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Flashcards in Nitrous Deck (27):
1

Analgesia

A neurologic or pharmacologic state in which painful stimuli are moderated

2

Anesthesia

Loss of sensation resulting from pharmacologic depression of nerve function or from neurologic dysfunction

3

Anxiolysis

reduction of fear or apprehension

4

Minimal sedation

  • Retains pts ability to independently and continously maintain an airway and
  • Respond normally to tactile stimulation and verbal command
  • Ventilatory and cardiovascular functions are unaffected

5

Minimal sedation Appropriate initial dosing

  • Initial dosing of a single enteral drug is no more than the max recommended dose (MRD) of a drug that can be prescribed for unmonitored home use 

6

Minimal Sedation Drugs

  • Short procedure 1-2hrs
    • Triazolam 0.25mg
  • Int procedure 1/2 day
    • Apprazolam 0.5 mg
  • Long full day
    • Lorazepam 2mg

7

NO2 and sedative agents

  • NO2 when used with a sedative agent may produce
    • Minimal, moderate, deep sedation
    • General anesthesia

8

Incremental Dosing

Administration of multiple doses of a drug to achieve a desired, but not to exceed MRD

9

Supplemental Dosing

  • During min sedation supp dosing is a single additional dose of the initial dose of the initial drug that may be necessary for prolonged procedures
  • The supp dose should not exceed 1/2 of the inital dose 
  • Should not be administered until the dr has determined the clinical half-life of the intial dose has passed
  • Total aggregate dose must not exceed 1.5 X the MRD on the day of treatment

10

Moserate Sedation 

  • Patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation
  • No interventions are required to maintain an airway
  • Spontaneous ventilation is adequate

11

Titration

  • Titration- incremental doses of a drug until desired affect is achieved
  • Titration applies to moderate sedation or greater
  • One must know whether the previous dose has taken full effect before administering an additional drug increment

12

Deep Sedation

  • Patients cannot be easily aroused by respond purposefully following repeated or painful stimulation
  • Ability to independently maintain ventilatory function may be impaired

13

General Anesthesia 

  • Patients are not arousable, even by painful stimulation
  • Ability to maintain ventilatory function and cardiovascular function is often impaired

14

Stages of General Anesthesia 4 stages

  • Analgesia
    • drowsiness to loss of eyelash reflex
  • Excitment
    • Agitation and delerium
  • Surgical
    • Subdivided into 4 planes based on eye movements and status of respiratory musculature
  • Medullary depression
    • Depression of vasomotor and respiratory centers leading to coma and death

15

4 Planes of Surgical Anesthesia 

  • Plane I
    • rollinf eyes, plane ends when eyes become fixed
  • Plane II
    • Loss of corneal and laryngeal reflexes
  • Plane III
    • Pupil starts dilating and light reflex is lost
  • Plane IV
    • Intercostal paralysis, shallow abdominal respiration, dilated pupil

16

Enteral

  • Agent is absorbed theough the
    • GI tract
    • Oral Mucosa ( oral, rectal, sublingual)

17

Parenteral

  • Drug bypasses the GI tract
  • Intramuscular
  • Intravenous
  • Intranasal
  • Submucosal
  • Subcutaneous
  • Intraosseous

18

Transdermal

Drug is administered by patch or ionotophoresis through the skin

19

Inhalation

Primary effect is due to absorption thru the gas/blood interface 

20

Sedatives and Anxiolytics 3

and effects

  • Benzodiazepines (best) (anticonvulsant amnesia)
  • Barbiturates (Anticonvulsant)
  • Antihistamines (Antiemetic)
  • All produce
    • Primary effect follows a dose response
    • Respiratory depression
    • Dependence
    • Paradoxical excitation

21

Metabolism of Triazolam and half-life

  • A benzodiazepine short half life of 2-4 hrs
  • Metabolized via hepatic microsomal oxidation or glucorondidation
  • Any patient with a compromised liver will have a longer half-life of the drug

22

Patient Assesment for minimal sedation

  • Healthy ASA I ASA II
    • review of med hx and medications
  • ASA III ASA IV
    • Consultation with primary physician or med specialist

23

Pre-op Preparation

Baseline vital signs to be obtained 6

  • General activity level
  • Respiration
  • BP
  • Pulse
  • Mental status and alertness
  • Room air oxygen saturation

24

ASA Classifications

  • ASA I  - Healthy
  • ASA II
    • Mild systemic disease, no functional limitation
  • ASA III
    • Severe systemic disease, definite functional limitation
  • ASA IV
    • Severe systemic disease that is constant threat 
  • ASA V
    • Unlikely to survive 24 hrs

25

Mallampati Classification

  • Class I
    • Full visibility of tonsils, uvula, SP
  • Class II
    • Visibility of hard and soft palate
    • Upper portion of tonsils and uvula
  • Class III
    • SP, HP, and base of uvula are visible
  • Class IV
    • Only HP

26

Reversal agent for Triazolam

Flumazenil

27