can identify you can identify the presence of a larger bubble okay so large bubble the larger bubble may be due to the contamination okay so whenever you see a larger bubble it is mandatory that you have to return the cat rest okay should not use that particular cat rests but I hope you remember the auntie auntie rest like an auntie rest solution which is used in your operative dentistry that is sodium right right right to person does sodium nitrate that has been okay that they contain is capable of releasing the metal ions which can be related to the incidence of edema so like to prevent this rusting process few people they use this and that leads to the complication of local anesthesia so care should be taken like before you start the procedure when you are using cat rays you should see the size of the bubble because if the size of the bubble is more than that then definitely complete some sort of contamination because few people they store this local anaesthetics in disinfectants like alcohols so whenever you use an alcohol contaminated see this point the local anaesthetic solution containing alcohol produces say uncomfortable burning sensation or injection right so all these things has to be taken into consideration because they can give an application based question on this particular area so it's already known I think this is the to marks question for you in the final year right burning sensation upon injection is mainly due to I mean it can be a normal response to the pH of the drug means the pH of earlier what you're using may be the PK value has some role and the second one of the catalyst contains sterilizing solution like alcohol I was discussing in the last slide that alcohol can be used for disinfection of these cat raisers sometimes contaminates the ELMO sometimes the overheated cat rages can also cause a burning sensation or cat raisers which contains some a supersuit can also make a note about these four points which are the primary reasons for the burning sensation upon injection okay so next one is the Food and Drug Administration lactation categories this is a very very important previously asked in PG a followed by names okay and of course their high chances that they can repeat the same questions so categories are the S category as question mark estar and NS MS is very simple and as means not safe and cushion per clearly says that you don't pay anything okay as is for the safety very simple as is safe for nutrient nursing infants and medication are usually compatible with the breastfeeding whereas s question mark you don't have proper literature means you don't know you don't have any idea whereas estar potential for significant effects on nursing women it's going to cause the damage but the medication can be given with some caution notice means not at all safe okay so categories of pregnancy drugs we'll be discussing in pharmacology which is important thing because there are many questions which are asked on this in 2000 17 neat so there are different categories of drugs which are to be given in the pregnancy will discuss in pharmacology but now we'll be focusing more on the local anesthetics which comes out of these categories and the lactation categories right so most of the local anesthetics all the local anesthetics they come Center B and C category and what is most commonly used your little kind so can Lido kind and pre low kinda comes under B category and rest all they comes under C category okay next one not safe okay so in lactation time epinephrine is not sure okay epinephrine is not safe which is only safest one the safest one is Lu token so Lido kind which comes under a pregnancy B category is the safest one okay both for the lactation as well as for the pregnancy category okay so please do make a note about these points which were very very important so Dan for now signing off doctor's taken from team MDS conquer the only extracting that I'm going to cover in the part three part three will not be a video class will be a class which will be taken on your respective groups okay so we will be dealing with a few things which are already discussed here I'm just going to ask few questions answer them that is the first part in the path tree and followed by the problem-solving okay I'm going to I'm going to explain the problem-solving step face I hope you remember all those things how much amount of local anesthesia is present in one cat race how much amount of epinephrine is present in one cat race how many cartridges can we give to this particular individual who's of sixty cases I hope you you have encountered such questions in your ug life right either in your vibe or in your clinical scenario in the department's because is the most commonly asked viable question so such things are again most common for your need and aims and PJ and all other exams including NB t it right so such things will be discussed the the third part I'll be discussing on the group and stay positive stay blessed and stay at home all the