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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
Q

When giving nitrous oxide to someone with Cerebrovascular disease (stroke) what does it do to anxiety and blood pressure?

A
  • Reduce

- It is also good for these pts because you are administering O2 that helps these pts

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26
Q

T/F N2O is non-epiliptogenic

A

True

27
Q

What can nitrous oxide do to pregnant women?

A
  • Absolutely contraindicated in 1st trimester (can cause spontaneous abortions)
  • N2O can cross the placenta
  • Should consult OB
28
Q

T/F Epileptics are more sensitive to hypoxia from nitrous oxide

A

True

29
Q

What can nitrous oxide do for gagging pts?

A
  • Effective in eliminating/minimizing sever gagging
  • May require placing pts in upright position
  • Can use in radiographs or impressions
30
Q

What are some contraindications of using nitrous oxide?

A
  • Compulsive personality
  • Claustrophobic patient
  • Children with behavior problems
  • Pts with sever personality disorders
  • Respiratory tract infections
  • Potentially contagious diseases
  • COPD
31
Q

What is a normal oxygen saturation level?

A

95 and above

32
Q

How is N2O prepared?

A

-Heating ammonium nitrate crystals which decomposes into N2O and H2O

33
Q

What are good properties of nitrous oxide?

A
  • Non-irritating
  • Sweet smelling
  • Colorless gas
34
Q

What is the systemic effect of Nitrous oxide on the CNS?

A
  • Slight depression of sight, hearing, touch, memory, concentration and pain
  • Postrema (vomiting center) not affected
35
Q

What are the systemic effects of cardiovascular systems when using nitrous oxide?

A
  • No changes in heart rate or cardiac output.

- Slight depression of myocardial contraction

36
Q

What are the systemic effects that nitrous oxide has on the skeletal muscle?

A

-No muscle relaxation

37
Q

What are the systemic effects that nitrous oxide has on the reproductive system?

A
  • Spontaneous abortions
  • Fetal malformations
  • Fertility is decreased
38
Q

What does chronic exposure to high levels of nitrous oxide do?

A

-Sensory neuropathy

39
Q

What equipment is included for nitrous oxide?

A
  • Flow meters
  • Reducing valves
  • Gas cylinders
  • Reservoir bag
  • Conducting tubing
  • Nasal hood
40
Q

What does the blue gas cylinder have in it?

A

-N2O

41
Q

What does the green gas cylinder have in it?

A

-O2

42
Q

Why is the conducting tubing corragated?

A

-So it won’t kink

43
Q

How many tubes do you find on the nasal hood?

A

-4 tubes (2 to carry fresh gas 2 to carry used gas)

44
Q

What are four things that you monitor during inhalation sedation?

A
  • Baseline vital signs (properatively)
  • Verbal communication with patient
  • Vital signs recorded periodically during the procedure (every 10 minutes)
  • Postoperative vital signs
45
Q

What should you tell the patient on the day of the appointment for using N2O

A
  • Use the restroom

- Remove contacts

46
Q

How should the pt be positioned when administering N2O?

A

-comfortable reclined position

47
Q

Where should you place the sedation unit?

A

-Behind pt out of line of site

48
Q

When you place the nasal hood what is the first thing you administer?

A

-O2 at 6 L / min

49
Q

What is the proper flow rate for adult pts?

A

-6L/min of 100% O2

50
Q

What is the proper flow rate for pediatric pts?

A

-3-4 L/min

51
Q

If the bag is overly inflated what might the problems be?

A
  • Minute volume to great

- Hose kinked

52
Q

What are the two methods of nitrous oxide administration?

A
  • Constant liter flow

- Constant oxygen flow

53
Q

What is the constant liter flow?

A

-Total liter flow of gases per minute kept constant and percentage adjusted

54
Q

What is the constant oxygen flow?

A

O2 flow kept constant and volume of N2O adjusted

-Need separate control knobs

55
Q

What percent of N2O do you start at?

A

20%

56
Q

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?

A

-Back of the Nitrous oxide

57
Q

If the 20 % nitrous oxide isn’t working how fast can you go up to 30%?

A

-increase by 5 % every minute

58
Q

What can occur because the pts don’t move during sedation?

A
  • Parethesia

- Hyper-esthesia

59
Q

What are the signs and symptoms of titration of N2O?

A
  • Lightheadedness (usually the first effect)
  • Tingling
  • Warmth, Floating, Heaviness (this is the ideal level)
60
Q

What are the signs and symptoms of oversedation of nitrous oxide?

A
  • Nausea
  • Vomiting
  • Loss of consciousness
61
Q

What is the maximum time that you want to have someone on nitrous oxide?

A

1 hour

62
Q

What are the stages of anesthesia?

A
  • minimal
  • moderate
  • deep
  • general anesthesia
63
Q

What are the objective tests to determine the discharge of the patient after using nitrous oxide?

A

-Touching tip of nose with little finger (Trieger Test)

64
Q

What are some absolute contraindications for using nitrous oxide?

A
  • 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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