Anesthesia Management – Flashcards
76 test answers
Unlock all answers in this set
Unlock answers 76question
by 2030, how many americans are estimated to be over the age of 65?
answer
70 million
Unlock the answer
question
what age is the life expectancy projected to increase to by the year 2050?
answer
82.6
Unlock the answer
question
what is the issue among dental students and treating patients with mental retardation?
answer
63% of dental students report never treating someone with mental retardation; 82% reported less than 5 hours of didactic time devoted to patients with ID
Unlock the answer
question
why is there such a low priority for care of the special needs population? - knowledge - experience - office routine - equipment - compensation
answer
lack of knowledge; lack of experience; presumed interference with normal office routine; presumed need for additional equipment; inadequate compensation
Unlock the answer
question
NDID
answer
neurodevelopmental intellectual disability
Unlock the answer
question
4 pervasive developmental disorders
answer
PDD-NOS, aspergers, retts, CDD (childhood disintegrative disorder)
Unlock the answer
question
one of the most common cases of autism
answer
Fragile X Syndrome
Unlock the answer
question
characteristic of williams syndrome. what type of syndrome does this fall under?
answer
hyposocial; autism
Unlock the answer
question
"self-hugging". what type of syndrome does this fall under?
answer
smith-magenis syndrome
Unlock the answer
question
"happy puppet syndrome"; chromosome 15 abnormality. what syndrome does this fall under?
answer
angelman syndrome
Unlock the answer
question
hyperphagia occurs with this syndrome. what syndrome category does this fall under?
answer
prader-willi syndrome. autism.
Unlock the answer
question
what are some comorbidities that we see with autism?
answer
anxiety, ADHD, tourettes, OCD, depression, bipolar, seizures
Unlock the answer
question
Mild, moderate, severe, profound ID ranges with respect to IQ.
answer
55-75: mild; 40-55 moderate; 25-40 severe; <25 profound
Unlock the answer
question
what are some conditions that can be seen alongside intellectual disabilities?
answer
cerebral palsy, epilepsy, vision & hearing impairments, speech, language, and behavior problems
Unlock the answer
question
most common type of cerebral palsy
answer
spastic
Unlock the answer
question
cerebral palsy that involves twitching, jerking, uncontrolled limb, head & eye movement
answer
dyskinetic
Unlock the answer
question
cerebral palsy associated with tremors and poor sense of balance
answer
ataxic cerebral palsy
Unlock the answer
question
x-linked recessive genetic disease involving progressive skeletal muscular weakness and degeneration.
answer
muscular dystrophy
Unlock the answer
question
most significant type of muscular dystrophy
answer
Duchenne's Muscular Dystrophy
Unlock the answer
question
which gender is muscular dystrophy more common in and why? what is a muscle in particular that can be affected and lead to more serious problems?
answer
males. it is an x-linked recessive disorder so if they get one copy they will still acquire the trait. the respiratory muscles can be affected which can lead to a loss of pulmonary reserve - ability to clear secretions & cough reflex is decreased.
Unlock the answer
question
why can there be an issue with the lungs in those patients with muscular dystrophy?
answer
inability to clear secretions and their coughing reflex is reduced
Unlock the answer
question
what reflex is diminished in those with muscular dystrophy?
answer
coughing reflex and inability to clear secretions
Unlock the answer
question
what type of infections are those with muscular dystrophy prone to?
answer
pulmonary
Unlock the answer
question
volume of air present in the lungs at the end of passive expiration. who can this be decreased in?
answer
FRC - functional residual capacity. those with muscular dystrophy.
Unlock the answer
question
kyphoscoliosis is associated with which disorder? what can it result in?
answer
seen in muscular dystrophy; leads to restricted lung expansion and even further FRC (functional residual capacity)
Unlock the answer
question
most patients with this disorder are succumbed to respiratory failure, pneumonia, and/or congestive heart failure
answer
muscular dystrophy
Unlock the answer
question
approximately 50% of down syndrome patients experience what other problem?
answer
congenital heart defects: ASD, VSD, Patent ductus arteriosis, tetralogy of fallot
Unlock the answer
question
down syndrome - -weight -infections -immune system -seizures -thyroid -indigestion -muscles/skeletal -sleeping -blood glucose -mentality disorders
answer
overweight (obesity); prone to infections due to decreased immune system; increased seizures; hypothyroidism; GERD; musculoskeletal problems; sleep apnea; diabetes; alzheimers
Unlock the answer
question
which syndrome do you have to be careful laying back in the dental chair and why?
answer
down syndrome - atlantoaxial instability (C1 does not click into C2)
Unlock the answer
question
what two things in down syndrome can increase the patient's risk for aspiration?
answer
GERD & airway hypotonia
Unlock the answer
question
what is the issue with many anti-seizure drugs and metabolism? what drug can this have an effect on and how?
answer
anti seizure drugs induce the CYP34 pathway of the liver. benzos are metabolized through this pathway so increasing the speed with increase the speed of the benzo metabolism. Increasing the speed of benzo metabolism will decreases their efficacy.
Unlock the answer
question
drug that reverses benzodiazapines. what is the concern with this and someone taking a benzodiazapine for their seizures?
answer
flumazenil. If someone is taking a bento to control their seizures and flumazenil is administered, they can trigger a seizure in this individual.
Unlock the answer
question
where can the basic oral health care needs of patients with special needs be met? (unlike many would think...)
answer
in a regular dental office without sedation
Unlock the answer
question
who made the guidelines for anesthesia for those with special healthcare needs?
answer
SCDA - special care dentistry association
Unlock the answer
question
SCDA Guidelines for Anesthesia: -impairment -feelings about treatment -sitting ability -degree of dental needs -local anesthesia -medical state
answer
cognitive impairment, fear of dental treatment, inability to sit still, extensive dental needs, inability to achieve local anesthesia, medical complexity
Unlock the answer
question
why are those with SHCN treated as outpatients with regards to anesthesia?
answer
To avoid disrupting their normal routine & promotes behavioral and emotional stability.
Unlock the answer
question
Benefits of anesthesia: - treatment planning - time - preparation of patient
answer
allows implementation of original treatment plan; allows for procedures to be performed in a timely manner; prepares patient for future treatment without anesthetic interventions
Unlock the answer
question
4 anesthetic techniques
answer
premedication; deep sedation with open airway; TIVA (total intravenous anesthesia) with LMA (laryngeal mask airway) or endotracheal tube; endotracheal anesthesia with inhalational agents
Unlock the answer
question
often given to those with SHCN for sedation, transport to operatory, or IV placement. what are the two routes of administration for this?
answer
ketamine/midazolam. IM or oral
Unlock the answer
question
"The Fab Four" premeds for SHCN
answer
midazolam, triazolam, lorazepam, diazepam
Unlock the answer
question
3 of the fab four that have a contraindication of allergy and acute narrow angle glaucoma
answer
midazolam, lorazepam, diazepam
Unlock the answer
question
pregnancy category X pre-med
answer
triazolam
Unlock the answer
question
shortest premed onset of the fab four but also the shortest duration
answer
midazolam
Unlock the answer
question
anti-anxiety med used for premed
answer
diazepam
Unlock the answer
question
what is a precaution with diazepam?
answer
sedation intensified with CYP34A inhibitors & CYP2C19
Unlock the answer
question
premed well tolerated in the elderly
answer
lorazepam
Unlock the answer
question
precautions of lorazepam. what two classifications is this given?
answer
over sedation, depressive disorders, psychosis; sedative/hypnotic; anti anxiety.
Unlock the answer
question
premed usually used in children
answer
midazolam
Unlock the answer
question
triazolam precaution in the elderly. classification of this drug?
answer
excessive sedation in the elderly. triazolam is a sedative/hypnotic.
Unlock the answer
question
the fab four drug with active metabolites
answer
diazepam
Unlock the answer
question
parenteral dose form of ketamine. what is the benefit of this mix?
answer
ketamine/midazolam. rapid onset.
Unlock the answer
question
peak plasma concentration of ketamine: - IV - IM - Oral what is the stun dose?
answer
IV: 1 minute - IM: 5 minutes - oral: 30 minutes - stun dose: enough of the drug to gain compliance but not necessarily to a total anesthetic state
Unlock the answer
question
most common fab four drug used in the special needs population
answer
diazepam, lorazepam, triazolam, midazolam
Unlock the answer
question
fastest acting IM anesthetic available
answer
ketamine
Unlock the answer
question
ketamine amount given to gain compliance but not achieve a total sedated state. what is the problem with a very high dose of ketamine propose?
answer
stun dose. if given too much, it can impose a large problem of the person waking up.
Unlock the answer
question
puts patient in a 'catatonic' state
answer
ketamine
Unlock the answer
question
the ketamine dart
answer
ketamine, glylcopyrrolate, optional midazolam
Unlock the answer
question
fentanyl use
answer
deep sedation
Unlock the answer
question
midazolam use
answer
children
Unlock the answer
question
ketamine use - three ways of use
answer
IV, IM, oral
Unlock the answer
question
IV infusion or IV intermittent bolus used for deep sedation
answer
propofol
Unlock the answer
question
IV infusion only - used for deep sedation
answer
remifentanil
Unlock the answer
question
down syndrome and issues of airway
answer
large tonsils and maintaining an open airway
Unlock the answer
question
"TIVA"
answer
total intravenous anesthesia - multiple drug infusions
Unlock the answer
question
if we have trouble maintaining an open airway, what is usually used alongside the TIVA
answer
flexible LMA - laryngeal mask airway
Unlock the answer
question
hooked to an IV pole when there is not anesthesia machine for the patient. it absorbs the CO2 and then recirculates it to the patient
answer
KAB Absorber
Unlock the answer
question
when is emergence delirium needed to take place?
answer
when the patient wakes up very confused/angry/disoriented
Unlock the answer
question
given to deal with emergence dilirium
answer
dexmedetomidine (presidex)
Unlock the answer
question
mellowing agent for a patient waking up in serious delirium, which could result in them waking up angry
answer
dexmedetomidine (presidex)
Unlock the answer
question
three sites of action for dexmedetomidine
answer
brain (local ceruleus), spinal cord, autonomic nerves
Unlock the answer
question
Three effects that dexmedetomidine has on the CNS
answer
sedation/hypnosis; anxiolysis; analgesia
Unlock the answer
question
effect of dexmedetomidine on the autonomic nerves
answer
sympathetic nervous system depressant. decrease heart rate and blood pressure
Unlock the answer