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Anesthesia
Local Anesthsia CH. 10 Physical and Psychological Evaluation PG. 139-156
| Question | Answer |
|---|---|
| Before starting any dental therapy, what must be determined? | If the patient can tolerate, both physically and psychologically, the planned dental procedures in a relative safety. |
| Local anesthetic actions include depressant effects on excitable membranes like what? | CNS and CVS |
| What are the two most common occurring psychogenic reactions? | Vasopressor syncope and hyperventilation. |
| As a general standard of care, what does the dentist have the patient do? | Complete a medical history at initial office appointment and update regularly every 6 months. |
| When is it more difficult to achieve adequate analgesia? | Chronic pain or inflammation is present. |
| What is prudent to include in the medical history along prescription medications? | Nonprescription drugs, and herbal remidies |
| ASA IV | patients who demonstrate disability, undue fatigue, shortness of breath at rest |
| ASA III | unable to complete normal functions without disability |
| ASA III and IV are more likely to demonstrate some degree of what? | Liver perfusion leading to increase half-life of amide local anesthetics. |
| ASA III and IV heart failure patients are less tolerant to what, having a decreased functional reserve? | Stress |
| What is the ideal positioning for a patient receiving local anesthetics? | supine |
| When should myocardial patients (ASA IV) not receive dental elective dental care? | 6 months of an MI because reinfarction is more likely to occur during this time? |
| Angina Pectoris | Transient chest pain produced by myocardial ischemia, relieved by rest of the administration of a vasodilator. |
| What may provoke an anginal episode? | anxiety, or inadequate pain control that increases myocardial oxygen requirements |
| Are vasopressors in local anesthetics contraindicated in stable angina? | No, can use a judicious amount. |
| T/F Hypertensive patients should have their blood pressure monitored at each appointment and be manages according to the most recent reading | True |
| Who are acceptable for risk of dental care including use of local anesthetics with vasopressors? | Patients with mild to moderate elevations in systolic or diastolic pressure |
| The presence of a prosthetic heart valve indicates the need for what? | Antibiotic prophylaxis before any dental care. |
| The presence of methemoblobinemia congenital or idopathic represents a relative contraindication to what local anesthetic? | Prilocaine |
| Use of minimal effective doses of local anesthetic with vasoconstrictors is indicated with what? | Cerebrovascular accident (CVA), transient ischemic attack (TIA) |
| Patients who are clinically hyperthyroid are sensitive to what? | catecholamines and may demonstrate an exaggerated response to vasopressors included in local anesthetic solutions. |
| If a patient may be unable to open his or her mouth adequately thus making some injection technique impossible, what do you do? | Vazirani-Akinosi, closed mouth mandibular block or extraoral nerve blocks |
| What is significant with liver dysfunction and local anesthetics? | The half life of the amide local anesthetics may be significantly prolonged, thereby increasing the risk of overdose. |
| What can severe overdose reactions of local anesthetics manifest themselves as? | Generalized tonic-clonic convulsions |
| If local anesthetics are carefully administered they could be used as what? | anticonvulsants in a patient during grand mal seizures. |
| T/F Malignant Hyperthermia (MH) represents a relative contraindication to dental care | True |
| Atypical plasma cholinesterase represents a relative contraindication to what type of anesthetics? | Ester |
| When is there a relative contraindication to pregnancy? | During the first trimester |
| T/F Local anesthetics and vasopressors are not teratogens and may be administered to pregnant patients during any trimester. | True |
| What are the six vital signs? | blood pressure, heart rate and pulse, respiratory rate, temperature, height, and weight. |
| A person with a blood pressure of 200.115 should not do what? | Not undergo invasive elective dental treatment until BP is under a safe limit. |
| What could the administration of local anesthetics do to a patient if they have extreme high blood pressure? | Further elevate the blood pressure of an already anxious patient. |
| A relative contraindication to administering epinephrine containing local anesthetics is what? | Cardiac dysrythmias unresponsive to medical treatments |
| Epinephrine and catecholamines may provoke what leading to a lethal dysrythmias? | irritability |
| What does cimetidine (H2-receptor blocker) modifies the biotransformation of lidocaine by competing with it for binding to hepatic oxidative enzymes resulting in what? | Increase in half-life of the circulating local anesthetics. |
| Interaction between amide local anesthetics and cimetidine might be of greater clinical significance in the history of CHF why? | Percentage of cardiac output delivered to the liver falls while the percentage of cardiac output to the brain increases. Local anesthetic overdose is also increased. |
| T/F Minimal local anesthetics should be administered with patients with cimetidine, ASA III + CHF | True |
| What type of anesthetics can inhibit the bacteriostatic action of the sulfonamides? | Ester local anesthetics |
| Methemoglobin results when what is administered in excessive dosages? | Prilocaine |
| The administration of norepinephrine and levonordefrin should be avoided in patients taking what? | TCA's (Tricyclic Antidepressants) |
| Administration of vasopressors in patients being treated with nonselective b-blockers increase the likelihood of what? | serious elevation of the blood pressure accompanies by a reflux bradycardia. |
| Local anesthetics containing a vasopressor should not be administered to a patient that has done what on the day of their dental appointment? | Cocaine |
| Malignant Hyperthemia (MH) is a relative contraindication what what type of local anesthetics? | Amides |
| Atypical plasma cholinesterase represents what type of contraindication to ester local anesthetics? | Relative contraindication |
| What topical anesthetic can cause methemglobinemia to occur? | Benzocaine |
| What is the diagnosis of methemglobinemia? | cyanosis and a distinctive brown color of arterial blood. |
Created by:
daisenmurray
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