5. Nitrous Oxide/Oxygen Analgesia Flashcards
Potential Candidates
\_\_\_\_ or fearful Young children \_\_\_\_ challenged Hyperactive gag reflex Those undergoing an \_\_\_\_ or extensive procedure
anxious
behaviourally
invasive
Anxiety is a stress response to an ill anticipated situation, feelings of ____ or anticipation of possible danger.
Fear is a physiological process that occurs when the person is threatened by more ____ identifiable danger.
Phobia is a persistent or ____ fear that results in a compulsion to avoid a specific object, activity or situation; it can impede daily ____.
threat
immediate
irrational
function
Phobias
usually originate in ____
persist throughout ____
lead to avoidance of ____ therapy contribute to diminished dental ____
childhood
life
dental
health
____% of Americans are very nervous or terrified of having dental treatment.
7-15
Assessing the need for anesthesia and sedation in the general population
18 percent of adults would visit the dentist more frequently if they were given a ____ to make them less nervous
____ discrepancy between the number of patients who would prefer to receive sedation and the availability of these services
drug
threefold
Patient Assessment:
History
Medical History \_\_\_\_ disease Cardiovascular disease \_\_\_\_ Psychiatric condition Previous experience with \_\_\_\_
Medication Prescribed \_\_\_\_ Alternative remedies \_\_\_\_ drugs Allergy
respiratory pregnany sedation medication recreational
Patient Assessment:
Physical Examination ■ ■ ■ ■ \_\_\_\_ exam Neurologic exam \_\_\_\_ exam Cardiovascular exam
airway
pulmonary
American Society of Anesthesiology Classification of Physical Status (ASA)
I - normal, ____ patient
II - a paitnet with ____ systemic disease
III - a patient with ____ systemic disease limiting activity but not incapacitating
IV - a patient w ____ disease that is a constant threat to life
V - moribund patient not expected to live more than ____ hours with or without treatment
healthy mild severe incapicitating 24
Stages of Anesthesia
Stage I
begins with ____ and ends with the patient’s loss of ____ analgesia/sedation
Stage II, or REM stage
____ and sometimes dangerous responses to stimuli
____ and uncontrolled movement
Stage III, or surgical anesthesia
____ muscles relax
breathing becomes regular
eye ____ stop
Stage IV, or overdose
____ paralysis
death
induction consciousness uninhibited vomiting skeletal movements medullary
ADA guidelines
■
“ a minimally depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an ____ and respond appropriately to ____ stimulation or verbal command . . .”
airway
physical
Guidelines for the Elective Use of Conscious Sedation, Deep Sedation and General Anesthesia in Pediatric Dental Patients
(1) Facilitate the provision of quality ____
(2) Minimize the extremes of disruptive behavior
(3) Promote a ____ psychologic response to treatment
(4) Promote patient welfare and safety
(5) Return the patient to a physiologic state in which ____ discharge, as determined by recognized criteria, is possible
care
positive
safe
Assessment by Observation
\_\_\_\_ Calm Responsive to \_\_\_\_ Response to tactile stimulation Response to \_\_\_\_ No response
agitation
voice
pain
Sedation:
Routes of Administration
\_\_\_\_ Oral \_\_\_\_ Intramuscular \_\_\_\_ Submucosal \_\_\_\_
inhalation
intravenous
rectal
intranasal
Assessment of Technique ■ ■ ■ \_\_\_\_ effective \_\_\_\_ effective \_\_\_\_
clinically
cost
safe
Inhalation
A technique of administration in which a gaseous or volatile agent is introduced into the ____ tree and whose primary effect is due to ____ through the pulmonary bed.
pulmonary
absorption
Airway Physiology
Airways become ____ as you move toward
the periphery but the ____
increases.
smaller
cross-sectional area
Airway Physiology
Central and peripheral respiratory sensory receptors
The central chemoreceptors respond to ____ and the peripheral chemoreceptors respond to ____
The normal respiratory rate (RR) is ____ breaths per minute
carbon dioxide (CO2) oxygen (O2)
14-16
Composition of respiratory gases
O2
% in inspired air: ____%
CO2
% in inspired air: ____%
N2
% in inspired air: ____%
- 94
- 04
- 3
1976 - ____ devices for O2
safe
Training Requirements Pennsylvania
At least ____ hours of undergraduate or postgraduate didactic instruction and clinical experience
Must provide ____ and address of training facility
____ seal
Completed by course director
14
name
hospital/facility
Office/ Equipment Certification
Make, model and serial number
Is the equipment in proper working order? Is the equipment properly ____?
Does the equipment contain a fail
Do you have written office ____ for administering nitrous oxide/oxygen analgesia and handling emergencies related to the administration of nitrous oxide/oxygen analgesia
calibrated
procedures
Regulation
■ ____ Administration
■ U.S. ____
food and drug
department of transportation
Preparation (N2O)
____ > (heat - 240o) > ____ + ____
NH4NO3
N2O
2H2O
Properties of nitrous oxide
Properties \_\_\_\_ \_\_\_\_ smelling Colorless \_\_\_\_ form in cylinder Not \_\_\_\_ or explosive Supports combustion of other agents Undergoes little \_\_\_\_ Non allergenic Present in the \_\_\_\_
nonirritating sweet liquid flammable biotransformation atmosphere
Solubility (Partition Coefficients)
Determines the time necessary for equilibration between two ____ to occur
Blood gas solubility coefficient N2O= ____
____ solubility = ____ onset and recovery
____ min onset and offset
phases 0.47 low rapid 3-5
low blood gas coefficient > ____ solubility > ____ onset of action and ____ elimination
low
fast
rapid
COmparison of blood: gas partition
You don’t have to remember these numbers!! But realize with the lower partition coefficient is going to be ____ solubility, ____ onset, and ____ offset.
____ > Desflurane > Sevoflurane > Isoflurane > Enflurane > ____
low
fast
fast
N2O
halothane
Concentration Effect
Occurs when ____ concentrations of a gas are administered
The higher the ____ more rapidly the ____ tension of the gas increases
high
inspired partial pressure
arterial
Second Gas Effect
Administration of high concentrations of N2O ____ the rate of concomitantly inhaled
gases
Uptake is more ____ than predicted
accelerates
uptake
Potency of Anesthetic Gases
MAC = the minimal ____ concentration of anesthetic that prevents movement in ____% of subjects in response to a surgical stimulus
Dose at which an anesthetic gas produces its ____
____ effect
alveolar
50
effect
additive
MAC for inhaled anesthetics
• Nitrous oxide is going to be much less potent than isoflurane so you need more and more of that drug. So MAC is ____ proportional to potency.
____ > desflurane > sevoflurane > isoflurane > enflurane > ____
inversely
N2O
halothane
A MAC of ____ prevents movement in at least 95% of patients.
1.2-1.3
