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обезболивание

хирургической

стоматологии

классификация

методов

обезболивания

лекция

пим

курс

00:00:00

[music]

00:00:02

good afternoon,

00:00:04

second year students of the Faculty of Dentistry,

00:00:07

today we will discuss the topic of

00:00:11

pain relief in dental surgery,

00:00:14

indications and contraindications,

00:00:17

classification of pain relief methods, and

00:00:20

we are still discussing this topic with you

00:00:24

in the course of mastering the discipline of

00:00:26

propaedeutics and materials science, and I will read

00:00:29

it to you, I am an associate professor of the department propaedeutics

00:00:32

Kobzev and Yulia Alexandra The first question

00:00:38

of our lecture today is we will analyze the

00:00:40

classification of methods of pain relief,

00:00:44

after which we will move on to general

00:00:47

anesthesia and discuss what

00:00:51

current indications and

00:00:53

contraindications exist for

00:00:55

performing anesthesia in a clinic,

00:00:59

then we will discuss the types of indications and

00:01:02

contraindications for local anesthesia,

00:01:05

we will analyze anesthetic drugs in

00:01:08

filtration and conduction anesthesia

00:01:10

and we will start with the fact that most

00:01:18

dental interventions

00:01:20

on the right involve pain,

00:01:24

therefore adequate

00:01:27

anesthesia is

00:01:31

one of the important components of success; the

00:01:35

modern level of development of medicine,

00:01:39

including pharmacology, provides the

00:01:43

possibility of pain relief for

00:01:46

any surgical intervention

00:01:50

through the facial area, there is a

00:01:54

classification of pain relief methods

00:01:57

according to anesthesia are divided into general

00:02:01

and local and combined general

00:02:06

anesthesia this anesthesia is

00:02:10

inhalation and non-inhalation

00:02:15

inhalation anesthesia is divided into

00:02:18

mask endotrachial and

00:02:22

laryngeal anesthesia non-inhalation anesthesia is

00:02:27

divided into intravenous and

00:02:31

intramuscular local anesthesia

00:02:36

is divided into injection and

00:02:38

injection methods convection

00:02:42

anesthesia includes those types

00:02:44

of anesthesia which is done by

00:02:47

injection, respectively, it can be

00:02:50

infiltration anesthesia, conduction

00:02:53

anesthesia, trunk anesthesia and non-

00:02:56

sectional anesthesia, and

00:02:57

anesthesia is divided into

00:03:00

topical anesthesia, electroanesthesia,

00:03:03

combined anesthesia

00:03:07

implies on rnr then

00:03:09

[music]

00:03:11

analgesia from oral gizia, balanced

00:03:18

anesthesia of places for combined

00:03:21

anesthesia and electroanalgesia

00:03:27

Well, actually, we’ll start someone, we’re

00:03:30

discussing this, yes, pain relief from

00:03:34

general anesthesia, let’s actually

00:03:37

define what general

00:03:39

anesthesia is,

00:03:40

this is a state of reversible inhibition of the

00:03:44

central nervous system, which

00:03:47

is achieved by pharmacological

00:03:49

means, it involves suppressing the

00:03:53

perception of painful stimuli,

00:03:56

achieving peace,

00:03:58

autonomic blockade and muscle

00:04:01

relaxation

00:04:03

that occurs against the background of switching off

00:04:08

consciousness, but at the same time we

00:04:12

maintain adequate gas exchange and

00:04:17

blood circulation, we regulate

00:04:20

metabolic processes, very often

00:04:27

the question arises what is the indication for

00:04:31

this type of anesthesia,

00:04:35

it should be noted that children, like any

00:04:39

other intervention,

00:04:41

can receive anesthesia only with the

00:04:44

written consent of the parents,

00:04:47

except In addition, doctors are forced to

00:04:51

resort to this type, and without patients

00:04:55

who are intolerant to all

00:04:58

local anesthetics, patients who

00:05:02

have defects in the development of the central

00:05:04

nervous system, neuropsychiatric

00:05:07

disorders, Down's disease, mental retardation,

00:05:10

complicating contact with the

00:05:13

patient, complicating his ability to

00:05:18

behave in a chair, the ability to

00:05:20

maintain a certain body position for a long time

00:05:24

open mouth, again, such patients

00:05:28

are indicated for anesthesia; well, like

00:05:32

any other method, along with

00:05:34

indications, there are also

00:05:36

contraindications for general anesthesia;

00:05:39

this is an acute infectious disease and

00:05:42

catarrh of the upper respiratory tract; also a

00:05:47

contraindication is impaired

00:05:49

nasal breathing of the reflections and nasal passages

00:05:53

and it is impossible to measure weight

00:05:56

air ducts

00:06:01

There is a fairly large group

00:06:03

of patients who have diseases of the

00:06:06

cardiovascular system,

00:06:08

very often they take steroidal

00:06:11

anticoagulants,

00:06:13

and in this group of patients

00:06:16

anesthesia is also not recommended

00:06:19

categorically; in addition, there is

00:06:22

a condition called acute

00:06:24

conditions of the

00:06:27

cardiovascular system or

00:06:28

disorders, and this is stroke and myocardial infarction

00:06:34

considered acute condition up to

00:06:37

six to eight months,

00:06:39

certainly a contraindication is

00:06:42

all diseases of the cardiovascular

00:06:45

system that are in the stage of

00:06:49

decompensation; also, intervention in the

00:06:53

area of the root of the tongue, the tonsil of the posterior

00:06:56

wall of the pharynx is considered as a

00:06:58

contraindication to general anesthesia;

00:07:02

anesthesia is not recommended in the final

00:07:09

stages of pregnancy or on the eve of childbirth

00:07:12

because this is exactly what intervention

00:07:16

can provoke hypertonicity of the uterus and

00:07:21

contribute to the onset of premature

00:07:24

labor or any other problems with the

00:07:27

fetus; therefore, in no case are

00:07:30

such patients recommended to undergo

00:07:33

general anesthesia; in addition,

00:07:36

there are

00:07:38

technical contraindications, in particular,

00:07:41

limited mouth opening

00:07:44

[music]

00:07:45

in patients who suffer from contractures

00:07:48

or ankylosis

00:07:50

and, of course, the so-called patients with a

00:07:55

full stomach, that is, people who have

00:07:58

recently taken food, are definitely not

00:08:02

allowed to undergo anesthesia because

00:08:07

there is a risk of asphyxia with vomit,

00:08:10

which in general is extremely undesirable.

00:08:14

Let's look at what local

00:08:17

anesthesia is; it is a temporary loss of

00:08:21

sensitivity in areas of the body. involves

00:08:26

anesthesia of the tissue of the surgical field

00:08:29

without turning off the patient's consciousness,

00:08:33

while the doctor acts on the peripheral

00:08:37

parts of the nervous system.

00:08:39

You have already said that there is a distinction between

00:08:42

injection and non-injection methods.

00:08:47

Such anesthesia is not injection; local

00:08:51

anesthesia allows you to obtain only

00:08:54

superficial anesthesia of tissues; for

00:08:57

this purpose, we use

00:09:00

drugs that influence low temperatures

00:09:04

exposure of laser beams to

00:09:07

electromagnetic waves of vision into

00:09:10

anesthetic tissue using electrophoresis,

00:09:13

in general, this is rather an overview of those methods

00:09:18

that are possible in practice; most often,

00:09:22

topical anesthesia is used

00:09:24

by applying or aerosolizing a

00:09:28

substance such as, in particular, 10 percent

00:09:33

lidocaine, which is intended

00:09:36

specifically for topical use

00:09:38

or, accordingly, this is an

00:09:42

application of helium anesthesiologists digging

00:09:49

injectable local anesthesia,

00:09:52

it is aimed exclusively at

00:09:55

influencing the corresponding area of

00:10:00

the body by mastering the

00:10:03

behavior of the anesthetic solution due to which

00:10:06

pain

00:10:08

sensitivity is eliminated, it is divided into

00:10:12

induction local anesthesia into

00:10:16

filtration conduction. By

00:10:19

infiltration anesthesia we

00:10:20

mean near the peripheral

00:10:23

nerve fibers and their At the end of the administration of

00:10:25

the anesthetic and conduction anesthesia, the

00:10:31

drug is administered near the nerve trunk; what

00:10:37

indications for local anesthesia do we know?

00:10:38

Almost any

00:10:43

intervention in the oral cavity

00:10:47

that is accompanied by pain is an

00:10:50

indication for local

00:10:52

anesthesia within the legal framework

00:10:55

of our country in accordance with Federal

00:10:59

Law 323 on the Fundamentals of Protecting the Health of

00:11:01

Citizens of the Russian Federation, any

00:11:03

citizen has the right to anesthesia for

00:11:07

any medical manipulation that is

00:11:10

associated with the potential for even the possibility of

00:11:13

pain, and

00:11:17

dental intervention, but in

00:11:19

general, we know with you, it is almost

00:11:21

always accompanied by the potential for

00:11:26

such a pain,

00:11:29

therefore

00:11:32

operations on the soft tissues

00:11:33

of the maxillofacial area are anesthetized accordingly. facial area operations on the

00:11:37

jaws and teeth of the oral cavity

00:11:40

local anesthesia show la damn

00:11:43

them to people elderly people with respiratory

00:11:46

cardiovascular insufficiency, that

00:11:49

is, in cases where there is a risk of

00:11:53

minor anesthesia

00:11:56

what are the contraindications of any

00:12:00

anesthesia is contraindicated when performing

00:12:03

long and traumatic operations when,

00:12:06

in fact, the intended the time of

00:12:08

intervention, it initially does not

00:12:11

coincide with the duration of action of the

00:12:14

local anesthetic,

00:12:17

naturally intolerance to local

00:12:19

anesthetics, allergic

00:12:26

wariness towards the local

00:12:28

in aesthetics

00:12:30

in case of pronounced lability or

00:12:32

inferiority of the patient’s psyche,

00:12:36

it is undesirable to administer local

00:12:39

anesthesia during some plastic

00:12:41

surgeries when the injected anesthetic

00:12:45

solution significantly changes the ratio

00:12:47

and volume of tissues. called

00:12:54

local anesthetic drugs or

00:12:58

anesthetics anesthetics are substances that

00:13:01

act on receptors by reducing the

00:13:03

permeability of sodium channels, as a

00:13:06

result of which the entry of

00:13:08

sodium ions into the cell is blocked; the

00:13:11

generation of an action potential is disrupted; sensitivity is not carried

00:13:16

out; pain;

00:13:19

taste; temperature;

00:13:21

and then tactile types of

00:13:24

sensitivity;

00:13:28

what are the requirements for an anesthetic?

00:13:31

must irritate tissues must not

00:13:34

dilate blood vessels have the ability for

00:13:37

slow absorption and revenge resistance

00:13:40

to sterilization have sufficient

00:13:43

strength long-term effects and low

00:13:47

toxicity base constrictor and

00:13:51

these are the substances that are used to

00:13:56

reduce the systemic and toxic

00:13:59

effect of the anesthetic, as well as for

00:14:02

its prolonged action, these

00:14:05

include adrenaline and norepinephrine Lebanon

00:14:10

or fin dren vasopressin Philip Resin according to the

00:14:17

chemical structure in must anesthetics are

00:14:19

divided into esters and amides

00:14:23

prescription ethics in the group of esters it

00:14:26

is characteristic that they quickly

00:14:28

undergo hydrolysis

00:14:29

and rhinestones therefore act

00:14:32

for a short time

00:14:34

local anesthetic groups of

00:14:36

esters include novocaine

00:14:39

anesthesin Dicaine or Cohen What kind of

00:14:45

anesthetics amide group

00:14:48

diffuses better into tissues together with injections

00:14:51

acts faster has a large zone

00:14:55

of anesthesia and stronger

00:14:57

interaction with tissues, which

00:15:00

prevents the entry of local

00:15:02

anesthetic into the bloodstream is mainly

00:15:06

metabolized in the liver by

00:15:08

hydrolysis

00:15:10

to the local anesthetic amide group

00:15:14

does poking trimecaine and

00:15:17

Cohen beer apply? bupivacaine

00:15:21

and ti docs and and arctic

00:15:24

[music]

00:15:28

what kind of anesthesia exist in the upper

00:15:35

jaw is it conduction anesthesia tuberal

00:15:40

in front detailed anesthesia in the area of the

00:15:44

greater palatine foramen or palatal

00:15:47

incisive and certainly infiltration the

00:15:51

main types of anesthesia in the lower

00:15:55

jaw is conduction monde bullet rn

00:15:59

and and true sebaceous

00:16:00

anesthesia in the area of the mental

00:16:03

nerve or mental anesthesia

00:16:06

infiltration anesthesia which on the

00:16:11

lower jaw will be effective perhaps

00:16:13

in the area of only the anterior teeth

00:16:17

infiltration anesthesia

00:16:20

infiltration anesthesia

00:16:23

involves anesthesia of the final

00:16:27

small branches of a

00:16:28

large nerve trunk;

00:16:33

direct

00:16:34

infiltration anesthesia is distinguished when

00:16:37

the anesthetic is injected directly into the tissues of the

00:16:40

surgical field and indirect when the

00:16:45

anesthetic solution from the created

00:16:48

depot under the mucous membrane penetrates into the

00:16:52

thickness of the spongy substance of the bone, excuse me,

00:16:56

permeating the nerves coming from the dental

00:16:59

plexuses of the tooth and another

00:17:02

one of infiltration anesthesia in the

00:17:06

upper jaw;

00:17:09

infiltration anesthesia is more

00:17:11

effective throughout the entire

00:17:13

alveolar arch of the

00:17:15

upper jaw; this is due to the

00:17:18

anatomical features structure, the

00:17:21

compact plate of the alveolar

00:17:24

process of the upper jaw with the vestibular

00:17:27

and it on the sides is quite thin

00:17:32

throughout the entire alveolar process,

00:17:34

it has a significant number of small

00:17:36

holes through which

00:17:39

blood and lymphatic vessels and

00:17:43

nerves pass, and this creates very good

00:17:47

conditions for the diffusion of the anesthetic solution,

00:17:49

spongy bone, therefore the effect

00:17:54

of infiltration anesthesia on the upper

00:17:57

jaw is quite high, regardless

00:18:01

of the group affiliation of the tooth;

00:18:05

infiltration anesthesia on the lower

00:18:07

jaw; the peculiarities of its implementation are also

00:18:11

caused by the structural features of this

00:18:14

jaw; and according to the CD on the I plate is somewhat

00:18:18

thicker compared to the upper jaw and

00:18:21

denser, and the number of holes in it is

00:18:25

much smaller; these holes

00:18:29

are located predominantly in the area of

00:18:32

incisors and fists, less often than small molars

00:18:37

or premolars; the alveolar part is thicker

00:18:43

than the alveolar process of the upper

00:18:45

jaw, especially in the area of small and

00:18:48

large crooked teeth;

00:18:51

therefore, the effectiveness of infiltration

00:18:55

anesthesia is

00:18:57

not very high; in practice, it is

00:19:01

used in the treatment or removal of

00:19:05

lower incisors and canines;

00:19:09

in cases where these teeth have

00:19:12

pathological mobility, the technique of

00:19:18

infiltration anesthesia,

00:19:21

during infiltration anesthesia, an

00:19:25

anesthetic solution should be injected into the

00:19:27

transitional fold of the vestibule of the mouth where there

00:19:30

is a submucosal layer on the upper

00:19:33

jaw, the projection in which is taken

00:19:35

slightly above the projection of the tops of the teeth

00:19:40

on the lower jaw, slightly below the

00:19:44

projection of the tops of the teeth, the syringe is held in the

00:19:51

right hand with

00:19:52

three fingers in the form of a food pirate

00:19:56

so that 1 memory freely reaches

00:20:02

[music] the

00:20:05

distal end of the piston therefore

00:20:10

[music]

00:20:12

our fingers should be located

00:20:17

[music]

00:20:19

as far as possible from the cannula

00:20:26

[music] the

00:20:31

needle is immersed at an angle of 45 degrees with a

00:20:37

bevel of the bone reaching

00:20:46

One and a half milliliters of anesthetic

00:20:49

solution are injected into the bones, and a depot is formed, and in

00:20:53

aesthetics on the palatal side, the needles are

00:21:00

made into the angle formed by both the

00:21:03

alveolar and copper processes of the

00:21:06

upper jaw

00:21:08

[music]

00:21:10

where there is a small amount of loose

00:21:14

fiber

00:21:16

that usually surrounds the

00:21:19

nerve trunks passing here on the palatal side

00:21:23

no more than 0.5 milliliters of

00:21:27

anesthetic

00:21:28

[music] is injected

00:21:34

from the lingual side of the calvi and the

00:21:45

anesthetic solution is introduced into the lar part of the lower jaw instead of the

00:21:57

transition of the mucous membrane to the lingual area; in this case, the peripheral branches and lingual are switched off

00:22:00

and anesthesia of the

00:22:03

mucous membrane of the

00:22:05

alveolar part from the lingual side is achieved

00:22:09

[music]

00:22:12

what is an

00:22:15

aspiration test during infiltration

00:22:20

anesthesia,

00:22:23

it is necessary to carry out aspiration

00:22:26

tests to prevent vision, it

00:22:30

will meet in the right direction

00:22:32

[music]

00:22:37

or when a needle gets into a blood

00:22:39

vessel, an aspiration test is carried out with a

00:22:49

syringe

00:22:50

by capturing the solutions of the corpus with the reverse

00:22:55

movement of the piston

00:23:02

varieties of infiltration anesthesia

00:23:07

this is the intro league mental or inside the

00:23:11

ligament

00:23:12

inside the septal or introsiptal

00:23:17

and inside the bullets paired anesthesia or

00:23:20

intropules paired conduction

00:23:27

anesthesia with conduction

00:23:30

anesthesia the anesthetic is injected not into the

00:23:33

tissues of the surgical field but at some

00:23:36

distance from it into the area of the nerve

00:23:42

conducting pain impulses from the area of

00:23:46

intervention of the conductor and

00:23:51

the anesthesia allows you to turn it off

00:23:54

Hollywood, but significantly in the area of the upper

00:24:01

or lower jaw and adjacent soft

00:24:05

tissues, due to this, it has an

00:24:09

advantage over infiltration

00:24:11

anesthesia

00:24:13

if it is necessary to remove several

00:24:16

teeth,

00:24:17

neoplasms, opening under the tip of

00:24:24

ulcers and others, during conduction

00:24:31

anesthesia,

00:24:32

the solution is injected near the nerve trunk,

00:24:36

they are in its thickness, that is, Perry did not lie

00:24:41

sufficiently pronounced anesthesia

00:24:43

is achieved by introducing a smaller

00:24:46

amount of anesthetic than with

00:24:49

infiltration anesthesia of the tobiral

00:24:59

anesthesia with flax tubera and anesthesia

00:25:05

block the upper

00:25:07

posterior alveolar branches of which are

00:25:12

located in the carp, palatine fossae are visible

00:25:15

and on the posterior outer surface of the tubercle of the

00:25:18

upper jaw 18-25 millimeters

00:25:27

above the edge of the

00:25:29

upper alveolus 3

00:25:31

[ music] of a

00:25:34

large molar corresponding to

00:25:37

the middle of

00:25:39

its crown in the area of the tubercle of the upper jaw

00:25:41

there are several holes through them the

00:25:50

upper posterior alveolar branches enter the

00:25:54

bone tissue during tuberal

00:26:00

anesthesia it is necessary to introduce an

00:26:03

anesthetic solution according to the location of

00:26:06

these holes or slightly higher than their

00:26:12

technique;

00:26:14

patients are asked to open their mouth slightly

00:26:17

then moves the spatula or mirror

00:26:21

outwards for the patients, the needle is placed at an

00:26:25

angle of 45 degrees to the crest of the alveolar

00:26:27

process, the bevels should be facing the

00:26:32

bones, the stake of the game is made at the level of the

00:26:37

crown of the 2nd molar or

00:26:41

between the second and third

00:26:43

molars into the mucous membrane,

00:26:46

departing from the transitional folds by 0 5

00:26:50

centimeters to the outside

00:26:52

[music] the

00:26:55

needle is moved up back and inward

00:26:59

to a depth of two and a half centimeters,

00:27:02

moving the syringe outward so that the needle

00:27:08

is always located as close to the

00:27:11

bone as possible; this to a certain extent prevents

00:27:14

damage to the arteries and veins of the wing of the prominent

00:27:17

venous plexus and hemorrhages into the

00:27:20

surrounding tissues after the vision of two

00:27:27

milliliters of

00:27:28

anesthetic anesthesia solution

00:27:30

occurs in seven ten minutes the

00:27:39

anesthesia zone 1 2 3 large

00:27:47

molars the periosteum of the alveolar process

00:27:51

and the covering and mucous membrane in the

00:27:54

area of these teeth on the vestibular

00:27:58

side the mucous membrane and bone

00:28:01

tissue of the posterior outer wall of the

00:28:03

maxillary sinus the

00:28:05

posterior boundaries of the zone anesthesia is

00:28:08

constant the

00:28:09

anterior border can run along the

00:28:12

middle of the crown of the first large

00:28:13

molar or reach the middle of the

00:28:17

first small molar. Infra-

00:28:25

orbital anesthesia

00:28:27

[music]

00:28:32

with infra-orbital anesthesia

00:28:36

blocks the peripheral branches of the

00:28:39

infraorbital nerve,

00:28:42

the lesser pes anserine, the anterior superior

00:28:47

alveolar branches and the middle superior

00:28:50

alveolar type, anesthetics are carried to the the

00:28:55

orbital canal is often created with a depot from an

00:28:57

anesthetic solution in the area of the

00:29:01

infraorbital foramen, to determine the

00:29:09

infraorbital foramen leading into the canal,

00:29:11

anatomical landmarks are used

00:29:14

[music]

00:29:20

when palpating the lower edge of the orbit, a

00:29:27

bony protrusion or groove is felt

00:29:30

[music]

00:29:34

corresponding to the junction with the

00:29:36

genital process of the upper jaw,

00:29:38

found with a bone like as a rule, it

00:29:48

is located 0 5 centimeters inside

00:29:51

from the middle of the lower edge of the orbit 0

00:29:56

50 75 centimeters below this landmark

00:30:00

is located the infraorbital foramen the

00:30:04

infraorbital foramen is located 0 5

00:30:10

by 0 75 centimeters below the point of

00:30:13

intersection and the lower edge of the orbit with a

00:30:18

vertical line drawn through the

00:30:24

middle of the 2 upper small molar

00:30:28

tooth infraorbital foramen

00:30:33

[music]

00:30:37

is determined 0 5 by 0 75 centimeters

00:30:41

below the intersection of the lower edge of

00:30:45

the orbit with a vertical line

00:30:48

drawn through the pupil of the eye

00:30:51

looking straight forward outside the oral

00:30:56

method according to the indicated landmark

00:31:01

determines the projection of the infraorbital

00:31:04

foramen on the skin with the index finger in the

00:31:15

orbital with the index finger of the left

00:31:17

hands fix the tissue at this point of the bone

00:31:22

with the aim of accidental injury, prevention of

00:31:26

accidental injury to the eyeball,

00:31:29

in addition, it helps to quickly find the

00:31:34

entrance to the canal, then they retreat the projection of

00:31:39

the hole onto the skin downwards and inside

00:31:42

by one centimeter, they make the needle cool,

00:31:47

giving the needle a straight line so that it does not push it

00:31:51

up from behind and to the outside in the direction of the

00:31:55

preparation hole, the needle is

00:31:59

immersed to the bone in the area of the

00:32:03

infraorbital hole, 0 5 1

00:32:07

milliliter of anesthetic is released and carefully

00:32:11

move the corner, they find the passage into the canal, I

00:32:14

determine this by the characteristic

00:32:17

failure or by the pain reaction,

00:32:21

entering the infraorbital canal,

00:32:24

advances the needle to the depth from seven to

00:32:27

ten millimeters and

00:32:30

another 0.5 to 1 milliliter of anesthetic solution is injected;

00:32:36

anesthesia occurs after 35 mouths; it is often

00:32:41

impossible to enter the canal; this may

00:32:45

depend on different shapes and

00:32:47

sizes and the location of the infraorbital

00:32:49

foramen; it is difficult to find the canal in the

00:32:53

presence of a deep

00:32:55

course fossa in the literature

00:33:01

cases of exit of the proposed

00:33:03

excellent nerve from two or three holes are given; the

00:33:06

introduction of two milliliters of an

00:33:08

anesthetic solution in the area not only in the

00:33:10

infraorbital foramen does not significantly

00:33:14

affect the severity of anesthesia

00:33:17

in the zone of innervation of the upper anterior and

00:33:20

middle

00:33:21

alveolar branches of the lesser pes anserine

00:33:26

inside the generic method to find the projection of the

00:33:31

infraorbital foramen on the skin

00:33:34

the index finger of the left hand

00:33:37

touches the soft tissue at this point of the

00:33:40

bone with the thumb, the upper lip is pulled

00:33:46

up and forward, while the

00:33:49

movable mucous membrane moves to the

00:33:52

saw blade

00:33:53

and produces 0 5 cm

00:33:56

anterior to the transitional folds at the level of the

00:34:00

gap between the central and lateral

00:34:04

incisors, the needle is advanced

00:34:07

from behind upward and outward along the direction

00:34:11

and infraorbital canal, while releasing a

00:34:16

small amount of anesthetic to

00:34:19

anesthetize the tissues along the path and gunas, the

00:34:23

subsequent stages of anesthesia

00:34:26

do not differ from those with the extra-generic

00:34:31

method, if it is impossible to insert a

00:34:35

needle between the lateral and central

00:34:38

incisors, then it should be inserted at the level of the

00:34:41

canine 1 or 2 small molars

00:34:48

to get a needle into the canal with this method it is not

00:34:51

possible anesthesia

00:34:54

occurs due to the diffusion of the anesthetic

00:34:57

from the infraorbital area into the holes in the

00:34:59

canal of the same name extraorally. The

00:35:03

informe tal method of anesthesia has

00:35:05

significant disadvantages compared to the

00:35:07

measure, it is more difficult to perform

00:35:11

with it. bring and stupid

00:35:13

infraorbital hole through

00:35:15

significant tissue thickness; it cannot be

00:35:18

performed with periostitis and the anterior

00:35:20

part of the alveolar process;

00:35:24

therefore, this method is used

00:35:26

quite rarely in a clinic;

00:35:30

zones of anesthesia; incisors and canines and small

00:35:34

molars; bone tissue of the

00:35:35

alveolar process; mucous

00:35:38

membrane of the alveolar process with the

00:35:40

vestibular sides in the area of these

00:35:42

teeth mucous membrane bone tissue

00:35:45

anterior posterior outer

00:35:48

lower and upper walls of the maxillary

00:35:50

sinus skin infraorbital region of the

00:35:54

lower eyelid wing of the nose nasal septum

00:35:58

skin and mucous membrane of the upper lip

00:36:02

anesthesia in the area of the greater palatine

00:36:05

foramen directly in the pelvis and in the area of the

00:36:08

greater

00:36:09

palatine it blocks the holes

00:36:12

For this anesthetic, the large frontal nerve must be led to the

00:36:15

area of the greater palatine foramen; it

00:36:19

is located at the level of the middle of the box.

00:36:26

3 large molars, in the absence of the

00:36:31

last one, 2 large molars will be broken behind the deep

00:36:34

or 0 5 centimeters

00:36:37

anterior to the border of the hard and soft

00:36:40

palate to determine the projection of the large one.

00:36:46

the holes in the mucous membrane of the

00:36:48

hard new are rich in drawing two mutually

00:36:51

intersecting lines, one

00:36:55

parallel to the border of the hard and soft

00:36:57

palate at the level of the middle of the crown of 3

00:37:00

large molars from the gingival

00:37:03

edge to the midline of the

00:37:06

upper jaw, the corresponding sides of

00:37:10

the other through the middle 1 and

00:37:14

perpendicular to it, that is, from front to

00:37:16

back. the intersection of these two lines

00:37:21

will correspond to the projection of the greater

00:37:24

palatine foramen with the

00:37:28

patient’s mouth wide open towards the

00:37:30

needle and produces one centimeter

00:37:32

in front and inside, that is, the mucous membrane is surrounded by the

00:37:35

midline from the projection of the palatine

00:37:38

foramen, the needle is

00:37:42

moved up slightly to the back and to the

00:37:44

outside until it comes into contact with the bone.

00:37:49

zero to five milliliters of anesthetic after 35

00:37:52

minutes anesthesia appears

00:37:55

and the zones of anesthesia are the mucous

00:38:01

membrane of the hard palate of the alveolar

00:38:03

process on the palatal side from the 3rd

00:38:06

molar to the middle of the crown of the calla

00:38:09

to

00:38:10

sometimes the anesthesia zone increases

00:38:14

and passes to the vestibular surface of the

00:38:17

3rd molar, often the

00:38:23

anesthesia zone does not extends to the

00:38:25

front

00:38:26

further than level 2 of the small molar tooth, the

00:38:33

incisive anesthesia blocks the nasal palatine

00:38:37

nerve of the

00:38:38

incisor and the hole is located between the

00:38:41

central incisors at 7-8 millimeters

00:38:44

from the gingival margin or behind the

00:38:48

incisor.

00:38:54

inside the household method, the patient's head is

00:38:58

as far west as possible, someone's mouth is wide

00:39:01

open, the needle is given a vertical position

00:39:05

in relation to the anterior part of the

00:39:07

alveolar process of the upper jaw with

00:39:11

it on the right side

00:39:12

in a stake produces the mucous membrane of the

00:39:15

incisal knot, having previously lubricated

00:39:19

it,

00:39:20

application anesthesia without pain in

00:39:23

preliminary schools produces several

00:39:26

drops go from the mouth of the incisive hole,

00:39:30

if the needle is inserted exactly at the address of that

00:39:33

hole, then the direction of the glee does not

00:39:36

coincide with the axis of the incisive canal since it is

00:39:39

impossible to comply with the conditions they are

00:39:42

prevented by the lower jaw,

00:39:45

advancing the needle until it contacts the bone,

00:39:51

injects 0 3 0 5 milliliters of

00:39:54

anesthetic solution, from here it diffuses into

00:39:58

rice canal and blocks the nasa in it, the

00:40:00

effect of anesthesia is more pronounced

00:40:06

if the needle is advanced into the canal by 0 50 75

00:40:12

centimeters and an anesthetic solution is allowed in it,

00:40:16

while it

00:40:22

is turned off and the bridge is a fashionable view from us,

00:40:26

they benefit the nerve to the anterior part of the

00:40:28

upper dental plexus, but enter with a

00:40:33

needle it is not always possible into the canal,

00:40:37

especially in patients with lower

00:40:40

macro and

00:40:45

or

00:40:49

upper micro rope of the zone of anesthesia

00:40:57

[music] the

00:41:05

mucous membrane and periosteum of the

00:41:11

alveolar process from the palatal side

00:41:14

and the hard palate in a triangle whose apex

00:41:21

faces the median base of the

00:41:25

front teeth and the sides pass through the

00:41:32

middle of the fangs sometimes the zone of

00:41:42

anesthesia

00:41:44

extends to 1

00:41:48

small molar inclusive or

00:41:55

narrows to the area of the central incisors

00:42:04

anesthesia of the

00:42:06

lower alveolar nerve in the area of the

00:42:10

hole and le monde bullet rnai anesthesia

00:42:15

the name Sunday corresponds to its

00:42:17

essence

00:42:18

since the hole of the lower jaw

00:42:20

turns off not the mandibular nerve

00:42:23

but its peripheral lower alveolar

00:42:27

and zygomatic nerves to perform most of

00:42:31

Asia, one should be well oriented in

00:42:34

some anatomical formations of

00:42:38

the branch of the lower jaw, the opening of the lower

00:42:44

jaw through which the lower

00:42:48

alveolar nerve enters the bone canal

00:42:51

is located on the inner surface of the

00:42:53

jaw from the anterior edge and at a

00:42:56

distance of 15 millimeters from the posterior but

00:43:00

13 from the notch of the lower jaw by 22

00:43:04

millimeters and from the base of the lower jaw

00:43:06

by twenty-seven millimeters, the height of the

00:43:09

location of this hole in an

00:43:12

adult corresponds to the level of the

00:43:13

chewing surface of the lower large

00:43:16

molars, and in old people and children, the

00:43:23

hole in the lower jaw is slightly lower in front and from the inside, covered by a

00:43:26

bony protrusion with the tongue of the lower jaw,

00:43:29

therefore the anesthetic solution must be

00:43:32

injected 075

00:43:34

one centimeter above the level of the hole

00:43:37

above the upper polys of the bony protrusion; there

00:43:41

is also loose fiber in which

00:43:44

the anesthetic spreads well,

00:43:47

therefore, the needles should be

00:43:49

inserted 075 one centimeter above the

00:43:52

level of the chewing surface of the lower

00:43:55

large molars inside the oral

00:44:00

method of anesthesia is carried out using the

00:44:03

thumb or index finger, we

00:44:06

first palpate the bony

00:44:09

anatomical landmarks and, adaptively

00:44:12

without palpation of anesthesia, using a finger

00:44:18

or palpation, the

00:44:21

location behind the malar fossa and we of the

00:44:23

succulent ridge is determined, which is a

00:44:26

guideline for inserting a needle from the coronoid

00:44:30

process to the lingual side of the alveolar

00:44:32

jaw of the lower jaw, the

00:44:34

bone ridge descends or temporal ridge in the

00:44:38

lower part, this ridge is divided

00:44:41

into internal and external legs that

00:44:44

limit a small area behind the

00:44:47

malar triangle between the anterior

00:44:51

edge of the ramus of the lower jaw passing to the

00:44:53

bottom into the cashier or

00:44:55

not and the succulent ridge there is a

00:44:57

small depression triangular shapes

00:45:00

behind the malar

00:45:02

fossa bone landmarks are palpated

00:45:05

with the index with the finger of the left hand

00:45:07

if anesthesia is performed on the right or with the

00:45:10

thumb if it is performed on the left the

00:45:13

patient's mouth is wide open, the doctor

00:45:17

feels the anterior edge of the branch of the lower

00:45:19

jaw at the level of the distal edge of the

00:45:21

crown of the 3rd molar,

00:45:25

moving the finger slightly outward,

00:45:28

determines the temporal ridge, the projection

00:45:32

mentally transfers to the mucous membrane, the

00:45:36

finger fixes in the back of the malar fossa,

00:45:40

placing the syringe at the level of the small

00:45:42

molars of the opposite side

00:45:44

in the cola blocks, make inward from the wiz of the

00:45:47

ridge and 075 one centimeter above the

00:45:51

chewing surface of the 3rd

00:45:54

molar

00:45:56

advances the needle outward and backward and at a

00:46:00

depth of 0 5 to 0 75 centimeters

00:46:03

reaches the bone, having released about 5 to 1

00:46:09

milliliter of anesthetic solution, turns it off,

00:46:11

moving the needle another two

00:46:15

centimeters,

00:46:16

it reaches the bone groove in which the

00:46:18

lower alveolar is located,

00:46:21

before it enters the canal of the lower

00:46:23

jaw, there will also be two to

00:46:26

three milliliters of anesthetic to

00:46:27

turn off

00:46:28

this nerve Often there is a

00:46:32

need to move the syringe to the

00:46:34

level of the central incisors and advance the

00:46:36

needle behind parallel to the inner

00:46:39

surface of the lower jaw branch to a

00:46:41

depth of 2 centimeters towards the

00:46:43

mandibular foramen and under the active

00:46:48

method,

00:46:49

when performing anesthesia under the active

00:46:52

method, the main landmark is

00:46:54

the wing, the lower forest fold is visible,

00:46:57

it is located inside the saggy face

00:46:59

comb and can be wide and narrow

00:47:02

or have the usual average transverse

00:47:05

size; the

00:47:06

patient’s mouth is wide open; the syringe

00:47:09

is placed at the level of the small molars or the

00:47:12

first large molar; of

00:47:25

large

00:47:28

molars, the needle moves outwards from

00:47:32

behind until it contacts the bone tissue, the

00:47:35

depth of immersion is about two

00:47:38

centimeters, after which 2-3

00:47:41

milliliters of an anesthetic are injected to turn off the

00:47:42

lower alveolar and lingual nerve,

00:47:46

then rusal anesthesia or anesthesia

00:47:51

in the area of the mandibular ridge along the way is

00:47:54

shaved with this anesthesia

00:47:58

anesthetic the solution is injected into the area of the

00:48:00

mandibular ridge, it is located

00:48:04

together with the connection of the cosmos of the ridges

00:48:07

coming from the coronoid and we silk

00:48:09

processes above and in front of the bone

00:48:13

uvula of the lower jaw,

00:48:14

below inward from the ridge is the

00:48:17

lower alveolar ridge, which is also the

00:48:20

nerves

00:48:23

surrounded by loose tissue,

00:48:26

bringing anesthetics to these zones, these

00:48:29

nerves can be turned off and at the same time

00:48:33

the technique of holding the mouth as

00:48:36

wide as possible into the stake of the needle

00:48:39

perpendicular to the mucous membrane of the

00:48:41

cheek,

00:48:42

here you control the prince of the opposite

00:48:45

side where it is located at the level of the

00:48:47

molars, excuse me, the place in the stake

00:48:53

is.

00:48:54

formed by the intersection of a horizontal

00:48:57

line drawn 0-5 centimeters

00:49:00

below the chewing surface of the upper 3

00:49:02

large molars and grooves

00:49:05

formed by the lateral scots of the wing,

00:49:08

the mandibular fold is visible and a flexible

00:49:10

needle is advanced to the bone to a depth of

00:49:15

0-25 to two centimeters,

00:49:17

two milliliters of anesthetic blocker

00:49:20

and lower alveolar buccal nerves are injected

00:49:23

move the needle a few milliliters in the

00:49:26

opposite direction, the eggs dig a

00:49:28

milliliter of anesthetic to turn off the

00:49:30

lingual nerve,

00:49:31

anesthesia occurs after five minutes, the

00:49:34

zone of anesthesia is the same as with

00:49:36

anesthesia into the opening of the lower jaw,

00:49:38

plus the tissues innervated by the carnivorous nerves,

00:49:42

mucous membrane, skin of the cheek, mucous

00:49:46

membrane of the alveolar part of the lower

00:49:47

jaw from the middle of the second

00:49:49

small molar to the middle of the

00:49:52

second large molar connection with the

00:49:56

peculiarities of the relationship of the eternal

00:49:58

world with the lower alveolar and zygomatic

00:50:01

nerves,

00:50:02

anesthesia in the zone of innervation of the carnivorous

00:50:05

nerve always appears to me in this case,

00:50:09

additional

00:50:11

infiltration anesthesia should be carried out in the area of the

00:50:13

surgical field to turn off the

00:50:17

peripheral endings of the countable nerve

00:50:21

of the mental anesthesia

00:50:23

to perform mental anesthesia

00:50:26

it is necessary to determine the location of the

00:50:28

mental foramen the

00:50:30

skull is located at the level of the middle of the

00:50:33

alveolus of the lower 2 small molars

00:50:38

and the interalveolar septum between the

00:50:41

second and first with painters 2 13

00:50:46

millimeters above

00:50:48

the base of the body of the lower jaw the project

00:50:52

holes are thus located in the

00:50:54

middle of the distance between the anterior edge the

00:50:56

masticatory muscle and the middle of the lower

00:51:00

jaw of the mental foramen

00:51:04

opens towards the back to the top and outwards,

00:51:11

this should be remembered

00:51:13

to give the game a direction

00:51:17

allowing it to be inserted into the canal, there is an

00:51:21

intraoral method when, with

00:51:26

the patient’s jaws closed or half closed, the

00:51:29

soft tissues of the cheek are pulled to the side into the

00:51:32

needle stake, making a retreat a few

00:51:35

millimeters outward from the transitional

00:51:37

folds at the level of the middle of the crown of the

00:51:39

first large

00:51:41

molar and a depth of up to a

00:51:46

centimeter down to the front and inward to

00:51:50

the mental foramen, the subsequent

00:51:53

moments of performing anesthesia do not

00:51:55

differ from those with the actual method, in fact, in the

00:51:58

method, the

00:51:59

anesthesia zone is actually

00:52:02

shown here in the

00:52:06

pictures. soft tissues of the chin and

00:52:10

lower lip small molars canines

00:52:13

incisors bone tissue alveolar jaws

00:52:16

mucous membrane on the vestibular

00:52:18

side and within oak trees, sometimes

00:52:22

the zones of anesthesia extend to the

00:52:25

second molar,

00:52:28

this is the topic of our lecture today,

00:52:32

we have covered all the lecture

00:52:34

material, I thank you for your attention and

00:52:39

At the next lectures on the discipline of

00:52:43

propaedeutics and material, I look forward to seeing

00:52:47

everyone have a good day

00:52:49

[music]

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This feature is available in the UDL Helper extension. Make sure that "Show the video snapshot button" is checked in the settings. A camera icon should appear in the lower right corner of the player to the left of the "Settings" icon. When you click on it, the current frame from the video will be saved to your computer in JPEG format.

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It costs nothing. Our services are absolutely free for all users. There are no PRO subscriptions, no restrictions on the number or maximum length of downloaded videos.