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Flashcards in Anesthesia Part II Deck (76):
1

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

What is a secondary consideration?

Injecting slowly

anesthetic w/ or w/out vasoconstriction

*not size, position of needle

2

1 indication for withdrawing needle if positive aspiration:

Too much blood, can't see, switch out

3

How long should the LA injection last?

1-2 minutes

4

Diameters of needles:

25 gauge

27 gauge

30 gauge

5

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

2x

6

What is a positive aspiration telling us?

Intervascular injection

7

Dosing for lidocaine:

*max dosage

3.2 mg/lb

7 mg/kg

*up to 500 mg

8

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

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

36 mg

72 mg

9

3 pieces of information to determine max dosing of LA:

MRD

Weight

How much already gave

*doesn't matter where giving

10

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

Slow administration of drug

11

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

CV ASA II, III, or IV

12

3 situations to NOT give someone LA:

*1 situation OK

BP above 200

MI one month ago

Uncontrolled/Active Hyperthyroidism

*stroke 6 months ago

13

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

Yes

*6 month cut-off

14

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

Why?

No

increase risk of paresthesia through contamination

15

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

young/lighter

16

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

Levonordefrin

17

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

Pt position (heat at or near heart)

18

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

Give cold or hot?

Additionally?

Hematoma

Cold

Pressure

19

A frequent cause of toxicity from LA is what?

Intravascular injection

20

Why do we have caution with Liver Disease pts?

Biotransformation impacted

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

21

What anesthetic has considerations regarding methemoglobin?

Prilocaine

22

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

Wrong Dosing

*too much drug

23

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

True

24

What is the most common emergency in Dentistry?

This is most often related to what?

Syncope

LA administration

25

Apply the topical anesthetic a minimum of ____

*don't paint

1 minute

26

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

False

27

Aspirate a minimum of....

Ideally aspirate...

once

twice

28

The ideal deposition is 1 mL per minute

Recommended 1.8 mL per minuted

*1 to 2 minutes total

True

29

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

5-10

30

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

False

31

2 types of Mx injections:

3 types of Mb injections:

Nerve blocks, Infiltrations

Nerve blocks, PDL, Intraosseous

32

Infiltration, aka _______, is indicated for what procedures?

Nerve block is deposition near _____

supraperiosteal, limited area (one or two teeth)

Major nerve trunk (greater distance/wider area blocked)

33

3 computer assisted LA delivery systems:

The wand

Comfort Control Syringe

Anaeject

34

Facial nerve paralysis happens when LA is injected into where?

Parotid gland

35

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

Facial nerve paralysis

36

How to prevent Facial n. paralysis?

Contact w/ bone

*no bone = no injection

37

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

Hematoma

38

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

pressure

2

ice

39

What complication can happen with good technique?

Paresthesia

40

Too much rate of deposition (pressure) can cause Paresthesia

*also alcohol, sterilizing agents

True

41

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

True

42

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

taste impaired

43

T/F
Small gauge needles almost never totally sever a nerve

True

44

Pressure within the nerve sheath

Paresthesia

45

Most Paresthesia resolves spontaneously over a period of ________

Normally lasts for at least ____ months

weeks to months

2

46

Most paresthesia develops where?

Mandible

47

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

True

48

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

*leads to limited opening

Trismus

49

Trismus is caused by trauma to the blood vessels where?

Infratemporal fossa

50

Trismus is often relieved by doing what?

Exercise

*chewing gum, tongue depressors

51

Trismus resolves in what time frame?

If longer than this, considered...

48 hours

infection

52

Medical contraindication to Vasoconstrictor:

ASA IV, V (CV effects)

53

Local anesthetic (plain) is ok where?

Local anesthetic in 2 ____ should have vasoconstrictor

1 quadrant

2 quadrants

54

What is the safest LA?

Lidocaine w/ epi

55

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

1 cartridge for ___lbs of body weight

20

56

Administer oxygen in milde OD

True

57

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

Oraverse

58

Best pregnancy LA

lidocaine

*B and Safe for lactation

59

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

methemoglobinemia

*acetaminophen, prilocaine

60

What is the antidote to methemoglobinemia?

methylene blue

blue drug into blue patient = pink

61

T/F
Don't worry about an amide allergy

True

62

At what ASA do you limit vasoconstrictor?

At what ASA do you not give vasoconstrictor?

III if CVS

IV, V

63

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

Avoid vasoconstrictor with what class?

Anticonvulsants, Antipsychotics (and benzodiazepenes)

Antidepressants

64

What kind of antidepressants may enhance CV actions of vasoconstrictors?

Especially avoid what vasoconstrictor?

Tricyclics

levonordefrin

65

If pt on glucocorticoids consider what?

stress reduction

*nitrous, IV sedation

66

H2 receptor blocker does what to Lidocaine?

increases half life

67

Opioids increase risk for LA overdose

True

68

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

Non-Selective

69

Cocaine is an absolute contraindication with epi for how long?

24 hours

70

Alcohol may ____ the effectiveness of LA's

decrease

71

Epi may cause _____ w/ Digoxin

arrhythmias

72

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

myocardial

73

T/F
Absolute contraindication to LA's if uncontrolled hyperthyroidism

True

74

T/F
Pheochromocytoma is ok with LA's

False

*absolute contraindication

75

T/F
Epinephrine reaction is an allergy

False

76

What is the safest trimester for pregnancy

2nd

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