Podcast
Questions and Answers
Use of propofol or ketamine would automatically categorize a sedation procedure as deep sedation, based on the medication used.
Use of propofol or ketamine would automatically categorize a sedation procedure as deep sedation, based on the medication used.
False (B)
Patients receiving prilocaine, articaine, benzocaine, nitrates, or sulfa antibiotics may be at risk for:
Patients receiving prilocaine, articaine, benzocaine, nitrates, or sulfa antibiotics may be at risk for:
- SARS-Co-V2 infection
- Cholecystitis
- Methemoglobinemia (correct)
- Local anesthetic toxicity
On the capnographic wave form, an upward slope of the plateau commonly indicates:
On the capnographic wave form, an upward slope of the plateau commonly indicates:
- Hypoventilation
- Methemoglobinemia
- Hyperventilation
- Airway obstruction (correct)
A metabolic equivalent score (METS) greater than _____ indicates good cardiac reserve and low cardiac risk, according to the Duke Activity Status Index.
A metabolic equivalent score (METS) greater than _____ indicates good cardiac reserve and low cardiac risk, according to the Duke Activity Status Index.
Which of the following should NOT be considered in management of bronchospasm?
Which of the following should NOT be considered in management of bronchospasm?
What volume of D50 would you administer if you intend to provide 25 grams of dextrose to the patient?
What volume of D50 would you administer if you intend to provide 25 grams of dextrose to the patient?
As discussed in MAJ Jenzer's lecture, a normal patient with an oxygen saturation of 90% would be expected to have a partial pressure of oxygen of approximately ______ mm Hg.
As discussed in MAJ Jenzer's lecture, a normal patient with an oxygen saturation of 90% would be expected to have a partial pressure of oxygen of approximately ______ mm Hg.
Which of the following would NOT be considered appropriate in the management of laryngospasm?
Which of the following would NOT be considered appropriate in the management of laryngospasm?
What is the initial dose of flumazenil?
What is the initial dose of flumazenil?
After the first dose of flumazenil, what should the additional doses be (if needed)?
After the first dose of flumazenil, what should the additional doses be (if needed)?
What is the concentration of naloxone (supplied in the bottle)?
What is the concentration of naloxone (supplied in the bottle)?
Which of the following could be used to manage intraoperative hypertension? (Select all that apply)
Which of the following could be used to manage intraoperative hypertension? (Select all that apply)
What is the onset of fentanyl?
What is the onset of fentanyl?
What is the duration of fentanyl?
What is the duration of fentanyl?
What is the initial dose of naloxone?
What is the initial dose of naloxone?
Army dental specialists follow Guidelines for Teaching Pain Control and Sedation to Dentists and Dental students and Guidelines for the Use of Sedation and General Anesthesia by Dentists produced by which of the following entities?
Army dental specialists follow Guidelines for Teaching Pain Control and Sedation to Dentists and Dental students and Guidelines for the Use of Sedation and General Anesthesia by Dentists produced by which of the following entities?
What would be the ASA physical status classification of a patient presenting with a systemic illness that causes some functional limitations?
What would be the ASA physical status classification of a patient presenting with a systemic illness that causes some functional limitations?
Which of the following is NOT characteristic of a benzodiazepine?
Which of the following is NOT characteristic of a benzodiazepine?
Which of the following statements is true?
Which of the following statements is true?
An opioid that is lipophilic will:
An opioid that is lipophilic will:
Which of the following is NOT true regarding benzodiazepine mechanism of action?
Which of the following is NOT true regarding benzodiazepine mechanism of action?
The duration of action for diazepam is:
The duration of action for diazepam is:
Which of the following is NOT included in the definition of minimal sedation?
Which of the following is NOT included in the definition of minimal sedation?
If a patient responds only to repeated or painful stimulation, which level of sedation has been achieved?
If a patient responds only to repeated or painful stimulation, which level of sedation has been achieved?
According to Southerland et al. (2016), a patient with BP >180/110 with no history of hypertension-related end organ damage and no current symptoms should:
According to Southerland et al. (2016), a patient with BP >180/110 with no history of hypertension-related end organ damage and no current symptoms should:
Which of the following is NOT a medication that should be avoided or closely managed in patients with compromised renal function?
Which of the following is NOT a medication that should be avoided or closely managed in patients with compromised renal function?
Which of the following hormones is produced by the anterior pituitary?
Which of the following hormones is produced by the anterior pituitary?
Which of the following is produced by the hypothalamus?
Which of the following is produced by the hypothalamus?
Which of the following is produced by the adrenal medulla?
Which of the following is produced by the adrenal medulla?
Match the BP with the appropriate classification.
Match the BP with the appropriate classification.
Tachypnea is defined as > _____ breaths per minute at rest.
Tachypnea is defined as > _____ breaths per minute at rest.
According to current policy it is acceptable to achieve minimal sedation using a single oral medication either in one dose or divided doses.
According to current policy it is acceptable to achieve minimal sedation using a single oral medication either in one dose or divided doses.
A patient with an Apnea Hypoxia Index of 5 to 14 during a sleep test would have ________ Obstructive Sleep Apnea.
A patient with an Apnea Hypoxia Index of 5 to 14 during a sleep test would have ________ Obstructive Sleep Apnea.
Which of the following is NOT a negative effect of smoking with regard to sedation?
Which of the following is NOT a negative effect of smoking with regard to sedation?
According to the AHA/ACC, a patient with systolic BP 120-129 and diastolic BP < 80 would be in which Blood Pressure Category?
According to the AHA/ACC, a patient with systolic BP 120-129 and diastolic BP < 80 would be in which Blood Pressure Category?
Heart rate > _____ bpm would be considered tachycardia.
Heart rate > _____ bpm would be considered tachycardia.
Which measure is commonly used at Tingay Dental Clinic to prevent diffusion hypoxia?
Which measure is commonly used at Tingay Dental Clinic to prevent diffusion hypoxia?
Nitrous oxide gas is odorless.
Nitrous oxide gas is odorless.
For inhalational anesthetics, Minimum Alveolar Concentration (MAC) is inversely proportional to potency.
For inhalational anesthetics, Minimum Alveolar Concentration (MAC) is inversely proportional to potency.
Nitrous oxide exhibits very high solubility in blood.
Nitrous oxide exhibits very high solubility in blood.
An escort is required for nitrous oxide sedation.
An escort is required for nitrous oxide sedation.
Nitrous oxide may induce a gag reflex.
Nitrous oxide may induce a gag reflex.
Nausea and vomiting are relatively common complications of nitrous oxide sedation.
Nausea and vomiting are relatively common complications of nitrous oxide sedation.
Nitrous oxide gas has a pale yellow color.
Nitrous oxide gas has a pale yellow color.
What is the maximum percentage of nitrous oxide that can be delivered at Tingay Dental Clinic if the provider is not credentialed for moderate sedation?
What is the maximum percentage of nitrous oxide that can be delivered at Tingay Dental Clinic if the provider is not credentialed for moderate sedation?
The oxygen-hemoglobin dissociation curve relates the percentage of saturated hemoglobin to the:
The oxygen-hemoglobin dissociation curve relates the percentage of saturated hemoglobin to the:
A medication administered rectally would be considered to have been delivered ____________.
A medication administered rectally would be considered to have been delivered ____________.
Select ALL of the beta-1 selective beta blockers from the list below.
Select ALL of the beta-1 selective beta blockers from the list below.
For ENTERAL SEDATION, positive pressure oxygen must be:
For ENTERAL SEDATION, positive pressure oxygen must be:
Benzodiazepines:
Benzodiazepines:
Which drug produces a 'hangover effect'?
Which drug produces a 'hangover effect'?
What is the MRD of lorazepam?
What is the MRD of lorazepam?
What is the reversal agent for benzodiazepines?
What is the reversal agent for benzodiazepines?
At Tingay Dental Clinic, which reversal agent is ready to administer (without diluting)?
At Tingay Dental Clinic, which reversal agent is ready to administer (without diluting)?
After oral administration, many drugs are absorbed by the small intestine and transported via the ___________ system to the liver, where they undergo extensive metabolism before reaching systemic circulation.
After oral administration, many drugs are absorbed by the small intestine and transported via the ___________ system to the liver, where they undergo extensive metabolism before reaching systemic circulation.
Diazepam is pregnancy category:
Diazepam is pregnancy category:
A patient who combines an opioid with a MAOI may develop:
A patient who combines an opioid with a MAOI may develop:
In addition to IV D50, what would be another alternative for managing an unconscious patient with hypoglycemia?
In addition to IV D50, what would be another alternative for managing an unconscious patient with hypoglycemia?
One reason for variable efficacy of oral sedative agents is that bioavailability may range from:
One reason for variable efficacy of oral sedative agents is that bioavailability may range from:
Which of the following would be MOST likely to cause respiratory depression when used as a single agent?
Which of the following would be MOST likely to cause respiratory depression when used as a single agent?
In the MHS, it is acceptable to give one tablet of diazepam and one tablet of lorazepam while performing minimal sedation.
In the MHS, it is acceptable to give one tablet of diazepam and one tablet of lorazepam while performing minimal sedation.
The STOP BANG questionnaire is used to screen for:
The STOP BANG questionnaire is used to screen for:
Which has the shortest duration of action?
Which has the shortest duration of action?
What is the MRD of triazolam?
What is the MRD of triazolam?
Absolute contraindications to benzodiazepines include: > Narrow angle glaucoma > Hypersensitivity/Allergy AND...
Absolute contraindications to benzodiazepines include: > Narrow angle glaucoma > Hypersensitivity/Allergy AND...
A patient must be NPO for 8 hours prior to enteral sedation.
A patient must be NPO for 8 hours prior to enteral sedation.
What is the CONCENTRATION of flumazenil (in the bottle)?
What is the CONCENTRATION of flumazenil (in the bottle)?
Which drug class is associated with a 'paradoxical reaction'?
Which drug class is associated with a 'paradoxical reaction'?
Which organization sets the policy for sedation in Army Dental Treatment Facilities?
Which organization sets the policy for sedation in Army Dental Treatment Facilities?
According to current policy, combination nitrous oxide plus enteral sedation:
According to current policy, combination nitrous oxide plus enteral sedation:
Which TWO of the following forms are REQUIRED (rather than recommended) for ENTERAL sedation at TDC?
Which TWO of the following forms are REQUIRED (rather than recommended) for ENTERAL sedation at TDC?
What is the FDA pregnancy category of triazolam?
What is the FDA pregnancy category of triazolam?
What is the mechanism of action for benzodiazepines?
What is the mechanism of action for benzodiazepines?
Current DHA policy mandates that dental specialists providing moderate sedation must have an observer in the room during the procedure dedicated solely to patient monitoring. This observer may not assist the provider with the clinical procedure being performed.
Current DHA policy mandates that dental specialists providing moderate sedation must have an observer in the room during the procedure dedicated solely to patient monitoring. This observer may not assist the provider with the clinical procedure being performed.
According to the current DHA Procedural Instruction, dental assistants present during procedures completed under moderate sedation must complete ACLS certification.
According to the current DHA Procedural Instruction, dental assistants present during procedures completed under moderate sedation must complete ACLS certification.
When monitoring end-tidal CO2 in a closed system (e.g. endotracheal tube in place),
When monitoring end-tidal CO2 in a closed system (e.g. endotracheal tube in place),
When performing end-tidal CO2 monitoring in an open system (e.g. moderate sedation at Tingay Dental Clinic),
When performing end-tidal CO2 monitoring in an open system (e.g. moderate sedation at Tingay Dental Clinic),
Which of the following would be an appropriate treatment for bronchospasm?
Which of the following would be an appropriate treatment for bronchospasm?
The capnographic waveform shown is an example of:
The capnographic waveform shown is an example of:
The capnographic waveform shown is an example of:
The capnographic waveform shown is an example of:
Which of the following is not consistent with the definition of moderate sedation?
Which of the following is not consistent with the definition of moderate sedation?
How many hours prior to moderate sedation does a patient need to be NPO after eating a 'light meal'?
How many hours prior to moderate sedation does a patient need to be NPO after eating a 'light meal'?
Which of the following is not part of an airway evaluation?
Which of the following is not part of an airway evaluation?
Which of the following is NOT a side effect of morphine?
Which of the following is NOT a side effect of morphine?
Which of the following is a SYNTHETIC opioid that can cause fatal reactions in patients taking MAO inhibitors?
Which of the following is a SYNTHETIC opioid that can cause fatal reactions in patients taking MAO inhibitors?
The naloxone in Tingay Dental Clinic is supplied in 1-ml vials. If you dilute this 1-ml in normal saline to a total volume of 4 ml, what concentration is achieved?
The naloxone in Tingay Dental Clinic is supplied in 1-ml vials. If you dilute this 1-ml in normal saline to a total volume of 4 ml, what concentration is achieved?
Fentanyl is _______ times more potent than morphine.
Fentanyl is _______ times more potent than morphine.
On a normal capnogram, the end-tidal CO2 peaks at _________ mmHg.
On a normal capnogram, the end-tidal CO2 peaks at _________ mmHg.
On a capnographic waveform, the vertical line on the right side of each wave is referred to as the:
On a capnographic waveform, the vertical line on the right side of each wave is referred to as the:
Match the electrocardiogram component to the correct aspect of the cardiac cycle.
Match the electrocardiogram component to the correct aspect of the cardiac cycle.
Please identify this rhythm.
Please identify this rhythm.
In which of Guedel's stages of anesthesia would your patient be if you detect abnormal respiration, eyes divergent, dilated pupils, impaired blink reflex, and/or disinhibited movement?
In which of Guedel's stages of anesthesia would your patient be if you detect abnormal respiration, eyes divergent, dilated pupils, impaired blink reflex, and/or disinhibited movement?
Which of the following is NOT included in the definition of DEEP sedation?
Which of the following is NOT included in the definition of DEEP sedation?
Flashcards
American Dental Association Guidelines
American Dental Association Guidelines
Guidelines for teaching pain control and sedation in dentistry.
ASA Class 3
ASA Class 3
Patient with systemic illness causing functional limitations.
Benzodiazepines
Benzodiazepines
Drugs that do not produce analgesia but can cause respiratory depression when mixed.
Diazepam Duration
Diazepam Duration
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Deep Sedation
Deep Sedation
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Nitrous Oxide Limit
Nitrous Oxide Limit
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Anterior Pituitary Hormone
Anterior Pituitary Hormone
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GABA Receptor Agonists
GABA Receptor Agonists
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Elevated Blood Pressure
Elevated Blood Pressure
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Tachycardia
Tachycardia
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NPO Guidelines
NPO Guidelines
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STOP BANG Questionnaire
STOP BANG Questionnaire
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End-tidal CO2 Monitoring
End-tidal CO2 Monitoring
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Flumazenil
Flumazenil
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Fentanyl Potency
Fentanyl Potency
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Nitrous Oxide Combination Use
Nitrous Oxide Combination Use
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Triazolam Duration
Triazolam Duration
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Maximum Recommended Dose (MRD) of Lorazepam
Maximum Recommended Dose (MRD) of Lorazepam
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Indications for Methemoglobinemia
Indications for Methemoglobinemia
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Capnographic Waveform
Capnographic Waveform
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Albuterol Usage
Albuterol Usage
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D50 Administration
D50 Administration
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Flumazenil Initial Dose
Flumazenil Initial Dose
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Naloxone Concentration
Naloxone Concentration
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Managing Intraoperative Hypertension
Managing Intraoperative Hypertension
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Fentanyl Onset and Duration
Fentanyl Onset and Duration
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Initial Dose of Naloxone
Initial Dose of Naloxone
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Study Notes
Sedation Guidelines and Regulations
- Army dental specialists adhere to guidelines from the American Dental Association for teaching pain control and sedation.
- The ASA physical status classification categorizes a patient with a systemic illness causing some functional limitations as Class 3.
Sedation and Medications
- Benzodiazepines do not produce analgesia and have minimal respiratory depression unless combined with other substances.
- Diazepam has a duration of action of 1 to 2 hours.
- Deep sedation is characterized by a patient responding only to repeated or painful stimulation.
- Nitrous oxide is the only medication allowed at 50% maximum concentration at Tingay Dental Clinic without moderate sedation credentialing.
Hormones and Drug Mechanisms
- The anterior pituitary produces Adrenocorticotropic hormone, while the hypothalamus produces Corticotropin-releasing hormone.
- Benzodiazepines act as GABA receptor agonists, enhancing GABA binding without blocking chloride ion influx.
Blood Pressure and Heart Rate
- Blood pressure of 130-139 / 80-89 categorizes as elevated, while > 180 / 110 is a hypertensive crisis.
- A heart rate exceeding 100 bpm is classified as tachycardia.
Patient Management and Assessments
- Patients should be NPO for 6 hours prior to moderate sedation after a light meal.
- The STOP BANG questionnaire screens for Obstructive Sleep Apnea (OSA).
Monitoring and Safety
- End-tidal CO2 monitoring during sedation identifies hypoventilation and airway obstruction, with a normal capnogram showing CO2 peaks at 35-45 mmHg.
- An escort is not required for nitrous oxide sedation, despite some sedation guidelines.
Drug-Specific Information
- Flumazenil reverses benzodiazepine effects and is available at a concentration of 0.1 mg/ml.
- Fentanyl is 100 times more potent than morphine and is associated with respiratory depression as a single agent.
Questions Highlight
- Combination nitrous oxide with enteral sedation is acceptable with adherence to moderate sedation policies.
- Triazolam has the shortest duration of action among benzodiazepines.
- The maximum recommended dose (MRD) for lorazepam is 4 mg, while for triazolam, it's 0.5 mg.
Complications and Contraindications
- Methemoglobinemia can occur with certain anesthetics and conditions should be assessed before procedures.
- Absolute contraindications for benzodiazepines include untreated wide-angle glaucoma and hypersensitivity/allergy.
Clinical Situations and Responses
- The capnographic waveform can indicate various respiratory conditions; an upward slope suggests airway obstruction.
- In cases of bronchospasm, albuterol is the preferred treatment option.
Dosage Calculations and Treatments
- Administer 50 ml of D50 to provide 25 grams of dextrose to an unconscious patient with hypoglycemia.
Flumazenil Dosage
- Initial dose of flumazenil: 0.2 mg IV, administered over 15 seconds.
- Additional doses, if needed, should be 0.2 mg IV, repeated at 60-second intervals.
- Maximum cumulative dose for flumazenil: 1.0 mg.
Naloxone Concentration
- Naloxone is supplied at a concentration of 0.4 mg/ml.
Managing Intraoperative Hypertension
- Effective treatments for managing intraoperative hypertension include:
- Labetalol: 5-20 mg IV.
- Esmolol: 10-30 mg IV.
- Addressing patient discomfort.
- Allowing restroom breaks when possible.
Fentanyl Onset and Duration
- Onset of fentanyl: 2 to 3 minutes.
- Duration of action: 30 to 60 minutes.
Initial Dose of Naloxone
- Initial dose of naloxone ranges from 0.1 to 0.2 mg.
Studying That Suits You
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Description
Test your knowledge of sedation practices in dentistry with this flashcard quiz. Each card addresses essential guidelines and institutions relevant to pain control and sedation. Ideal for dental students and professionals seeking to enhance their understanding of sedation protocols.
