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Anesthetic
| Question | Answer |
|---|---|
| What is the cardiac dose of epinephrine? | 0.04mg |
| When giving the PSA injection and the syringe is parallel to the occlusal plane, what is the most likely complication? | contact with pterygoid plexus |
| Where does epinephrine and levonorderfrin metabollize? | liver |
| Case study: Older women with high blood pressure, overwirght, being treated for being overweight, etc. What is the limiting factor? | vasoconstrictor |
| A patient received 3 carps of 4% Priolocaine with 1:200,000 epi. How many mg. of LA did she receive? | 216mg |
| How many carps of 2% Lido with 1:100,000 epi can you give a healthy 200 lbs man? | 8 carps |
| What is administered in the case of anaphylactic shock? | epinephrine and oxygen |
| What are signs and symptoms of acute generalized anaphylactic shock? | Bronchoconstriction |
| Where is the lingual nerve located in relation to the IA nerve? | Anterior and medial |
| If you are using a 30 gauge short needle for the mandibular block, what is the potential complication? | Cannot reach target area, needle too short, breakage |
| If the patient feels an "electric shock" during an injection, what happened? | contacted nerve membrane |
| What local anesthetic agent would you give to a patient with uncontrolled hyperthyroidism? | 3% Mepivacaine |
| The normal dose of epinephrine can be administered to the following patient? -MI within 6 months -Daily angina -cardiac pacemaker | cardiac pacemaker |
| What anesthetizes the mandibular 1st premolar? | mental |
| You administer an IA injection and the patient does not get numb but cannot close their eye and complains her face feels numb. What happened? | Injected into parotid gland |
| How would you avoid injecting into the parotid gland? | contact bone before depositing |
| If you need 60 min of anesthesia, what anesthetic would you use? | Medium length anesthetic; 2% lido, 2% mepivicaine, 4%Prilocaine, 4% Articaine, Procaine |
| A healthy patient comes in late for your appointment with heavy calculus, gingival bleeding and history of cancelled appointments. You administer 1 carp of 2% Lido with 1:100,00 epi and patient looses consciousness. What happened? | Syncope |
| Next to the mental, which injection has the next highest aspiration rate? | IA |
| After administering 6 carps of 3% Mepivacaine the patient's arms and legs start to twitch, breathing is short and rapid, heart rate is elevated. What is the cause? | LA overdose |
| How do you treat a local anesthetic overdose? | Monitor vitals and oxygen |
| How much epi is in 2% Lido with 1:100,000 epi when compared to 2% Lido with 1:50,000 epi? | 1/2 or 0.018 mg compared to 0.036mg |
| What would a patient be allergic to in a carpule of anesthetic? | Sodium Bisulfite |
| What is the preservative in 3% Mepivacaine? | none |
| How would you treat someone who stopped breathing? | Positive pressure (CPR) and oxygen |
| If a patient presents with facial trauma and trismus and cannot open for the IA what is an alternative injection? | Vasirani-Akinosi |
| What is the metabolic byproduct of esters? | PABA |
| When inflammation is present, why is it difficult to get the patient numb? | Iflammation causes the tissues to become more acidic=lower pH=higher pKa=more water soluable |
| What happens to anesthetic when it is injected into an inflammed area? | Ineffective |
| Which anesthetic id appropriate for long lasting pain/procedure? | 0.5% Bupivacaine |
| How much anesthetic is given for the PSA? | 0.9mL to 1.8mL (1/2 to 1 carp) |
| When giving the right IA, what gets numb? | Buccal gingiva from the premolar to central and teeth 25-32. |
| When giving a GP, what gets numb? | Palatal tissue of molars and premolars (distal of canine) |
| You give an injection and the patients' face distends and edema sets in at the site of injection. What is the most likely cause? | Hematoma |
| How much anesthetic is given for the the left IA? | 1.3 mL to 1.5 mL (2/3 to 3/4 carp) |
| When giving the left IA, you contact while only inserting 1/4 the length of the needle. What should you do? | Withdrawl slightly, redirect barrel more anterior over the incisors, advance the needle, reposition barrel over premolars and advance until bone is contacted |
| You administer 2 carps of 3% Mepivacaine for an IA and the patient does not get numb. What happened? | Injection too low |
| What is the advantage of a vasoconstrictor? | reduce toxicity |
| What injection is appropriate for treatment on the maxillary cuspid? | ASA |
| You have just given a left IA and the central and lateral are not numb. Why? | crossover |
| A patient presents with pressure and cold sensitivity on #15. The radiograph indicates a periodontal abscess. What injections should you give? | PSA, GP |
| What is a contraindication for the PSA | Hemophilia |
| You administer 6 carps of 2% lido with 1:50,000 epi to a patient. Shortly after he complains of a headache and shakiness. What happened? | Epi overdose |
| What is the most common reaction to epinephrine? | Fear and enxiety |
| After administering anesthetic the patient complains of substernal tightness and itching. The patient begins to make wheezing noises. What is the most likely cause? | Anaphylaxis |
| If you inject into the parotid glad during an IA, if results in anesthetizing what nerve? | Facial nerve (VII) |
| What is the primary sensory nerve for the teeth? | Trigeminal (V) |
| What happened when a carp has a distended stopper and bubble? | it has been frozen |
| If a patient has an allergy to preservatives, what could she be allergic to in a carp of anesthetic? | Sodium bisulfite |
| Where to local anesthetics take action? | on the nerve sheaths (membrane) |
| What is the term when a patient losses numbness, you administer anesthesia again, and still doesn't get numb | tachyphylaxis |
| What property of anesthesia accounts for it's potency? | lipid solubility |
| What is a true allergic reaction to LA? | Ananphylaxis, uticaria |
| Which system is most susceptible to the actions of LA? | CNS |
| After giving an injection, the site of penetration becomes blueish. What is the likely cause? | Hematoma |
| True or False: Levonodefrin is absolutely contraindicated for people take tricyclic antidepressants. | True |
| Patient has pain in their chest and left side of their neck and subsides in 3-5 min. What is the situation? | Angina |
| How do you treat angina? | If no response from the 1st dose of nitro, you can give another dose in 2 min. (max. 3 doses). If then no response, call 911. |
| A 55 lbs child can receive how many carps of Mepivacaine 3%? | 2 carps |
| A 100 lbs person received 3 carps of 2% lido. Now the DDS wants to give Mepivacaine. How many more mg can the patient receive? | 200-108=92mg |
| How many carps of 2% lido with 1:100,000 epi can you give an ASA III cardiac patient? | 2 carps |
| Patient is anxious and running late to her appointment. A minute or so after given anesthetic, patient has cold hands and fingers. What is the problem? | Syncope |
| How do you treat a patient in syncope? | Supine position with legs above heart, ammonia, oxygen, 911 if needed |
| How can you prevent syncope from happening? | Recognize anxiety of patient, and reassure |
| What is an allergic reaction to topical? | Tissue sloughing and angioedema |
| IF you have a positive aspiration what you indicate the need to withdrawl and change carp? | If you are unable to see the next aspiration results |
| When giving a long buccal, what gets numb? | buccal mucosa of molars |
| Where do you inject for the long buccal? | distal and buccal to the most posterior molar |
| When you give an IA and all the teeth get numb EXCEPT the 1st molar. What is the issue? How do you correct it? | innervated my the mylohyoid nerve, use the Gow Gates |
| What gets numb when anesthesia is directed toward the incisive foramen? | NP, palatal tissues central to canine |
| How do you treat a hemotoma? | Direct pressue for 2+ min, ice, aspirin for soreness, will reside in 7-14 days |
| Where is the lingual nerve in relation to the IA nerve? | medial and inferior |
| After receiving and injection, the patient feels jittery and anxious. What is the the cause? | Injected into the blood stream, LA toxicity |
| What do you do if a patient state they have an allergy to LA? | assume patient is truely allergic, don't use any similar drugs, refer to Dr to be tested. No tx until know if it's a true allergy |
| Most common reaction to dental anesthesia? Positive and negative | Positive reaction: CNS depressant Negative reaction: vasodepressor, syncope, hyperventilation |
| If you give an IA injection of 3% Mepivacaine and the patient feels pain when dental tx begins. What is the problem? | Deposition site is too low |
| Why would you not give a patient an amide if their liver is comprimised? | Since amides are metabolized in the liver, they have a higher potential for toxicity |
| You give a GP and the patients' throat feels numb. What caused this? | LA dripped down throat or hit the medial palatine nerve |
| What foramen is for Trigeminal 2? Trigeminal 3? | Trigeminal 2: Rotundum Trigeminal 3: Ovale |
| Patient begins breathing rapidly and hands and fingers get cold. What is it? | Hyperventilation |
| How do you treat hyperventilation? | Stop tx., position patient upright, BLS if needed, remove items from mouth, cup hands and breath into hands (no paper bag) |
| You gave a patient 3 carps of 2% lido. How much anesthetic did they receive in mg? | 108mg |
| How many carps of 2% Lido with 1:50,000 epi can a 140 lbs person receive? | 5.5 carps |
| What is the purpose of a vasoconstrictor? | counteracts the effects of the vasodilating LA, keeps anesthetic in target area, promotes depth and duration to anesthesia |
| Which ingredient is the main cause of allergic reaction in anesthetic? | Sodium bisulfite |
| What factor reduces systemic toxicity? | Slow injections and negative aspirations |
| What steps do you do for the GP injection? | 27 gauge needle, clean, dry, topical for 2 min., apply pressure for 30 sec, insert anterior to GP foramen, deposit small amount until blanching occurs. |
| If 300 mg is the healthy dose of 3% Mepivacaine 1:20,000 levo, how many carpules can a 173 lbs man safely receive? | 8 carps |
| How much vasoconstrictor is given with 8 carps of 3% Mepivacaine with 1:20,000 levo | 0.72 mg |
| Prior to giving an injection, you notice small 1-2 mm bubbles in the cartridge. What does this indicate? | Nitrogen gas, no concern |
| What is the primary nerve for the mandibular 1st molar? | IA |
| A patient has asthma, allergies to cosmetics, etc. What topical can safely be administered? | Lidocaine - patch |
| Signs and symptoms of acute generalized anaphylaxis? | Pallor, palpitations, bronchospasm, tachycardia, tight chest |
| Which of the following cause vasodilation? -lidocaine -articaine -mepivacaine -procaine | All are vasodilating but esters are more vasodilating - Procaine |
| What injection is most appropriate for hemostasis when scaling 12 and 13? | MSA field block |
| How many mg of vasoconstrictor can a healthy adult receive? | 0.2mg |
| What anesthetic would you choose for a patient with uncontrollable hyperthyroid? | Anything without epi |
| What is a pertinent contraindication for a patient with a recent MI? | No tx. for 6 months |
| What is the preservative in 3% Mepivacaine? | There is no preservative in 3% Mepivacaine |
| The nerve that exits the mandibular foramen is a branch of what greater nerve? | IA |
| The maximum depth and angle on a PSA is where in regards to the pterygoid plexus? | Anterior |
| Where do you insert the needle for the MSA? | Height of the mucobuccal fold over the 2nd premolar |
| The DDS would like you to give 2% Mepivacaine to a 55 lbs child. How many carpules can you give them? | 55/150 x 8 = 2.9 2.5 carps |
| What is a relative contraindication for hyperthyroidism? | Sensitive to catecholamines |
| Patient with smaller facial features. What should you do to prevent a hematoma? | Less depth, don't penetrate into the pterygoid plexus |
| A patient is contraindicated to receive a vasoconstrictor. What anesthetic can be given? | 3% Mepivacain (plain), 4% Prilocaine (Citanest plain) |
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