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Anesthesia Part II Flashcards

1
Q

What is the most important thing to consider with OD other than Dosage?

What is a secondary consideration?

A

Injecting slowly

anesthetic w/ or w/out vasoconstriction

*not size, position of needle

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2
Q

1 indication for withdrawing needle if positive aspiration:

A

Too much blood, can’t see, switch out

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3
Q

How long should the LA injection last?

A

1-2 minutes

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4
Q

Diameters of needles:

A

25 gauge

27 gauge

30 gauge

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5
Q

Epi dilution: 1:50k is ____x the amount of 1:100k

A

2x

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6
Q

What is a positive aspiration telling us?

A

Intervascular injection

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7
Q

Dosing for lidocaine:

*max dosage

A

3.2 mg/lb

7 mg/kg

*up to 500 mg

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8
Q

How much drug is in 2% solution, standard cartridge?

How much drug is in 4% solution, standard cartridge?

A

36 mg

72 mg

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9
Q

3 pieces of information to determine max dosing of LA:

A

MRD

Weight

How much already gave

*doesn’t matter where giving

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10
Q

To prevent OD, what should we do (outside of proper dosage)?

A

Slow administration of drug

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11
Q

LA with or without vasoconstrictor, what are we thinking about for med pts?

A

CV ASA II, III, or IV

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12
Q

3 situations to NOT give someone LA:

*1 situation OK

A

BP above 200

MI one month ago

Uncontrolled/Active Hyperthyroidism

*stroke 6 months ago

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13
Q

If a pt is 6 months past an MI or Stroke, can we treat?

A

Yes

*6 month cut-off

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14
Q

Do we want to put LA cartridges in a disinfecting solution?

Why?

A

No

increase risk of paresthesia through contamination

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15
Q

Who has greater risk for LA OD, young/lighter or old/heavier?

A

young/lighter

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16
Q

What vasoconstrictor should you avoid if you are on Tricyclic Antidepressants?

A

Levonordefrin

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17
Q

When doing LA, what is the most important thing to do to mitigate syncopy?

A

Pt position (heat at or near heart)

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18
Q

If you give a right PSA injection, withdraw needle and the face swells, what happened?

Give cold or hot?

Additionally?

A

Hematoma

Cold

Pressure

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19
Q

A frequent cause of toxicity from LA is what?

A

Intravascular injection

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20
Q

Why do we have caution with Liver Disease pts?

A

Biotransformation impacted

*can’t eliminate drugs in the body - change the dosing

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21
Q

What anesthetic has considerations regarding methemoglobin?

A

Prilocaine

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22
Q

Slow administration is important to reduce toxicity effects of LA, but what is the main factor to consider when preventing an OD?

A

Wrong Dosing

*too much drug

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23
Q

People give the higher dosage often b/c technique is faulty (wrong needle, gauge, placement, etc)

A

True

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24
Q

What is the most common emergency in Dentistry?

This is most often related to what?

A

Syncope

LA administration

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25
Apply the topical anesthetic a minimum of ____ *don't paint
1 minute
26
T/F | Pts need anesthetic administered as it is advanced through the tissue toward the periosteum
False
27
Aspirate a minimum of.... Ideally aspirate...
once twice
28
The ideal deposition is 1 mL per minute Recommended 1.8 mL per minuted *1 to 2 minutes total
True
29
Do not leave the pt for _____ minutes after the injection b/c most LA complications occur within this time
5-10
30
LA's w/ vasoconstrictors produce more pain than plain solutions
False
31
2 types of Mx injections: 3 types of Mb injections:
Nerve blocks, Infiltrations Nerve blocks, PDL, Intraosseous
32
Infiltration, aka _______, is indicated for what procedures? Nerve block is deposition near _____
supraperiosteal, limited area (one or two teeth) Major nerve trunk (greater distance/wider area blocked)
33
3 computer assisted LA delivery systems:
The wand Comfort Control Syringe Anaeject
34
Facial nerve paralysis happens when LA is injected into where?
Parotid gland
35
Loss of motor function, cosmetic problem, inability to close affected eye
Facial nerve paralysis
36
How to prevent Facial n. paralysis?
Contact w/ bone *no bone = no injection
37
What is usually a cosmetic issue - inconvenience for the pt and an embarrassment for the dentist?
Hematoma
38
Immediately following a Hematoma you should put ____ on the site for ___ minutes with _____
pressure 2 ice
39
What complication can happen with good technique?
Paresthesia
40
Too much rate of deposition (pressure) can cause Paresthesia *also alcohol, sterilizing agents
True
41
Any technique involving a needle insertion into a foramen can lead to Paresthesia
True
42
Paresthesia is a special problem if you hit the lingual (chorda tympani nerve) why?
taste impaired
43
T/F | Small gauge needles almost never totally sever a nerve
True
44
Pressure within the nerve sheath
Paresthesia
45
Most Paresthesia resolves spontaneously over a period of ________ Normally lasts for at least ____ months
weeks to months 2
46
Most paresthesia develops where?
Mandible
47
Withdraw slightly prior to injection, more volume, more bathing of nerve, and lower concentrations all may avoid Paresthesia
True
48
A motor disturbance of the Trigeminal Nerve, especially spasm of the muscles of mastication *leads to limited opening
Trismus
49
Trismus is caused by trauma to the blood vessels where?
Infratemporal fossa
50
Trismus is often relieved by doing what?
Exercise *chewing gum, tongue depressors
51
Trismus resolves in what time frame? If longer than this, considered...
48 hours infection
52
Medical contraindication to Vasoconstrictor:
ASA IV, V (CV effects)
53
Local anesthetic (plain) is ok where? Local anesthetic in 2 ____ should have vasoconstrictor
1 quadrant 2 quadrants
54
What is the safest LA?
Lidocaine w/ epi
55
Max dose of 2% lidocaine w/ 1:100k epi is: 1 cartridge for ___lbs of body weight
20
56
Administer oxygen in milde OD
True
57
How can you prevent chewing/trauma of soft tissues w/ children?
Oraverse
58
Best pregnancy LA
lidocaine *B and Safe for lactation
59
What causes chocolate-brown blood after sleepiness, cyanosis, respiratory distress (then leads to death)
methemoglobinemia *acetaminophen, prilocaine
60
What is the antidote to methemoglobinemia?
methylene blue blue drug into blue patient = pink
61
T/F | Don't worry about an amide allergy
True
62
At what ASA do you limit vasoconstrictor? At what ASA do you not give vasoconstrictor?
III if CVS IV, V
63
Avoid high doses of LA with what 2 class of drugs? Avoid vasoconstrictor with what class?
Anticonvulsants, Antipsychotics (and benzodiazepenes) Antidepressants
64
What kind of antidepressants may enhance CV actions of vasoconstrictors? Especially avoid what vasoconstrictor?
Tricyclics levonordefrin
65
If pt on glucocorticoids consider what?
stress reduction *nitrous, IV sedation
66
H2 receptor blocker does what to Lidocaine?
increases half life
67
Opioids increase risk for LA overdose
True
68
What type of Beta Blockers aren't to be used with Vasoconstrictors?
Non-Selective
69
Cocaine is an absolute contraindication with epi for how long?
24 hours
70
Alcohol may ____ the effectiveness of LA's
decrease
71
Epi may cause _____ w/ Digoxin
arrhythmias
72
What type of damage could LA cause in a Sickle Cell pt?
myocardial
73
T/F | Absolute contraindication to LA's if uncontrolled hyperthyroidism
True
74
T/F | Pheochromocytoma is ok with LA's
False *absolute contraindication
75
T/F | Epinephrine reaction is an allergy
False
76
What is the safest trimester for pregnancy
2nd

Tim's Cards (140 decks)

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