Day 4 -Sedation Dentistry & Nitrous

Question 1

What ASA status is the cut off for sedation dentistry?

Answer 1

ASA IV and above

Question 2

What is the youngest age for sedation dentistry?

Answer 2

1 year

Question 3

What are the 3 pharmacodynamic ways we can administer sedation?

Answer 3

inhalation, oral, and parental (most common)

Question 4

What is another term for minimal sedation?

Answer 4

Anx-io-lysis

Question 5

What type of sedation is this: Patient is comfortable…Patient understands and desires…relaxation…Very little change in vital signs….Can achieve with oral or inhalational

Answer 5

Anxiolysis/mild sedation

Question 6

What type of sedation is this: Alteration of mood, Little/minor change with vital signs, Patient must remain cooperative Can achieve with oral or IV

Answer 6

Conscious/Moderate sedation

Question 7

How can we achieve anxiolysis/mild sedation? (2 ways)

Answer 7

oral or inhilational

Question 8

How can we achieve conscious/moderate sedation? (2 ways)

Answer 8

oral or IV

Question 9

What type of sedation is this? Patient is unconscious and not cooperative…Protective reflexes may be affected- must protect airway…Can have significant change with vital signs….Can achieve with any route!

Answer 9

DEEP sedation

Question 10

What are the 3 ways we can achieve DEEP sedation?

Answer 10

Inhalational, Oral, or Parenteral

Question 11

What type of sedation/anestheisa? Loss of consciousness…Loss of cooperation….Loss of protective reflexes…Increased potential for adverse events…Not typically done in the dental office

Answer 11

GENERAL ANESTHESIA

Question 12

When can a sedation patent be scheduled?

Answer 12

The is no reason why any patient cannot

be seen anytime during the day- NONE

Question 13

By law, WHO is responsible for all necessary equipment and supplies?

Answer 13

anesthesia provider

Question 14

Nitrous is used for _______ sedation

Answer 14

conscious

Question 15

Does Nitrous produce analgesia?

Answer 15

SOMETIMES

Question 16

Nitrous oxide is a _______ CNS _______

Answer 16

NON-selective CNS depressant

Question 17

What is the amount of drug necessary to inhibit movement in 50% of patients when a painful stimulus is applied

Answer 17

MAC…minimum alveolar concentration

Question 18

A LOW Blood-Gas partition coificient = ????

Answer 18

RAPID induction (nitrous is really low!)

Question 19

A HIGH Oil-Gas partition coefficient = ????

Answer 19

INCREASED POTENCY (nitrous is really low)

Question 20

How much Nitrous gets metabolized?

Answer 20

TRICK Question! NONE!!

Question 21

The precise mechanism by which inhalation anesthetics produce loss of perception of sensations and unconsciousness = _______

Answer 21

UNKNOWN!!!

Question 22

Inhalation anesthetics may interfere with the physiological functioning of nerve cell ________ in the brain via an action at the _____ matrix of it

Answer 22

membranes…lipid

Question 23

The EFFECTS of nitrous are _____ dependent

Answer 23

dose

Question 24

A high concentration and greater duration of use increases the frequency of ______ & _______

Answer 24

nausea & vomiting

Question 25

What are the two most frequently increased negative health effects from CHRONIC nitrous toxicity?

Answer 25

neurological diseases and spontaneous abortions

Question 26

N2O abuse: is it a controlled substance? Is it a drug of dependence? What is over use that looks like MS?

Answer 26

NOT a controlled substance, Yes drug of dependence, causes Myelopathy…looks like MS

Question 27

Are the effects of peripheral neuropathy REVERSIBLE with abstinence?

Answer 27

YES

Question 28

N2O interacts with endogenous ______ system to produce addictive behavior

Answer 28

OPIOID!!!

Question 29

________ reverses the clinical actions of N2O (think OPIOID!!)

Answer 29

Naloxone

Question 30

Concentrations of N2O in excess of ___% were employed in the vast majority of cases where allegations of sexual misconduct were involved

Answer 30

50%!!!

Question 31

What color is every oxygen tank ever made? What color is every N2O tank ever made?

Answer 31

Oxygen = green……Nitrous = blue

Question 32

What side of the flowmeter is oxygen ALWAYS located? What about Nitrous?

Answer 32

oxygen is always on the riGht (GGGgreen)….Nitrous is always on the Left (bLLLLue)

Question 33

What are a few signs and symptoms of Nitrous sedation that is TOO DEEP?

Answer 33

Laughing,crying…increased BP,HR….Sweating,Tearing…NAUSEA…SLEEPINESS

Question 34

What amount of Oxygen do you always start with? What amount of Nitrous do you always start with?

Answer 34

5 L / min O2…… 0 L/min N2O

Question 35

What is the process for adding nitrous to the patient? How quickly do you titrate?

Answer 35

titrate N2O up 1 or .5 L/min and Oxy down .5/1 L/min…..every 1 min you make an adjustment

Question 36

When is the patient most likely to shiver from the N2O administration?

Answer 36

at the end of the appointment

Question 37

What is the most common medical event in the dental clinic?

Answer 37

syncope (fainting)

Question 38

What is the dose of Aspirin I would administer if i thought a Pt was having an MI? What special ingesting instructions do I give?

Answer 38

325 mg…chew it or crush it

Question 39

How much BENEDRYL do I administer if I think a Pt is showing early signs of an allergic reaction?

Answer 39

50mg

Question 40

What is the dose of epi in an ADULT epi pen? child?

Answer 40

0.3mg epi for adult…0.15mg for kiddos…WOW thats a lot (our max dose in dentistry is 0.2 for a healthy pt

Question 41

What two benzo’s can help in a grand mal seizure?

Answer 41

valium and medazolam

Question 42

What is the difference between an incisive injection and a mental injection on the mandibular?

Answer 42

APPLY PRESSURE IN INCISIVE!!!! THE PRESSURE ANESTHETISES THE PM to MIDLINE!!!!