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Anesthesia
Local Anesthesia CH. 18 Sytemic Comlications PG. 303-331
| Question | Answer |
|---|---|
| Whenever any drug is administered, two types of actions may be observed. What are these? | Desirable actions, which are clinically sought and beneficial and undesirable actions that are not sought. |
| Before administering any drug, the doctor must ask the patient what? | Specific questions about his or her medical and drug history. |
| Overdose Reactions | Clinical signs and symptoms that manifest as a result of an absolute or relative over administration of a drug which can lead to elevated blood levels. |
| Local anesthetics are drugs that act to depress excitable membranes like what? | CNS (Central Nervous System) and Myocardium (CVS- Cardiovascular System) |
| Toxic reactions is a synonym for what? | Overdose |
| Allergy | Is a hypersensitive state acquired through exposure to a particular allergen (a substance capable of inducing altered bodily reactivity), re-exposure to which brings about a heightened capacity to react. |
| Overdose reaction to develop what must happen? | Large enough amount of the drug must have been administered so that excessive blood levels occur in the target organs or tissues. |
| T/F Overdose reactions are dose related? | True |
| T/F Allergic reaction are not dose related? | True |
| Idiosyncrasy | abnormal unexpected response to a drug, differing from its pharmacological actions and thus resembling hypersensitivity. |
| What is the treatment of Idiosyncrasy reactions? | Symptomatic positioning, airway, breathing, circulation, and definitive care. |
| What must occur for an Overdose Reaction to occur? | The drug must first gain access to the circulatory system in quantities sufficient to produce adverse effects on various tissues of the body. |
| Target Organs | Level of a drug in the blood sufficiently high to produce adverse effects in various organs and tissues of the body in which the drug exerts a clinical actions. |
| Who is more susceptible to an Overdose Reaction due to a compromised absorption, metabolism, and excretion? | Young and Elderly people. |
| You may have an increased local anesthetic blood levels and thus may experience toxic actions of the local anesthetic at lower administered doses because of protein binding competition? | Patient's taking meperidine (Demerol), phenytoin (Dilantin), quinidine (anti-dysrhythmic), desipramine (tricyclic antidepressant) |
| During pregnancy what happens to the renal function? | May be disturbed, leading to impaired excretion of certain drugs, their accumulation on the blood, and increased risk of an overdose. |
| Hepatic and Renal dysfunction | Impair body's ability to break down and excrete the local anesthetic, leading to an increased anesthetic blood level. |
| Congestive heart failure | decreases liver perfusion ( the volume of blood flow through the liver during a specific period) thereby increasing the half-life of amide local anesthetic and increasing the risk of an overdose. |
| Serum Pseudocholinesterase | Enzyme produced in the liver, circulates the blood and biotransforms the ester local anesthetics. |
| What happens with a Pseudocholinesterase deficiency? | Can prolong the half-life of an ester local anesthetic and increase blood level. |
| Apprehensive Patient | Overreacts to stimulation (experiencing pain when gentle pressure is applied) is more likely to receive a larger dose of local anesthetic. |
| Vasodilating Effects | Increases perfusion leading to increased rate of drug absorption form the site of injection into the cardiovascular system resulting in shorter duration and increased blood levels. |
| T/F The lowest concentration of a given drug that is clinically effective should be selected for use. | True |
| T/F The smallest dose of a given drug that is clinically effective should be administered. | True |
| Terminating pain control of a local anesthetic is done how? | Diffusion of the drug out of the nerve tissue, and its absorption into the CVS and removal from the area of injection. |
| What is the single most important factor in local anesthetics? | Rate at which the drug is injected. |
| Vascularity of Injection Site | More rapid absorption of the drug from that area into the circulation. |
| What are some areas in the oral cavity that are less well perfused (i.e no vascularity)? | Gow Gates Injection Site. |
| What are some areas in the oral cavity that are well perfused (i.e. vascularity)? | Inferior Alveolar, and Posterior Injection Sites. |
| Presence of Vasoconstrictors | Produces a decrease in the perfusion of an area and a decreased rate of systemic absorption of the drug. Decreases the clinical toxicity of the local anesthetic. |
| What type of anesthetic as a group undergoes more rapid biotransformation in the liver and blood? | Esters |
| Plasma pseudocholinesterase hydrolyzes Esters to what? | PABA (paraaminobenzoic acid) |
| Atypical pseudocholinesterase | Relative contraindication to the administration of ester local anesthetics. Amides may used without risk of an overdose. |
| Amides | Biotransformed in the liver by hepatic microsomal enzymes. |
| History of liver disease ASA II or III | Amide local anesthetics may be used judiciously (relative contraindication). |
| T/F A percentage of all anesthetics is eliminated unchanged through the kidneys. | True |
| Renal dysfunction | Delay elimination of the active local anesthetic form the blood. Gradual increase in the level of active local anesthetic in the blood. |
| What is the MRD dependent on? | Patient's age, physical status, and weight. |
| T/ F Maximum recommended dose of local anesthetics should be determined after consideration of the patient's age, physical status, and body weight. | True |
| T/F Vasoconstrictors increase the duration of anesthesia and reduce systemic toxicity of most local anesthetics by delaying their absorption into the CVS. | True |
| What happens if you rapidly administer and IA injection? | Retrograde (directed or moving backward) blood flow in the artery as the drug is deposited, thus producing a overdose reaction. Blood flow is reversed due to high pressure produced by the rate of an injection. |
| How can you prevent an intravascular injection? | Use an aspirating syringe. |
| T/F Use a needle no smaller than a 25 gauge. | True |
| Why would you not want to use a smaller gauge needle in aspirating? | Increase in resistance to the return of blood into the lumen of smaller gauge needles resulting in an unreliable aspiration test. |
| T/F Aspirate in at least two planes before injection. | True |
| T/F Slow injection is the most important factor in preventing adverse drug reactions even more so than aspiration. | True |
| What is the minimum time to deposit anesthetic? | 60 Seconds (1 minute). |
| Blood or plasma level of a drug | amount absorbed into the circulatory system and transported in plasma throughout the body. |
| CNS depression happens when? | Local anesthetics cross the blood-brain barrier. |
| What are signs of CNS toxicity? | Cortical sensitivity, agitation, talkativeness, and irritability. |
| What are the signs of CVS toxicity? | Minor alteration on the electrocardiogram, myocardial depression, decreased cardiac output, and peripheral Vasodilation. |
| What are the signs of Major CVS toxicity? | Massive peripheral vasodilation, marked reduction in myocardial contractility, severe bradycardia, and cardiac arrest. |
| T/F Rarely are drugs other than oxygen necessary to terminate a local anesthetic overdose. | True |
| What are signs of a mild overdose reaction? | Retention of consciousness, talkativeness, and agitation along with increased heart rate, blood pressure, and respiratory rate 5-10 minutes after injection. |
| What is the algorithm used in management of all medical emergencies? | Position, Airway, Breathing, Circulation, Definitive care |
| What position is not recommended in management of an epinephrine overdose of a patient and why? | Supine position, accentuates (make more noticeable or more prominent) the CVS effects. |
| What are the common clinical manifestations of epinephrine overdose? | Anxiety and restlessness |
| What is the more correct position for a patient in management of an epinephrine overdose and why? | Semisitting or erect position to minimize further elevation in cerebral blood pressure. |
| Cross-allergenicity occurs with what type of local anesthetics? | Esters |
| Allergy to what has a common relationship to fruits and vegetables? | Sodium Bisulfite |
| What can happen to a patient that is allergic to Sodium Bisulfite? | Bronchospasm |
| T/F Sodium Bisulfite is found in all dental local anesthetic cartridges that contain a vasoconstrictor, but is not found in plain local anesthetic solutions. | True |
| What are some local anesthetics you could use if there is a sodium bisulfite allergy? | mepivacaine 3% and prilocaine 4% |
| T/F Allergy to epinephrine can occur in a patient. | False |
| What do you do if a patient states they are allergic to local anesthetics? | Assume the patient is truly allergic, do not use any drug until it is disproved. Do a dialogue history and consultation and test for allergy to local anesthetics. |
| What is the most important question to ask if the patient states they are allergic to a local anesthetic? | Describe exactly what happened. |
| What drugs are used in management of allergic reactions? | Vasopressors ( epinephrine), Histamine Blockers (Benadryl), Corticosteroids (hydrocortisone sodium succinate) |
| What drug is used in treatment of seizures due to an overdose of local anesthetics? | Anticonvulsants such as diazepam |
| Aromatic ammonia is used for what? | Treatment of syncopal episodes |
| What position is recommended as being the best tolerated for the administration of all local anesthetic injections? | Supine position |
| What are the four emergency protocols in an alleged allergy patient? | No treatment of an invasive matter, an appointment for immediate consultation and allergy testing; use of general anesthesia; Histamine blockers as a local anesthetic; electronic dental anesthesia or hypnosis. |
| If a patient is allergic to an Ester, what local anesthetic could you administer? | Amides |
| If a patient is allergic to an amide, what local anesthetic could you administer? | Other amide local anesthetics could be give due to no cross-allergenicity between amides exist. |
| Immediate reactions (Type I, II, and III) | develop within seconds to hours of exposure. (I.e. anaphylaxis) |
| Delayed reactions (Type IV) | develop hours to days after exposure. |
| Urticaria | wheals, which are smooth, elevated patches of skin. Intense itching. |
| Angioedema | Localized swelling |
| T/F Bronchospasm is the classic respiratory allergic response. | True |
| What is the most dramatic and acutely life-threatening allergic reaction? | Generalized Anaphylaxis |
| What are the two items that are only to be administered with an acute phase of the anaphylactic reaction? | Epinephrine and Oxygen |
| What should be done immediately if the patient loses consciousness and no signs of allergy is present? | Place the patient is the supine position with the legs slightly elevated. |
| What is the name for a patient passing out but has no sign of allergy? | Vasopressor syncope due to psychogenic reaction. |
| What should you never do after administering a local anesthetic to a patient? | Leave the patient alone. |
Created by:
daisenmurray
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