Chapter 11: General Anesthetics

Which of the following dental specialists is most likely to use general anesthetic drugs in their offices?

A. Prosthodontist

B. Endodontist

C. Oral and maxillofacial surgeon

D. Orthodontist

E. Pediatric dentist

C. Oral and maxillofacial surgeon

Which of the following general anesthetic agents was introduced in the middle 1800s and led to a dramatic reduction in surgically related mortality?

A. Propofol

B. Isoflurane

C. Ether

D. Nitrous oxide

C. Ether

According to Guedel's description of the stages and planes of anesthesia, the induction period refers to stage

A. I.

B. II.

C. I and II.

D. I, II, and III.

E. None of the above is correct.

C. I and II.

Nitrous oxide, as used in the dental office, maintains the patient in stage _____ of Guedel's system of stages and planes.

A. I

B. II

C. III

D. IV

A. I

The loss of respiratory control (i.e., diminished carbon dioxide response, paralysis of intercostal muscles) first occurs during which of Guedel's stages of anesthesia?

A. Stage I

B. Stage II

C. Stage III

D. Stage IV

C. Stage III

Which of the following intravenous general anesthetic agents can be administered intramuscularly (IM)?

A. Methohexital (Brevital)

B. Ketamine (Ketalar)

C. Diazepam (Valium)

D. Propofol (Diprivan)

B. Ketamine (Ketalar)

Recovery from a single intravenous dose of methohexital (Brevital) is accelerated as a result of _______ to lean tissues.

A. drug excretion

B. drug redistribution

C. drug metabolism

D. enzyme induction

B. drug redistribution

The following are characteristics of propofol except which one?

A. Rapid onset of action

B. Produces little vomiting

C. Undergoes phase II metabolism in the liver

D. Intravenous anesthetic

E. Structurally related to barbiturates

E. Structurally related to barbiturates

Which of the following effects is not a characteristic of the action of ketamine?

A. Produces "dissociative" anesthesia

B. Causes xerostomia

C. Increases cardiac output

D. Causes recovery associated with delirium and hallucinations

B. Causes xerostomia

Which of the following is the major disadvantage of the use of opioids as an adjunctive drug to general anesthesia in preanesthetic medication?

A. Hypertensive crisis

B. Respiratory depression

C. Hallucinations

D. Salivary stimulation

B. Respiratory depression

Nitrous oxide has _____ onset and _____ solubility in blood.

A. rapid; high

B. rapid; low

C. slow; high

D. slow; low

B. rapid;low

Nitrous oxide combined with oxygen (N2O/O2) has become a primary part of dental office _____ procedures.

A. anxiety reduction

B. general anesthesia

C. sleep apnea

D. bruxism

A. anxiety reduction

The average percentage of nitrous oxide required for patient comfort is

A. 10%.

B. 25%.

C. 35%.

D. 50%.

C. 35%

At the termination of a N2O/O2 sedation procedure, the patient should be placed on 100% oxygen for at least _____ minutes.

A. 2

B. 5

C. 8

D. 11

B. 5

Diffusion hypoxia may occur if insufficient 100% oxygen is delivered at the termination of a nitrous oxide procedure because

A. the lungs are insufficiently inflated.

B. the loss of carbon dioxide could decrease ventilation.

C. nitrous oxide is highly soluble in blood.

D. nitrous oxide has a slow onset and recovery.

B. the loss of carbon dioxide could decrease ventilation.

The best indicator of the degree of sedation under nitrous oxide is

A. response to a painful stimulus.

B. percent nitrous oxide being delivered.

C. response to questions.

D. muscle tone.

E. eye movements.

C. response to questions.

The correct method for administration of nitrous oxide is to put the patient on

A. 100% oxygen for 2 to 3 minutes and then put the nitrous oxide level at 20% of the level of oxygen.

B. 100% oxygen for 2 to 3 minutes and then put the nitrous oxide level at 50% of the level of oxygen.

C. 100% oxygen for 2 to 3 minutes and add nitrous oxide in 5 to 10% increments until sedation is achieved.

D. 50% oxygen and 50% nitrous oxide.

E. 75% oxygen and 25% nitrous oxide.

C. 100% oxygen for 2 to 3 minutes and add nitrous oxide in 5 to 10% increments until sedation is achieved.

Nitrous oxide cylinders are _____ and oxygen cylinders are _____: (1) red, (2) green, (3) blue, (4) orange, and (5) tan.

A. 1; 2

B. 3; 2

C. 2; 4

D. 3; 4

E. 3; 5

B. 3;2

A patient for whom nitrous oxide is to be administered should be warned to avoid eating a large meal within _____ hours of the appointment.

A. 2

B. 3

C. 4

D. 5

B. 3

Nitrous oxide has been shown to reduce the activity of methionine synthetase, the enzyme involved with the function of which vitamin?

A. Vitamin B1

B. Vitamin K

C. Vitamin B6

D. Folic acid

E. Vitamin B12

E. Vitamin B12

Nitrous oxide is contraindicated for use in a patient with which of the following conditions?

A. Diabetes

B. Emphysema

C. Hypertension

D. Glaucoma

E. None of the above

B. Emphysema

Desflurane and sevoflurane have a low blood/gas partition coefficient. This means they have a more rapid onset and shorter duration of action than the other halogenated hydrocarbon anesthetics.

A. Both parts of the statement are true.

B. Both parts of the statement are false.

C. The first part of the statement is true; the second part is false.

D. The first part of the statement is false; the second part is true.

A. Both parts of the statement are true.

Which inhalational agent has a pungent smell and can cause respiratory acidosis with deeper levels of anesthesia?

A. Isoflurane

B. Halothane

C. Enflurane

D. Sevoflurane

E. Nitrous oxide

A. Isoflurane

Which of the following types of agents is used during balanced general anesthesia to help the patient pass from stage I to stage III and skip over the signs of stage II?

A. Ketamine

B. Propofol

C. Ultrashort-acting IV barbiturate

D. Opioids

c. Ultrashort-acting IV barbiturate

The more soluble the anesthetic is in body tissues, the more rapid the onset and recovery will be.

A. Both statements are true.

B. Both statements are false.

C. The first statement is true, the second is false.

D. The first statement is false, the second is true.

d. The first statement is false; the second is true.

Features of nitrous oxide administration include each of the following except one. Which is the exception?

A. Nitrous oxide has low solubility in blood.

B. Nitrous oxide alone is a good choice for a general anesthetic.

C. Nitrous oxide has a quick onset.

D. The patient will recover quickly following termination of administration of nitrous oxide.

B. Nitrous oxide alone is a good choice for a general anesthetic.

A patient should be given 100% oxygen for 5 minutes after treatment with nitrous oxide to prevent

A. neuropathy.

B. dissociative anesthesia.

C. diffusion hypoxia.

D. respiratory paralysis.

C. diffusion hypoxia

The correct method for administration of nitrous oxide is to put the patient on

A. 100% oxygen for 2 to 3 minutes and then put the nitrous oxide level at 20% of the level of oxygen.

B. 100% oxygen for 2 to 3 minutes and then put the nitrous oxide level at 50% of the level of oxygen.

C. 100% oxygen for 2 to 3 minutes and add nitrous oxide in 5 to 10% increments until sedation is achieved.

D. 50% oxygen and 50% nitrous oxide.

E. 75% oxygen and 25% nitrous oxide.

C. 100% oxygen for 2 to 3 minutes and add nitrous oxide in 5 to 10% increments until sedation is achieved.

A patient who has been administered nitrous oxide often will think the procedure is shorter than it was due to which quality of nitrous oxide?

A. Euphoria

B. Anesthesia

C. Analgesia

D. Amnesia

D. Amnesia

Which of the following are types of intravenous general anesthetics? (Select all that apply.)

A. Opioids

B. Enflurane

C. Etomidate

D. Isoflurane

E. Propofol

A.Opioids

C.Etomidate

E. Propofol

Which of the following are true of etomidate? (Select all that apply.)

A. It is a halogenated hydrocarbon for general anesthesia.

B. It is used for induction of general anesthesia.

C. It can cause adrenal suppression.

D. It produces dissociative anesthesia.

B. It is used for induction of general anesthesia.

C. It can cause adrenal suppression.

Which of the following are benzodiazepines that are used for conscious sedation and preanesthetic medication prior to general anesthesia? (Select all that apply.)

A. Diazepam (Valium)

B. Fentanyl (Sublimaze)

C. Midazolam (Versed)

D. Methohexital sodium (Brevital)

A. Diazepam (Valium)

C. Midazolam (Versed)

Which of the following statements are true about volatile general anesthetics? (Select all that apply.)

A. They are liquids that evaporate easily at room temperature.

B. They are classified as halogenated hydrocarbons and ethers.

C. They are known to have good solubility in body tissues.

D. They are administered intravenously (IV).

A. They are liquids that evaporate easily at room temperature.

B. They are classified as halogenated hydrocarbons and ethers.

The less soluble the anesthetic is in body tissues, the more rapid the _____. (Select all that apply.)

A. onset

B. breathing rate

C. heart rate

D. recovery

A. onset

D. recovery

What are the goals of surgical anesthesia? (Select all that apply.)

A. Good patient control

B. Adequate muscle relaxation

C. Reduced respiratory rate

D. Reduced cardiac output

E. Pain relief

A. Good patient control

B. Adequate muscle relaxation

E. Pain relief

The more soluble the anesthetic is in body tissues, the more rapid the onset and recovery will be.

True

False

False

Nitrous oxide is a complete anesthetic.

True

False

False

To prevent diffusion hypoxia, patients should be given 100% oxygen for 5 minutes after treatment with nitrous oxide.

True

False

True

Patients should be instructed to fast before a dental procedure using nitrous oxide.

True

False

False

Nitrous oxide has amnestic qualities.

True

False

True