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Dental Anesthesiology 2020 > Lecture 6 > Flashcards

Lecture 6 Flashcards

1
Q

What are 5 volatile anesthetics?

A
  • Halothane
  • Enflurane
  • Isoflurane
  • Desflurane
  • Sevoflurane
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2
Q

What are gaseous anesthetics?

A

-Nitrous oxide

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3
Q

What are three desirable qualities of inhaled anesthetics?

A
  • Rapid induction (onset)
  • Rapid termination (elimination)
  • Effect compartment
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4
Q

What are four factors that control uptake of nitrous oxide?

A
  • Inspire concentration
  • Ventilation
  • Solubility
  • Cardiac output
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5
Q

How is solubility measured?

A

-Partition coefficient

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6
Q

An increase in cardiac output does what with nitrous oxide?

A

-Increases its uptake in the blood

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7
Q

What is the Partial pressure of O2 in the alveolus?

A

-103 mmHg

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8
Q

What is the partial pressure of O2 in capillaries?

A

-40 mmHg

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9
Q

T/F Nitrous oxide is relatively insoluble in the blood

A

True

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10
Q

What is the onset of action of Nitrous oxide for inhalation?

A

-Less than 20 seconds with 2-3 minutes for clinical actions to develop

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11
Q

How long does it take to reach the peak clinical effect of nitrous oxide for inhalation?

A

-3-5 minutes

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12
Q

What is the depth of sedation for nitrous oxide for inhalation?

A

-Sedation levels easily changed either way

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13
Q

What is the duration of action for inhalation of nitrous oxide?

A

-Duration variable, at discretion of administrator

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14
Q

What is the recovery time for the inhalation of nitrous oxide?

A

-Recover usually complete following 3-5 minutes of inhalation of 100% O2

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15
Q

What is diffusion hypoxia?

A

-Hangover effect

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16
Q

How can diffusion hypoxia occur?

A

-If pt. breathes room air at conclusion of N2O-O2 sedation

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17
Q

How do you prevent diffusion hypoxia?

A

-Administer 100% O2 for 5 minutes at termination of procedure

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18
Q

Is titration possible with inhalation of nitrous oxide ?

A

-Yes

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19
Q

What is the ability to titrate nitrous oxide mean?

A

-Adds safety to administer Nitrous oxide

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20
Q

T/F Nitrous oxide has analgesic properties so it can be used instead of local anesthetic in certain procedures

A

True

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21
Q

What are the disadvantages of Nitrous oxide?

A
  • Initial cost of equipment
  • N2O is not a potent agent, failures can occur
  • must be able to inhale gases through nose
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22
Q

What are three indications for nitrous oxide?

A
  • Management of fear and anxiety
  • Medically compromised pts
  • Management of gagging
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23
Q

When giving nitrous oxide to the medically compromised pts with cardiovascular disease what effects does it have?

A
  • Lower anxiety means lower myocardial ischemia
  • Oxygen administration
  • Analgesic effect of N2O
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24
Q

When giving nitrous oxide to someone with respiratory disease what should you know?

A
  • Administered safely to asthmatic pts
  • N2O is non-irritating to trtacheo-bronchial tree
  • Increased stress is potential cause of acute exacerbation of asthma
  • May not work with chronic nasal obstruction
  • Relative contraindication with COPD
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25
When giving nitrous oxide to someone with Cerebrovascular disease (stroke) what does it do to anxiety and blood pressure?
- Reduce | - It is also good for these pts because you are administering O2 that helps these pts
26
T/F N2O is non-epiliptogenic
True
27
What can nitrous oxide do to pregnant women?
- Absolutely contraindicated in 1st trimester (can cause spontaneous abortions) - N2O can cross the placenta - Should consult OB
28
T/F Epileptics are more sensitive to hypoxia from nitrous oxide
True
29
What can nitrous oxide do for gagging pts?
- Effective in eliminating/minimizing sever gagging - May require placing pts in upright position - Can use in radiographs or impressions
30
What are some contraindications of using nitrous oxide?
- Compulsive personality - Claustrophobic patient - Children with behavior problems - Pts with sever personality disorders - Respiratory tract infections - Potentially contagious diseases - COPD
31
What is a normal oxygen saturation level?
95 and above
32
How is N2O prepared?
-Heating ammonium nitrate crystals which decomposes into N2O and H2O
33
What are good properties of nitrous oxide?
- Non-irritating - Sweet smelling - Colorless gas
34
What is the systemic effect of Nitrous oxide on the CNS?
- Slight depression of sight, hearing, touch, memory, concentration and pain - Postrema (vomiting center) not affected
35
What are the systemic effects of cardiovascular systems when using nitrous oxide?
- No changes in heart rate or cardiac output. | - Slight depression of myocardial contraction
36
What are the systemic effects that nitrous oxide has on the skeletal muscle?
-No muscle relaxation
37
What are the systemic effects that nitrous oxide has on the reproductive system?
- Spontaneous abortions - Fetal malformations - Fertility is decreased
38
What does chronic exposure to high levels of nitrous oxide do?
-Sensory neuropathy
39
What equipment is included for nitrous oxide?
- Flow meters - Reducing valves - Gas cylinders - Reservoir bag - Conducting tubing - Nasal hood
40
What does the blue gas cylinder have in it?
-N2O
41
What does the green gas cylinder have in it?
-O2
42
Why is the conducting tubing corragated?
-So it won't kink
43
How many tubes do you find on the nasal hood?
-4 tubes (2 to carry fresh gas 2 to carry used gas)
44
What are four things that you monitor during inhalation sedation?
- Baseline vital signs (properatively) - Verbal communication with patient - Vital signs recorded periodically during the procedure (every 10 minutes) - Postoperative vital signs
45
What should you tell the patient on the day of the appointment for using N2O
- Use the restroom | - Remove contacts
46
How should the pt be positioned when administering N2O?
-comfortable reclined position
47
Where should you place the sedation unit?
-Behind pt out of line of site
48
When you place the nasal hood what is the first thing you administer?
-O2 at 6 L / min
49
What is the proper flow rate for adult pts?
-6L/min of 100% O2
50
What is the proper flow rate for pediatric pts?
-3-4 L/min
51
If the bag is overly inflated what might the problems be?
- Minute volume to great | - Hose kinked
52
What are the two methods of nitrous oxide administration?
- Constant liter flow | - Constant oxygen flow
53
What is the constant liter flow?
-Total liter flow of gases per minute kept constant and percentage adjusted
54
What is the constant oxygen flow?
O2 flow kept constant and volume of N2O adjusted | -Need separate control knobs
55
What percent of N2O do you start at?
20%
56
At the end of a 60-90 second period as what are you feeling, if the pt doesn't respond normal what should you do?
-Back of the Nitrous oxide
57
If the 20 % nitrous oxide isn't working how fast can you go up to 30%?
-increase by 5 % every minute
58
What can occur because the pts don't move during sedation?
- Parethesia | - Hyper-esthesia
59
What are the signs and symptoms of titration of N2O?
- Lightheadedness (usually the first effect) - Tingling - Warmth, Floating, Heaviness (this is the ideal level)
60
What are the signs and symptoms of oversedation of nitrous oxide?
- Nausea - Vomiting - Loss of consciousness
61
What is the maximum time that you want to have someone on nitrous oxide?
1 hour
62
What are the stages of anesthesia?
- minimal - moderate - deep - general anesthesia
63
What are the objective tests to determine the discharge of the patient after using nitrous oxide?
-Touching tip of nose with little finger (Trieger Test)
64
What are some absolute contraindications for using nitrous oxide?
- Sever emotional disturbances or drug problems - 1st trimester - Cancer treatment with Bleomycing sulfate - Pernicious anemia or vitamin B12 deficiency - Pneumothorax - Cystic fibrosis - Recent Pneumoencephalography - Significant bowel obstruction

Dental Anesthesiology 2020 (9 decks)

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