Anesthesia sectional #3 helpful hints

Compared to a cartridge of LA with 1:100,000 epinephrine, how much epi does a cartridge of 1:200,000 have?

1:200,000 epi. has HALF the amount of epi. as a cartridge of 1:100,000

What is the maximum dosage for a cardiac pt?

2 carts. of epi 1:100,000 (18)

Can epi be used if pt. has cardiac dysrhythmias?

No, epi is relatively contraindicated for pts. w/ cardiac dysrhythmias because epi is usually never administered by itself. Lidocaine is a stabilizing drug for cardiac dysrhythmias so the effects cancle each other out

What nitrous % affects the majority of pts?

95% of population will achieve desired level of sedation at 50% or less

What symptoms are seen at desired levels of nitrous?

• overall relaxation, tingling of fingers or toes, tongue

• conscious and muscles-relaxed

• feeling of well-being, euphoria

• stable vitals

• warm sensation

• voice change due to effects on tympanic membrane

• pain control

• heaviness or floating feelings

How are nitrous/oxygen tanks labeled and stored?

Oxygen

• Green tank

• 2,000 psi pressure

• gas state

• 625 L in E cylinder

Nitrous

• blue tank

• 750 psi

• liquid/gas state

• 1,600 L in E cylinders

What are the ideal properties of nitrous?

• Poorly soluble in blood

  • faster onset, quicker offset

Syncope

• definition?

• causes?

• treatment?

• temporary loss of consciousness (fainting)

• most common dental emergency encountered

• causes: cessation of blood flow to the brain due to anxiety, hypotension, dehydration, medications, hypoglycemia

• treatment:

  • Position: supine/feet elevated

  • circulation: monitor vitals

  • airway/breathing: 100% oxygen

  • Drugs if needed (aromatic ammonia, ephedrine, atropine, bradycardic)

Allergic reactions/ anaphylaxis

• causes?

• signs/symptoms?

• treatment?

allergic reaction/ anaphylaxis

• causes: foods, drugs, latex, idiopathic

• signs/symptoms: fever, angiodema, dyspnea, wheezing, extremely low BP

• treatment: Call 911

  • position: conscious- comfortable; unconscious- supine

  • circulation: monitor vitals

  • airway/breathing: administer 100% oxygen

  • drugs: epi, albuterol, benadryl, steroids, IV fluids, antihistamines (mild)

  • transport to ER

Trismus

• causes?

• managment?

• prolonged tetanic spasm of the jaw muscles by which the normal opening of the mouth is restricted (locked jaw)

• Causes:

  • Most common: trauma to muscles or blood vessels in the infratemporal fossa secondary to the dental injection of LA

  • cross- contamination (alcohol)

  • hemorrhage: the more needle penetrations, the greater the probability of tissue damage and/or hemorrhage

• Prevention:

  • proper technique

  • affective amount of anesthetic

  • not always preventable

• Management:

  • Arrange an appt. for evaluation

  • treat with heat therapy, warm saline rinses, analgesics and muscle relaxants, anti-inflamatory meds, antibiotics

  • physical therapy

  • record incident in chart

  • no relief: OMFS evaluation

Management of peri-injection site lesions/sores

supportive care of the symptoms

• rule out infection

• pain management

may last 7-10 w/ or w/out treatment

Herpes/ Stomatitis may cause

What is the most common injection complications?

Post injection pain

What are some PDL injection complications?

• evulsion of tooth

• post injection pain

• damage/ infection

• NO soft tissue injury

CPR compressions

CPR (5 cycles):

1 cycle = 30 chest compressions and 2 rescue breathes

• Chest compressions need to be 100/minute

• minimize interruptions in chest compression

Atypical pseudocholinesterase deficiency and LA

pt. cant metabolize esters

• procaine

• novocaine

• tetracaine

• benzocaine

• cocaine

can only take amides

Absolute VS relative contraindications for nitrous

Absolute:

• inability to use a nasal mask

• inner ear infection or recent inner ear surgey

• pneumothorax

• patient refusal

Relative:

• psychiatric disorders

• drug use: pts seeking euphoria

• severe CPD (Chronic Obstructive Pulmonary Disease)

• pregnancy

• bowel obstruction

Intravascular injection effects

• LA toxicity

• cardiac and cns effects

Evaluation of adequate nitrous flow rates

• Have pt breathe in 100% oxygen for approx. 5 mins

• use reservoir bag as an indicator

Documentation

Nitrous:

• Document the final tritaion of nitrous used during the procedure as well as the start and stop time

• document the length of the post-oxygenation period

• provide commentary or observations re: the pt during the sedation

Complications of LA:

• post- injection intraoral lesions

• infection

What does PCABD stand for?

P- Position: optimize blood flow to the brain

• conscious: semi-supine/ comfortable

• unconscious: supine or trendelenberg (feet elevated)

C- Circulation: adequate blood flow to vital organs

• check for pulse, no pulse begin CPR/ call for AED

A- Airway: establish airway patency

• unconscious: head tilt/ jaw thrust

B- Breathing: adequate inflation and deflation of lungs

• conscious: 100% oxygen

• unconscious: evaluate for 10 seconds for chest rise, 100% oxygen

D- Drugs/ Defibrillate: stabilization of vital signs and resoration of perfusing rhythm

• only if necessary: use appropriate dose/drug

Seizures

• symptom of LA overdose

• sign of hypoglycemia

Hypoglycemia

• blood glucose <70 mg/dL

• causes: prolonged fasting, improper DM drug use

• signs/symptoms:

  • shakiness, nervousness, tremor

  • palpitations, tachycardia

  • sweating, pallor, coldness, clamminess

  • hunger, nausea, vomiting

  • headache, impaired judgement, altered mental status

  • seizures, unconsciousness

• treatment:

  • drugs

LA overdose

blood or plasma levels of LA reach levels that result in CNS depression followed by cardiovascular depression

• Causes: administration of LA in highly vascular areas

  • not aspirating before depositing

  • administering dosages greater than recommended volumes

  • drug - drug interactions which result in increased plasma levels of LA

• Signs and symptoms: CNS excitation, CNS depression, agitation, slurred speech, sweating, vomiting, loss of consciousness, tonic. - clonic seizures, respiratory arrest, cardiac arrest

Treatment: Mild OD

• PCABD (drugs not usually indicated)

Treatment: Severe OD

• PCABD

• management is based on presence or absence of convulsions

• immediately summon EMS

Nitrous flow meter components

• 2 parallel tapering tubes (Blue: Nitrous, Green: Oxygen)

• floating ball indicates amount of gas being delivered

  • middle of the ball is the reference point

• flow rate: L/min

What is the biggest predictor of poor pain control in kids

Anxiety is the biggest predictor of poor pain control

Buffering anesthetics

• increases the amount of active anesthetic (RN) within the cart

• changes the pH of injection solution

• benefits: greater pt comfort, more rapid onset (1-2mins), decreased post injection tissue injuring

Oraquix Max. recommended dosages

• 1 cart. per quadrant

• Max. recommended dosage per appointment is 5 carts (8.5 grams)

Managment of prolonged numbness

Reassurance:

• speak directly w/ pt

• explain what parethesia is and its prevalence

• bring pt. in for eval

• consult w/ DDS or specialty for plan of action