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History Flashcards

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1
Q

Was general anesthesia created before or after local anesthesia?

A

BEFORE

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2
Q

What type of anesthesia was first created?

A

Ether

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3
Q

What is the order that the following were created?
Ether Nitric Oxide
Chloroform

A

Ether - 1275
Nitric Oxide - 1700
Choloform - 1831

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4
Q

What professional founded anesthesiology?

A

A dentist

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5
Q

Who found ether?

A

William Morton

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6
Q

Who found nitrous?

A

Dr. Wells

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7
Q

What was the first local anesthestic?

A

Cocaine

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8
Q

How long after nitrous oxide’s first clinical use was cocaine founded?

A

31 years

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9
Q

Who discovered the effects of cocaine?

A

Sigmund Freud and Carl Koller

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10
Q

Why do we not use cocain any longer?

A

incosistent in efficacy

difficult to obtain

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11
Q

What are ester based anesthetics?

A

TOPICAL

tropocaine, eucaine holocain, benzocaine

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12
Q

What are amide based anesthetics?

A

LOCAL

lidocaine, bupivacaine, artisane,

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13
Q

All ester and amide anesthetics have differing amount of CNS and cardiovascular toxicity. T or F

A

True

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14
Q

What is unique about Bupivacaine?

A

LONG duration of action

VERY toxic to CNS and CV

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15
Q

What is pain?

A

Physical feeling caused by disease or injury
Bodily sensation induced by noxious stimulus - received by naked nerve endings
Unpleasant sensation -

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16
Q

What is dental pain classified as?

A

Nociceptive pain - only find nociceptive nerve endings in dental pulp

TYPE C - dull pain

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17
Q

What is nociceptive pain?

A

stimulation of peripheral nerve fibers that respond only t0 stimuli approaching or exceeding harmful intensity (nociceptors)

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18
Q

What can nociceptive pain be classified as?

A

Visceral
Deep somatic
Superficial somatic

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19
Q

How is pain transmitted?

A

pseudounipolar nerve fiber

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20
Q

What is the resting potential?

A

-70 mV

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21
Q

What is the concentration of Na and K in a resting cell?

A

HIGH extracellular Na
LOW extracellular K

(High intracellular K - High extracellular Na_

Inside cell is NEGATIVE
Outside cell is POSITIVE

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22
Q

What is the threshold potential?

A

-55 mV - then action potential occurs

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23
Q

What is the peak potential?

A

+40 mV

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24
Q

What is the hyper polarization?

A

-90 mV

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25
What is the importance of Ca in an action potential?
Structural component of the sodium channel | Facillitates movement of Na and K
26
Inside the cell is positive or negative?
NEGATIVE
27
Outside the cell is positive or negatively charged?
Positive
28
What is type C nerve fibers?
Dull pain | Unmyelinated - slow conduction
29
If the neuron is large, myelinated, plus a large concentration gradient then AP's are ____ _____ _____
Easier to initiated Faster More resilient
30
Why do we add epinephrine to anesthesia?
Epinephrine is a vasoconstrictor (fight of flight) - Constricts blood flow to and from the targeted area. Allows the anesthesia that was injected to remain at a higher concentration in that area, faster and longer affect.
31
What does anesthesia actually do?
Blocks the Na channels - no neuronal signals are sent. | Different LA bind to one of the four Na channels>
32
How does anesthesia "block" sodium channels?
Displace Ca ions from sodium channel. Bind to vacated Ca sites - dysfunctional sodium channel Equated to conduction blockade
33
What receptor site do most LA's bind?
Intracellular side
34
How does lidocaine reach the inside of the cell to target the receptor site?
Henderson and Hassaelbach
35
What is the Henderson- Hasselbach equation?
``` pKa = pH - log(base/acid) pKa = pH - log (LA / LAH+) ```
36
How come bupivicaine lasts longer?
Because of the pKA
37
What type of molecules can cross the cell membrane?
Uncharged - basic form
38
Local anesthetic works at what pH?
7.4
39
Bumpivicaine will have less nonionized molecules therefore works slower. T or F (has a greater pKa)
True
40
What receptors doe epinephrine target?
alpha 1 adrenergic -- causes vasoconstrictionof periphery beta structures - heart lungs ** epinephrine will target both alpha and beta
41
Where is Lidocaine metabolized?
Liver (hepatice) Lung (pulmonary) ** good to consider if patients have liver damage or lung problems **
42
What is the max does of Lidocaine?
7mg/kg
43
What is the end organ target for epinephrine?
blood vessels in oral cavity
44
Where are the epinephrine (norepinephrine) receptors found-- post or presynaptic, parasympathetic or sympathetic?
Post-synaptic sympathetic
45
Is anyone allergic to epinephrine?
NO!! it is idogenous - found normally in the human body
46
What receptors does norepinephrine work on?
Beta and Alpha
47
What receptors do epinephrine like to target?
ALPHA 1
48
Where do you find alpha 1 receptors?
Highly vascularized region
49
What does an alpha 1 agonist do?
Vasoconstriction
50
What does an alpha 1 antagonist do?
Impedes vasoconstriction
51
What does a beta receptor do?
bronchodilation
52
Epinephrine will bind to all receptors - but has a higher affinity for alpha 1 receptors. T or F
True! | Will get many affects beside the desired affect.
53
What does an alpha 2 receptor do and where is it found?
Found on the presynaptic sympathetic cell terminal. | Inhibits the release of norephinephrine
54
Alpha and Beta receptors are found in different end organs. T or F
True alpha 1 - blood vessels, pancreas, intestine and bladder alpha 2 - platelets, CNS Beta - Bronchioles, blood vessels
55
What are epinephrine and norepinephrine?
Alpha 1 agonist | vasoconstriction
56
What is phentolamine mesylate? (oraverse)
Alpha 1 antagonist Impedes vasoconstriction ** reverses the effects of epinephrine NOT Local anesthetic** Allows the vessels to dilate - moving more LA out of the region, less numb quicker
57
Which can you use on pregnancy patients? Lidocaine or Bupivicaine?
Lidocaine
58
What is observed in a lidocaine overdose?
CNS signs first (seizures) followed by cardiac problems
59
What is observed in a bupivicaine overdoes?
Cardiac signs first followed by CNS signs
60
1% concentrated anesthetic
10 mg/cc
61
.5% cocentrated anesthetic
5 mg/cc
62
1 ml = ____ cc
1
63
How do you determine the mg/cartridge?
multiply mg/cc by how many ml are in the cartridge 1. 8 ml = 1.8 cc 1. 8cc x mg/cc = how many mg in a cartridge
64
How many milligrams of mepivacaine are contained within 2 cartridges of mepivacaine 3%?
2 (1.8) = 3.6 mg 3% = 30 mg/cc 3.6 x 30 = 108 mg
65
Prefilled dental cartridge contains how many ml?
1.8
66
What does the cartridge consist of?
Glass Tube Stopper Aluminum Cap Diaphragm
67
How is the concentrations of vasoconstrictor in local anesthetics displayed?
1 : 50,000 1: 100,000 1 : 200,00 Grams / ml
68
1 : 50,000
.02 mg/ml
69
1 : 100,000
.01 mg / ml
70
1 :200,000
.005 mg/ml
71
What components make up the needle?
``` Bevel Shaft Hub Syringe adaptor Cartridge penetration end ```
72
What are the advantages of a larger gauge needle?
``` Less deflection Greater accuracy of injection less chance of needle breakage easier aspiration no perceptual difference in patient comfort ```
73
Larger gauge needle is: small or large sized?
SMALL
74
Red: Yellow: Blue:
25 gauge 27 gauge 30 gauge
75
needles come in two lengths - what are they?
Long | Short
76
When loading the syringe should you place the carpule in first of the needle?
Carpule
77
Firmly push the piston to engage in the carpule once loaded. T or F
True
78
If you have a carpule with 1 : 50,000 epi what is the mg of epi found in the carpule?
(.02 mg/ml)(1.8 ml) = .036 mg per cartridge
79
How much lidocaine in a cartridge of lichen 2% with epinephrine 1 : 100,000? How much epi?
Lidocaine: 36 mg Epinephrine: .018 mg
80
What is the maximum dose of epinephrine for a normal healthy patient?
.2 mg per appointment
81
What is the maximum number of cartridges can be given to a patient when the cartridge has 1 : 1000,000 epi?
.018 mg epi .2/.18 = 11.1 cartridges

Anesthesia (3 decks)

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