Anesthesia and Nasal Cannula in Dentistry

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Questions and Answers

What is the purpose of a nasal cannula?

To administer general anesthesia

To monitor vital signs

To administer nitrous oxide sedation (correct)

To administer local anesthesia

What is the maximum needle penetration for maxillary injections in children?

Exactly 5 mm

More than 5 mm

Less than 2 mm (correct)

Exactly 2 mm

What is the most common dental office/clinic medical emergency?

Respiratory distress

Cardiac arrest

Syncope (correct)

Allergic reaction

What is the most common local anesthetic complication in children?

Biting of the lower lip Signup and view all the answers

What is the primary purpose of nitrous oxide sedation?

To reduce anxiety and fear Signup and view all the answers

What is the limiting drug in local dental anesthesia?

The drug that will limit the total volume of drug that can be administered Signup and view all the answers

What is the color of the tank for Nitrous Oxide?

Blue Signup and view all the answers

What is the MRD of epinephrine for a healthy patient?

0.2 mg per appointment Signup and view all the answers

What is the purpose of the Vazirani-Akinosi injection?

For patients with trismus (difficulty opening the mouth) Signup and view all the answers

Why is it necessary to give 100% O2 for at least 3-5 minutes at the end of nitrous oxide sedation?

To prevent diffusion hypoxia Signup and view all the answers

What is the insertion site for the Inferior Alveolar (IA) injection?

Long needle length, inserted 20-25 mm Signup and view all the answers

What is a contraindication for nitrous oxide sedation?

Pregnant patients Signup and view all the answers

What type of nerve fibers does the Mandibular branch of the Trigeminal nerve carry?

Sensory and Motor Signup and view all the answers

What is the minimum percentage of oxygen that should be maintained during nitrous oxide sedation?

25% Signup and view all the answers

What is the flow rate used for adult patients during nitrous oxide sedation?

5-6L/min Signup and view all the answers

What percentage of nitrous oxide has been shown to produce analgesia?

35-50% Signup and view all the answers

What are the two branches of the Inferior Alveolar (IA) nerve?

Mental nerve and Incisive nerves Signup and view all the answers

Which of the following is NOT a branch of the Trigeminal nerve?

Mylohyoid nerve Signup and view all the answers

Through which foramen does the Mandibular branch of the Trigeminal nerve exit the skull?

Foramen ovale Signup and view all the answers

What nerves are branches of the Inferior Alveolar Nerve?

Buccal nerve and lingual nerve Signup and view all the answers

What causes 'Lingual Shock' when giving an inferior alveolar nerve injection?

Moving the needle through the mandible and past the lingual nerve Signup and view all the answers

Which tooth or teeth may have a branch from the mylohyoid nerve and have problems with anesthesia?

Mandibular first molars Signup and view all the answers

What is the absolute maximum number of cartridges of Lidocaine/1:100,000 epi that can be given?

11 cartridges Signup and view all the answers

Who is known as the 'Father of Anesthesia'?

Dr. Horace Wells Signup and view all the answers

What is the purpose of a scavenger system in nitrous oxide sedation (N2O-O2)?

To collect and remove excess nitrous oxide Signup and view all the answers

Study Notes

Nasal Cannula and Anesthesia

A nasal cannula is a nose cone or mask used for administering nitrous oxide sedation.

Mandibular Anesthesia

In children, needle penetration for maxillary injections is LESS THAN 2 mm due to less dense maxillary and mandibular bones.
Supraperiosteal injections of the mandible can be used in children at the level of the plane of the mandibular teeth.
In adults, supraperiosteal injections work better in the maxilla than the mandible due to denser mandibular bone.

Local Dental Anesthesia

Most adverse reactions to local dental anesthesia occur within 5-10 minutes of injection.
The most common local anesthetic complication in children is biting of the lower lip.
Maximum Recommended Dose (MRD) is the limiting drug in local dental anesthesia, calculated using patient's weight, drug concentration, and amount of anesthetic in a standard cartridge.

Calculating MRD

To calculate MRD, you need the patient's weight, drug concentration as a percentage, and the amount of anesthetic in a standard cartridge.
Example: 2% Lidocaine = 2 x 10 x 1.8 mL in a standard anesthetic cartridge = 36 mg/mL.

Epinephrine MRD

Epinephrine MRD for healthy patients is 0.2 mg per appointment.
Epinephrine MRD for compromised patients is 0.04 mg per appointment.

Vazirani-Akinosi Injection

The Vazirani-Akinosi injection is used for patients with Trismus (difficulty opening the mouth).

Inferior Alveolar (IA) Injection

The IA injection is the most used injection in dentistry.
Insertion site for IA: Long needle length, inserted 20-25 mm.
The three landmarks for IA:
- Pterygomandibular raphe
- Mandibular plane of occlusion
- Coronoid notch

Branches of Inferior Alveolar Nerve

The IA nerve divides into two branches: Mental nerve and Incisive nerves.

Trigeminal Nerve (V)

The Trigeminal nerve has three branches:
- V1 – Ophthalmic
- V2- Maxillary
- V3- Mandibular
The Mandibular branch is the largest branch of Trigeminal and carries both sensory and motor nerve fibers.

Lingual Shock

Lingual shock occurs when moving the needle through the Asse and past the lingual nerve during an inferior alveolar nerve injection.

Mylohyoid Nerve

The mylohyoid nerve can cause incomplete anesthesia of mandibular first molars due to accessory innervation.

Nitrous Oxide Sedation

Nitrous oxide is used as an anxiolytic, anesthetic, and analgesic.
Tanks for Oxygen and Nitrous Oxide are colored green and blue, respectively.
100% O2 should be given for at least 3-5 minutes at the end of nitrous oxide sedation to prevent diffusion hypoxia.
Nitrous oxide sedation is generally considered to be a weak inhalation general anesthetic that can provide mild, moderate, or deep sedation but NOT general anesthesia.

Contraindications for Nitrous Oxide Sedation

Nitrous oxide is contraindicated in:
- Eye surgery recently using intraocular gas
- Pregnant patients (teratogenic)
- Severe respiratory compromise or obstruction
- Patients with a history of stroke, hypotension, and other cardiac conditions.

Scavenger System

A scavenger system in nitrous oxide sedation collects and removes excess nitrous oxide to prevent it from being vented back into the room.

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Description

This quiz covers the use of nasal cannula in anesthesia and mandibular anesthesia techniques, including needle penetration and supraperiosteal injections in children and adults.