Ch 36 Anxiety And Pain Control Flashcards
Physical process of receiving a painful stimulus, transmits to brain and interpreted
Pain perception
Interpretation of and response to pain message
Highly variable among individuals
Many factors influence
Pain reaction
Varies among individuals
High and low
Pain threshold
Pain control mechanisms (6)
Remove the painful stimulus
-fulcrum
Block the pathway of pain message
-LA
Prevent pain reaction by raising threshold
-Nitrous oxide
Depress dental nervous system
-general anesthesia
Paychosedation methods
-reduce anxiety result of clinicians behavior or actions
Nonopioid analgesics
What drug is used and when to use them
NSAIDs
Acetaminophen (Tylenol)
Use for mild to mod pain during and post procedure
When should NSAIDs be used with caution
Bleeding is a concern
Hemostasis during tx
State of conscious sedation
Used for pain control and anxiety
Some degree of analgesia and higher pain threshold
Nitrous oxide oxygen sedation
Chemical and physical properties of nitrous
Gas
Heavier than air
Nonallergenic
Nonflammable
Blood solubility of nitrous
Where do the gas molecules pass readily to tissue
Solubility results in
Can diffusion hypoxia occur if 100% oxygen not administered
Relatively soluble (3-5 min)
Alveoli blood interface and blood brain interface
Rapid onset and recovery
Yes
True or false
Nitrous remains unchanged in blood and tissues bc it is not metabolized in body
Enters through lungs and exits though blood
True
False_ enters and exits almost entirely through lungs
Three basic parts of nitrous
Gas storage cylinder
Gas delivery system
- scavenger system with nasal hood (mask)
(reduces exposure of clinician administering )
Color code of cylinders
Oxygen
Nitrous
Green (white international)
Blue
What makes up the sum of the total gas flow rate
Nitrous and oxygen (adjusted independently )
Mask/hood
Scavenger system
Delivers and collects exhaled gas and directs it to scavenger system
Removed exhaled gas to keep nitrous oxide levels low in room. Connected to evac sys
Minimum oxygen flow
Oxygen fail safe systems will automatically shut off if oxygen falls below min.
30% or 3L/min
True
Absolute contraindications (5)
Chronic respiratory disease
Upper tract infection or other acute conditions (sinus, mouth breather, cough)
Tympanic membrane graft
Recent ophthalmic surgery
Pregnancy (FIRST trimester )
May cross placenta
Relative contraindications
Current antidepressants or other psychotropic drugs
Recovering drug or alcohol addiction
Certain phobias
Unable to understand directions
Blew,chin therapy
Scavenger system is connected to
High speed volume evacuation
Order for turning on gas cylinders
1- oxygen
2-nitrous oxide
Avg adults gas flow
Avg for children
6-7 L/min
4-5L/min
Increasing percentage of nitrous until optimum sedation level is achieved
Titration
Titration started at
(Then assess after 1-2 minutes)
If adjustment needed up or down by
20-40% of nitrous results in adequate sedation
How much time needed for titration
10-15% concentration
5-10%
True
5minutes
Completion of sedation
Oxygen for a full _ minutes
5 or longer if needed but no less
Method for minimizing occupational exposure
Effective scavenging system that can move 45 L/min or air
Advantages
Reduce pts reaction to pain by raising pain threshold
Reduce gag reflex
Very safe with few side effects
Disadvantages
Low potency
Able and willing to breath through nose
Expensive
Potential for rec abuse by health pros
Widely used in topical
High allergic reactions
Elimination via kidneys
Esters
Safe effective and min side effects
Metabolized by liver
Amides
Time for intermediate acting amide
Influencing duration
60 minutes
Vascularity at site of injection
Lidocaine max dose
500 mg
Longest acting and onset of all LA (recd for posttx pain control and good for procedures greater than 60min)
Most potent
1:200,000
Bupivacaine
What procedures require LA
SRP 4mm or greater
Extensive instrumentation
Challenging pockets, furcations, surfaces etc
Soft tissue manipulation
Best choice for heart failure
2% lidocaine 1:100,000
(Cardiac dosage for epi)
Oraqix combo
2.5% lido 2.5% Prilocaine
Subgingival liquid rod gel delivery
Buffering increases ___ of LA
pH
