Flashcards in Anesthesia Part II Deck (76):
What is the most important thing to consider with OD other than Dosage?
What is a secondary consideration?
anesthetic w/ or w/out vasoconstriction
*not size, position of needle
1 indication for withdrawing needle if positive aspiration:
Too much blood, can't see, switch out
How long should the LA injection last?
Diameters of needles:
Epi dilution: 1:50k is ____x the amount of 1:100k
What is a positive aspiration telling us?
Dosing for lidocaine:
*up to 500 mg
How much drug is in 2% solution, standard cartridge?
How much drug is in 4% solution, standard cartridge?
3 pieces of information to determine max dosing of LA:
How much already gave
*doesn't matter where giving
To prevent OD, what should we do (outside of proper dosage)?
Slow administration of drug
LA with or without vasoconstrictor, what are we thinking about for med pts?
CV ASA II, III, or IV
3 situations to NOT give someone LA:
*1 situation OK
BP above 200
MI one month ago
*stroke 6 months ago
If a pt is 6 months past an MI or Stroke, can we treat?
*6 month cut-off
Do we want to put LA cartridges in a disinfecting solution?
increase risk of paresthesia through contamination
Who has greater risk for LA OD, young/lighter or old/heavier?
What vasoconstrictor should you avoid if you are on Tricyclic Antidepressants?
When doing LA, what is the most important thing to do to mitigate syncopy?
Pt position (heat at or near heart)
If you give a right PSA injection, withdraw needle and the face swells, what happened?
Give cold or hot?
A frequent cause of toxicity from LA is what?
Why do we have caution with Liver Disease pts?
*can't eliminate drugs in the body - change the dosing
What anesthetic has considerations regarding methemoglobin?
Slow administration is important to reduce toxicity effects of LA, but what is the main factor to consider when preventing an OD?
*too much drug
People give the higher dosage often b/c technique is faulty (wrong needle, gauge, placement, etc)
What is the most common emergency in Dentistry?
This is most often related to what?
Apply the topical anesthetic a minimum of ____
Pts need anesthetic administered as it is advanced through the tissue toward the periosteum
Aspirate a minimum of....
The ideal deposition is 1 mL per minute
Recommended 1.8 mL per minuted
*1 to 2 minutes total
Do not leave the pt for _____ minutes after the injection b/c most LA complications occur within this time
LA's w/ vasoconstrictors produce more pain than plain solutions
2 types of Mx injections:
3 types of Mb injections:
Nerve blocks, Infiltrations
Nerve blocks, PDL, Intraosseous
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)
3 computer assisted LA delivery systems:
Comfort Control Syringe
Facial nerve paralysis happens when LA is injected into where?
Loss of motor function, cosmetic problem, inability to close affected eye
Facial nerve paralysis
How to prevent Facial n. paralysis?
Contact w/ bone
*no bone = no injection
What is usually a cosmetic issue - inconvenience for the pt and an embarrassment for the dentist?
Immediately following a Hematoma you should put ____ on the site for ___ minutes with _____
What complication can happen with good technique?
Too much rate of deposition (pressure) can cause Paresthesia
*also alcohol, sterilizing agents
Any technique involving a needle insertion into a foramen can lead to Paresthesia
Paresthesia is a special problem if you hit the lingual (chorda tympani nerve) why?
Small gauge needles almost never totally sever a nerve
Pressure within the nerve sheath
Most Paresthesia resolves spontaneously over a period of ________
Normally lasts for at least ____ months
weeks to months
Most paresthesia develops where?
Withdraw slightly prior to injection, more volume, more bathing of nerve, and lower concentrations all may avoid Paresthesia
A motor disturbance of the Trigeminal Nerve, especially spasm of the muscles of mastication
*leads to limited opening
Trismus is caused by trauma to the blood vessels where?
Trismus is often relieved by doing what?
*chewing gum, tongue depressors
Trismus resolves in what time frame?
If longer than this, considered...
Medical contraindication to Vasoconstrictor:
ASA IV, V (CV effects)
Local anesthetic (plain) is ok where?
Local anesthetic in 2 ____ should have vasoconstrictor
What is the safest LA?
Lidocaine w/ epi
Max dose of 2% lidocaine w/ 1:100k epi is:
1 cartridge for ___lbs of body weight
Administer oxygen in milde OD
How can you prevent chewing/trauma of soft tissues w/ children?
Best pregnancy LA
*B and Safe for lactation
What causes chocolate-brown blood after sleepiness, cyanosis, respiratory distress (then leads to death)
What is the antidote to methemoglobinemia?
blue drug into blue patient = pink
Don't worry about an amide allergy
At what ASA do you limit vasoconstrictor?
At what ASA do you not give vasoconstrictor?
III if CVS
Avoid high doses of LA with what 2 class of drugs?
Avoid vasoconstrictor with what class?
Anticonvulsants, Antipsychotics (and benzodiazepenes)
What kind of antidepressants may enhance CV actions of vasoconstrictors?
Especially avoid what vasoconstrictor?
If pt on glucocorticoids consider what?
*nitrous, IV sedation
H2 receptor blocker does what to Lidocaine?
increases half life
Opioids increase risk for LA overdose
What type of Beta Blockers aren't to be used with Vasoconstrictors?
Cocaine is an absolute contraindication with epi for how long?
Alcohol may ____ the effectiveness of LA's
Epi may cause _____ w/ Digoxin
What type of damage could LA cause in a Sickle Cell pt?
Absolute contraindication to LA's if uncontrolled hyperthyroidism
Pheochromocytoma is ok with LA's
Epinephrine reaction is an allergy