Week 1 Flashcards by Marjorie Wolfe

The pre-anesthetic assessment consists of (3)

1) complete medical/dental history
2) physical examination
3) psychological examination

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List what should be included in the complete medical/dental history (5)

1) current conditions
2) past conditions
3) OTC drugs, supplements
4) adverse reactions to meds
5) problems with previous dental treatment

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What are concomitant meds?

2+ meds taken on same day which can alter efficacy and safety of LA’s

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Physical examination includes (4)

1) visual exam
2) BP
3) Pulse and RR
4) patient’s weight

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The patient’s weight is used to determine the ____________ of LA’s

maximum recommended dose

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T/F: We have to decrease the MRD for children because they have immature livers

True

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Acceptable HR’s for adults and children

adult: 60-100
child: 75-100
toddler: 120-160

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At what BP should you retake and refer for immediate med consult?

> 200/>115

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At what BP should you consider nitrous for stress reduction?

140-159/90-94

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What are some signs of moderate anxiety?

1) stiff posture
2) nervous “play”
3) “white knuckle” syndrome
4) sweating
5) “too cooperative”
6) nervous conversation
7) quick answers

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What are 3 things we can do for stress reduction protocol?

1) adequate pain control
2) decrease pain of injection
3) select LA of appropriate duration

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How does stress affect the body in regards to pain?

it decrease the pain reaction threshold

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Risk assessment ABCDE

A → antibiotics; anesthesia; anxiety; allergy

B → bleeding

C → chair positioning

D → drugs; devices

E → equipment; emergencies

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an unpleasant often strong emotion caused by anticipation or awareness of danger

fear

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what % of people in the population avoid dental care b/c of fear?

6-14%

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*and tends to be a learned response from personal experience or from the experience of others.

anxiety

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T/F: Fear is long-term

false! it’s short-lived

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Anxiety is from ______________ or thought of dentistry

anticipation

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Fear refers to the ___________ occurring in the dental office

reaction

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What are the most relevant routes of drug administration in dentistry?

oral, topical, subcutaneous, inhalation

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Which drug is most effective and most popular drugs for anxiety management in dentistry

benzodiazepenes

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These are good for mild to moderate pre-treatment anxiety

Benzodiazepenes

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Which benzos are the most common anxiolytic agents?

diazepam and triazolam

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Nitrous oxide documentation MUST include.. (4)

1) Informed consent obtained and documented in chart

2) Percentage of N2O administered

3) Length of time the patient was sedated

4) Flow rate of gases during administration

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What are some features of nitrous that allow it to provide ideal sedation? (4)

-rapid onset of 2-5 mins -wide safety margin -quick recovery -no hangover effect

T/F: Nitrous has low solubility in the blood

true

T/F: Nitrous can't cross the placenta

false! it can which is why you need a med consult if you have a pregnant pt

administration of drug increases the possibility of a life threatening situation =

absolute contraindication

administration of drug is preferably avoided due to possible adverse reactions =

relative contraindication

List some examples of absolute contraindications (5)

1) Nasal Obstruction 2) Vit B12 Deficiency (can render B12 inactive) 3) Alcoholic / Recovering Addict 4) Uncommunicative (disability or language barrier) 5) Patient Refusal

List some examples of relative contraindications

1) Middle ear infection 2) Balance disorder 3) Susceptibility to Motion Sickness 4) Claustrophobia 5) Pulmonary Diseases (med consult) 6) Immunocompromised (med consult) 7) Pregnancy (med consult) 8) Psychiatric Disorders/Bipolar (med consult) 9) Marijuana or Hallucinogenic Drug Use

Common side effects of nitrous

nausea, vomiting, headaches

When does the nitrous pressure gauge start to fall?

once all the liquid is gone and only gas remains

Which button is used to over sedation?

flush button

Name the safety feature: N2O flow terminated if O2 delivery pressure falls

oxygen fail safe

Name the safety feature: * allows atmospheric air in if flow of gases stops

emergency air inlet

Name the safety feature: rapid delivery of high flow O2 to patient (oversedation)

oxygen flush button

nitrous oxide administration

1. Select appropriatley sized nasal hood 2. Inflate the bag --> start with 5-6 L/min of 100% O2 3. Place the nasal hood --> patient adjusts for comfort --> tighten 4. Instruct patient to breath normally --> adjust flow rate 5. Gradually titrate N2O- O2 in 10% intervals, watching for signs of sedation --> ask how they feel 6. Typical pt requires 50% N2O - 50% O2 7. When treatment is completed --> N2O to zero and incrase O2 to re-establish flow rate --> 100% O2 for 5 MINUTES 8. Document the procedure * NEVER leave the patient unattended

Nervous system breakdown

divided into CNS and PNS -CNS and PNS divided into afferent and efferent -PNS divided into somatic and autonomic -Autonomic divided into sympathetic and parasympathetic

3 main functions of neurons

1) receive information 2) process info 3) send response

Describe the structure of a neuron

cell body, dendrites, axon

What is the terminal end of an axon called?

synaptic knob

T/F: Nerves are only found in the PNS

true

CT around an axon

endoneurium

group of axons

fascicle

CT around one fascicle

perineurium

CT around group of fascicles

epineurium

Which fibers are the largest and have the fastest impulse generation?

TYPE A FIBERS

Which A fibers are used for muscle movement

alpha

Which A fibers are used for proprioception, touch, and pressure?

Beta

Which A fibers are used for muscle tone?

Gamma

Which A fibers are used for pain and temperature?

Delta

T/F: A fibers can be afferent or efferent while B fibers are only efferent.

True

Where are Type B fibers found?

preganglionic ANS vascular smooth muscle

Which are the smallest, most numerous, and unmyelinated fibers

Type C fibers

Which fibers are responsible for dull, achy pain?

Type C

What type of fibers are prevalent in the oral cavity?

Type A and Type C

Which fibers require more anesthetic volume? why?

Type A cuz they're larger

Types of stimuli that trigger nerve impulses

chemical thermal mechanical electrical

Neurons maintain RMP via?

1) Sodium-Potassium Pump 2) closed K+ channels 3) closed Na+ channels

What causes the absolute refractory period?

inactivation of sodium channels during repolarization

What causes the relative refractory period?

hyper-polarization before RMP is established

T/F: an action potential cannot be generated in the relative refractory period

False! it can be if a larger stimulus is applied

2 types of synapses

electrical and chemical

What are the 2 ways that LA's cause reversible local anesthesia?

1) prevent generation of impulses 2) preven conduction of impulses

What do "membrane-stabilizing drugs" do?

decrease rate of depolarization

Small/large diameter nerve fibers are less/more sensitive to LA's

small; more

Small/large diameter nerve fibers require more/less volume of LA's

Large; more volume

What are the 2 major routes of LA delivery?

1) topical 2) submucosal injection

T/F: Submucosal injections are more effective than topical.

True

Which ion channels do LA's bind to inside the cell?

Na+