P1-ANES SAS 2 & 3 INTRO & PAIN

Anesthesiology

Medical specialty concerned with total care of patient

Anesthesia, intensive care medicine, critical

emergency medicine and also pain medicine.

Anesthesiology encompasses the following

study and use of Anesthesia and Anesthetics to safely support

a patient’s vital function through the perioperative period

Core element of anesthesiology

perioperative period

time period of a patient’s surgical procedure

General, regional, local, sedation

Types of anesthesia

General anesthesia

Method of medically inducing loss of consciousness ( reversible depression of the central nervous

system) resulting in loss of sensation and response to all external stimuli in the whole body

Regional anesthesia

the anesthesia injected near a cluster of nerve to numb only a specific area of your body that

requires surgery when the patient is conscious.

Spinal block

subarachnoid block

intra dural block

intrathecal block.

Example of regional anesthesia

Local anesthesia

Temporary loss of sensation or pain in a circumscribed area of the body by topically applied or injected agent without depressing the level of consciousness.

Sedation

combination of medicines to help you relax ( a sedative) and to block pain ( an anesthetic )during medical or dental procedure.

1. Anesthesiologist

2. Anesthetist

3. Surgeons

4. Physicians

5. Dentists

6. Veterenarians

‘ who can administer anesthesia

Depression of excitation in nerve endings

Inhibition or blocking of the conduction process in peripheral nerves.

Modes of action of LA

produces loss of sensation without inducing a loss of consciousness

- the only method and substance that induces a transient and completely reversible state of anesthesia in our clinical practice.

Clinica significance of LA

1. Non- irritating

2. Reversible

3. Low degree of systemic toxicity

4. Potent Local Anesthetic

5. Rapid onset

6. Sufficient duration

7. Adequate tissue penetration

8. Low Allergic Reactions

9. Stable in solutions

10. Sterile or capable of sterilization

Properties of A

Compression of tissues

Low temperature

Anoxia

Chemical irritants

Chemical agents

Methods to induce Local Anesthesia:

Botulinum Toxin (Botox)

Muscle relaxant inhibits or blocks messages from Brain/ Spinal cord to the muscles

Pain

most commonly experienced symptom in dentistry.

-Duration

-Location

-Intensity

-Etiology

List the components that classify pain

-Acute pain

-Chronic pain

Pain based on duration:

Acute pain

Thsi type of pain is sudden onset, 1st pain

-Sharp

-Localized

-Thorbbing

What is the feeling of acute pain

A-delta fibers

In acute pain, the information is carried out through?

Delta fibers

which fiber is fast

Glutamate

What is the NT for acute pain

Chronic pain

THis pain is long lasting

Dull and aching pain

Feeling of chronic pain

C-fibers

In chronic pain, information is carried through?

Substance P

What is the NT of chronic pain

-Headache

-Joint

-Back

-Cardiac

-Atomach

-Referred

Pain based on location:

Referred pain

THis pain is felt in an area tater than the site of origin

Psychogenic pain

This pain profuced or caused by psychic or mental factors rather than organic factor

Phantom pain

This pain is felt on part of the body that has been lost

Somatic and visceral

In etiology, where is Nociceptive pain start or found

-Peripheral neuropathic pain

-Central neuropathic pain

In etiology, two categories of neuropathic pain

Nociceptors

THis is a receptor preferentially sensitive to a noxious stimulus

-Mild pain

-Moderate pain

-Severe pain

Pain based on intensity:

1-3

Pain scale reading: mild pain

4-6

Pain scale reading: moderate pain

7-10

Pain scale reading: Severe pain

Noxious stimulus

Pain would usually be initiated by?

Neuralgia

Pain present in the NERVE

Physioanatomical

What type of aspect does pain have for physiological processes and anatomical parts

Pain Perception

The physioanatomical aspect is involved in what perception?

Pain reaction threshold

Minimum intensity of the stimuli for it to be considered painful

Pain detection level

Other name for pain reaction threshold

High pain threshold

Type of threshold; hyporeactive px in response to stimuli

Low pain threshold

Type of threshold: hypereactive px in response to stimuli

Pain reaction tolerance

The Maximum intensity of pain a patient can tolerate without the need for intervation

Descarets-1644

Who develoepd the specific theory and date

Specific theory

THis theory describes pain systems as a straight-through channel from the skin to the brain

-pressure

-cold

-hot

-stretch

-touch/tactile

-pain

list the 6 specific cutaneous receptors

Von Frey

Who developed specific cutaneous receptors

Specific cutaneous receptors

What concept did Von Frey develop?

Nociceptors (pain receptors)

Presence of specific nerve ending for pain perception called

-Dorsal horns

-Anterior and lateral spinothamaic tracts

The Nociceptors would synapse in the _________ of the spinal cord and crossover to the ____________

Thalamus

Part of brain that is pain generation

Cerebral cortex

Part of brain that is pain localization

Goldscheider (1894)

Who developed pattern theory and date

Pattern theory

Theory that states Pain is not a separate entity but are produced by the over summation of other sensory input at the dorsal horn of the spinal cord

Melzack and wall 1965

Who proposed gate control theory and date

Gate control theory

What theory claims the existence of a so called "gate" in the spinal cord that controls the passage of information from periphery to brain

-Periphery

-Brain

Gate control theory would say the gate in the spinal cord controls the information from________ to __________

Dentinal sensitive

IN hydrodynamic theory, this is caused by direct stimulation of sensory nerve ending in the dentin which are primarily located near the pulp

DEJ

Most sensitive part of tooth where no nerve endings exist

nerve endings (near pulp) -> stimulated due to movement of dential fluids ( present in dentinal tubules)

What does Hydrodynamic theory suggest

stimuli-> periphery (skin or tooth)-> brain -> pain is interpreted

Interpret pathway of pain

Mechanical

What type of pain stimuli is most common in dentistry

-1st order neuron

-synapse

-2nd order neuron

-Thalamus

-3rd order neuron

-Cortex

Pathway of pain

1st order neuron

In pathway of pain, which part caries electrical impulse from periphery to spinal cord

Synapse

In pathway of pain, which part is Point of Communication between the primary and secondary neuron ( impulse converts from electrical to chemical)

2nd order neuron

In the pathway of pain, which part carries impulse from spinal cord to thalamus

Thalamus

In pathway of pain, which part Generates pain, Part of the brain that interprets the impulse

3rd order neuron

In pathway of pain, which part carries impulse from thalamus to cortex

Cortex

In pathway of pain, what part is responsible for pain localization

Supraspinal

What mode does opioid anagesics have where they depress the cortex so the brain can not lo

Descending neuron

In descending modulatory pathway, what inhibits production of neurotransmitters in the 1st order neuron

Interneuron

What does descending neuron activate?

-Inhibit neutrotransmitter production in the 1st order neuron

-Prevent depolarization of 2nd order

MOA of endogenous opioids

Spinal

what mode of action in modulatory pathways of pain is considered indirect

-Tissue injury

-Inflammation

Inflammation and pain, what leads to production of numerous chemicals at the site of injury

Prostaglandin

This is one of the chemicals produced that causes sensitization of free nerve endings( nociceptors)

-Age

-Gender

-Race

-Fatigue

-Emotional stability

-Fear and apprehension

Psychological factors that affects pain reaction

-Removal of cause

-Blocking the pathway of painful impulses

-Raising the pain threshold

-Preventing pain reaction by cortical depression

-Using psychosomatic method

List metohds of pain control