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Oral surgery > 7. Types of anesthesia in oral and maxillofacial surgery. Premedication and general anesthesia. > Flashcards

7. Types of anesthesia in oral and maxillofacial surgery. Premedication and general anesthesia. Flashcards

1
Q

Types of Anesthesia

A
  • Local
  • General
  • Neuroleptanasthesia
  • Sedation
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2
Q

Premedication in the context of maxillofacial surgeries

A
  • Administration of medications with specific pharmacological actions before surgery or anesthesia
  • Enhances patient safety and comfort during the surgical procedure
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3
Q

Factors that influence the selection and dosage of premedication drugs

A
  • Patient’s age
  • Weight
  • Physical status
  • Type of anesthesia
  • Level of anxiety and fear
  • Pre-existing medical conditions.
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4
Q

How timing of premedication determined

A
  • Factors such as => onset
  • Peak effect
  • Duration of action
  • Route of administration
  • Ensures medication =>achieves intended effects at the appropriate time
  • Optimises its efficacy in preparing the patient for anesthesia and surgery
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5
Q

Used for learning objectives of premedication

A

10 A’s

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6
Q

10 A’s for premedication

A
  1. Anxiolysis-Relief of anxiety
  2. Analgesia
  3. Amnesia of preoperative events
  4. Antisialogogue effects-reduction in salivary and bronchial secretions
  5. Anti-emetic effect
  6. Anti-acid effect-reduction in stomach acid
  7. Allergies
  8. Antiautomatic-parasympathetic/Sympathetic reflexes care-Vagolytic actions
  9. Anaesthetic induction
  10. Antibiotic regime
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7
Q

Routes of administration for premedication

A
  • Enteral
  • Parenteral
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8
Q

Enteral routes of administration

A
  • Oral
  • Rectal
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9
Q

Parenteral routes of administration

A
  • Intranasal
  • Intramuscular
  • Intravenous
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10
Q

Premedication drug groups

A
  • Benzodiazepines
  • Opoids
  • Barbituates
  • Phenothiazines
  • Butyrophenones
  • Anticholinergics
  • Alpha adrenoceptor antagonists
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11
Q

First Cranial nerve

A

-Olfactory nerve(smell)

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12
Q

Second Cranial nerve

A

Optic nerve (sight)

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13
Q

Third Cranial nerve

A

Oculomotor nerve (Orbital muscles for eye movement)

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14
Q

Fourth Cranial nerve

A

Trochlear nerve (Orbital muscles for eye movement)

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15
Q

Fifth cranial nerve

A 
Trigeminal nerve( Motor: movement of the **jaws** and **muscles of mastication**
Sensory: sensation of feeling for the **face, teeth, and periodontal ligaments**, and anterior two thirds of the **tongue**)
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16
Q

Sixth Cranial nerve

A

Abducens nerve (Orbital muscles for eye movement)

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17
Q

Seventh Cranial nerve

A

Facial Nerve ( Motor: to the muscles of facial expression
Sensory: taste to anterior two-thirds of tongue
Secretory: to submandibular and sublingual glands)

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18
Q

Eighth Cranial nerve

A

Auditory Nerve(Sense of hearing, position, and balance)

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19
Q

Tenth Cranial nerve

A

Vagus nerve( Pharyngeal and laryngeal movements: digestive tract)

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20
Q

Eleventh Cranial Nerve

A

Accessory nerve(Neck movements: sternocleidomastoid and trapezius muscles)

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21
Q

Twelfth Cranial nerve

A

Hypoglossal nerve ( Motor: tongue movement (muscles)

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22
Q

Largest cranial nerve

A

Trigeminal nerve

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23
Q

Trigeminal nerve divisions

A
  • Division I- Ophthalmic
  • Division II- Maxillary nerve
  • Division III- Mandibular nerve
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24
Q

Ophthalmic and maxillary nerve are

A

Afferent only(sensory)

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25
Q

Mandibular nerve is

A

Efferent (motor) and afferent (sensory)

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26
Q

Ophthalmic Nerve origin

A

exits skull through superior orbital fissure on the superior surface of the orbit

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27
Q

Ophthalmic Nerve branches

A
  • *-Lacrimal nerve** (smallest),
  • *-Frontal nerve**(largest )
  • Nasociliary nerve
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28
Q

Ophthalmic Nerve sensations

A

-Touch, pain, pressure
-Skin of upper third of face (forehead and anterior scalp, and the skin around the eyeball, eyelid and nose,
and part of the nasal mucosa)
-Maxillary sinus

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29
Q

Maxillary nerve sensations

A

touch, pain, pressure, and temperature

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30
Q

The maxillary nerve innervates

A
  • Middle third of face and the palate
  • Pulp of all maxillary teeth
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31
Q

The maxillary nerve exists the brain through

A

Foramen rotundum

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32
Q

Four important branches of the Maxillary nerve

A
  • -Pterygopalatine*
  • -Posterior superior alveolar (PSA)*
  • -Infraorbital*
  • -Zygomatic nerve*
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33
Q

Which branch of the Pterygopalatine Nerve passes through the greater palatine foramen and what does it become?

A

Descending palatine nerve becomes Greater palatine nerve

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34
Q

Greater palatine nerve innervation

A
  • Mucosa of posterior part of hard palate
  • Palatal gingiva of posterior teeth
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35
Q

Nerves that arise posterior to the Greater palatine foramen

A

Middle and Posterior (lesser) palatine nerves enter the palate through the lesser palatine foramen to spread posteriorly to supply the tonsils and mucosa of the soft palate

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36
Q

Long branch of Pterygopalatine nerve that runs along roof of nasal cavity

A
  • Nasopalatine nerve
  • Runs along nasal septum->enters bone of palate->arises in anterior palate through incisive foramen
37
Q

Nasopalatine nerve Innervates

A

-Soft tissue of the nasal septum and gingiva

-Palatal soft tissue lingual to the anterior teeth

38
Q

The right and left nasopalatine nerves combined with the greater palatine nerves innervate

A

Soft tissues of entire hard palate

39
Q

-Once in maxillary bone the posterior superior alveolar nerve supplies

A

-Maxillary molars(except mesiobuccal root of maxillary first molars)

  • Alveolar bone
  • PDL
  • Facial gingiva of maxillary molars
  • Mucosa of part of maxillary sinus
  • Cheek mucosa next to maxillary molars
40
Q

Within the infraorbital canal the infraorbital nerve gives off two branches

A

Middle superior alveolar nerve(MSA) and Anterior superior alveolar nerve (ASA)

41
Q

Branches of middle superior alveolar nerve supply

A
  • Maxillary premolars and mesiobuccal root of maxillary first molar
  • Alveolar bone
  • Periodontal ligaments
  • Facial gingiva
  • In maxillary premolar region and part of maxillary sinus
42
Q

Second branch given off by the infraorbital nerve while in the infraorbital canal

A

Anterior superior alveolar nerve

43
Q

Anterior superior alveolar nerve supplies

A
  • Pulp
  • Supporting alveolar bone
  • Periodontal ligaments
  • Facial gingiva
  • Of maxillary anterior teeth and part of maxillary sinus
44
Q

Infraorbital nerve exits from

A

Infraorbital foramen

45
Q

After exiting from the infraorbital foramen, the infraorbital nerve splits into terminal branches that innervate

A
  • Skin and mucosa of side of nose(nasal nerve)
  • Skin and mucosa of lower eyelid(palpebral nerve)
  • Skin and mucosa of upper lip, facial gingiva of maxillary premolars and facial gingiva of anterior teeth(labial nerve)
46
Q

The zygomatic nerve supplies

A

-Skin of temporal region and lower part of orbit

47
Q

Division III of trigeminal nerve

A

Mandibular nerve

48
Q

Mixed nerve (sensory and motor) and only motor portion of trigeminal nerve

A

Mandibular nerve

49
Q

Motor fibres of mandibular nerve supply

A

-8 muscles of mastication

-Mylohyoid muscle

-Anterior belly of the digastric muscle

50
Q

Sensory fibres of mandibular nerve supply

A
  • Touch, pain, pressure and temperature
  • Lower third of face
  • Floor of mouth
  • Anterior two thirds of tongue(not taste)
  • Mandibular teeth
51
Q

The mandibular nerve exits the neurocranium through

A

Foramen ovale

52
Q

Four main branches of mandibular nerve

A
  • Auriculotemporal nerve
  • Buccal nerve
  • Lingual nerve

- Inferior alveolar nerve

53
Q

Auriculotemporal nerve supplies

A
  • Pain and proprioception fibres to the TMJ
  • Skin of outer ear
  • Lateral aspect of skull and cheek
54
Q

Buccal nerve innervates

A

-Mucosa and skin of cheek in area of mandibular molars up to corner of mouth

-Sometimes second premolars

55
Q

Lingual nerve innervation

A
  • Touch, pain, pressure, temperature(not taste)
  • Dorsal(top) and ventral(bottom) surface of anterior two thirds of the tongue and adjacent tissues(floor of mouth, inner surface of mandible and lingual gingiva of entire mandible)
56
Q

Once the Inferior alveolar nerve enters the mandible through the mandibular foramen it is in the

A
  • Mandibular canal
  • Gives off dental branches that spread through trabecular bone of mandible
  • Enter apical foramen of all mandibular molars and premolars
  • Innervates PDL and alveolar processes of those teeth
57
Q

Within the mandibular canal, the Inferior alveolar nerve splits near the roots of the premolars to become

A

-Mental and incisive nerves

58
Q

Incisive nerve supplies

A
  • Mandibular incisor and canine teeth
  • Their PDLs and alveolar processes
59
Q

The mental nerve branch of the Inferior alveolar nerve exits from the body of the mandible through

A

-Mental foramen

60
Q

Mental nerve supplies

A
  • Facial gingiva of the mandibular incisors, canines, and premolars
  • Mucosa and skin of the lower lip and chin on that side up to the midline
61
Q

Motor(efferent) branches of mandibular nerve supply to muscles of mastication

A
  • Masseteric nerve-(Masseter muscle and TMJ)
  • Posterior and anterior temporal nerves(Temporalis muscle)
  • Medial pterygoid nerve(medial pterygoid muscle)

-Lateral pterygoid nerve(lateral pterygoid muscle)

62
Q

Facial nerve fibres are

A

Mixed(sensory and motor)

63
Q

Efferent fibres of facial nerve innervate

A
  • Muscles of facial expression
  • Posterior belly of digastric muscle
  • Stylohyoid muscle
  • Stapedius muscle
64
Q

Secretory fibres of Facial nerve innervate

A

-Secretions from Sublingual(Under mucosa in floor of mouth superior to mylohyoid muscle) and Submandibular glands(Located in submandibular fossae on medial surface of mandible inferior to mylohyoid muscle)

65
Q

The Chorda tympanic fibres of the facial nerve join with

A

-Lingual nerve and supply sense of taste to anterior two thirds of tongue

66
Q

The glossopharyngeal nerve type

A
  • Mixed nerve(sensory and motor)
  • Supplies parts of tongue and pharynx
67
Q

Afferent fibres of Glossopharyngeal nerve supply

A

-Taste and sensation to posterior one third of tongue

-Sensation to mucosa of pharynx and tonsils

68
Q

Motor nerves of the Glossopharyngeal innervate

A

Stylopharyngeus muscle of the pharnyx

69
Q

Secretory fibres of the Glossopharyngeal nerve innervate

A

Parotid gland

70
Q

Hypoglossal nerve innervation

A
  • Descends steeply to muscles that move tongue
  • Genioglossus, styloglossus, hyoglossus
71
Q

Inferior Alveolar nerve block -Halstead Technique

A
  • Targets Inferior alveolar nerve
  • Anaesthetises
  • Teeth and bone on one side of mandible
  • Soft tissues on buccal aspect anterior to mental foramen
  • Soft tissues of lower lip
  • Reflected and attached gingivae from premolar teeth to midline
  • Lingual nerve-anterior two thirds of tongue
  • Injection at pterygotemporal space on medial aspect of ramus(region of mandibular foramen)
72
Q

Halstead Technique procedure

A
  • Long 35mm needle no narrower than 27 gauge used
  • Patient mouth open wide
  • Thumb on coronoid notch
  • Index finger extraoral at height of posterior border of ramus
  • Syringe passed across lower premolars
  • Penetration of syringe between external oblique ridge and pterygomandibular raphae
  • Height of penetration halfway between thumbnail
  • Advance needle until bone contacted(25mm of needle insertion)
  • Withdraw, aspirate and inject 1.5-2 ml of solution
73
Q

Gow-gates technique

A
  • More superior than Halstead technique(more branches of mandibular nerve affected)
  • Anaesthetises inferior alveolar nerve, lingual, long buccal, mylohyoid and auriculotemporal nerves
  • Mouth wide open
  • Parallel plane between corner of mouth and intertragal notch used as guide
  • Syringe passed along maxillary canine of opposite side and across palatal cusps of maxillary second molar on injected side
  • When bone of condyle contacted, slight withdraw, aspiration and injection of 2ml solution
  • More effective than Halstead approach
74
Q

Akinosi-Varizani Technique

A
  • Anaesthetises inferior alveolar nerve, Lingual nerve, mylohyoid nerve and occasionally long buccal nerve
  • Administered with patients mouth closed
  • Long needle no narrower than 27 gauge used
  • Syringe introduced intraorally at level of mucogingival junction of maxillary molars
  • Syringe advanced to medial surface of ramus where insertion into occurs
  • Hub of needle adjacent to distal surface of maxillary second molar→ Needle should be in correct place for injection
  • Aspiration and injection of 2ml solution slowly
75
Q

Mental and incisive nerve block

A

-Anaesthetises

  • teeth and jaws from premolars to anteriors
  • Soft tissues of lower lip and chin to midline on one side
  • First molar in some cases
  • Usually intraoral but extraoral approach can be used
  • Needle inserted at depth of buccal sulcus between premolar teeth at apices→ Targeting mental foramen
  • 1.5ml solution injected and tissues massaged to encourage entry of solution into foramen
76
Q

Long buccal nerve block

A
  • Anaesthetises the buccal gingivae and mucosa and part of the cheek in the mandibular molar region
  • 0.5ml solution in region of coronoid notch of mandible
77
Q

Maxillary Nerve block

A

-Anaesthetises

  • Teeth and bone of maxilla on one side
  • Buccal and palatal mucosa
  • Skin of lower lip, lower eyelid and lateral aspect of the nose
  • Intraoral and extraoral approaches
  • Intraoral methods-Tuberosity approach and greater palatine foramen approach
78
Q

Tuberosity approach

A
  • Solution deposited high in buccal sulcus → distal surface of maxillary second molar
  • Angle of 45 degrees to depth of 30.. mm
  • 2 ml solution deposited
79
Q

Infraorbital nerve block technique

A
  • ION approached from either intraoral or extraoral sides
  • Intraoral approach→ long needle into buccal sulcus(between premolar teeth)

→Advance towards infraorbital foramen(palpated extraorally)

→1-1.5ml solution deposited at 16mm following aspiration

80
Q

Infraorbital nerve block targets

A
  • Teeth and associated bone from second premolar to central incisor
  • Adjacent gingivae of the teeth
  • Mucosal and skin of one half of upper lip
  • Part of skin of nose affected
81
Q

Greater palatine foramen approach

A
  • Mouth wide open=> greater palatine foramen identified →depression medial to second maxillary molar) distal surface)
  • Insertion into pterygopalatine fossa(via greater palatine foramen)
  • Needle angle 45 degrees superiorly and posteriorly to depth of 30 mm
  • 2 ml solution injected
82
Q

Nasopalatine nerve block

A
  • Anaesthetises tissue of hard palate adjacent to incisor teeth
  • 0.2-0.5 ml solution adjacent to incisive papilla
83
Q

Injection in parotid gland results in

A

-Facial nerve→ Hemifacial paresis

84
Q

Length of Halstead Anaesthesia

A
  • Teeth→ 45mins
  • Soft tissues→ up to 3 hours
85
Q

Weisbrem technique

A
  • Open mouth as wide as possible
  • Syringe on opposite premolars
  • Advanced to lateral edge of plica pterygomandibularis(pterygomandibular fold)
  • Needle 0.5 cm below chewing surface of maxilllary third or second molar=>
  • In absence of teeth 1.5 cm from alveolar crest
  • Needle advanced to contact bone, withdrawn, aspiration and injection of 1.5ml
  • On withdrawl, rest of solution deposited for lingual nerve
  • Anesthesia after 5-7 minutes
86
Q

Nitrous oxide, and how it functions in dental anesthesia

A

*Aka laughing gas
* Crosses the alveoli of the lungs and dissolves into the passing blood=> brain
* Dissociated and euphoric feeling
* Used in combination with oxygen.

87
Q

General anesthesia drugs commonly used in dentistry, and their purpose

A
  • Midazolam
  • Ketamine
  • Propofol, and fentanyl
  • Put a person in a twilight sleep or render them completely unconscious and unaware of pain
88
Q

Purpose of combining nitrous oxide with oxygen during its administration

A
  • Ensures patient receives an adequate supply of oxygen while experiencing the sedative and euphoric effects of nitrous oxide

Oral surgery (106 decks)

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