Pain and Anxiety Flashcards
Local anaesthesia
Anaesthesia= loss of all sensation
Sensory nerve supply Responds to things like temperature pain
Sensation felt by electrical impulses sensory neurons to the brain then information acts
Local anaesthesia block the electrical impulses so don’t reach the brain
Local anaesthesia drugs either 2.2ml 1.8ml
Anaesthesic-block electrical nerve transmissions
Sterile water-acts as solution
Buffering agent- PH neutral maintains the contents
Preservative-shelf life
Vasoconsitrutictor-prolong action not all Anaesthesia closing local blood vessels so not carried away into blood stream
Common Anaesthesia
Lidocaine- 2% lignocaine hydrochloride 1:80000adreline as a vasoconstrictor
Articaine-carticane 1:100000 adrenaline as a Vasco constrictor
Citanest-3%priolocaine hydrochloride octapresin vascocontricter
Mepivacaine-3%no vascoconstricter
Increase rate of heart beat Affects Hypertension hbp Cardiac arrest poor heart Hyperthyroidism overactive thyroid gland
Elderly patients
HRT hormone replacement therapy affects of menopause prevent bones thinning
Thyroxine drug under active thyroid high heart rate
Also with antidepressants
Can use citanest but not pregnancy as it can affect uterus muscles
Local anaesthesia equipment
Diagpham silver bit needle pierces
Aspirating technique is designed to avoid the injection into the blood vessels
The plug or jumps back and is released so blood flow into cartilage and correctly goes into nerve
Topical anaesthesia gel 5% lidocaine paste 20% benzocaine
Useful for scaling fitting of matrix bands and stimulation of gag
Techniques administration
Nerve blocka soft tissue and jaw bone need to be used for 1 quadrant
Inferior dental block
all lower teeth lingualGum half of tongue lower lip and incisors bucks gum
Only bucaal gum molars not
Mental nerve block- soft tissues buccaneering or labial affected
Posterior superior dental nerve block-nerve maxillary antrum both upper second third molars affected
Locals infiltration
Over apex of tooth
Needle insertion mucous membraine soak thru pores of bone anaesthesia the nerve supply
Only for nerve endings not nerve trunk
Upper teeth lower incisals only for gingivae
Intraligamentary injection
Infiltration or a nerve block to produce deeper Anastasia around a hyper sensitive tooth
1.8ml gun shaped ligmaject syringe
Nerve block fails cannot be used for gingival infection u less tooth to be extracted
Intraosseous injection
Between gum to teeth gingvae into spongy bone Short duration Doesn’t numb lip check or tongue Good for extractions Not used for infection on gums Directly into sponagy bone
Local anaesthesia for extractions
You should also numb surrounding periodontium as well as periodontal ligaments
UPPER TEETH
Local infiltration for label and buckle and palatal sides..by all injection anaesthesia the tooth and buffalo and labial side while palatial peridontium
2nd and 3rd molars=
Posterior superior dental block
LOWER TEETH
inferior dental block injection numbs up the lingual in a part as well end section is mental nerve
The bone in I scope region is thin so u can numb labia and lingual local infiltration rather then the block
Lower molars will need local bucal infiltration
Local anaesthesia for restorative treatments
Not needed over loaded unless gingvae areas are just so need removal for the procedure part
-if a cavity has been present and the gum grow over it
-A crown a crown lenghting technique or for denture good look
-crown lost but a been a growth gingiva over growth
Need it for good impressions
UPPER TEETH RESTORATIVE-
enough is local buccal or labial infiltration for 3and 2 molars posterior superior Dental block preferred
LOWER TEETH-
Lower incisors= labial infiltration
Inferior dental nerve block numb every tooth but mental block other than lower molars
Preparation for local anaesthesia
If end is broken use artery forceps Spencer Wells or mosquito forceps
Topical service Anastasia applied cotton wall
Cartilage stored use room temperature because cold ones cause pain
Sometimes for large surgical procedures the injection site might be dried and disinfected with iodine or chlorhexidine on a cotton wall for 15 seconds
Inoculation injury
I needle is a sort of cross infection no matter how small
A resheathed use so no stick injury like a holder
Stop working immediately so other people are not at risk of cross infection as well
The pierced area should be squeezed and run under warm water you want to encourage bleeding
The winded area should be clean with disinfectant soap tried and covered waterproof dressing
Senior team should be notified The patient’s history medical should be reviewed to see if the HIV positive
If necessary report to the occupational health advisor 0H a I hospital and They will give you advice
The contact details are stored in infection control policy documentation
The incident should also be recorded in the accident book low risk of serious infections or our RIDDOR report written and process followed
Patient advice of the local Anastasia
Sensation lost several hours 2 roughly
Do you not eat drink smoke we might burn and hurt yourself
Chewy foods should be avoided
When the Anastasia is wearing off you feel something like pins and needles which is called paraesthesia
Wait until that’s finished to start eating or drink
If you have a nerve block injection it might be tender on the tissues of your mouth
Intraligamentary cause soreness around gingeva
Contact surgery if anything
Anxiety control
Two main anxiety control
General anaesthesia only is hospital
Unconscious
Conscious sedation can be done in a dental clinic or community clinic the techniques
Oral sedation
Inhalation sedation
Intravenous sedation
A state of relaxation used for a long procedures restorative
Special-needs patients who are uncooperative can have the Maison mache general Anastasia all sedation technique on the hospital premises under endotracheal Anastasia in hospital with critical care
Patient state of mine acupuncture and Hypno ptosis
General Anastasia endotracheal anaesthesia
Endotracheal Anistasia mixture of gases that go directly into the lungs through nas preaches like tube
Floor nose nasopharyngeal
Then a special instrument called laryngoscope guided thru trachea
The oropharynx pack with gauze protect forgien body
No danger of obstruction
Refferal for general anaesthesia
A referral letter medical history and dental relevance Justify the use of general anaesthesia
Clear explanation given hospital dentist satisfied and appropriate
Written consent obtained
Give clear comprehensive pre-and post up instructions
Comply with dental requirements
Staff must be trained for critical care throughout leaving without adult if needed provide recovering for the patient
Reasons for local Anastasia and dental workplace for hospital
Young patients who need one or more extractions of a permanent or Carious adult tooth who will not cooperate
Older patient patients impacted the molar surgical technique
All the patience of a dental infection where LA can I be you so safely without extra spread
Patients request only for XLA
Conscious sedation
Gives the state of Relaxation
Insures the patient has they got protective airways
Patience remain conscious is able to understand
Verbal contact remain throughout
So the needle can be put in
If patients are to Nervous And won’t cooperate
ORAL SEDATION-can be given the night before the dental appointment and second one 1 hour before the treatment it is a sedative tablet temazepam or diazepam
INHALATION SEDATION- known as relative analgesic breathes a mixture nitrous oxide and oxygen nasal mask duration of the dental appointment
INTRAVENOUS SEDATION-drug injected into patients vein anxiety removed
Advantages of sedation technique
Patients are conscious throughout and cooperate they
retain their reflexes in the airways there is
no need for general Anastasia for long periods
and a separate anaesthesiaist
this is not required
But GDC has given strict lines on the sedation
Full medical history before
Patient should be given alternatives and explained
A form has to be given
Written consent
Adequate recordkeeping of the drug
Everyone was should stay within their own limits of skill and experience
The dentist takes the responsibility of the sedation injection
Appropriate and minimal amount of drug use
Second appropriate trained person
An ideal person will be a dental sedation nurse
Conscious sedation guidelines
This technique must either be used when suitable equipment and drugs immediately available
Everyone has to be trained to monitor patient
Supervision must be hold until the dentist thinks they’re going to be discharge to adult escort
Oral sedation
The pre-medication of temazepam and diazepam can be used for gag reflex when impressions taken reducing them
Or sedation is suitable for adults but not for children because they are addicted if they overused
Escort available
Less sedated than other techniques
Pulse oximeter machine should be used to monitor
Connected to the finger probe because the pulse rate oxygen levels and blood
Will make a sound of something is wrong
Inhalation sedation
Safest and best for children under 16
Mixture of nitrogen oxide and oxygen
Administrate through autoclave a disposable nose mask nasal hood they are called
Checks are given before entered into sedation
All equipment is working full of gas cylinders and spare gas cylinders
Adult escort accompany the patient patient’s records have been read again
Pre-operative instructions have been obeys
Patient is not suffering from a cold that will affect the breathing through the nose
Hundred percent oxygen given at 1st to the nasal had to get used to it
Then adjusted for 10 percent nitrous oxide administrated
Patient told relaxing feeling come 5 percent added u can hear patient voice
Further 5 percent
To accept injection and dental treatment required
End of procedure nitrogen oxide switched off 100% oxygen given the two mins
Praise the patient for future appointments
Ask patient to remove nasal hood
Sit up
12 hours
Don’t drive don’t operate machinery don’t drink alcohol don’t sign legal documents
Advantages
Light snack 2 hours before hand
Don’t need pulse oxide meter
Safe for children’s and simple
Disadvantages
Prevent oxygen normal machine cannot be used
Scavenging system removed form surgery inhaled by staff
COSHH Regulations followed working with gasses
Not for pregnant
Nitrogen oxide addictive
Intravenous sedation
Give us more level of consciousness
High levels of anxiety like surgical extraction
Hypnovel injection midazolam injected into the vein
Doesn’t produce anaesthesia or analgesic
Provides relaxation to the brain to except the local anaesthetic to be administrated
IV IV sedation produces amnesia and is suitable for patients of the age of 16
Snack allow but not less 2 hours before
Injection usually given on then on top of hand DORSUM or vein in between elbow ANTECUBITAL FOSSA
Vein called VENEPUNCTURE sits in there
Different needles is butterfly needle vendlon needle
Y-can needle
Process called titration ensure doesn’t become over dosed and fall unconscious
Slurring speech difficulty in touch
Equipment you should have available throughout resuscitation kit and drug Flumazenil (anexate) emergency antidote pulse oximetry machine
Must not be left unattended in the room recovery takes an hour
Same as previous instructions
Advantages
No nasal mask in the way
Rapid controlled sedation
Very effective and amnesia produced good for future confidence next procedure
No nitrous oxide pollution in the surgery no long-term risk of stuff
Disadvantages
Drug does not produce analgesia so you have to use local Anastasia to carry out
For children under 16 the drug is unpredictable
Should be careful is over 65 elderly patients have problem liver function and unable to excrete the drug
Respiratory depression areas will need to be supported if this happens
Once drug is given it can’t be switched off need to be an adult supervision for the rest of the day
The technique of accidentally injecting an artery instead of a vein
Special monitoring equipment is extremely expensive
Dental Nurses duty
Able to assist the dentist in the preparation of all the agents and equipment monitor the patient throughout and inform dentist of any impending problems
Require and assist effectively any emergency things
No everything in emergency emergency care of what to do
BOTH Inhalation and intravenous sedation
Check or pre-op instructions and see if patient is still fit for sedation
Monitor and resuscitate equipment ready for correct functioning
Monitor the patient’s skin colour respiratory rate and pulse
Inform dentist of any changes in patient condition
Be prepared for immediate assistance in a substation procedures dentist direction
Save got the patient until dentist a lot of them to return home with escort
Before leaving sedation qualified dental nurse remove cannula apply dressing and give instructions of everything make sure hazardous waste goes into the bin
Duties specific inhalation sedation
Check the machine correct function in still in the lab in insure spell oxygen and nitrous oxide available
Duty specific care of intravenous sedation
Have blood pressure monitor and equipment ready assist in its records
Lay armour drugs syringe needle labels cannula wipes and dressings
Laye out all dental instruments
Help raise the vein when necessary
Have pulse oximetry meter ready for use
Care of patient
Extra support from dental nurse if people nervous
Caring compassionate, all times
Three nurses trained may be required
Oneness assistance sedation and monitoring patient
Second nurse assistant dentist to complete treatment
Third nurse monitoring previous patient in recovery area
Monitoring patient’s
COLOUR-lips nail beds fingers ears purple cyanosis deficient oxygenation sweating serve deficieny
BREATHING-watching the inhalation sedation machine rhythmic movement of upper abdomen
Pulse oximeter record blood oxygen 95-100 normal
Alarm indicate below 90% could be due to a airway blockage
PULSE-radial pulse inner wrist/ carotid pulse neck
Oximetry machine automatically indicate Attached finger probe
BLOOD PRESSURE-usually taken with machine automatic systolic pressure maximum slowly let’s go diastolic pressure between heart beats
Measured through millimetres of mercury
HEALTHY -120/80 s/d
Preop anxious patient might be high
Above 140/90 cardiovascular problem unsuitable for intravenous sedation so use inhalation
Blockage of the airway
Caused by obstruction in the Larynx Patient’s face is blue the skin is clear me but sweat over it rise and pulse and blood pressure patient also wheezing was snoring
It blocks the laryngeal entrance can be fixed by pulling jaw foreard
Block it by a foreign body is extremely serious it’s right under conscious sedation as the reflexes
Overdose of anaesthetic or sedative
Overdose may paralyse respiratory muscles
If so reverse affects anecdote flumazenil reverse midazlom injection
A cardiac arrest may happen unless oxygen introduced
Resuscitation/ emergency procedures
Collapse occurs during such as sedation then use basic life support
Effective manual suction device to clear the airways
Orpharyngeal guedel air ways
Manual pulmonary resuscitator eg laerdal pocket face mask
Resuscitation drugs including flumazneil
Syringes and needles for drawing up and injecting emergency drugs
A cylinder of oxygen
Hypnosis
Alternate the state of mind verbal achieving hypnotises suggestion
For example dragon words link then an out an example as you breathe if you saw yourself becoming more and more relaxed
Acupuncture
Reduce anxiety there is disorders produce anaesthesia
Needle pricks causes the body to release his own painkillers called ENDORPHINS which as local analgesia
Form of hynisis
Distraction of pain
Works for gag reflex impression long term dental chronic pain temporomandibular disorders
