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Local Anesthesia

WREB Anesthesia Questions 2015

QuestionAnswer
What would you give a patient that had done methaphetamine 12 hours ago? No contraindications
What organ would the CVS affect? Heart
When giving the IA injection you should deposit the anesthetic where? superior to the mandibular foramen
If you don't touch the bone when giving an IA injection you could? The needle tip may be resting within the parotid gland near the facial nerve (Cranial nerve 7). Transient paralysis of the facial nerve is produced if the solution is deposited.
When giving the ASA injection you should insert where? Height of the mucobuccal fold directly over first premolar.
What does a local anesthetic conduction block do? block sodium movement through sodium channel, thus block nerve conduction. Primary action of local anesthetics in producing a conduction block is to decrease the permeability of the ion channels to sodium ions.
What anesthetic is the greatest vasodilator? Procaine or Novocaine
When administering the PSA how much anesthetic should you deposit? .9-1.8 ml
You give a patient three carpules of lidocaine 2%, how many did you administer? 36 mg X3= 108 mg
A patient has had allergies in the past to cosmetic products. What anesthetics would you want to avoid? Esters due to PABA
You gave the patient three carpules, they’re not numb, you give them more and it has no effects. What is most likely the cause? Tachyphylaxis (an increased tolerance to a drug that is administered repeatedly)
Why do you take a patient’s vital signs at the beginning of each appointment Baseline in case of an emergency
Syncope- most common dental medical emergency, can be prevented by correct patient positioning
Mandibular division of the Trigeminal nerve exits through what cranial foramen? Foramen ovale
Maxillary division of the Trigeminal nerve exits through what cranial foramen? Foramen rotundum
Your patient comes in with limited opening, what injection should you give them? Vaxirani-Akinosi
Concerns with alcoholics? Could have liver problems, would have a hard time excreting amides because they are metabolized in the liver…? Significant liver dysfunction or heart failure represents a relative contraindication to the administration of amide LA drugs.
What injection would you give to anesthetize the first mandibular premolar IA nerve block
A patient has a periapical abscess on #14. Why is anesthetic not as ikely to work in that area and where would you anesthetize? It’s not as likely to work because of the infection, the PH would be lower, give a PSA?
Contraindication for levonordefrin (and norepinephrine) would be trycyclic antidepressants!!!
What would you give a patient with contraindications to epinephrine? Levonordephrine Plain
You have a patient that has daily chest pain and diabetes. What would you have readily available? Nitroglycerin and sugar or glucose
What would you give a patient that had chest pain on the left that extends to the neck for 3-5 min? Nitroglycerin
Epinephrine remains the most effective and used vasoconstrictor Clinically used frequently for hemostasis in the 1:50,000 concentration. It is the drug of choice for management of acute asthmatic episodes (bronchospasm) Contraindicated in hyperthyroidism.
Norepinephrine Produces intense peripheral vasoconstriction Increases BP, decreases heart rate, so not effective for bronchospasm. Norepinephrine is used as a vasoconstrictor in management of hypotension
T/F The use of a mixture of epinephrine and norepinephrine is to be absolutely avoided True
Levonordephrine closely resembles norepinephrine contains sodium bisulfite, produces less cardiac and CNS stimulation than does epinephrine
T/F The administration of either levonordefrin or norepinephrine is absolutely contraindicated in patients receiving tricyclic antidepressants. True
What do you recommend for a patient who has Trismus? Heat and light exercise
What would you give your pt. if they were experiencing anaphylaxis? epinephrine
What happens if you give a pt. with hyperthyroidism too much of a vasoconstrictor, what can it lead to? Thyroid storm
Thyroid storm life-threatening health condition that is associated with untreated or undertreated hyperthyroidism. individual's heart rate, blood pressure, and body temperature can soar to dangerously high levels.
Pt. has previously had allergies to wine or salad bar. What is this from? Sodium Bisulfite
What would you give a pt. who cannot have a vasoconstrictor, or were just there for a short procedure? Mepivicaine 3% plain Lidocaine plain has a very short duration, depends on length of appt
The pt. has a relative contraindication to an anesthetic. What do you do? You can use it in a limited amount, do not exceed MRD
A patient needs levonordefrin, what anesthetic would you give them? Mepivicaine 2%
If bone is not contacted during an IA injection, the needle tip is usually located too far posterior. To correct this: you should place the needle more: Anteriorly
When do you administer a buccal nerve block? It is commonly given following an IA, but it is only indicated when manipulation of the tissues is contemplated. For ex. Scaling, curettage, etc. Only when the buccal soft tissues need to be anesthetized
What is the absolute MRD for Articaine? 500
After receiving more of a local anesthetic with epinephrine, your healthy patient becomes really talkative, their muscles start twitching, and they end up convulsing and become unconscious. What is the reason for this? toxic reaction
Your patient has had reactions with dried fruit and red wine in the past. What topical anesthetic would be indicated? Lidocaine
What would be a contraindication for giving a PSA nerve block? Hemophilia
What is the FDA regulation amount for local anesthetic in a cartridge? 1.8 ml
When giving a Gow Gates injection, what information should be explained to your patient? Your patient will have to keep their mouth open wide for two minutes
Your patient has high blood pressure but it is controlled with medication. After giving her a local anesthetic she said her lower eyelid began to feel weird and she couldn’t close her eye all the way. What do you tell the patient? She may experience swelling for the next 12 hours ?
What modifications would you make for anesthetizing a child? Penetrations not as deep as for an adult
How does initial depolarization decrease pain to the patient? decreases the pain threshold
In what situation could you give a patient a normal dose of epinephrine? The patient has a pacemaker (Don’t think there is a contraindication for it?)
Dental work is going to be done on the mandibular anterior area, what injections would you do to anesthetize this area? MI (bilaterally)
Created by: daisenmurray