Anesthesia Part II Flashcards
What is the most important thing to consider with OD other than Dosage?
What is a secondary consideration?
Injecting slowly
anesthetic w/ or w/out vasoconstriction
*not size, position of needle
1 indication for withdrawing needle if positive aspiration:
Too much blood, can’t see, switch out
How long should the LA injection last?
1-2 minutes
Diameters of needles:
25 gauge
27 gauge
30 gauge
Epi dilution: 1:50k is ____x the amount of 1:100k
2x
What is a positive aspiration telling us?
Intervascular injection
Dosing for lidocaine:
*max dosage
3.2 mg/lb
7 mg/kg
*up to 500 mg
How much drug is in 2% solution, standard cartridge?
How much drug is in 4% solution, standard cartridge?
36 mg
72 mg
3 pieces of information to determine max dosing of LA:
MRD
Weight
How much already gave
*doesn’t matter where giving
To prevent OD, what should we do (outside of proper dosage)?
Slow administration of drug
LA with or without vasoconstrictor, what are we thinking about for med pts?
CV ASA II, III, or IV
3 situations to NOT give someone LA:
*1 situation OK
BP above 200
MI one month ago
Uncontrolled/Active Hyperthyroidism
*stroke 6 months ago
If a pt is 6 months past an MI or Stroke, can we treat?
Yes
*6 month cut-off
Do we want to put LA cartridges in a disinfecting solution?
Why?
No
increase risk of paresthesia through contamination
Who has greater risk for LA OD, young/lighter or old/heavier?
young/lighter
What vasoconstrictor should you avoid if you are on Tricyclic Antidepressants?
Levonordefrin
When doing LA, what is the most important thing to do to mitigate syncopy?
Pt position (heat at or near heart)
If you give a right PSA injection, withdraw needle and the face swells, what happened?
Give cold or hot?
Additionally?
Hematoma
Cold
Pressure
A frequent cause of toxicity from LA is what?
Intravascular injection
Why do we have caution with Liver Disease pts?
Biotransformation impacted
*can’t eliminate drugs in the body - change the dosing
What anesthetic has considerations regarding methemoglobin?
Prilocaine
Slow administration is important to reduce toxicity effects of LA, but what is the main factor to consider when preventing an OD?
Wrong Dosing
*too much drug
People give the higher dosage often b/c technique is faulty (wrong needle, gauge, placement, etc)
True
What is the most common emergency in Dentistry?
This is most often related to what?
Syncope
LA administration
Apply the topical anesthetic a minimum of ____
*don’t paint
1 minute
T/F
Pts need anesthetic administered as it is advanced through the tissue toward the periosteum
False
Aspirate a minimum of….
Ideally aspirate…
once
twice
The ideal deposition is 1 mL per minute
Recommended 1.8 mL per minuted
*1 to 2 minutes total
True
Do not leave the pt for _____ minutes after the injection b/c most LA complications occur within this time
5-10
LA’s w/ vasoconstrictors produce more pain than plain solutions
False
2 types of Mx injections:
3 types of Mb injections:
Nerve blocks, Infiltrations
Nerve blocks, PDL, Intraosseous
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)
3 computer assisted LA delivery systems:
The wand
Comfort Control Syringe
Anaeject
Facial nerve paralysis happens when LA is injected into where?
Parotid gland
Loss of motor function, cosmetic problem, inability to close affected eye
Facial nerve paralysis
How to prevent Facial n. paralysis?
Contact w/ bone
*no bone = no injection
What is usually a cosmetic issue - inconvenience for the pt and an embarrassment for the dentist?
Hematoma
Immediately following a Hematoma you should put ____ on the site for ___ minutes with _____
pressure
2
ice
What complication can happen with good technique?
Paresthesia
Too much rate of deposition (pressure) can cause Paresthesia
*also alcohol, sterilizing agents
True
Any technique involving a needle insertion into a foramen can lead to Paresthesia
True
Paresthesia is a special problem if you hit the lingual (chorda tympani nerve) why?
taste impaired
T/F
Small gauge needles almost never totally sever a nerve
True
Pressure within the nerve sheath
Paresthesia
Most Paresthesia resolves spontaneously over a period of ________
Normally lasts for at least ____ months
weeks to months
2
Most paresthesia develops where?
Mandible
Withdraw slightly prior to injection, more volume, more bathing of nerve, and lower concentrations all may avoid Paresthesia
True
A motor disturbance of the Trigeminal Nerve, especially spasm of the muscles of mastication
*leads to limited opening
Trismus
Trismus is caused by trauma to the blood vessels where?
Infratemporal fossa
Trismus is often relieved by doing what?
Exercise
*chewing gum, tongue depressors
Trismus resolves in what time frame?
If longer than this, considered…
48 hours
infection
Medical contraindication to Vasoconstrictor:
ASA IV, V (CV effects)
Local anesthetic (plain) is ok where?
Local anesthetic in 2 ____ should have vasoconstrictor
1 quadrant
2 quadrants
What is the safest LA?
Lidocaine w/ epi
Max dose of 2% lidocaine w/ 1:100k epi is:
1 cartridge for ___lbs of body weight
20
Administer oxygen in milde OD
True
How can you prevent chewing/trauma of soft tissues w/ children?
Oraverse
Best pregnancy LA
lidocaine
*B and Safe for lactation
What causes chocolate-brown blood after sleepiness, cyanosis, respiratory distress (then leads to death)
methemoglobinemia
*acetaminophen, prilocaine
What is the antidote to methemoglobinemia?
methylene blue
blue drug into blue patient = pink
T/F
Don’t worry about an amide allergy
True
At what ASA do you limit vasoconstrictor?
At what ASA do you not give vasoconstrictor?
III if CVS
IV, V
Avoid high doses of LA with what 2 class of drugs?
Avoid vasoconstrictor with what class?
Anticonvulsants, Antipsychotics (and benzodiazepenes)
Antidepressants
What kind of antidepressants may enhance CV actions of vasoconstrictors?
Especially avoid what vasoconstrictor?
Tricyclics
levonordefrin
If pt on glucocorticoids consider what?
stress reduction
*nitrous, IV sedation
H2 receptor blocker does what to Lidocaine?
increases half life
Opioids increase risk for LA overdose
True
What type of Beta Blockers aren’t to be used with Vasoconstrictors?
Non-Selective
Cocaine is an absolute contraindication with epi for how long?
24 hours
Alcohol may ____ the effectiveness of LA’s
decrease
Epi may cause _____ w/ Digoxin
arrhythmias
What type of damage could LA cause in a Sickle Cell pt?
myocardial
T/F
Absolute contraindication to LA’s if uncontrolled hyperthyroidism
True
T/F
Pheochromocytoma is ok with LA’s
False
*absolute contraindication
T/F
Epinephrine reaction is an allergy
False
What is the safest trimester for pregnancy
2nd
