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Pediatric Dentistry Prepatory Boards > Anesthesia > Flashcards

Anesthesia Flashcards

1
Q

What does a low ETCO2 indicate?

A

LOW ⬇️ ETCO2 indicates:

POOR SYSTEMIC PERFUSION, which can be caused by

  1. HYPOVOLEMIA (low blood volume)
  2. SEPSIS SHOCK
  3. DYSRHYTHMIAS
  4. CARDIAC ARREST (no CO2 production)
  5. HYPER-ventilation.
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2
Q

Dosage for Ketamine

A

Induction with 2 mg/kg of ketamine usually produces 15 to 30 minutes of unconsciousness within seconds.

Ketamine may also be administered:

  1. rectally at 10 mg/kg,
  2. orally at 6 to 10 mg/kg, or
  3. intranasally at 3 to 6 mg/kg to induce anesthesia.
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3
Q

What is Alveolar Dead 💀 Space?

🚫⛽️ .3

A

DEAD SPACE 💀

  • ALVEOLI which have little or NO BLOOD flowing through their adjacent PULMONARY CAPILLARIES
  • ALVEOLI that are VENTILATED but NOT PERFUSED

-The VOLUME of air that is INHALED that does NOT 🚫 take part in the GAS ⛽️ EXCHANGE

In HUMANS, about a THIRD (1/3) of every resting breath has no change in O2 and CO2 levels.
In adults, it is usually in the range of 150 mL

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4
Q

What does high ETCO2 indicate?

A

An ELEVATED ⬆️ EtCO2 level indicates:

  1. INCREASE ⬆️ in alveolar dead space
  2. INCREASE ⬆️ metabolic activity.
  3. HYPOventilation
  4. HYPOtension (hemorrhage, pump failure, anaphylaxis, etc.)
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5
Q

What is Ketamine? Properties?

A

Ketamine is a DISSOCIATIVE ANESTHETIC

  • has a RAPID ONSET and a SHORT DURATION of action, causes CENTRAL DISLOCATION while providing ANALGESIA and AMNESIA.
  • does NOT significantly affect blood pressure and/or cardiac output. ↔️ BP/CO
  • INCREASES the production of ⬆️ SECRETIONS, anticholinergic medications (e.g., atropine, glycopyrrolate) are usually needed.

-DREAMS and HALLUCINATIONS 👻🧠 are the most common side effects associated with ketamine: 5% to 10% of prepubescent children and 30% to 50% of ⬆️ OLDER children experience this adverse effect.
Administration of a BENZODIAZEPINE concomitantly with ketamine ⬇️ DECREASES the incidence of dreams and hallucinations.

Contraindications to the use of ketamine:

  1. active upper RESPIRATORY tract infection 🤧
  2. INCREASED ⬆️ intracranial pressure, open-globe injury,
  3. PSYCHIATRIC or seizure disorders.🤪
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6
Q

What is Malignant Hypothermia?

A

Temp - Cont - AD

Malignant hyperthermia (MH) is a disease that causes a FAST RISE in body TEMPERATURE and SEVERE MUSCLE CONTRACTIONS when someone with MH gets GENERAL ANESTHESIA

MH is passed down through FAMILIES.
AD; Autosomal Dominant

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7
Q

What is the reversal agent for Malignant Hypothermia?

A

DANTROLENE

2.5 mg/kg rapid IV bolus, repeat PRN

produces RELAXATION of skeletal MUSCLE without causing complete paralysis, and is the only xenobiotic proven to be effective for both treatment and prophylaxis of malignant hyperthermia (MH).

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8
Q

What are signs of Malignant Hypothermia?

A

Early clinical signs of MH:

  1. ⬆️ INCREASE in end-tidal CARBON DIOXIDE (even with increasing minute ventilation),
  2. Tachycardia
  3. Tachypnea (breathing rapid/shallow)
  4. Muscle rigidity
  5. Hyperkalemia.

Later signs:

  1. Fever
  2. Myoglobinuria (myoglobin in urine)
  3. Multiple organ failure.
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9
Q

What triggers Malignant Hyperthermia?

A
  1. ALL INHALED General Anesthetics:

Sevoflurane, Isoflurane, Halothane

Chloroform (Trichloromethane, Methyltrichloride) Desflurane. Enflurane. Methoxyflurane.. Trichloroethylene. Xenon.

  • *N20 is OK**
  • *IV (Propofal) OK**
  1. SUCCINYLCHOLINE
    Depolarizing muscle relaxants.
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10
Q

What is Propofol dosage?

A

INDUCTION DOSE:

higher in ⬆️ YOUNGER patients (2.9 mg/kg for children less than 2 years of age)

than in ⬇️ OLDER patients (2.2 mg/kg for patients 6 to 12 years of age)

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11
Q

What is Propofol? Properties?

A

PROPOFOL: sedative-hypnotic agent

  • most commonly used IV INDUCTION AGENT in pediatric anesthesia.
  • very rapid onset and is associated with a REDUCED rate of postoperative NAUSEA and VOMITING. ⬇️🤢🤮⬇️
  • associated with PAIN🥺 on IV administration, particularly in small veins. (Emla cream/Lido)
  • After induction, propofol is considered a useful agent for MAINTAINING hypnosis and amnesia. It can be used as a SOLE anesthetic AGENT for nonpainful procedures.
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12
Q

What is the normal range for End-Tidal Co2

A

35-45 mm HG

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13
Q

What increases ⬆️ Alveolar Dead Space?💀

A

⬆️⬆️⬆️ Dead Space 💀💀💀

  1. Airway diseases: ASTHMA 😬, bronchitis, emphysema 🚬
  2. Right-to-Left shunt. ➡️2⬅️💔
    -Tetralogy of Fallot
    -Tricuspid Atresia
    -Transposition of Great Vessels
    (CYANOT.T.T.IC 🥶)
  3. Pulmonary Embolism, Pulmonary Hypotension
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14
Q

What does Ventilation and Perfusion mean?

A

GAS ⛽️ EXCHANGE occurs in the lungs between alveolar air and blood of the pulmonary capillaries.
For effective gas exchange to occur, ALVEOLI must be ventilated and perfused.

VENTILATION 💨 (V) refers to the FLOW OF AIR into and out of the alveoli
PERFUSION 🔴 (Q) refers to the FLOW OF BLOOD to alveolar capillaries.

The ratio of ventilation to perfusion (V/Q). Changes in the V/Q ratio can affect gas exchange and can contribute to hypoxemia.

HIGH V/Q ratio decreases pCO2 ⬇️ and increases pO2.⬆️ (TACHYPNEA)

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15
Q

What is the normal partial pressure for O2 (PaO2) in Blood.

A

The normal partial pressure reference value for oxygen: PaO2 more than 80 mmHg

A drop in the oxygen carried in blood is known as HYPOXEMIA

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16
Q

What’s the difference between Hypoxia and Hypoxemia.

A

The term hypoxia and hypoxemia are not synonymous.

  • HYPOXEMIA is defined as a DECREASE ⬇️ in the PARTIAL PRESSURE of oxygen in the BLOOD whereas
  • HYPOXIA is defined by REDUCED ⬇️ level of TISSUE oxygenation.
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17
Q

T/F Nail Polish can effect a Pulse Oximeter?

A

True

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18
Q

What happens with Methemoglobinemia?

A

Hemoglobin is the protein in red blood cells (RBCs) that carries and distributes oxygen to the body. Methemoglobin is a form of hemoglobin.

MetHb

With methemoglobinemia, the hemoglobin can carry oxygen, but is NOT ABLE TO RELEASE it effectively to body tissues.

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19
Q

What is the danger of topical anesthetics containing Benzocaine for children 👶 under 24 months?

A

The U.S. Food and Drug Administration (FDA) is warning the public that the use of benzocaine, the main ingredient in over-the-counter (OTC) gels and liquids applied to the gums or mouth to reduce pain, is associated with a rare, but serious condition. This condition is called METHEMOGLOBINIA and results in the amount of oxygen carried through the blood stream being greatly reduced. In the most severe cases, methemoglobinemia can result in death.

Methemoglobinemia has been reported with all strengths of benzocaine gels and liquids, including concentrations as low as 7.5%. The cases occurred mainly in children aged TWO YEARS OR YOUNGER who were treated with benzocaine gel for TEETHING.

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20
Q

What are the signs of Methemoglobinia?

A 
Gray or blue colored skin,🥶 lips, and nail beds
Shortness of breath 🌬
fatigue 😑
confusion 🤪
headache 🤕 
lightheadedness ☁️
and rapid heart rate 💓

The signs and symptoms usually appear within minutes to hours of applying BENZOCAINE and may occur with the first application of benzocaine or after additional use. If you or your child has any of these symptoms after taking benzocaine, seek medical attention immediately

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21
Q

Contraindications for General Anesthesia

A
  1. Risks outweigh proposed procedure
  2. Respiratory infection 🤧
  3. Active systemic disease with elevated temperature 🤒
  4. NPO violation 🍎
  5. Medical conditions / Lab Values that contraindication for GA ⛑
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22
Q

What values does a pulse oximeter measure?

What can it NOT measure?

A

MEASURES: peripheral oxygen saturation (SpO2)
More specifically, it measures what percentage of hemoglobin, the protein in blood that carries oxygen, is loaded.
Acceptable normal ranges for patients without pulmonary pathology are from 95 to 99 percent

CANNOT Measure: it cannot determine the METABOLISM of oxygen, or the AMOUNT of oxygen being used by a patient. For this purpose, it is necessary to also measure carbon dioxide (CO2) levels.

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23
Q

O2 Saturation (SaO2) determines what?

A

SaO2

the percentage of AVAILABLE BINDING sites on HEMOGLOBIN that are bound with oxygen in ARTERIAL blood.

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24
Q

Anemia’s effect on SaO2

A

SaO2 is unaffected by the content of hemoglobin, so anemia does not affect SaO2.

25
Q

What is CaO2?

A

CaO2 is ARTERIAL OXYGEN CONTENT

CaO2 directly reflects the TOTAL NUMBER of OXYGEN MOLECUES in ARTERIAL blood, both bound and unbound to hemoglobin. CaO2 depends on the

  1. hemoglobin content
  2. SaO2, and the
  3. amount of dissolved oxygen.

Units for CaO2 are ml oxygen/100 ml blood

26
Q

What is PaO2?

A

PaO2, the PARTIAL PRESSURE of OXYGEN in the ARTERIAL blood, is determined solely by

  1. the pressure of inhaled oxygen (the PIO2),
  2. PaCO2
  3. The architecture of the lungs.
27
Q

What is FIO2? Does it change at different altitudes?

A

FRACTION OF INSPIRED OXYGEN

FIO2 is the SAME at all altitudes; 21%

The percentage of individual gases in air (oxygen, nitrogen, etc.) doesn’t change with altitude, but the atmospheric (or barometric) pressure does. FIO2, the fraction of inspired oxygen in the air, is thus 21% (or .21) throughout the breathable atmosphere.

PaO2 DECLINES ⬇️ with altitude because the inspired oxygen pressure declines with altitude Average barometric pressure at sea level is 760 mm Hg; it has been measured at 253 mm Hg on the top of Mt. Everest.

28
Q

What is Tachynpea?

A

Respiratory rate is > 24 breaths/min

One reason why a person breathes faster than normal is to take in more oxygen. The oxygen level in the body may be too low, or the carbon dioxide level may be too high. The body tries to correct this by breathing more quickly.

⬇️O2 ⬆️Co2

29
Q

What is Dissolved O2?

What percentages is it found in blood?

A

Oxygen is carried in the blood in two forms:

  1. Dissolved in PLASMA and RBC water, ~2% of the total.
  2. Reversibly bound to hemoglobin ~98% of the total.

When the bound and dissolved oxygen are added together, arterial blood normally contains about 20 ml O2/100 ml blood (20 vol %).

100 ml of PLASMA contains 0.3 ml O2 (or 0.3 vol%).

30
Q

What is External Respiration?

Partial Pressure Alveolus/Capillary?

A

EXTERNAL RESPIRATION:

oxygen diffuses across the respiratory RESPIRATORY MEMBRANE from the alveolus to the capillary:

O2 Alveolus ➡️ Capillary

carbon dioxide diffuses out of the capillary into the alveolus.

CO2 Capillary ➡️ Alveolus

The partial pressure of oxygen in the ALVEOLI is about 104 mm Hg
whereas its partial pressure in the blood of the CAPILLARY is about 40 mm Hg.

Diff of 64mm Hg

creates a very strong PRESSURE GRADIENT that causes oxygen to rapidly cross the respiratory membrane from the alveoli into the blood.

31
Q

Pulmonary Artery function?

A

The PULMONARY ARTERY carries DEOXYGENATED BLOOD ➡️ into the LUNGS from the heart, where it branches and eventually becomes the capillary network composed of pulmonary capillaries.

❤️ 🔵RIGHT VENTRICLE ➡️ PA ➡️LUNGS➡️ PV ➡️ LEFT ATRIUM🔴❤️

These pulmonary capillaries create the respiratory membrane with the alveoli.

32
Q

Pulmonary Vein function?

A

The PULMONARY VEINS are the veins that transfer OXYGENATED blood from the lungs to the heart. The largest pulmonary veins are the FOUR main pulmonary veins, TWO from each lung that drain into the LEFT ATRIUM of the heart.

LUNGS 🔴 ➡️ 2/4 PV ➡️ LEFT ATRIUM ❤️🔴

The pulmonary veins play an essential role RESPIRATION, by receiving blood that has been oxygenated in the alveoli and returning it to the left atrium.

33
Q

Dextro-Transposition of the great arteries. (CHD)

What Happened?

A

It is called a cyanotic congenital heart defect (CHD) because the NEWBORN infant turns blue 🥶 from lack of oxygen.

The AORTA and the PULMONARY ARTERY are transposed.

DEoxygenated blood from the RIGHT HEART is pumped immediately through the AORTA and circulated to the body and the heart itself, bypassing the lungs altogether, while the LEFT HEART pumps OXygenated blood continuously back into the lungs through the pulmonary artery. In effect, TWO SEPARATE “circular” (parallel) CIRCULATORY SYSTEMS are created.

RIGHT VENTRICLE ➡️ AORTA = DeOX blood
LEFT VENTRICLE ➡️ PA = OX blood

Often accompanied by other heart defects ASD/VSD/PDA

34
Q

Levo-Transposition of the great arteries

What is it?

A

ACYANOTIC heart defect in which the primary arteries are transposed, with the aorta anterior and to the left of the pulmonary artery, and the morphological left and right ventricles with their corresponding atrioventricular valves are also transposed. The systemic and the pulmonary circulation are connected. Complications arise from the fact that the right ventricle, which is adapted for pumping blood into the low-pressure pulmonary circulation, is being tasked with pumping blood at a much HIGHER PRESSURE against the HIGH RESISTENCE of the systemic circulation.

35
Q

What is Internal Respiration?

A

INTERNAL RESPIRATION is about ensuring the transport of oxygen in the blood from the lungs to the cells, and the transport of metabolic carbon dioxide from the tissue cells into the blood and to the lungs.

O2 blood ➡️ O2 cells
CO2 cells ➡️ CO2 blood

  • The PRESENCE of CO2 in the red blood cell is crucial to OXYGEN DISTRIBUTION.
  • The presence of CO2 gas and the DROP in PH within red blood cells, independently and together, alter the HEMOGLOBIN (Hb), which DECREASES ⬇️ its AFFINITY for OXYGEN. this change is known as the BOHR Effect.

Reduced pH and increased PCO2 not only predisposes hemoglobin to release its oxygen, but also to release NITRIC OXIDE (a gas), a potent VASODIALATOR

OVERBREATHING reduces dissolved PCO2, and thus decreases CO2 and carbonic acid in red blood cells. This means reduced hydrogen ion concentration, increased pH in red blood cells.

36
Q

What is Dissociative Anesthesia?

What are two Dissociative Agents used in dentistry?

A 
Dissociatives are a class of HALLUCINOGEN  which DISTORT PERCEPTION  of sight and sound and produce feelings of detachment – dissociation – from the environment and self. 
This is done through reducing or BLOCKING SIGNALS to the conscious mind from other parts of the BRAIN 🧠

Nitrous Oxide, Ketamine

37
Q

Is Nitrous Oxide contraindicated in patients with Asthma? Sickle Cell Anemia?

A

No.

It is NON-IRRITATING to the MUCOUS MEMBRANES and since anxiety can trigger an asthmatic episode, its ANTI-ANXIETY effects can reduce the possibility of an occurrence.

The same holds true for patients with sickle cell anemia. The ⬆️ INCREASED levels of OXYGEN during nitrous oxide/oxygen analgesia/anxiolysis may ⬇️ REDUCE the occurrence of a CRISIS.

38
Q

What is the difference between Analgesia and Anesthetic?

A
  • ANALGESIA means the inability to sense pain. It’s a LOSS OF SENSATION but ONLY to PAIN. … However, in practice, analgesics, drugs that cause analgesia, may, in some cases, also cause some sedation.
  • ANESTHETIC is a word that literally means without feeling, sensation, or perception. It may include analgesia (relief from or prevention of pain), paralysis (muscle relaxation), amnesia (loss of memory), or unconsciousness
39
Q

Is Nitrous Oxide Analgesic or Anesthetic?

A

The mechanism of action of nitrous oxide is TRIFOLD and includes ANALGESIA, ANXIOLYSIS and ANESTHESIA
- Its analgesic mechanism of action is described as opioid in nature and may involve a number of spinal neuromodulators

40
Q

Does Nitrous Oxide combine with Hemoglobin?

A

No.

Nitrous oxide has the fastest onset among inhalation agents, and is transported in blood as FREE GAS

it does NOT combine with hemoglobin, and it does not undergo biotransformation.

Systemic elimination occurs with pulmonary exhalation; its ⬇️ LOW SOLUBILITY in BLOOD allows nitrous oxide to be removed rapidly from the body

41
Q

What Vitamin does Nitrous Oxide effect?

A

B12

Nitrous oxide IRREVERSIBLY OXIDIZES vitamin B12, ⬇️ REDUCING the activity of B12-dependent enzymes such as METHIONINE and THYMIDYLATE synthetases.

This is the likely mechanism for adverse health effects reported in those individuals who are chronically exposed to trace amounts of the drug, such as infertility, spontaneous abortion, blood dyscrasias, and neurologic deficits.

42
Q

Medical conditions contraindicated with Nitrous Oxide?

A

Contraindications for use of nitrous oxide/oxygen inhalation may include:

  1. some chronic obstructive pulmonary diseases.
  2. current upper respiratory tract infections.
  3. recent middle ear disturbance/surgery.
  4. severe emotional disturbances or drug-related de-
    pendencies.
  5. first trimester of pregnancy.
  6. treatment with bleomycin sulfate.
  7. methylenetetrahydrofolate reductase deficiency.
  8. Cobalamin (vitamin B-12) deficiency.
43
Q

Nitrous Oxide equipment

A

Inhalation equipment must have the capacity for delivering 100 percent, and never less than 30 percent, oxygen concentration at a flow rate appropiate to the child’s size.

If nitrous oxide/oxygen delivery equipment capable of delivering more than 70 percent nitrous oxide and less than 30 percent oxygen is used, an inline oxygen analyzer must be used.

The equipment must have an appropriate scavenging system to minimize room air contamination and occupational risk.

44
Q

What is the effect of HYPERKALEMIA on the HEART ❤️?

What status allows a doctor to know if a patient is becoming Hyperkalemic?

A

HYPERKALEMIA:

While mild hyperkalemia probably has a limited effect on the heart, moderate hyperkalemia can produce EKG CHANGES

  • PEAKED ⬆️ T WAVES
  • Prolongation of PR interval
  • Widening QRS Complex
  • Loss of P wave
  • “Sine Wave”
  • Asystole

severe hyperkalemia can cause SUPPRESSION of ELECTRICAL ACTIVITY of the heart ❤️ and can cause the heart to stop beating.

Administer EPINEPHRINE IMMEDIATELY

45
Q

On ECG what does the T-Wave

represent?

A

In electrocardiography,
the T wave represents

REPOLARIZATION of the VENTRICLES.

During ventricle contraction (QRS complex), the heart depolarizes. Repolarization of the ventricle happens in the opposite direction of depolarization and is negative current, signifying the RELAXATION of the CARDIAC MUSCLES of the VENTRICLES.

46
Q

What does the body need O2 for?

A

The Production of ATP (energy)

47
Q

What does O2 bind to in the Hemoglobin?

A

Iron / Fe

Each Hemoglobin has 4 Fe binding sites that can bind to one O2 unit each.

Forms OXYHEMOGLOBIN

RELAXED form of Hemoglobin

48
Q

What is the HARMFUL effect of NITROUS OXIDE?

🧬

A

HARMFUL NITROUS OXIDE

N2O acts by OXIDIZING VIT 12 from the active, reduced COBALAMIN to the INACTIVE FORM.

This in turn, INACTIVATES METHIONINE SYNTHETASE which requires active Cobalamin and Folate.

The inactivation of Methionine Synthetase DECREASES DNA 🧬 PRODUCTION, thereby interfering with cell proliferation.

49
Q

Larygospasm

A

Laryngospasm is an uncontrolled or involuntary muscular CONTRACTION (spasm) of the VOCAL FOLDS.

The condition typically lasts less than 60 seconds, but in some cases can last 20–30 minutes and causes a partial blocking of BREATHING IN, while breathing out remains easier.

It may be triggered when the vocal cords or the area of the trachea below the vocal folds detects the entry of water, mucus, blood, or other substance. It is characterized by stridor and/or retractions.

It is also a complication associated with ANESTHESIA. The spasm can happen often without any provocation, but tends to occur AFTER tracheal EXTUBATION.

In children, the condition can be particularly deadly, leading to CARDIAC ARREST within 30–45 seconds, and is a possible cause of death associated with the induction of general anesthesia in the pediatric population.

Laryngospasm in the operating room is treated by hyperextending the patient’s neck and administering assisted ventilation with 100% oxygen. In more severe cases it may require the administration of an intravenous muscle relaxant, such as SUCCINYLCHOLINE, and reintubation.

50
Q

Succinylcholine

Indications/contraindication?

A

Used to cause short-term paralysis as part of general anesthesia. usually for facilitation of endotracheal INTUBATION.

It works by BLOCKING the action of ACETYLCHOLINE on SKELETAL muscles.

Contraindication

Serious side effects include MALIGNANT HYPERTHERMIA and allergic reactions. It is not recommended in people who are at risk of high blood POTASSIUM or a history of MYOPATHY.

(MH) from suxamethonium administration can result in a drastic and uncontrolled increase in skeletal muscle ⬆️ OXIDATIVE METABOLISM. This overwhelms the body’s capacity to supply oxygen, remove carbon dioxide, and regulate body temperature, eventually leading to circulatory collapse and death if not treated quickly.

51
Q

What are the H’s and T’s?

↩️💔5

A

The Hs and Ts is a mnemonic used to aid in remembering the possible REVERSIBLE ↩️ causes of CARDIAC ARREST. 💔
A variety of disease processes can lead to a cardiac arrest; however, they usually boil down to one or more of the “Hs and Ts”.

  1. HYPOXIA
    - An absence of enough oxygen in the tissues to sustain bodily functions.
    - Early signs are anxiety, confusion, and restlessness
  2. HYPOVOLEMIA
    - A decreased volume of circulating blood in the body.
    - Early symptoms include headache, fatigue, weakness, thirst, and dizziness.

HYPOTHERMIA

  • When the body loses heat faster than it can produce heat, causing a dangerously low body temperature.
  • Hypothermia occurs as your body temperature falls below 95 F (35 C).

HYPER/HYPO KALEMIA

  • The presence of potassium in the blood.
  • Hyper: high potassium is related to your kidneys, such as: Acute kidney failure. Chronic kidney disease.
  • Hypo: usually results from vomiting, diarrhea, adrenal gland disorders, or use of diuretics.
  • HYDROGEN ION (ACIDOSIS)
  • High concentration of hydrogen ions in the blood
  • Causes can include chronic alcohol use, heart failure, cancer, seizures, liver failure, prolonged lack of oxygen, and low blood sugar. Even prolonged exercise can lead to lactic acid buildup.

TENSION PNEUMOTHORAX
- when air leaks into the space between the lungs and chest wall. A blunt or penetrating chest injury, certain medical procedures, or lung disease can cause a pneumothorax.

TAMPONADE (Cardiac)

  • Compression of the heart caused by fluid collecting in the sac surrounding the heart.
  • Symptoms include low blood pressure, shortness of breath, and lightheadedness.

TOXINS

THROMBOSIS (pulmonary / cardiac)

52
Q

What is the Normal Respiratory Rates in Children?

A

Newborn: 30-60 breaths per minute

Infant (1 to 12 months): 30-60 breaths per minute

Toddler (1-2 years): 24-40 breaths per minute

Preschooler (3-5 years): 22-34 breaths per minute

School-age child (6-12 years): 18-30 breaths per minute

Adolescent (13-17 years): 12-16 breaths per minute

53
Q

What are some conditions where N20 is contraindicated?

👂

A

Contraindications for use of nitrous oxide/oxygen inhalation may include:

  1. some chronic obstructive pulmonary diseases.
  2. current upper respiratory tract infections.
  3. recent middle ear disturbance/surgery. 👂
  4. severe emotional disturbances or drug-related dependencies.
  5. first trimester of pregnancy.
  6. treatment with bleomycin sulfate.
  7. methylenetetrahydrofolate reductase deficiency
  8. Cobalamin (vitamin B12) Deficiency
54
Q

What is the Hemoglobin Oxygen Saturation in a Healthy Child?

A

95-100%

55
Q

What does MAC stand for?

N2O?

A

Minimum Alveolar Concentration (MAC)

-concentration required to render 50% of patients immobile

MAC of N2O is 105%

56
Q

What is the Hemoglobin O2 saturation in a healthy child?

A

Oxygen saturation is within the normal range when reading between 94–100%.

An oxygen saturation below 94% is hypoxemia

57
Q

Where is a precordial stethoscope placed?

A

Breath sounds and heart tones are best heard when a precordial stethoscope is positioned near the left sternal border between the second and fourth interspaces (above the nipple line).

Allows the anesthesiologist to immediately detect changes in the rate and character of heart and breath sounds, and it often gives the first warning of a physiologic alteration

58
Q

What conditions can increase the chance of Malignant Hyperthermia?

A

Some muscle disorders are known to be associated with malignant hyperthermia.

King-Denborough syndrome
Duchenne muscular dystrophy
Mitochondrial myopathies

Pediatric Dentistry Prepatory Boards (39 decks)

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