Week 1 Flashcards
The pre-anesthetic assessment consists of (3)
1) complete medical/dental history
2) physical examination
3) psychological examination
List what should be included in the complete medical/dental history (5)
1) current conditions
2) past conditions
3) OTC drugs, supplements
4) adverse reactions to meds
5) problems with previous dental treatment
What are concomitant meds?
2+ meds taken on same day which can alter efficacy and safety of LA’s
Physical examination includes (4)
1) visual exam
2) BP
3) Pulse and RR
4) patient’s weight
The patient’s weight is used to determine the ____________ of LA’s
maximum recommended dose
T/F: We have to decrease the MRD for children because they have immature livers
True
Acceptable HR’s for adults and children
adult: 60-100
child: 75-100
toddler: 120-160
At what BP should you retake and refer for immediate med consult?
> 200/>115
At what BP should you consider nitrous for stress reduction?
140-159/90-94
What are some signs of moderate anxiety?
1) stiff posture
2) nervous “play”
3) “white knuckle” syndrome
4) sweating
5) “too cooperative”
6) nervous conversation
7) quick answers
What are 3 things we can do for stress reduction protocol?
1) adequate pain control
2) decrease pain of injection
3) select LA of appropriate duration
How does stress affect the body in regards to pain?
it decrease the pain reaction threshold
Risk assessment ABCDE
A → antibiotics; anesthesia; anxiety; allergy
B → bleeding
C → chair positioning
D → drugs; devices
E → equipment; emergencies
an unpleasant often strong emotion caused by anticipation or awareness of danger
fear
what % of people in the population avoid dental care b/c of fear?
6-14%
*and tends to be a learned response from personal experience or from the experience of others.
anxiety
T/F: Fear is long-term
false! it’s short-lived
Anxiety is from ______________ or thought of dentistry
anticipation
Fear refers to the ___________ occurring in the dental office
reaction
What are the most relevant routes of drug administration in dentistry?
oral, topical, subcutaneous, inhalation
Which drug is most effective and most popular drugs for anxiety management in dentistry
benzodiazepenes
These are good for mild to moderate pre-treatment anxiety
Benzodiazepenes
Which benzos are the most common anxiolytic agents?
diazepam and triazolam
Nitrous oxide documentation MUST include.. (4)
1) Informed consent obtained and documented in chart
2) Percentage of N2O administered
3) Length of time the patient was sedated
4) Flow rate of gases during administration
What are some features of nitrous that allow it to provide ideal sedation? (4)
-rapid onset of 2-5 mins
-wide safety margin
-quick recovery
-no hangover effect
T/F: Nitrous has low solubility in the blood
true
T/F: Nitrous can’t cross the placenta
false! it can which is why you need a med consult if you have a pregnant pt
administration of drug increases the possibility of a life threatening situation =
absolute contraindication
administration of drug is preferably avoided due to possible adverse reactions =
relative contraindication
List some examples of absolute contraindications (5)
1) Nasal Obstruction
2) Vit B12 Deficiency (can render B12 inactive)
3) Alcoholic / Recovering Addict
4) Uncommunicative (disability or language barrier)
5) Patient Refusal
List some examples of relative contraindications
1) Middle ear infection
2) Balance disorder
3) Susceptibility to Motion Sickness
4) Claustrophobia
5) Pulmonary Diseases (med consult)
6) Immunocompromised (med consult)
7) Pregnancy (med consult)
8) Psychiatric Disorders/Bipolar (med consult)
9) Marijuana or Hallucinogenic Drug Use
Common side effects of nitrous
nausea, vomiting, headaches
When does the nitrous pressure gauge start to fall?
once all the liquid is gone and only gas remains
Which button is used to over sedation?
flush button
Name the safety feature:
N2O flow terminated if O2 delivery pressure falls
oxygen fail safe
Name the safety feature:
* allows atmospheric air in if flow of gases stops
emergency air inlet
Name the safety feature:
rapid delivery of high flow O2 to patient (oversedation)
oxygen flush button
nitrous oxide administration
- Select appropriatley sized nasal hood
- Inflate the bag –> start with 5-6 L/min of 100% O2
- Place the nasal hood –> patient adjusts for comfort –> tighten
- Instruct patient to breath normally –> adjust flow rate
- Gradually titrate N2O- O2 in 10% intervals, watching for signs of sedation –> ask how they feel
- Typical pt requires 50% N2O - 50% O2
- When treatment is completed –> N2O to zero and incrase O2 to re-establish flow rate –> 100% O2 for 5 MINUTES
- Document the procedure
* NEVER leave the patient unattended
Nervous system breakdown
divided into CNS and PNS
-CNS and PNS divided into afferent and efferent
-PNS divided into somatic and autonomic
-Autonomic divided into sympathetic and parasympathetic
3 main functions of neurons
1) receive information
2) process info
3) send response
Describe the structure of a neuron
cell body, dendrites, axon
What is the terminal end of an axon called?
synaptic knob
T/F: Nerves are only found in the PNS
true
CT around an axon
endoneurium
group of axons
fascicle
CT around one fascicle
perineurium
CT around group of fascicles
epineurium
Which fibers are the largest and have the fastest impulse generation?
TYPE A FIBERS
Which A fibers are used for muscle movement
alpha
Which A fibers are used for proprioception, touch, and pressure?
Beta
Which A fibers are used for muscle tone?
Gamma
Which A fibers are used for pain and temperature?
Delta
T/F: A fibers can be afferent or efferent while B fibers are only efferent.
True
Where are Type B fibers found?
preganglionic ANS
vascular smooth muscle
Which are the smallest, most numerous, and unmyelinated fibers
Type C fibers
Which fibers are responsible for dull, achy pain?
Type C
What type of fibers are prevalent in the oral cavity?
Type A and Type C
Which fibers require more anesthetic volume? why?
Type A cuz they’re larger
Types of stimuli that trigger nerve impulses
chemical
thermal
mechanical
electrical
Neurons maintain RMP via?
1) Sodium-Potassium Pump
2) closed K+ channels
3) closed Na+ channels
What causes the absolute refractory period?
inactivation of sodium channels during repolarization
What causes the relative refractory period?
hyper-polarization before RMP is established
T/F: an action potential cannot be generated in the relative refractory period
False! it can be if a larger stimulus is applied
2 types of synapses
electrical and chemical
What are the 2 ways that LA’s cause reversible local anesthesia?
1) prevent generation of impulses
2) preven conduction of impulses
What do “membrane-stabilizing drugs” do?
decrease rate of depolarization
Small/large diameter nerve fibers are less/more sensitive to LA’s
small; more
Small/large diameter nerve fibers require more/less volume of LA’s
Large; more volume
What are the 2 major routes of LA delivery?
1) topical
2) submucosal injection
T/F: Submucosal injections are more effective than topical.
True
Which ion channels do LA’s bind to inside the cell?
Na+
