sedation midterm 1

Question 1

PET scans can be used to assess

Answer 1

a patient who is anxious. They are the people who, even a mouth mirror hurts them. ​

Question 2

recalcitrant

Answer 2

having an obstinately uncooperative attitude toward authority or discipline.

Question 3

What is compounding local mean? ​

Answer 3

Compounding means getting 5% lidocaine

Question 4

About ____% of the U.S. Population avoid dental care because of fear

Answer 4

10 -30%

*means many untreated ppl

Question 5

What is it difficult to obtain profound anesthesia for?

Answer 5

I+D, endodontic access on acutely inflamed pulps, reducing facial fractures, extracting deeply impacted 3rds

Question 6

What does iatrosedation mean?

Answer 6

dental term that refers to chairside manner

• It involves sights, sounds, and smells ​
• we do this for everyone, it means be nice to them

Question 7

What is TENS? ​

Answer 7

electrode that you hook up via a patch. Not bad on backs and knees. What you’re doing is distracting the nerves

Question 8

What are the pharmacologic methods of sedation? ​

Answer 8

Oral, inhalationals, IM, IV, and submucosal​

Question 9

both sights and __and__ can trigger anxiety

Answer 9

smells and sounds

Question 10

What is used in surgery that has eugonal in it?​

Answer 10

Dry socketp aste ​
* Know that Eugenol was a smell that people did not like and that there is an emotional aspect linked to the memory formation

Question 11

What is anxiolysis? Do they responds to commands?

Answer 11

minimal sedation where you have the diminution or elimination of anxietyand patients CAN respond to verbal commands

Question 12

1) What is a moderate sedation or a conscious sedation​
2) Are reflexes preserved? ​
3) Can a patient breath on their own? ​
4) Can the patient talk back to your or let you know of their pain? ​
5) What parallels sedation that something do daily ​
6) Concern of sleep apnea and sedation?

Answer 12

1) This is a state that medically depresses the consciousness ​2) Yes, they are maintained ​
3) Yes, patient’s ability to maintain patent airway independently and continuously ​
4) Yes, patient can tell us when they are feeling bad physical stimuli and can respond to verbal commands ​
5) Really deep sleepers snore so that’s partial airway obstruction- if you snore nightly and sleep deeply that is caused sleep apnea​
6) People with sleep apnea have a reduced airway and this can increase their chances o adverse effects during sedation ​

Question 13

1) what is deep sedation
2) Can you maintain your protective reflexes?
3) do why?

Answer 13

1) A medically controlled state of depressed consciousness or unconsciousness from which the patient is not easily aroused.
2) Can you maintain your protective reflexes
3) local allergy

Question 14

1) what is general anesthesia
2) What is an indication for anesthesia as a general dentist​
3) Taking 4 wisdom teeth on a patient with general anesthesia – why does he do local anesthesia still?

Answer 14

1) medically controlled state of unconsciousness accompanied by a loss of protective reflexes, including the inability to maintain and airway and respond purposefully to physical stimulation or verbal command
2) True local anesthetic allergy ​3) Post op pain – after post op, want the patient to not feel our work

Question 15

What are the 4 stages of Guedel? ​

Answer 15

1- corresponds to (minimal) conscious sedation, with stage 3 equating to general anesthesia
2- heralded by excitement and delirium, with stage 4 being near cardiovascular collapse

Question 16

What was it common with Guedel stage 2 General?

Answer 16

diethyl ether

Question 17

Stage 2 is heralded by excitement and delirium – why is this scary for kids? ​

Answer 17

Stage 2 anesthesia is characterized by a patient that might be excited, thrashing, kicking. What is crazy is they are sedated, but they are not acting like so since they are in Stage 2. So then you give the patient a ton of anesthesia MORE, and then boom, you kill the dude

Question 18

What kills people in a local anesthetic overdose? ​

Answer 18

SA/AV node and Purkinje fibers will be shut down so then the heart stops leading to Asystole. AED will not work because think about how the heart works – needs a depolarization, which the local inhibits. This may not be true. SA/AV node have tne calcium channels in Phase 0 where as sure, the ventricles have Na in Phase 0. ​

Question 19

Why is there a stage 2? Why do patients get excited? ​

Answer 19

HINT is EPILEPSY. Seizures is an excitable thing. So what’s happening with anesthesia, is that you’re turning off the off switches in the brain. Inhibiting the inhibitor leading then to excitement ​

Question 20

Is cocaine a anesthetic? ​what is the plant called?

Answer 20

fuck yeah!

plant was Tonalgia

Question 21

sedation golden rules

Answer 21

Most patients do well with iatrosedation, and one drug, the local anesthetic.​

When administering sedative drugs, one should still use good chair side techniques.​

If you are sedating a patient, then you need to know their medical history even better than if using L.A. alone

All sedatives/anxiolytics, regardless of the route of drug administration, can place the patient into deep sedation or general anesthesia.​

Without training beyond this course, one’s sedative goals are minimal conscious sedation or Guedel’s stage 1​

Most morbidity/mortality from dental office sedations are from respiratory arrest. ​

Patients under 6 or over 65 require special precautions. (Postoperative cognitive dysfunction)​

A consciously minimally sedated patient is less likely to have a medical emergency than a person with local anesthesia alone, but general anesthesia is risky on the medically compromised person.​

Each state has its own rules and regulations regarding sedation in the dental office. ​

Question 22

Analgesia

Answer 22

The diminution of pain in the conscious patient

Question 23

Local Anesthesia

Answer 23

The elimination of sensations, especially pain, in one part of the body by the topical application or regional injection of a drug.

Question 24

How many hours before sedation should you fast? ​

Answer 24

6 hours pre op

Question 25

If you are going to sedate someone deeper, why should patient’s fast? ​

Answer 25

If sedated, protective reflexes blunted which means they can aspirate. Nitrous is also a emetic​

Question 26

Which patients can’t fast? ​

Answer 26

• infants

* Diabetics - Insulin and don’t eat = recipe for hypoglycemia

Question 27

What level of sedation does fasting become relevant? ​

Answer 27

Really, moderate sedation with anxiolysis

Question 28

When do we not have the luxury of having a patient fast?​

Answer 28

Emergency surgery

Question 29

Why is the black box here? Why can’t eat with sedation?

Answer 29

Deep sedation – get sick, and you vomit, and then they ‘all aspirate. Protective reflexes are zero under GA and also narcotics can make you throw up and you can aspirate ​

Question 30

**indications for sedation?

Answer 30

BP control

Question 31

Why NOT do sedation? ​

Answer 31

Possible serious complications ​

Hassles with permits​

Mandated CE hours​

Increased malpractice​

Doing OK without it ​

Never taught how​

Need to buy more equipment