Anesthesia Part II Flashcards

1
Q

What is the most important thing to consider with OD other than Dosage?

What is a secondary consideration?

A

Injecting slowly

anesthetic w/ or w/out vasoconstriction

*not size, position of needle

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2
Q

1 indication for withdrawing needle if positive aspiration:

A

Too much blood, can’t see, switch out

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3
Q

How long should the LA injection last?

A

1-2 minutes

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4
Q

Diameters of needles:

A

25 gauge

27 gauge

30 gauge

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5
Q

Epi dilution: 1:50k is ____x the amount of 1:100k

A

2x

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6
Q

What is a positive aspiration telling us?

A

Intervascular injection

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7
Q

Dosing for lidocaine:

*max dosage

A

3.2 mg/lb

7 mg/kg

*up to 500 mg

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8
Q

How much drug is in 2% solution, standard cartridge?

How much drug is in 4% solution, standard cartridge?

A

36 mg

72 mg

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9
Q

3 pieces of information to determine max dosing of LA:

A

MRD

Weight

How much already gave

*doesn’t matter where giving

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10
Q

To prevent OD, what should we do (outside of proper dosage)?

A

Slow administration of drug

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11
Q

LA with or without vasoconstrictor, what are we thinking about for med pts?

A

CV ASA II, III, or IV

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12
Q

3 situations to NOT give someone LA:

*1 situation OK

A

BP above 200

MI one month ago

Uncontrolled/Active Hyperthyroidism

*stroke 6 months ago

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13
Q

If a pt is 6 months past an MI or Stroke, can we treat?

A

Yes

*6 month cut-off

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14
Q

Do we want to put LA cartridges in a disinfecting solution?

Why?

A

No

increase risk of paresthesia through contamination

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15
Q

Who has greater risk for LA OD, young/lighter or old/heavier?

A

young/lighter

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16
Q

What vasoconstrictor should you avoid if you are on Tricyclic Antidepressants?

A

Levonordefrin

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17
Q

When doing LA, what is the most important thing to do to mitigate syncopy?

A

Pt position (heat at or near heart)

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18
Q

If you give a right PSA injection, withdraw needle and the face swells, what happened?

Give cold or hot?

Additionally?

A

Hematoma

Cold

Pressure

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19
Q

A frequent cause of toxicity from LA is what?

A

Intravascular injection

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20
Q

Why do we have caution with Liver Disease pts?

A

Biotransformation impacted

*can’t eliminate drugs in the body - change the dosing

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21
Q

What anesthetic has considerations regarding methemoglobin?

A

Prilocaine

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22
Q

Slow administration is important to reduce toxicity effects of LA, but what is the main factor to consider when preventing an OD?

A

Wrong Dosing

*too much drug

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23
Q

People give the higher dosage often b/c technique is faulty (wrong needle, gauge, placement, etc)

A

True

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24
Q

What is the most common emergency in Dentistry?

This is most often related to what?

A

Syncope

LA administration

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25
Q

Apply the topical anesthetic a minimum of ____

*don’t paint

A

1 minute

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26
Q

T/F

Pts need anesthetic administered as it is advanced through the tissue toward the periosteum

A

False

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27
Q

Aspirate a minimum of….

Ideally aspirate…

A

once

twice

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28
Q

The ideal deposition is 1 mL per minute

Recommended 1.8 mL per minuted

*1 to 2 minutes total

A

True

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29
Q

Do not leave the pt for _____ minutes after the injection b/c most LA complications occur within this time

A

5-10

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30
Q

LA’s w/ vasoconstrictors produce more pain than plain solutions

A

False

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31
Q

2 types of Mx injections:

3 types of Mb injections:

A

Nerve blocks, Infiltrations

Nerve blocks, PDL, Intraosseous

32
Q

Infiltration, aka _______, is indicated for what procedures?

Nerve block is deposition near _____

A

supraperiosteal, limited area (one or two teeth)

Major nerve trunk (greater distance/wider area blocked)

33
Q

3 computer assisted LA delivery systems:

A

The wand

Comfort Control Syringe

Anaeject

34
Q

Facial nerve paralysis happens when LA is injected into where?

A

Parotid gland

35
Q

Loss of motor function, cosmetic problem, inability to close affected eye

A

Facial nerve paralysis

36
Q

How to prevent Facial n. paralysis?

A

Contact w/ bone

*no bone = no injection

37
Q

What is usually a cosmetic issue - inconvenience for the pt and an embarrassment for the dentist?

A

Hematoma

38
Q

Immediately following a Hematoma you should put ____ on the site for ___ minutes with _____

A

pressure

2

ice

39
Q

What complication can happen with good technique?

A

Paresthesia

40
Q

Too much rate of deposition (pressure) can cause Paresthesia

*also alcohol, sterilizing agents

A

True

41
Q

Any technique involving a needle insertion into a foramen can lead to Paresthesia

A

True

42
Q

Paresthesia is a special problem if you hit the lingual (chorda tympani nerve) why?

A

taste impaired

43
Q

T/F

Small gauge needles almost never totally sever a nerve

A

True

44
Q

Pressure within the nerve sheath

A

Paresthesia

45
Q

Most Paresthesia resolves spontaneously over a period of ________

Normally lasts for at least ____ months

A

weeks to months

2

46
Q

Most paresthesia develops where?

A

Mandible

47
Q

Withdraw slightly prior to injection, more volume, more bathing of nerve, and lower concentrations all may avoid Paresthesia

A

True

48
Q

A motor disturbance of the Trigeminal Nerve, especially spasm of the muscles of mastication

*leads to limited opening

A

Trismus

49
Q

Trismus is caused by trauma to the blood vessels where?

A

Infratemporal fossa

50
Q

Trismus is often relieved by doing what?

A

Exercise

*chewing gum, tongue depressors

51
Q

Trismus resolves in what time frame?

If longer than this, considered…

A

48 hours

infection

52
Q

Medical contraindication to Vasoconstrictor:

A

ASA IV, V (CV effects)

53
Q

Local anesthetic (plain) is ok where?

Local anesthetic in 2 ____ should have vasoconstrictor

A

1 quadrant

2 quadrants

54
Q

What is the safest LA?

A

Lidocaine w/ epi

55
Q

Max dose of 2% lidocaine w/ 1:100k epi is:

1 cartridge for ___lbs of body weight

A

20

56
Q

Administer oxygen in milde OD

A

True

57
Q

How can you prevent chewing/trauma of soft tissues w/ children?

A

Oraverse

58
Q

Best pregnancy LA

A

lidocaine

*B and Safe for lactation

59
Q

What causes chocolate-brown blood after sleepiness, cyanosis, respiratory distress (then leads to death)

A

methemoglobinemia

*acetaminophen, prilocaine

60
Q

What is the antidote to methemoglobinemia?

A

methylene blue

blue drug into blue patient = pink

61
Q

T/F

Don’t worry about an amide allergy

A

True

62
Q

At what ASA do you limit vasoconstrictor?

At what ASA do you not give vasoconstrictor?

A

III if CVS

IV, V

63
Q

Avoid high doses of LA with what 2 class of drugs?

Avoid vasoconstrictor with what class?

A

Anticonvulsants, Antipsychotics (and benzodiazepenes)

Antidepressants

64
Q

What kind of antidepressants may enhance CV actions of vasoconstrictors?

Especially avoid what vasoconstrictor?

A

Tricyclics

levonordefrin

65
Q

If pt on glucocorticoids consider what?

A

stress reduction

*nitrous, IV sedation

66
Q

H2 receptor blocker does what to Lidocaine?

A

increases half life

67
Q

Opioids increase risk for LA overdose

A

True

68
Q

What type of Beta Blockers aren’t to be used with Vasoconstrictors?

A

Non-Selective

69
Q

Cocaine is an absolute contraindication with epi for how long?

A

24 hours

70
Q

Alcohol may ____ the effectiveness of LA’s

A

decrease

71
Q

Epi may cause _____ w/ Digoxin

A

arrhythmias

72
Q

What type of damage could LA cause in a Sickle Cell pt?

A

myocardial

73
Q

T/F

Absolute contraindication to LA’s if uncontrolled hyperthyroidism

A

True

74
Q

T/F

Pheochromocytoma is ok with LA’s

A

False

*absolute contraindication

75
Q

T/F

Epinephrine reaction is an allergy

A

False

76
Q

What is the safest trimester for pregnancy

A

2nd