Local Anesthsia CH. 10 Physical and Psychological Evaluation PG. 139-156
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| 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.
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| Local anesthetic actions include depressant effects on excitable membranes like what? | CNS and CVS
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| What are the two most common occurring psychogenic reactions? | Vasopressor syncope and hyperventilation.
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| 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.
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| When is it more difficult to achieve adequate analgesia? | Chronic pain or inflammation is present.
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| What is prudent to include in the medical history along prescription medications? | Nonprescription drugs, and herbal remidies
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| ASA IV | patients who demonstrate disability, undue fatigue, shortness of breath at rest
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| ASA III | unable to complete normal functions without disability
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| ASA III and IV are more likely to demonstrate some degree of what? | Liver perfusion leading to increase half-life of amide local anesthetics.
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| ASA III and IV heart failure patients are less tolerant to what, having a decreased functional reserve? | Stress
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| What is the ideal positioning for a patient receiving local anesthetics? | supine
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| 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?
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| Angina Pectoris | Transient chest pain produced by myocardial ischemia, relieved by rest of the administration of a vasodilator.
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| What may provoke an anginal episode? | anxiety, or inadequate pain control that increases myocardial oxygen requirements
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| Are vasopressors in local anesthetics contraindicated in stable angina? | No, can use a judicious amount.
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| T/F Hypertensive patients should have their blood pressure monitored at each appointment and be manages according to the most recent reading | True
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| 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
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| The presence of a prosthetic heart valve indicates the need for what? | Antibiotic prophylaxis before any dental care.
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| The presence of methemoblobinemia congenital or idopathic represents a relative contraindication to what local anesthetic? | Prilocaine
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| Use of minimal effective doses of local anesthetic with vasoconstrictors is indicated with what? | Cerebrovascular accident (CVA), transient ischemic attack (TIA)
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| Patients who are clinically hyperthyroid are sensitive to what? | catecholamines and may demonstrate an exaggerated response to vasopressors included in local anesthetic solutions.
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| 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
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| 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.
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| What can severe overdose reactions of local anesthetics manifest themselves as? | Generalized tonic-clonic convulsions
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| If local anesthetics are carefully administered they could be used as what? | anticonvulsants in a patient during grand mal seizures.
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| T/F Malignant Hyperthermia (MH) represents a relative contraindication to dental care | True
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| Atypical plasma cholinesterase represents a relative contraindication to what type of anesthetics? | Ester
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| When is there a relative contraindication to pregnancy? | During the first trimester
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| T/F Local anesthetics and vasopressors are not teratogens and may be administered to pregnant patients during any trimester. | True
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| What are the six vital signs? | blood pressure, heart rate and pulse, respiratory rate, temperature, height, and weight.
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| 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.
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| 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.
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| A relative contraindication to administering epinephrine containing local anesthetics is what? | Cardiac dysrythmias unresponsive to medical treatments
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| Epinephrine and catecholamines may provoke what leading to a lethal dysrythmias? | irritability
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| 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.
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| 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.
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| T/F Minimal local anesthetics should be administered with patients with cimetidine, ASA III + CHF | True
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| What type of anesthetics can inhibit the bacteriostatic action of the sulfonamides? | Ester local anesthetics
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| Methemoglobin results when what is administered in excessive dosages? | Prilocaine
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| The administration of norepinephrine and levonordefrin should be avoided in patients taking what? | TCA's (Tricyclic Antidepressants)
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| 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.
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| Local anesthetics containing a vasopressor should not be administered to a patient that has done what on the day of their dental appointment? | Cocaine
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| Malignant Hyperthemia (MH) is a relative contraindication what what type of local anesthetics? | Amides
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| Atypical plasma cholinesterase represents what type of contraindication to ester local anesthetics? | Relative contraindication
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| What topical anesthetic can cause methemglobinemia to occur? | Benzocaine
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| What is the diagnosis of methemglobinemia? | cyanosis and a distinctive brown color of arterial blood.
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