Pain mng study guide 2.pdf

Pain Management Study Guide Exam #2 Medical Emergency Ques2ons: What is the Most common dental office/clinic medical emergency? o Syncope Nitrous is used as: o Anxioly2c (to relieve anxiety or fear of the dental experience; most common are fear of needle and drill) o Anesthe2c (not a...

Pain Management Study Guide Exam #2 Medical Emergency Ques2ons: What is the Most common dental office/clinic medical emergency? o Syncope Nitrous is used as: o Anxioly2c (to relieve anxiety or fear of the dental experience; most common are fear of needle and drill) o Anesthe2c (not a subsAtute for local) o Analgesic (insensi2vity to pain without loss of consciousness) What color are the tanks for Oxygen and Nitrous Oxide? o Oxygen (Green) o Nitrous Oxide (Blue) 100% O2 should be given for at least 3-5 minutes at the end of nitrous oxide sedaAon to prevent diffusion hypoxia o Lack of oxygen following sedaAon gives pt a ‘hungover” feeling with headache, grogginess, nausea etc. Den2sts and dental hygienists have the highest potenAal for abuse of Nitrous oxide Nitrous oxide is a colorless, odorless gas that is slightly heavier than oxygen gas Nitrous oxide seda2on is generally considered to be a weak inhalaAon general anestheAc that can provide mild, moderate or deep sedaAon but NOT general anesthesia. Know that nitrous oxide sedaAon is generally safe with few contraindicaAons. o Nitrous oxide is contraindicated: § Eye surgery recently using intraocular gas § pregnant paAents (teratogenic) § Severe respiratory compromise or obstrucAon — Severe asthma — COPD — Emphysema § CauAon should be used in paAents with a history of stroke, hypotension and other cardiac condiAons. The flow rate used for adult paAents is 5-6L/min. – NOT ON EXAM - Flow rate is different for pediatric paAents The paAent starts on 100% Oxygen and the nitrous oxide Atrated (added in increments) o Nitrous is added in 5-10% increments. o 35% -50% nitrous oxide has been shown to produce analgesia o ALWAYS maintain at least 25% oxygen o Remember to have the paAent inhale 100% oxygen for at least 3-5 minutes at the end of the sedaAon procedure. Nasal cannula: is a nose cone or mask for administering nitrous oxide sedaAon Mandibular anesthesia: Know the differences in children and adolescents for anesthesia? o For children needle penetraAon for maxillary injecAons is LESS THAN 2 mm o Maxillary and mandibular bone are less dense in children so less needle depth is needed o Supraperiosteal injecAons of the mandible can at Ames be used (BUT NOT ON ADULTS) at the level of the plane of the mandibular teeth (instead of 5-10 mm. above for adults) for the IANB. In adults, supraperiosteal injecAons work beUer in the maxilla than the mandible because the bone in the mandible is denser. Most adverse reac2ons to local dental anesthesia occur within 5-10 minutes of injecAon Most common local anestheAc complicaAon in children → bi2ng lower lip. The limiAng drug in local dental anesthesia is the drug that will limit the total volume of drug that can be administered. MRD stands for Maximum Recommended Dose o To calculate the MRD you must have: § Pa2ent’s weight § Drug concentra2on as a percentage § Amount of anesthe2c in the standard cartridge selected How to calculate the milligrams of anestheAc in a standard cartridge o Ex: 2% Lidocaine = 2 x 10 x 1.8 mL in a standard anestheAc cartridge = 36 mg/mL) § Epinephrine MRD for healthy paAent is 0.2 mg per appointment § Epinephrine MRD for compromised paAent 0.04 mg per appointment The Vazirani-Akinosi injec2on is used for pts with Trismus (difficulty opening mouth) The IA (Inferior Alveolar) is the most used injecAon in denAstry. o InserAon site for IA: Long needle length, inserted 20-25 mm. o The three landmarks for the IA: § Pterygomandibular raphe § Mandibular plane of occlusion § Coronoid notch The Long buccal nerve is NOT a branch of the Inferior Alveolar Nerve What nerves are branches of the IAN? o IA divides into 2 branches § Mental nerve § Incisive nerves Know the three branches of the Trigeminal nerve (V) o V1 – Ophthalmic o V2- Maxillary o V3- Mandibular Three branches Exit the skull (Standing Room Only) o V1 à Superior orbital fissure o V2 à Foramen rotundum o V3 à Foramen ovale The Mandibular branch is the largest branch of Trigeminal and carries both SENSORY and MOTOR nerve fibers. What causes “Lingual Shock” when giving an inferior alveolar nerve injecAon? o Caused when moving needle through Assue and past lingual nerve What tooth or teeth might have a branch from the mylohyoid nerve and have problems with anesthesia? o Mand first molars à incomplete anesthesia due to accessory innervaAon by mylohyoid nerve that is not usually anestheAzed by IA block The absolute maximum number of cartridges of Lidocaine/1:100,000 epi is 11 cartridges that can be given. Who was Horace Wells? o “Father of Anesthesia”: in 1844, Dr. Horace Wells discovered that nitrous oxide has analgesic properAes. What is a scavenger system in nitrous oxide sedaAon (N2O-O2)? o Scavenger system collects and removes excess nitrous oxide to prevent being vented back into the room.