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Anesthesia

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is the term used for temporary loss of feeling or sensation

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Anesthetics

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are the drugs that produce the temporary loss of feeling or sensation

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Methods of pain control used in dentistry to alleviate or reduce anxiety and pain include

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Topical anesthesia Local anesthesia Inhalation sedation Antianxiety agents Intravenous sedation General anesthesia

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What is the primary purpose of topical anesthesia in dentistry?

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To provide a numbing effect in a specific area where an injection is to take place; it gives a numbing effects on the nerve endings located on the surface of the oral mucosa

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Forms of topical anesthesia available are

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Ointments, liquids, sprays, and patches

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Ointment type of topical anesthesia should remain on the site of injection for a minimum of _____ to _____ seconds and a maximum of ___ to ___ minutes to have optimum effectiveness

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15 to 30 1 to 2

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Spray topical anesthetic agents are applied to

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larger surface areas of the oral tissues

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What can be used to relieve a patient's strong gag reflex when taking an impression or intraoral radiograph?

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A Spray topical anesthetic agent

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A topical patch provides topical anesthesia within

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10 seconds

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A topical patch may be used for

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injections and for alleviation of discomfort from denture sores and oral ulcers

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When were local anesthetics first discovered?

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the mid-1800's

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Characteristics of Local Anesthetics

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1) Nonirritating to the tissues in the area of the injection 2) Associated with minimal toxicity (cause the least possible damage to body systems) 3) Rapid onset (take effect quickly) 4) Able to provide profound anesthesia (completely eliminate the sensation of pain during a procedure) 5) Sufficient duration (remain effective long enough to complete the procedure) 6) Completely reversible (leave the tissue in its original state after the patient's recovery) 7) Sterile or capable of being sterilized by heath without deterioration

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Local anesthesia is obtained by

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injecting an anesthetic solution near a nerve, where treatment is to take place

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How does a local anesthetic agent temporarily block the ability of the nerve membrane to generate an impulse?

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When the anesthetic solution attaches to specific receptors within the nerve, it slows down the neuron conductance, causing the patient to feel numbness in the area

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After the injection is completed, the anesthetic _____________, or spreads, into the nerve and blocks its normal action

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diffuses

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to obtain complete anesthesia after the injection, the nerve must be sufficiently _____________________ by a concentration of the anesthetic base to inhibit conduction in all fibers

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permeated

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How is the action of the local anesthesia reversed?

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the bloodstream carries away the solution

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What are the two chemical groups of anesthetic solutions used in dental care?

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Amides and esters

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When were amides first introduced into clinical practice and how are their standards maintained?

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Introduced in the 1940's and they are maintained by the standards by which all other local anesthetics are measured

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Ester-type anesthetics are used primarily as

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Topical anesthetics

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What is the difference between amides and esters?

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The way they are metabolized by the body

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Amide local anesthetics are metabolized by the

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liver

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Ester local anesthetics are metabolized primarily in the

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plasma

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Each local anesthetic cartridge contains a combination of which ingredients?

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Local drug anesthesia Sodium chloride Distilled water

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Local anesthetic drug

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The choice depends on the procedure, the health of the patient, and the dentist's preference

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Sodium chloride

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Makes the solution isotonic with body tissues

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Distilled water

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Supplies an added volume of solution

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________________ is the length of time from injection of the anesthetic solutions to complete and effective conduction blockage

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Induction

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_________________ is the length of time from induction until the reversal process is complete

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Duration

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A short acting local anesthetic agent can last from

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60 to 180 minutes

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An intermediate-acting local anesthetic agent lasts from

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120 to 240 minutes (Most local anesthetic agents in this group are used for general dental procedures)

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A long-acting local anesthetic agent lasts from

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240 to 540 minutes

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What is added to the local anesthetic agent to slow down the intake of an agent and increase the duration of action?

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Vasoconstrictor

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What happens when a vasoconstrictor is used?

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Constriction of blood vessels in the site Slowing of absorption into the cardiovascular system Minimization of anesthetic toxicity due to lowered blood level Prolongs effect of anesthetic agent by decreasing blood flow to area of injection Decreased bleeding at injection site; especially important during surgical procedures

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Formulation - Articaine

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Brand Name - Septocaine

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Formulation - Benzocaine

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Brand Name - Marcaine

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Formulation - Bupivacaine

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Brand Name - Sensorcaine

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Formulation - Chloprocaine

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Brand Name - Nesacaine

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Formulation - Etidocaine

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Brand Name - Duranest

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Formulation - Diphenythydramine

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Brand Name - Benedryl

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Formulation - Lidocaine

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Brand Name - Xylocaine, Daicaine, Diocaine, L-Caine, Nervocaine, Lidoject

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Formulation - Mepivacaine

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Brand Name - Carbocaine

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Formulation - Prilocaine

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Brand Name - Citanest

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Major vasoconstrictors used with local anesthetic agents include

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epinephrine, levonordefrin, and Neo-Cobefrin

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What are the ratios? of vasoconstrictor-to-anesthetic solution

answer

1:20,000; 1:50,000; 1:100,000; or 1:200,000

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With the concentration levels of a vasoconstrictor, the _____________ the ratio, the _____________ the percentage of vasoconstrictor; in most situations , it is desirable to use as high a ratio as possible

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smaller higher

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A vasoconstrictor may cause ____________ on the heart as the local anesthetic solution is absorbed into the body

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strain

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For patients with a history of heart conditions, it is recommended to use an anesthetic solution

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without a vasoconstrictor

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Heart conditions that are included in recommending local anesthetic *NOT* be used with vasoconstrictors are

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Angina, recent myocardial infraction, recent coronary artery bypass surgery, untreated or uncontrolled severe hypertension, and untreated or uncontrolled congestive heart failure

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Innervation

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Supply or distribution of nerves to a specific body part

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What will determine where the topical anesthetic is placed and the type of injection to be given?

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The location and innervation of the tooth or teeth to be anesthetized

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How do the Maxillary anesthesia techniques differ from the mandibular approach?

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Because of the porous nature of the alveolar cancellous bone in the maxilla

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The bone structure of the _______ allows the anesthetic solution to diffuse through the bone and reach the apices of the teeth in a different manner

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Maxilla

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What are the three types of local anesthetic injections that may be given in the maxillary arch?

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Local infiltration Field block Nerve block

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Local infiltration is

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completed b injecting into a small, isolated area

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Field block refers to the

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injection of anesthetic near a larger terminal nerve branch;

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If restoring two or three teeth, what type of injection is indicated?

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A field block

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Nerve block occurs when

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local anesthetic is deposited close to a main nerve trunk

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What type of injection is indicated for quadrant dentistry?

answer

A Nerve block

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Posterior superior alveolar, the inferior alveolar, and the nasopalatine nerves are examples of injections

answer

that indicated the use of a nerve block

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Local anesthesia in the __________ ______ may be necessary for procedures that involve the soft tissues of the palate

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palatal area

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What are common palatal injections?

answer

Anterior (or greater) palatine nerve block Nasopalatine nerve block

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Which nerve block provides anesthesia in the posterior portion of the hard palate?

answer

Anterior (or greater) palatine nerve block

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Which nerve block produces anesthesia in the anterior hard palate?

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The nasopalatine nerve block

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Because of the dense, compact nature of the mandibular bone, anesthetic solution does not ___________ __________ through it

answer

diffuse easily

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What type of injection is usually required for most mandibular teeth

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Block anesthesia

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For a nerve block on the mandibular

answer

the solution is injected near a major nerve, and the entire area served by that nerve branch is numbed

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Inferior alveolar nerve block is often referred to as

answer

mandibular nerve block

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How is the Inferior alveolar nerve block obtained?

answer

By injecting the anesthetic near, but not into, the branches of the inferior alveolar close to the mandibular foramen

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The dentist must be very careful not to

answer

inject into a blood vessel

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With an Inferior alveolar nerve block the patient will experience

answer

numbness over half of the lower jaw, including the teeth, tongue, and lip

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The Buccal nerve block provides anesthesia to

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the buccal soft tissues closest to the mandibular molars

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When is the incisive nerve block used?

answer

Only when the mandibular anterior teeth or premolars require anesthesia

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Where is the incisive nerve block injection given?

answer

at the site of the mental foramen; the branch of this nerve continues within the mandibular canal to the apices of anterior teeth

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What does the thumb ring and finger grip allow the dentist to do?

answer

These parts allow the dentist to control the syringe firmly and to aspirate effectively with one hand.

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What is the harpoon?

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A sharp hook that locks into the rubber stopper of the anesthetic cartridge, so the stopper can be retracted by pulling back on the piston rod. This action makes aspiration possible.

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What does the piston rod do?

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This rod pushes the rubber stopper of the anesthetic cartridge and forces the anesthetic solution out through the needle.

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What is the function of the barrel of the syringe?

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It firmly holds the anesthetic cartridge in place. The cartridge is loaded through the open side of the barrel. A window on the other side allows the dentist to watch for blood during aspiration.

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Threaded tip (needle adaptor)

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The hub of the needle is attached to the syringe on the threaded tip. The cartridge end of the needle passes through the small opening in the center of the threaded tip, puncturing the rubber diaphragm of the anesthetic cartridge.

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Local anesthetic solutions are supplied in

answer

glass cartridges

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Anesthetic cartridges have a ___________________ stopper at one end and an aluminum cap with a _________________________ at the other end

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rubber or silicone rubber diaphragm

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Cartridges are supplied in ___________________which are already _________________ and have been stored in a sealed environment

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Blister packs sterilized

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What is the purpose of the color-coding anesthetic cartridge system

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This standardization was introduced so that the dental practitioner could easily recognize different brands of anesthetic

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Cartridges should be stored at _______________________and protected from __________________. Heat and sun may cause the solution to __________________ and be less effective

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room temperature direct sunlight deteriorate

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Never use a cartridge that has been _____________. An _______________________________ rubber stopper and a large air bubble are signs that the solution may have been frozen

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frozen extruded (pushed out)

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Do not use a cartridge if it is ____________________________________ in any way. The glass may ______________ under the pressure of injection.

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cracked, chipped, or damaged shatter

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Never use a solution that is ___________________________________or has passed the ________________________ shown on the package. The solution may no longer be ________________

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discolored or cloudy expiration date effective

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Never save a ______________ for reuse.

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cartridge

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The cartridge end of the needle is the ______________ end of the needle. It fits through the __________________of the syringe and punctures the rubber diaphragm

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shorter threaded tip

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The ______________________is made of self-threading plastic or prethreaded metal. It is used to attach the ____________ to the threaded tip of the syringe

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needle hub needle

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___________________of the needle is protected by the needle guard and is 1 inch or 1 5/8 inches in length

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injection end

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The 1-inch short needle is used for ________________________

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infiltration anesthesia

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The 1 5/8 long needle is used for _______________________

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block anesthesia

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Before the injection, the needle is turned so that the beveled angle is ______________________

answer

toward the bone; This angle enables the dentist to deposit the solution next to the bone without actually contacting the bone

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The ________ is the hollow center of the needle through which the anesthetic solution flows

answer

lumen

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The most frequently used gauge numbers are _____________________

answer

25, 27, and 30

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To be certain that the solution is not being injected into a vessel, the dentist always _____________ before depositing any local anesthetic solution with an aspirating-type syringe

answer

aspirates

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When the tip of the needle reaches the target area, the dentist slowly pulls back on the _________________of the syringe. This creates a _______________________within the anesthetic cartridge.

answer

thumb ring negative pressure

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local anesthetic solutions are remarkably safe in their use, the importance of their systemic toxicity cannot be ignored. Manifestations of these toxic actions are variable and depend on the following:

answer

• Individual patient physiology • Local anesthetic solution • Rate of injection • Rate of absorption • Quantity of anesthetic injected • Other drugs in the patient's system

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_________________ is a condition in which numbness lasts after the effects of local anesthetic solutions should have worn off.

answer

Paresthesia

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Paresthesia may be caused by the following:

answer

• Use of contaminated anesthetic solution, most often contamination with alcohol or sterilizing solution used to disinfect the anesthetic cartridge before use • Trauma (injury) to the nerve sheath during the injection or surgery • Hemorrhage (bleeding) into or around the nerve sheath

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Paresthesia is __________________ only if damage to the nerve is severe

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permanent

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Inhalation sedation, also referred to as ______________________________, may be the safest type of sedation method used in dentistry if used properly.

answer

nitrous oxide/oxygen analgesia

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The use of N2O in dentistry dates back to _______, when _____________________(the first dentist) used these gases on his patients.

answer

1844 Horace Wells

question

Advantages of N2O Use

answer

• Administration is relatively simple and is easily managed by the dentist. • Although special training is required for the dentist and the dental assistant, the services of an anesthetist or other special personnel are not necessary. • This type of sedation has an excellent safety record, and the adverse effects are minimal. • N2O/O2 sedation produces a pleasant, relaxing experience for the patient. • The patient is awake and is able to communicate at all times. • Recovery is rapid and is complete within a matter of minutes. • N2O/O2 sedation may be used with patients of all ages.

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Disadvantages of N2O Use

answer

• Some patients may experience nausea or vertigo, which would be unpleasant. • Patients who have behavioral problems may react in a negative way and act out those behavior issues.

question

N2O/O2 analgesia is usually administered to a pregnant patient only after the _________ trimester and only with the permission of her obstetrician

answer

first

question

N2O, chemical name _________________________, is a tasteless, sweet-smelling, colorless gas that is compressed into a _______ cylinder

answer

dinitrogen monoxide blue

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A ________________indicates the rate of flow of the gas.

answer

flow meter

question

___________________are used to control the flow of each gas

answer

Control valves

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The ___________________is where the two gases are combined

answer

reservoir bag

question

The ____________carries the gases from the reservoir bag to the mask or nosepiece

answer

gas hose

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A _____________________is essential for protecting you and other dental personnel from the occupational risks of N2O

answer

scavenger system

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For dental professionals, the safest maximum allowable amount of N2O in the dental environment is __________________

answer

50 parts per million (ppm)

question

To reduce N2O hazards to dental personnel, you should take the following steps:

answer

• Use a scavenger system. • Use a patient mask that fits well so that gas does not leak around the edges. • Discourage patients from talking while receiving N2O/O2. • Vent gas outside the building. • Routinely inspect equipment and hoses for leaks. • Use an N2O monitoring badge system.

question

The vital signs of blood pressure, pulse, and respiration should be recorded __________________________administration of N2O/O2 analgesia

answer

before, during, and after

question

N2O/O2 sedation should begin with the administration of ____ % O2. Start with pure O2 while establishing the patient's _________________, and then slowly __________, or determine the concentration of, the N2O until desired results are achieved

answer

100 tidal volume titrate

question

The N2O/O2 analgesia should end with the administration of ________ % O2 for 3 to 5 minutes

answer

100

question

Sedatives may be used in the following situations:

answer

• Patients are very nervous about a procedure. • A procedure will be long or difficult. • Mentally challenged patients are receiving treatment. • Very young children are undergoing extensive treatment.

question

The most common pharmacologic methods for sedation and control of anxiety involve the use of ______________________ and _____________________________

answer

benzodiazepines (diazepam) barbiturates (pentobarbital, secobarbital)

question

_________________________ is a sedative that is often used for sedation of children; it produces the same type of effect

answer

Chloral hydrate (Noctec)

question

General anesthesia is most safely administered in a ______________ setting or at another facility with the necessary equipment for administration and management of an emergency

answer

hospital

question

General anesthesia is a controlled state of ________________________ characterized by loss of protective reflexes, including the ability to maintain an airway independently and to respond appropriately to physical stimulation or verbal command (Stage III general anesthesia)

answer

unconsciousness

question

Stage I: Analgesia is the stage during which a patient is ___________________________. The patient is able to keep the mouth open without assistance and is capable of following directions. The patient experiences a sense of ________________ and a reduction in pain. Vital signs are normal.

answer

relaxed and fully conscious euphoria

question

Stage II: Excitement is the stage during which the patient is _______________________________________________. The patient may become ___________________________________. Nausea and vomiting may occur. Excitement is an ____________________ stage

answer

Less aware of immediate surroundings and may start to become unconscious Excited and unmanageable Undesirable

question

Stage III: General anesthesia is the stage of anesthesia that begins when the patient becomes calm after ____________. The patient feels ________________________. The patient soon becomes unconscious. This stage of anesthesia can be achieved only under the guidance of an _______________________in a controlled environment such as a hospital setting

answer

stage II no pain or sensation anesthesiologist

question

Stage IV: Respiratory failure or cardiac arrest occurs when the lungs and heart ________________________. If this stage is not reversed quickly, the patient can die

answer

slow down or stop functioning

MDA Chapter 37 – Anesthesia and Pain Control – Flashcards

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