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AMED > Lecture 6 > Flashcards

Lecture 6 Flashcards

Anesthesia

1
Q

What does continual mean?

A

Repeated regularly and frequently in steady succession

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2
Q

What does continuous mean?

A

prolonged without and interruption at any time

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3
Q

What does time oriented anesthesia record mean?

A

documentation at appropriate time intervals of drugs, doses, and physiologic data obtained during patient monitoring

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4
Q

What does immediately available mean?

A

On site in the facility and ready for immediate use

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5
Q

What are the types of unconscious anesthesia techniques?

A

general anesthesia, inhalation general anesthesia

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6
Q

What are the types of conscious anesthesia techniques?

A

iatrosedation, hypnosis, local anesthesia, oral/rectal, nitrous oxide, intramuscular/intranasal, IV

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7
Q

Definition of pain

A

unpleasant sensory or emotional experience associated with actual or potential tissue damage or described in terms of such damage

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8
Q

Definition of analgesia

A

absence of pain in response to a stimulus that is normally painful

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9
Q

definition of anesthesia

A

absence of sensory modalities

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10
Q

definition of nociception

A

neural process of encoding noxious stimuli

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11
Q

definition of paresthesia

A

abnormal sensation, whether spontaneous or evoked

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12
Q

What is ASA I?

A

Healthy patient

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13
Q

ASA II

A

Mild systemic disease, patient in use of drugs

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14
Q

ASA III

A

Severe systemic disease with definite functional limitation, not incapacitating controlled by drugs

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15
Q

ASA IV

A

Severe systemic disease, with constant threat to life, incapacitatin

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16
Q

ASA V

A

moribund patient, unlikely to survive 24 hours

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17
Q

What are relevant tests for people taking anti-coagulants?

A

INR, bleeding time, PT/ aPTT, Platelet count

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18
Q

What is oxygenation

A

amount of oxygen contained in blood by hemoglobin, expressed in percentage as “Sp02”, measured by pulse oximetry and observation

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19
Q

What is ventilation

A

active exchange of inhaled and exhaled gases through respiration

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20
Q

What is circulation

A

cardiac output measured in both blood pressure and heart rate

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21
Q

What is minimal sedation

A

minimally depressed level of consciousness, produced by pharmacological method, that retains the patient’s ability to maintain an airway and respond normally to tactile and verbal command. ventilatory and cardiovascular functions are unaffected

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22
Q

what is moderate sedation?

A

when the patients respond purposefully to verbal commands, with light tactile stimulation, no interventions are required to maintain the patient airway, and spontaneous ventilation is adequate

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23
Q

what is deep sedation?

A

a drug induced depression of consciousness during which patients cannot be easily aroused by respond purposefully following repeated or painful stimulation. Independent ventilatory function may be impaired and patients may need assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate

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24
Q

What is general anesthesia?

A

drug induced loss of consciousness during which the patient is not arousable, even by painful stimulation and ability to have independent ventilation is impaired. positive pressure ventilation may be required.

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25
Q

What team is needed to perform minimal sedation?

A

dentist and assitant

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26
Q

What team is needed for moderate sedation

A

permitted dentist (dentist wtih moderate sedation permit) and dental assistant who can assist in emergency

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27
Q

What team is needed for deep sedation/GA?

A

Operating dentist, dedicated anesthesia provider for peds, GA trained dentist and 2 assistants for adults

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28
Q

define enteral

A

any route in which the agent is absorbed through the GI, first pass hepatic metabolism before affects are felt, seen, or measured

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29
Q

define parenteral (par-around) (enteral-GI system)

A

any route in which the agent bypasses the GI system, agent enters blood stream directly

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30
Q

what is considered a minor patient

A

13 years or younger

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31
Q

Do you need a different requirement for GA if you are working on a patient that is younger that 13 years old?

A

yes

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32
Q

What does a moderate sedation permit require?

A

precordial stethoscope, capnography, needs two additional support personnel other than operating dentist, operating dentist and one support personnel must have PALs certification

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33
Q

What is the training for pediatric minimal sedation?

A
  • 24 hours of pediatric minimal sedation instruction in addition to one clinical case
  • completion of CODA approved residency in pediatric dentistry
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34
Q

What is the pediatric minimal sedation agent limit?

A

dentist shall be limited to administering a single drug whose primary purpose is sedative via the oral route, and not exceed the manufacturer’s maximum recommended dose, plus a mix of nitrous oxide and oxygen.

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35
Q

if you have an oral conscious sedation permit for minors, what can you do/

A

provide, by definition, oral sedation to “moderate” levels for <13y.o

  • can use multiple oral agents
  • can use nitrous oxide alongside
  • can exceed the FDA MRD (Manufacturer’s recommended dosage)
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36
Q

What can you do if you have a pediatric minimal sedation permit?

A
  • restricted to one sedative only at or below the FDA MRD
  • can use nitrous oxide
  • can employ adjunctive agents for other therapeutic uses
  • use monitoring consistent with minimal sedation
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37
Q

What do you need to be competent in to be able to have a moderate sedation permit for adults?

A
  • need to take a CE course that fulfills the ADA guidelines (60 hours didactic, 20 live-patient experiences)
  • be competent in starting an intravenous line
  • be able to rescue from unintended deeper level of sedation
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38
Q

What is the adult dosage for adults for diphenhydramine/

A

25-50mg oral

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39
Q

What is the pediatric dosage for diphenhydramine/

A

5mg/kg/24hr not to exceed 300 mg

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40
Q

What is the adult dosage for hydroxyzine

A

50-100 mg oral

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41
Q

What is the pediatric dosage for hydroxyzine

A

0.6-2.2mg/kg

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42
Q

What is the adult dosage for doxylamine?

A

5-10mg oral

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43
Q

What is the pediatric dosage for doxylamine?

A
  • 1.9-3.125 mg (2-6 y.os)

* 3.75-6.25mg (6-12 y.os)

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44
Q

What is the duration for diphenhydramine?

A

15-60 minutes

45
Q

What is the duration for hydroxyzine?

A

15-60 minutes

46
Q

What is the duration of doxylamine?

A

60-120 minutes

47
Q

what is the adult dosage for triazolam?

A

0.125-0.5mg

48
Q

What is the pediatric dosage for triazolam?

A

no recommendations for pediatric use

49
Q

what is the adult dosage for lorazepam?

A

0.25mg-4.0mg oral

50
Q

What is the pediatric dosage for lorazepam?

A

no oral recommendation for pediatric use

51
Q

What is the adult recommendation for diazepam?

A

2-10mg oral

52
Q

what is the pediatric recommendation for diazepam?

A

1.5-2.5mg orally

53
Q

What is the pediatric recommendation for midazolam?

A

0.25-1.0mg/kg oral

54
Q

What is midazolam usually mixed with when giving to kids?

A

syrup

55
Q

What is the onset for triazolam?

A

15-30 minutes

56
Q

What is the duration for triazolam?

A

2-4 hour duration

57
Q

What is the onset for lorazepam?

A

30-60 minutes

58
Q

What is the duration for lorazepam/

A

> 3 hour procedures

59
Q

What is the onset for diazepam?

A

20-40 minutes

60
Q

What causes diazepam to have a prolonged duration?

A

due to enterohepatic circulation

61
Q

what is the onset for midazolam?

A

10-20 minutes/ .5-1 hour with common 0.5mg/kg dose

62
Q

What are the common benzodiazepines that we use in dentistry?

A

triazolam, lorazepam, diazepam, diazolam

63
Q

what are common non-benzodiazepines that we use in dentistry for anxiety?

A
  • eszopiclone (lunesta)
  • zolpidem (ambien)
  • zaleplon (sonata)
64
Q

What is the adult dosage for eszopiclone (lunesta)

A

1-3mg oral

65
Q

What is the adult dosage for zolpidem?

A

5-10mg oral

66
Q

What is the adult dosage for zalepon (sonata)

A

5-20mg

67
Q

What is the onset for eszopiclone (lunesta)

A

30 minutes

68
Q

what is the onset for zolpidem?

A

30 minutes

69
Q

What is the onset for zaleplone?

A

20 minutes

70
Q

What common non-benzodiazepines work best for patients that are pregnant and anxious in the chair?

A
  • zolpidem

- zaleplon

71
Q

Why is it not recommended for pediatric patients to use alpha 2 agonists?

A

because of their significant prolonged hypotension

72
Q

What is the risk for patients taking alpha 2 agonists?

A

at risk for orthostatic hypotension

73
Q

What are alpha 2 agonist?

A
  • clonidine
  • tizanidine (zanaflex)
  • guanfacine (tenex)
74
Q

what is the use of clonidine?

A

Antihypertensive

75
Q

What is the use of tizanidine

A

antihypertensive, muscle relaxant

76
Q

what is equipment is necessary when a patient is undergoing GA and you need to monitor them?

A
  • electrocardiogram
  • continuous blood pressure monitoring
  • continuous oxygen saturation
  • respiration and end-tidal CO2 monitoring
77
Q

What are the typical endodontic patients that you see in the OR?

A
  • Local anesthesia failure
  • endodontic surgery
  • pediatric referal (newly erupted first molars, extensive decay)
  • endodontic involvement of multiple teeth
  • fear and anxiety
78
Q

What are typical periodontal patients that you seen in the OR?

A
  • Local anesthesia failures
  • extensive surgical treatment
  • fear and anxiety
79
Q

what info is involved with a patient assessment for advanced pain and anxiety control?

A
  • age, complete medical history
  • current/past medications
  • previous surgeries, complications
  • body weight, habitus
  • exercise tolerance
  • estimate surgical length/involvement
  • post-operative pain control, surgical follow-up
80
Q

What are questions you should ask for a patient that is about to undergo dental surgery?

A

Have you had any previous surgeries? How did you recover before? Were there any complications post-op?

81
Q

If your patient is elderly and has limited ambulation, what should you be wary of?

A
  • prolonged recovery, -safety in ambulation/transport

- Post-operative pain control, GI disturbances, problems with voiding

82
Q

What should be wary of with patients with complex medical histories?

A
  • Management with consulting healthcare providers
  • specific therapies needed
  • increased risk of complications such as the use of anesthesia and surgical aspects
83
Q

Do we ask for physician consultation or clearance?

A

consultation

84
Q

What assessments should we ask the physician?

A
  • cardiovascular, pulmonary, hepatic, renal status and or compromise
  • previous surgical or procedural history
  • modification to prescribed medications
  • modification to post-operative pain medications,
  • request to optimize patient prior to surgery
  • “please provide information regarding”
85
Q

What other additional information would you suggest from the physician?

A
  • imaging (CT, MRI, echocardiogram, electrocardiogram)
  • previous reports (surgical reports, radiology reports, cardiology reports)
  • hematology modifications, appointments (factor 8 supplementation, cryprecipitate, PRP advisories)
  • additional lab testing 9coagulation, viral load, CBC)
86
Q

what should you do before scheduling a patient?

A
  • ascertain treatment goals (multiple visits? appliances, prostheses, surgical stents, imaging, patient is informed of surgical involvement/costs)
  • consultation with anesthesia, surgical staff (discuss patient’s needs and surgical demands, prepare patient for surgery and time frame)
  • scheduling with surgical staff, anesthesia (currently on tuesdays or thursdays)
87
Q

What is the patient pre-op instructions and consents needed prior to the OR?

A
  • Explain ALL treatment options prior to scheduling (IV moderate sedation, oral sedation, general anesthesia)
  • informed consent (risks/benefits of anesthetic choice, treatment course, aware that procedure is not risk free)
  • patient is aware of costs and insurance coverage
88
Q

What are the pre-op instructions for patients in the OR?

A
  • capable and responsible escort to drive patient home
  • ensure post-op instructions are being followed
  • report post-operative complications
  • explain dosing and schedule of post-op pain medications
  • administer post-op medications/provide post-operative care
89
Q

What is NPO status?

A

nothing by mouth

90
Q

What is the ideal NPO status for patients entering the OR?

A

Ideally 6 hours solids, 4 hours clear liquids, violations will result in cancellation and high aspiration with dental surgery

91
Q

What is a conservator?

A

Court appointed authority to make healthcare decisions for a patient.

92
Q

What is moderate sedation

A

the patient is awake and response and will have no recollection of the procedure

93
Q

What are treatment goals with a patient with moderate sedation

A

reduction of stress/anxiety/pain

-want to control hypertension, vaso-vagal syncope, tachycardia, hyperventilaltion from anxiety

94
Q

If the patient is undergoing moderate sedation, what kind of monitoring is required?

A
  • patient must be responsive to voice
  • check pulse oximetry (measures percentage of oxygen in blood, pulse rate)
  • non-invasive blood pressure
  • capnography: continuous measurement of exhaled CO2
95
Q

What are common moderate sedation drugs?

A
  • benzodiazepines

- opioid analgesic

96
Q

what is used to reverse benzodiazepines?

A

flumazenil

97
Q

What is used to reverse opioid analgesic?

A

naloxone

98
Q

Is benzodiazepines an analgesic?

A

no

99
Q

What are adjunctive drugs that are anti-inflammatory steroids?

A
  • dexamethasone
  • hydrocortisone
  • tramcinalone
100
Q

What are common non-steroidal anti-inflammatories that are used in conjunction after an OR visit for a patient?

A

keterolac, acetominophen

101
Q

What is an antiemetic that we can provide a patient after an OR visit?

A

ondasetron (zofran)

102
Q

What IV fluids should we give to the patient after an OR visit?

A

normal saline (0.9%)
lactated ringers solution
dextrose 5%
Dextrose 5% in lactated ringers

103
Q

what should we ensure in the immediate pre-operative period?

A
  • consents
  • escort availability
  • post-operative course
  • pre-medication
  • post operative pain management
  • follow up appointment scheduling
  • length of procedure
  • payment
104
Q

prior to beginning treatment, what should you make sure that you check/have in for your OR visit?

A

oxygen, suction, reversal/rescue medications, adequate monitoring

105
Q

What are the risks/benefits for patients that are intubated?

A

sore throat, deeper plane of anesthesia, inability to accurately duplicate “awake” occlusion

106
Q

What are the risks/benefits for patients that are non-intubated?

A

aspiration risks, loss of airway, instability of mandibular procedures

107
Q

At the conclusion of the OR visit, what should you do?

A

stay with the patient:

  • evaluate surgery
  • provide post op instructions
  • assess post op pain
  • provide post-operative pain medications, prescriptions,
  • ensure hemostasis, restorative function,
  • provide same information to escort/guardian
108
Q

what should the next appointment be for the patient?

A

surgical post-op visit, treatment under anesthesia, appliance delivery, restorative treatment

AMED (4 decks)

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