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Anesthesia
Midterm
192
Other
Professional
02/13/2011

Additional Other Flashcards

 


 

Cards

Term
What are the 3 branches of V1?
Definition

- nasociliary

- frontal

- lacrimal

 

(NFL)

Term
What are the 2 branches of the frontal nerve?
Definition

- supraorbital

- supratrochlear

Term
What are the 3 branches of the trigeminal nerve?
Definition

V1 - ophthalmic

V2 - maxillary

V3 - mandibular

Term
What are the branches of V2?
Definition

- zygomatic

- 2 pterygopalatine trunks

- PSA

- infraorbital

 

(ZIPP)

Term
What are the 9 branches of the infraorbital nerve?
Definition

- ASA

- MSA

- orbital

- pharyngeal branch

- pterygopalatine trunks

- nasopalatine

- greater palatine

- lesser palatine

- posterior palatine

Term
What does the PSA innervate?
Definition

- 3rd molar

- 2nd molar

- DB and palatal root of 1st molar

- associated BUCCAL gingiva

Term
The MSA is absent in what percent of people? Is this clinically relevant?
Definition

- 30-54%

- no

Term
What does the MSA innervate?
Definition

- MB root of 1st molar

- 2nd premolar

- 1st premolar

- associated BUCCAL gingiva

Term
When absent, what nerve supplies the region normally supplied by the MSA?
Definition
- ASA
Term
What does the ASA innervate?
Definition

- canine

- incisors to midline

- when MSA absent, premolars and MB root of 1st molar

Term
What does the greater palatine nerve innervate?
Definition

- hard palate posterior to D line angle of canine

 

(anterior border = D line angle of canine

medial border = midline of hard palate)

 

Term
What does the nasopalatine nerve innervate?
Definition
- hard palate anterior to D line angle of canines
Term
What are the branches of the sensory root of V3?
Definition

-mylohyoid (MOTOR)

- auriculotemporal

- lingual

- inferior alveolar (incisive and mental branches)

 

 

(MAIL)

Term
What are the branches of the motor root of V3?
Definition

- buccal (SENSORY)

- lateral pterygoid muscle

- temporal muscle

- masseter muscle

 

(BLT...Mmmm)

Term
What can be anesthetized by an IAN block?
Definition

- the entire ipsilateral half of the mandible except for B gingiva posterior to 2nd premolar

 

*lingual area not supplied by IAN, but lingual nerve is so close to IAN that block of IAN also affects lingual

Term
What is innervated by the incisive branch of the IAN?
Definition

- 1st premolar

- canine

- incisors (to midline)

Term
What is innervated by the mental branch of the IAN?
Definition

- lower lip

- gingiva anterior to mental foramen

 

(SOFT TISSUE)

Term
What nerve must be accounted for when placing an implant in the region of the 1st mandibular premolar? How?
Definition

- mental branch of IAN

- it loops anteriorly before entering mental foramen, so implants must be placed at least 2mm anterior to mental foramen to avoid damage

Term
What is innervated by the buccal nerve?
Definition

- buccal mucosa and gingiva posterior to mental foramen (i.e., the midline of the 2nd premolar)

- the cheek and the corner of the mouth

Term
What is innervated by the lingual nerve?
Definition

- lingual gingiva and mucosa

- tongue

Term
Dysesthesia
Definition
- painful sensation to normal touch
Term
Anesthesia
Definition
- complete lack of sensation
Term
Paresthesia
Definition
- spontaneous abnormal sensation
Term
Hypoesthesia
Definition
- decreased sensation to normal touch
Term
Hyperesthesia
Definition
- increased sensation to normal touch
Term
T/F: The mechanism of action of LAs is reversible.
Definition
- true
Term
T/F: Binding of LA molecule to Na channel decreases rate of depolarization.
Definition
- true
Term
Which organ is more susceptible to damage from LAs: the brain or the heart?
Definition
- the brain (must have much larger concentration to affect heart)
Term
What is the special term for the cell membrane surrounding an axon?
Definition
- axolemma
Term
The composition of myelin is mostly what?
Definition
- lipid
Term
What is the special term for the cytoplasm within an axon?
Definition
- axoplasm
Term
T/F: Unmyelinated fibers do not have Schwann cells.
Definition
- false (they do have Schwann cells, but lack the corresponding lipoprotein sheath)
Term
T/F: The AP threshold is reached by increasing the negative membrane potential by 15mV.
Definition
- false (it is reached by DECREASING the negative membrane potential by 15mV (from -70mV to -55mV)
Term
Which takes longer, depolarization or repolarization?
Definition

- repolarization (.7 ms)

 

(depolarization takes .3 ms)

Term
To which ion(s) is a nerve freely permeable at rest?
Definition

- K

- Cl

Term
T/F: A nerve membrane is impermeable to Na at rest.
Definition
- FALSE (it's slightly permeable to Na)
Term
What materials contribute to the negative charge of the intracellular membrane of a nerve at rest?
Definition
- proteins and amino acids
Term
Which ion has the largest extracellular concentration? Intracellular? (Cl, K, or Na)
Definition

intra - K

extra - Na

Term
Which is greater, the ratio of intra- to extracellular K, or the ratio of extra- to intracellular Na?
Definition
- intra- to extracellular K
Term
Are newer LAs esters or amides?
Definition
- amides
Term
Do biotoxins act by blocking Na channels internally or externally?
Definition
- externally
Term
T/F: The mechanism of action of benzocaine is receptor-dependent.
Definition
- false (it acts by expanding the nerve membrane)
Term
According to the specific receptor theory, LAs act by binding to channel receptors on which surface(s) (internal, external)?
Definition
- either internal or external
Term
Why might infection make an LA ineffective?
Definition
- the acidic environment will lead to a higher ratio of protonated to deprotonated LA, meaning that more of it will be charged and unable to penetrate the cell membrane
Term
Typically, are LAs with a higher pKa more likely to be protonated (charged) or deprotonated (uncharged) at physiological pH?
Definition
- protonated (charged)
Term
What is considered the gold standard for LAs?
Definition
- lidocaine
Term
Tachyphylaxis
Definition
- increasing tolerance to drug that is given repeatedly
Term
Increased protein binding = __ duration and potency.
Definition
- increased
Term
Increased pKa = __ onset and __ duration.
Definition

- slower

- shorter

Term
Increased lipid solubility = __ potency.
Definition
- increased
Term
Increased (nonnervous) tissue diffusibility = __ onset.
Definition
- decreased
Term
Increased vasodilator activity = __ potency and duration.
Definition
- decreased
Term
What is the uppermost limit of a safe dose of a typical LA (in mg/Kg)
Definition
- 5 mg anesthetic / 1 Kg body weight
Term
How many mg of anesthetic are in 1 cc?
Definition

- 20 mg

 

 

Term
What are the structural characteristics of a catecholamine?
Definition

- OH groups in 3rd and 4th position of aromatic ring

- NH2 attached to aliphatic side chain

Term
Which adrenergic receptor is responsible for vasoconstriction?
Definition
- alpha
Term
Which adrenergic receptor is associated with increased heart rate, strength of contraction, lipolysis and glycogenolysis?
Definition
- ß1
Term
Which adrenergic receptor is associated with broncho- and vasodilation?
Definition
- ß2
Term
Norepinephrine has the least effect on which adrenergic receptors?
Definition
- ß2
Term
In a 1:1000 ratio, what do the 2 numbers stand for?
Definition

1 = grams of drug

1000 = mL of solution

Term
In a concentration of 1:25,000, how many mg/mL are there?
Definition
1g / 25,000mL = 1000mg / 25,000mL = .04 g/mL
Term
For epinephrine, which adrenergic receptor activity predominates? (a or ß)
Definition
- ß
Term
Which has higher vasopressor potency, epinephrine or NE?
Definition
- epinephrine (NE is 25% as potent)
Term
Activity in which adrenergic receptor for NE predominates? (a or ß)
Definition
- a (almost exclusively)
Term
What is the correct dosage of epinephrine for a healthy person? For the CV impaired?
Definition

healthy = .2 mg

CV impaired = .04 mg

Term
What is the correct dosage of NE for a healthy person? For the CV impaired?
Definition

healthy = .34mg

CV impaired = .14mg

Term
Articaine is __x as potent and __x as toxic as lidocaine.
Definition

- 1.5

- .6

Term
What are the contraindications for articaine?
Definition

- methemoglobinemia (idiopathic or congenital)

- sulfur allergy

Term
What is an EMLA?
Definition
- eutectic mixture of local anesthesia oil in water solution w/ high concentrations of prilocaine and lidocaine
Term
T/F: An EMLA is ineffective on intact skin.
Definition
- false
Term
T/F: The presence of a vasoconstrictor lowers the pH of an LA solution.
Definition
- true
Term
What compound is added to an LA solution to maintain its pH near physiological norms?
Definition
- sodium bicarbonate (NaHCO2)
Term
Trismus
Definition
- tonic contraction of muscles of mastication (various causes)
Term
What are the 5 advantages of a reusable syringe?
Definition

- long-lasting

- autoclavable

- rust resistant

- visible cartridge

- easy aspiration

Term
What are the 3 disadvantages of a reusable syringe?
Definition

- large

- heavy

- disease transmission w/ improper care

Term
What is a pressure type syringe used for?
Definition
- PDL (periodontal ligament) injections
Term
What is the main disadvantage of a pressure type syringe?
Definition
- cost
Term
What are the 2 main advantages of a pressure type syringe?
Definition

- enclosed barrel

- ease of administration

Term
What are the 2 advantages of a jet injector?
Definition

- no needles

- can be used instead of topical

Term
What are the 2 disadvantages of a jet injector?
Definition

- cost

- soreness

Term
What is caused by an off-center perforation (of the cartridge by the needle)?
Definition
- leakage
Term
What are the lengths of a long and short dental needle?
Definition

long = 32mm

short = 20mm

Term
What are the 3 typical gauges of dental needles?
Definition
- 25 (largest, red), 27 (yellow) and 30 (smallest, blue)
Term
What are the 5 advantages of a larger gauged needle?
Definition

- less deflection

- easier aspiration

- no difference in comfort

- less breakage

- greater accuracy

Term
What is the volume of a typical dental anesthetic cartridge?
Definition
1.8 mL
Term
A 1% solution is how many mg drug / mL solution
Definition
- 10
Term
What 2 ingredients do vasopressor-containing LAs have that plain LAs don't?
Definition

- vasopressor (usually epinephrine)

- sodium metabisulfite (antioxidant)

Term
What 3 ingredients to all LA solutions contain?
Definition

- anesthetic drug

- HCL

- sterile water

Term
What causes an extruded rubber plunger?
Definition

- freezing

- storing too long in disinfectant

Term
What gas forms bubbles in LA cartridges?
Definition
- N2
Term
What are the 5 causes of burning on injection?
Definition

- high temperature of LA

- contamination with disinfectant

- vasoconstrictor

- low pH

- rapid injection

Term
T/F: Used needles should be stored with used cartridges.
Definition
- fasle (stored in separate containers)
Term
T/F: At low doses, LAs have anticonvulsant properties because they block epileptic foci.
Definition
- true
Term
The first CNS effect of LAs is on which impulse (inhibitory or facilitory)?
Definition
- inhibitory
Term
What are the 5 causes of failure to achieve anesthesia?
Definition

- pt variation (anatomic or metabolic)

- too much delay b/w injection and procedure

- intravascular injection

- intramuscular injection

- injection in infected area

Term
What are the 4 most common anatomical variations that cause anesthetic failure?
Definition

- mylohyoid

- multiple canals

- lingual nerve

- cervical plexus

Term
For an infiltration, how long does it take for anesthetic depth? For a block?
Definition

infiltration = 2 min

block = 5 min

Term
What is the most common cause of a brief seizure?
Definition
- syncope
Term
What is the most common complication in the dental office?
Definition
- syncope
Term
What are 4 strategies to overcome anesthesia failure in an infected area?
Definition

- give more anesthetic

- do a block

- do a PDL injection

- use bicarbonate in LA solution (to maintain more neutral pH, which preserves vasoconstrictor)

Term
What are the advantages of a PDL injection in an infected area?
Definition

- it's direct acting

- it's under pressure

Term
What injections can be used in ALL pts w/ bleeding disorders?
Definition

- infiltration

- PDL

- intraosseous

Term
A pt's anticoagulant can be witheld if they are not at high risk. An example of high risk is __, and an example of low risk is __.
Definition

high = valve replacement or clotting disorder

low = deep vein thrombosis

Term
What vitamin deficiency leads to increased clotting time?
Definition
- K
Term
If platelet count is greater than __, you can proceed w/ Tx.
Definition
- 70,000
Term
T/F: You can do a procedure on a pt with a moderate clotting factor deficiency.
Definition
- true (mild-mod, but not high)
Term
What are the solutions to a -caine "allergy"?
Definition

- use amide

- use antihistamine

- get allergy testing

Term
What are the LA-associated chemicals that most commonly cause allergic reactions?
Definition

- PABA (from ester metabolism)

- methylparaben (perservative used in multi-dose vials)

- sodium metabisulfate (anti-oxidant used in LAs with vasoconstrictors)

Term
Which 2 LAs can be used in epinephrine-sensitive pts (b/c they cause least amount of vasodilation w/o a vasoconstrictor)?
Definition

- prilocaine

- bupivicaine

Term
What are the 4 indications for an intraosseous injection?
Definition

- failed block

- short procedure

- bleeding disorder

- more profound anesthesia required

Term
What are the 5 advantages of an intraosseous injection?
Definition

- profound anesthesia

- no need for block

- safe in those w/ bleeding disorders

- immediate onset

- minimal complications

Term
Why is there more profound anesthesia from an intraosseous injection?
Definition
- higher concentration of nerve endings
Term
What are the 3 disadvantages of an intraosseous injection?
Definition

- technique sensitive

- difficult to access in posterior mandible

- short duration

Term
Why is the duration of an intraosseous injection short?
Definition
- bone is highly vascularized and has large surface area
Term
T/F: An intraosseous injection is administered in conjunction with a local infiltration.
Definition
- true
Term
What are the 3 causes of common bleeding abnormalities?
Definition

- hemophilia (missing clotting factor)

- thrombocytopenia (low platelets)

- anticoagulant medication

Term
For pts with liver disorders, which type of LA should be avoided (amide or ester)?
Definition
- amide (it's metabolized in liver by CYP450)
Term
For pts with renal disorders, what strategy should be used?
Definition
- limiting of LA
Term
What precautions should be taken with ASA II pts? ASA III?
Definition

II - exercise caution

III - limit epi to .04

Term
What are 3 the causes of needle breakage?
Definition

- small (gauged) needle

- bent needle

- manufacturer defect

Term
How do you prevent needle breakage?
Definition

- don't bend needle

- use higher gauge

- don't insert into tissue all the way to the hub

Term
What are the 2 causes of pain on injection?
Definition

- dull needle

- rapid deposition

Term
How do you avoid pain on injection?
Definition

- proper technique

- sharp needle

- use topical

- correct temp

Term
How do you avoid burning on injection?
Definition

- proper technique

- do not warm solution

- do not store in solution

Term
What are the 3 causes of persistent anesthesia?
Definition

- direct nerve trauma

- contaminated solution

- neurotoxicity

Term
What can you do to prevent persistent anesthesia?
Definition

- proper technique

- do not store/soak in solution

Term
What are the 5 causes of trismus?
Definition

- muscle trauma

- hemotoma

- infection

- excess volume

- contaminated solution

Term
How do you avoid trismus?
Definition

- proper technique

- do not store in solution

Term
How do you clinically manage trismus?
Definition

- heat

- exercise

- analgesics / NSAIDS

- muscle relaxants

- antibiotics

Term
What is the cause of a hematoma?
Definition
- nicking a vessel
Term
What is the treatment for a hematoma?
Definition
- pressure
Term
What are the 5 causes of edema?
Definition

- traumatic injection

- hemorrhage

- allergy

- irritation

- infection

 

(HAITI)

Term
How do you prevent edema?
Definition

- atraumatic injection

- proper handling of armamentarium

- complete medical Hx

Term
What are the 2 causes of localized sloughing?
Definition

- epithelial desquamation

- sterile abscess

Term
How do you prevent sloughing?
Definition
- proper injection technique
Term
What do you do if you inadvertently paralyze the facial nerve?
Definition

- reassure pt

- manually close eye (tape shut at night)

- avoid contacts

Term
What are the 2 causes of intraoral lesions?
Definition

- aphthous ulcers

- herpes

Term
What drugs can be used to treat intraoral lesions?
Definition

- zilactin

- valtrex

Term
LA overdose is usually caused by what?
Definition
- an excessive total dose
Term
How do you prevent vascular injection?
Definition

- aspirate

- inject slowly

Term
In methemoglobinemia, iron is not changed from its __ state to its __ state (which it has to be in to bind oxygen).
Definition
- oxidized (F3+) to reduced (F2+)
Term
Which LAs can cause methemoglobinemia?
Definition
- benzocaine, xylocaine (lidocaine)
Term
Methemoglobinemia can be caused by a deficiency of what enzyme?
Definition
- cytochrome b5 reductase
Term
How is methemoglobinemia treated?
Definition

- methylene blue

- supplemental oxygen

Term
When methemoglobin levels rise above __%, pts become cyanotic.
Definition
- 10%
Term
When methemoglobin levels rise above __%, pts have dyspnea and weakness.
Definition
- 30%
Term
Methemoglobin levels above __% are incompatible with life.
Definition
- 80%
Term
What are the signs of an anaphylactic allergic reaction?
Definition

- erythematous rash

- dyspnea

- tachycardia

- hypotension

Term
IAN
Definition

- coronoid notch

- occlusal plane

- pterygomandibular raphe

- opposite corner of mouth

- target = superior to mand. foramen, 3/4 distance from coronoid notch to pterygomandibular raphe

NUMBS - entire half of mandible EXCEPT B tissue D to 2nd premolar

 

Term
What are the complications from an IAN?
Definition

- VII block

- hematoma

- trismus

- failed anesthesia (mylohyoid n?)

Term
Buccal
Definition

Target = mucobuccal fold / ant. ramus near 3rd molar

- given directly following IAN

NUMBS - B tissue D to 2nd premolar

Term
Lingual
Definition

- lingual vestibule near 3rd molar

- target = posterior mylohyoid ridge

Term
V3 - Gow Gates
Definition

- target = mandibular condyle

- bite block for 1-2 min

- success > 95%

NUMBS - entire half of mandible (including cheek and temporal area)

Term
What are the complications of a V3-Gow Gates?
Definition

- hematoma

-trismus

- III, IV, VI paralysis (avoid by not injecting unless contacting bone)

Term
V3 - Closed
Definition

- mucogingival junction of max. 3rd molar

- maxillary tuberosity

- coronoid notch

- target = soft tissue medial to ramus, behind max. tuberosity

NUMBS - entire half of mandible EXCEPT B tissue D to 2nd premolar (same as IAN)

- success rate = 80%

Term
What are the complications of a V3-Closed?
Definition

- hematoma

- trismus

- VII palsy

Term
Mental / Incisive
Definition

- mucobuccal fold of mand. premolar

- target = mental foramen

- apply digital pressure for 1-2 min

NUMBS - ipsilateral anteriors, associated tissue, skin of lip and chin

Term
What is the complication from a mental block?
Definition
- hematoma
Term
PDL
Definition

- gingival crevice of any tooth

- inject under pressure

- consider 30 gauge needle

Term
For which mandibular injections do you use an entire carpule?
Definition

- IAN

- all V3s (gow-gates, closed)

Term
Which mandibular block has the greatest chance of a positive aspirate?
Definition
- IAN (10-15%)
Term
Which has a higher success rate, V3 open or closed?
Definition

- open > 95%

- closed = 80%

Term
Maxillary Infiltration
Definition

- max. vestibule of tooth

- target = apex of tooth

NUMBS - pulp of 1 or 2 teeth

Term
PSA
Definition

- mucobuccal fold over 2nd molar

- maxillary tuberosity

- zygomatic process

- target = above 3rd molar

- 45˚ to O plane, midline, and axis of 2nd molar

NUMBS - molars EXCEPT MB root of 1st

 

Term
What are the complications from a PSA?
Definition

- hematoma

- mand. anesthesia

Term
MSA
Definition

- mucobuccal fold over 2nd premolar

- target = apex of 2nd premolar

NUMBS - MB root of 1st molar, premolars

 

*BUT, absent in 30-54% of pts, in which case this area is supplied by ASA nerve

Term
ASA / Infraorbital
Definition

- mucobuccal fold over 1st premolar

- infraorbital depression

- target = infraorbital rim

- apply digital pressure

NUMBS - anteriors and associated B tissue, skin between lip and eye

Term
Greater Palatine
Definition

- junction of max. process and palate

- around 1st molar

- target = greater palatine foramen

- cotton swab pressure for 30s

NUMBS - ispilateral palate distal to canine, lateral to midline

Term
What is the complication for a greater palatine?
Definition
- ischemic necrosis
Term
Nasopalatine
Definition

- central incisor

- incisive papilla

- target = nasopalatine canal

- cotton swab pressure

NUMBS - anterior palate to M of 1st premolars

Term
What is the complication for a nasopalatine?
Definition
- necrosis
Term
V2 - High Tuberosity Approach
Definition

- (like PSA, but inserted farther)

- mucobuccal fold over 2nd molar

- maxillary tuberosity

- zygomatic process

- target = pterygopalatine fossa

- 45˚ to O plane, midline, and axis of 2nd molar

NUMBS - entire ipsilateral half of maxilla, skin between lip and eye

Term
What are the complications from a V2 block - high tuberosity approach?
Definition
- hematoma
Term
V2 - Greater Palatine Approach
Definition

- (same as greater palatine, but inserted farther)

- junction of max. process and palate

- around 1st molar

- greater palatine foramen

- target = pterygopalatine fossa

NUMBS - entire ipsilateral half of maxilla, skin between lip and eye

 

Term
What are the complications of a V2 greater palatine approach?
Definition

- hematoma

- penetration into orbit or nose

Term
What LAs have the longest duration (90+ min)?
Definition

- bupivicaine

- etidocaine

Term
What LAs have the shortest duration (30 min)?
Definition

- chloroprocaine

- prilocaine

- lidocaine

- mepivicaine

Term
Which LAs are esters?
Definition

- procaine

- propoxycaine

- tetracaine

- cocaine

Term
What is the only LA that is a ketone?
Definition
- duclonine
Term
Which injectable LA cannot be used for pulpal anesthesia?
Definition
- procaine
Term
Which 2 LAs are the only ones that have a max dosage NOT between 6 and 7 mg/Kg?
Definition

- bupivicaine = 1.3

- etidocaine = 8

Term
Which LA has the greatest vasodilation? Least?
Definition

greatest = procaine

least = mepivacaine

Term
Which LA is not suitable for injection?
Definition
- benzocaine
Term
Which are the topical LAs?
Definition

- benzocaine

- butacaine

- cocaine

- tetracaine

- duclonine

- lidocaine

Term
pKa
Definition

procaine 9.1

bupivacaine 8.1

lidocaine 7.9

prilocaine 7.9

articaine 7.8

etidocaine 7.7

mepivacaine 7.6

 

 

 

Term
Potency/Toxicity
Definition

procaine 1/1

prilocaine 2/1

lidocaine 2/2

mepivicaine 2/2

articaine 2/2

etidocaine 4/2-4

bupivacaine 4/4

propoxycaine 7/7

Term
Max Dosages (mg/Kg)
Definition
  • bupivicaine - 1.3
  • prilocaine - 6.0
  • procaine - 6.6
  • mepivicaine - 6.6
  • lidocaine - 6.6
  • lidocaine w/ epi - 7.0
  • articaine - 7.0
  • etidocaine - 8.0
Term
Vasodilation
Definition
  • greatest - procaine
  • more than lidocaine - bupivicaine, etidicaine
  • less than lidocaine - prilocaine
  • least - mepivicaine
Term
Which receptor is responsible for vasoconstriction?
Definition
- a1
Term
What is the Tx of choice for an acute anaphylactic reaction?
Definition
- epinephrine
Term
Which anesthetic block should always be done with a long needle?
Definition
- V2
Term
Which anesthetic has the strongest protein binding?
Definition
- bupivicaine
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