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Question 1

The most serious side effects reflect operator error and result from excessive concentrations in the blood caused by (1)

Answer 1

inadvertent intravascular injection

administration of excessive quantities of drug.

This can result in (1) convulsions, (2) respiratory arrest, and (3) cardiovascular collapse.

Question 2

Three guiding principles for anesthetic administration

Answer 2

1) Administer the smallest dose that is effective.
2) Use proper injection technique But Tony the patient says, don’t scrimp.
3) Use a vasoconstrictor-containing solution unless contraindicated

Question 3

TECHNIQUE FOR OPEN EXTRACTION OF SINGLE-ROOTED TOOTH

Answer 3

1. Flap 2. Determine need for bone removal 3. Grasp a small margin of bone with forceps 4. Remove bone with bur 5. Apical purchase 6. Irrigate well under depth of flap

Question 4

Treatment of allergic responses to local anesthetics*
Dermatological:
Anaphylactic shock:

Answer 4

Dermatological: antihistamines (later)
Anaphylactic shock: epi!!! wooooo
*Not common with amide local anesthetics

Question 5

Use during pregnancy

Answer 5

lidocaine, prilocaine category B articaine, mepivacaine, bupivacaine category C

Question 6

MAC =

Answer 6

minimum alveolar concentration. The alveolar concentration of gas at which 50% of all patients do not respond to a surgical stimulus.

Question 7

No antiinflammatory drugs during

Answer 7

treatment

Question 8

After procedures, use

Answer 8

opioids and anti-inflammatory agents

Question 9

A complete anesthetic produces:

Answer 9

unconsciousness, unresponsiveness, amnesia, immobility, and autonomic stability to the anesthetic state.

Question 10

Antimuscarinics:

Answer 10

minimize salivation, laryngospasm (block vagal stimulation), reflex bradycardia

Question 11

Various analgesics:

Answer 11

preoperative pain relief, sedation, amnesia

Question 12

Nitrous oxide and/or opioids:

Answer 12

reduce anesthetic requirement, provide analgesia

Question 13

Anti-nicotinics:

Answer 13

paralyze skeletal muscle

Question 14

Antiemetics

Answer 14

Additional drugs to maintain organ systems

Question 15

Anesthesia begins when the anesthetic reaches a critical concentration in

Answer 15

membrane lipids. (meyer-overton)

Question 16

Lipid basedtheories of anesthetic action

Answer 16

direct action on lipids leads to indirect action on proteins

Question 17

Direct action of the anesthetic on proteins leads to alterations in protein function
Molecular Mechanisms of General Anesthesia
The notion that anesthetics interact with ———— sites on proteins and affect their function is the more popular one these days

Answer 17

hydrophobiic

Question 18

General anesthetics have been demonstrated to block many different

Answer 18

ligand activated ion channels

Question 19

Common/favorable target for general anesthetics

Answer 19

GABA receptors are an attractive target
CNS proteins other than ligand gated ion channels might also play a role.

As a whole, it is a hodge-podge of things.

Question 20

Studies on the sympathetic nervous system indicate ———— generally more sensitive to anesthetics than ————

Answer 20

synaptic transmission

action potentials

Question 21

The reticular activating formation receives sensory inputs and is a major center supporting

Answer 21

consciousness and alertness. As its activity is depressed, its influences decrease and unconsciousness ensues.

Question 22

Many neuroscientists believe the ——— is essential to maintaining consciousness

Answer 22

thalamocortical loop

Question 23

The limbic system is involved in ——–. Inhibition of this system is likely to be involved in —————

Answer 23

memory

anesthetic-induced amensia.

Question 24

Pain pathways involve the

Answer 24

spinal cord

Question 25

4 stages of anesthesia

Answer 25

analgesics, excitement, surgical anesthesia, medullary paralysis

Question 26

Blood gas partition coefficient

Answer 26

Solubility of anesthetic in blood ratio of concentration of anesthetic in blood phase vs gas phase in equilibrium.

Question 27

Lower blood-gas partition coefficient

Answer 27

faster action and recovery

Question 28

Olive oil solubility determines

Answer 28

MAC

Question 29

Barbituates act as —————- by potentiating the activity of the————–.

Answer 29

CNS depressants

GABA-A receptor

Question 30

Barbituates: Binding of GABA to its receptor activates chloride channels————- . The influx of the negatively charged ———— hyperpolarizes the —————-, thus providing an inhibitory influence on —————-

Answer 30

chloride channels

chloride

post synaptic membrane

synaptic transmission.

Question 31

Barbituates

Use of intravenous agents in anesthesia has become more popular:

Answer 31

1) Rapid distribution 
Drug into vein rapidly gets to brain
3) No risk of malignant hyperthermia
4) Eliminate risk of occupational exposure to volatile anesthetics 
2) Reduced cardiac depression

Question 32

Barbituates Also used as ———- (total intravenous anesthesia).

Answer 32

maintenance

Question 33

Barbituates —————- major adverse effect

Answer 33

Respiratory depression

Question 34

Barbituates

Methoxhexital

Answer 34

Similar to thiopental but
Sleep time 5 -7 minutes
2.5 x more potent, faster acting, shorter duration of action
Cleared 3x faster than thiopental
Fast recovery renders it more favorable in dental outpatient procedures

Question 35

Ketamine produces

Answer 35

dissociative amnesia.

Question 36

Ketamine affects

Answer 36

glutamine receptors

Question 37

Dissociative Anesthesia is a unique anesthesia characterized by

Answer 37

analgesia and amnesia with minimal effect on respiratory function. The patient does not appear to be anesthetized and can swallow and open eyes but does not process information. This form of anesthesia may be used to provide analgesia during brief, superficial operative procedures or diagnostic processes. Ketamine hydrochloride is a phencyclidine derivative used to induce dissociative anesthesia. Ketamine is used for trauma patients with very unstable, low blood pressure or for elderly patients. Emergence may be accompanied by delirium, excitement, disorientation, and confusion