OMFS805: Comprehensive Control of Pain and Anxiety Final Information (Does not Include Nitrous )

Psychogenic Pain

related to emotional, mental issues

Neuropathic Pain

nerve injury

Nociceptive Pain

somatic and visceral

Transduction

stimuli into nerve impulse

Pressure Nerve Fiber Susceptibility

A > B > C

Hypoxia Nerve Fiber Susceptibility

B > A > C

Local Anesthesia Nerve Fiber Susceptibility

C> B > A

Transmission

nociceptors pass to dorsal horn of spinal cord and synapse with spinal neurons which carry impulse to thalamus

Allodynia

pain due to stimulus that does not normally cause pain

Dysthesia

unpleasant abnormal sesnation which can be spontaneous or provoked

Hyperalgesia

increased response to stimulus that is normally painful

Paresthesia

lack of sensation to normal of painful stimuli

Specific Receptor Theroy

LA acts by binding to specific receptor binding site present on the sodium channels, specific receptor binding site are present on either the external or internal surface of the sodium channels

Membrane Expansion Theory

LA are highly lipid soluble and easily penetrate the lipid portion of the cell membrane.

This causes expansion of the nerve membrane and results in a decrease of the diameters of the sodium channel

This inhibits the influx of sodium and nerve impulse generation

Fibers in MANTLE BUNDLES

MOLAR

Fibers in CORE BUNDLES

CHIN, CANINE

Molars anesthetize ___ and more _______

first

easily

Canines and anterior teeth anesthetize ___ and with more ____

later

difficulty

Pharmacodynamics

action of a drug in the body "What the drug does to the body

Pharmacokinetics

manner in which the body manages a drug

Bupivacaine

Marcaine

Etidocaine

Duranest

Lidocaine

Xylocaine

Mepivacaine

Carbocaine

Prilocaine

Citanest

Articaine

Septocaine

pKA factor on LA

time to onset

Lipid Solubility

potency

Protein binding

duration

Vasoactivity

duration and potency

LA Overdose is _____

Biphasic

What is affected first in a LA overdose

CNS before CVS

Dilution of Vasoconstrictors is expressed as a dilution ratio of ___:_____

grams : milliliters

ex: 1:1000= 1 gram in 1000ml

1 gram = ____ mg

0.01

If you have a 1:100,000 what is the dilution ratio?

1 gram : 100,000 mL

= 0.01 mg: 100,000 mL

1 Carpule = ____ mL

1.7

Maximum Dosage of Vasoconstrictor in a Healthy Person

0.2 mg

11 cartridges @ 1:100,000

5 cartridges @ 1: 50,000

Maximum Dosage of Vasoconstrictor in an Immune Compromised Person

0.04 mg

2 cartridges @ 1: 100,000

Absolute Contraindications of LA/ Epi

uncontrolled hyperthyroidism

malignant HTN

Pheochrromocytoma

Lidocaine 2% 1:100,000 epi

Lidocaine 2% 1:50,000 epi

Marcaine 0.5% 1:200,000 epi

Articaine 4% 1:100,000 epi

Articaine 4& 1:200,000 epi

Carbocaine 3% plain

Carbocaine 2% with Levonordorfen

MRD Lidocaine (Xylocaine) for Adult

7 mg / kg

MRD Lidocaine (Xylocaine) for Kid

4.4 mg/kg

MRD Mepivacaine (Carbocaine, Polocaine)

5.7 mg/kg with/out epi

400 mg total

MRD Bupivacaine HCl (Marcaine )

2 mg/ kg

90 mg total

MRD Articaine (Septocaine)

7 mg/ kg

500 mg total

MRD Prilocaine (Citanest)

8.8 mg / kg with/out epi

600 mg total

Methemoglobinemia

cyanosis like state that occurs as a result of too much methemoglobin

form of hemoglobin in which the ferric form of iron (Fe+++) is present

Nerve Block

depositing the LA solution within close proximity to a main nerve trunk

Field Block

depositing the LA in proximity to the larger nerve branches

Local Infiltration

small terminal nerve endings are anesthetized

Needle Gauges

25, 27, 30

Needle Lengths

long 40 mm

short 25 mm

Long Needle Uses

Nerve Blocks

Short Needle Uses

infiltration, isolated long buccal, PDL, intraseptal, intrapulpal

Dental Cartridges have about ___ cc / cartridge

1.7 cc (not marcaine 1.8)

How long do you leave benzocaine on for?

5 minutes

Supraperiosteal Injection

Posterior Superior Alveolar Nerve Block

1st molar ( not MB root), 2, and 3 rd molar

Middle Superior Alveolar Nerve Block

1st premolar, 2nd premolar, MB1 of 1st molar

Anterior Superior Alveolar Nerve Block

Infraorbital Nerve Block

Greater Palatine Nerve Block

molars

Nasopalatine Nerve Block

anterior

Inferior Alveolar Nerve Block

Buccal Nerve Block

Mental Nerve Block

PDL Injection

anesthesia of a single tooth are localized raea through diffusion through soft tissue and bone adjacent to PDL

Intraosseous Injection

deposition of solution into the interproximal bone between two teeth

intrapulpal injection

injection directly into the pulp chamber or root of tooth after exposure surgically or pathologically

Hematoma

Syncope

decrease BP, HR, and cerebral perfusion

Management of Syncope

lay flat and bring the chair downward towards head

oxygen

vitals

Pulse Oximetry

oxygen saturation and HR

EKG White on the __

Right

EKG Black on the __

left

"smoke above fire"

EKG Green on the __

bottom right below white

Capnography

exhaled oxygen

Short Acting LA

Procaine

Benzocaine

Proparacain

Intermediate LA

Lidocaine

Mepivacaine

Prilocaine

Articaine

Long Acting LA

Bupivacaine

Analgesic

acting to relieve pain

Anesthesia

insensitivity to pain

Intravenous Sedation

sedation obtained by giving medication directly into the venous circulation

IV sedation can be __, ___,__, or __

min

moderate

deep

GA

T/F: Local anesthesia is not necessary for IV sedation

FALSE

Venipuncture Placement Complications

vasospasm

hematoma

arterial puncture

Intraop Venipuncture Complications

air embolism

infiltration

extravascular drug administration

intra-artial injection of medicaiton

What do you do if a patient has an air embolism?

place pt on right side facing up

Post Op Venipuncture Complications

phebitis

phlebothrombosis

thrombophlebitis

What are common IV Sedation agents?

Benzodiazepines

Opiods

General Anesthetic Agents

Benzodiazepines

Diazepam

Midazolam

What is the main benzo used for sedation?

Midazolam

What is the reversal of Midazolam?

Flumazenil

Opiods

Morphine

Fentanyl