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Anesthesia
Final
| Term | Definition |
|---|---|
| Size 25 gauge needles are often considered the easiest size with which to aspirate. Why might this not always be true? | Since a 30 gauge is so small, it might be fully inside a blood vessel and allow aspiration whereas a 25 might not penetrate the vessel fully, preventing positive aspiration. |
| What does the Gow Gates injection block? | It is supposed to block the entire V3 nerve, if done correctly. |
| How far is the needle supposed to go into the tissue for an ASA? | Approx. 4-6mm or ¼” |
| What is the carpule limit in one location at a one time? Why? | If you go beyond 3, its not useful because the pH in the mouth has already been altered too much. |
| What is infiltration and where is it ineffective? | It is the blocking of the papilla to make the actual injection less painful for the patient. It is not as effective on the mandible due to dense cortical bone. |
| T/F are small bubbles ok in the cartridge? | TRUE |
| Which of the following is part of the syringe A) Thumb ring B) Needle Adaptor C) poston with harpoon D) All the above | D) ALL THE ABOVE |
| T/F the label is a protection mechanism for if the cartridge were to break | TRUE |
| T/F saliva inhibits topical anesthetic | TRUE |
| which common local anesthetic is largely metabolized in the blood plasma? | Articaine |
| which environment is anesthetic not as effective in? | acidic |
| T/F: amide local anesthetics are metabolized primarily by the liver? | true |
| T/F: the bigger the number gauge of a needle the smaller the needle is? | True |
| according to the FDA, which category does mepivacaine, and bupivacaine fall under for pregnancy and nursing? | category C |
| What does a vasopressor do to the injected tissues when patient feels a burning sensation? A) Increases the pH of the tissues B) Decreases the pH C) It increases the pH and then decreases it D) It decreases the pH of tissues then increases it | B) Decreases the pH of the tissues |
| True or False, Sodium (meta) Bisulfite is the antioxidant used in anesthetic. | True |
| Which is the anesthetic better used for manageable toxicity, rare allergic reactions and cheapest for dose. Mepivicaine 3% with neocobephrine 1/20,000 Articaine 4% with epi 1/200,000 Lidocaine 2% with epi 1/100,000 Bupivocaine with epi 1/50,000 | C) Lidocaine 2% with epi 1/100,000 |
| Rank the needle from largest to smallest 1 being the largest and 3 the smallest. 30,25,27 | 25 27 30 |
| Loc anes. attach themselves to specific receptors, after combining with receptor local anes. block conduction of nerve impulses by increas the permeability of the nerve cell membrane to sodium ions. true / false false / true Both / true Both / false | A) true / false Local anesthetics attach themselves to specific receptors, after combining with receptor local anesthetics block conduction of nerve impulses by decreasing the permeability of the nerve cell membrane to sodium ions. |
| What injection would you give to work on teeth # 29, 30, and 31? | lower R IA |
| Whats the minimum amount of time the topical needs to sit before giving the injection? | 1 minute |
| T/F: The area where you are applying topical needs to be dry before placing? | True |
| T/F: When giving a MI, the mental nerve numbs the teeth. | False. The mental numbs the tissue |
| What injection do you need to give topical and pressure anesthesia? | Greater palatine and nasopalatine |
| T/F: is it possible that a bigger needle hurts more and is more likely to damage small vessels? | True |
| Why should you not store any cartridge in the fridge? | It hurts more for the pt as it is injected |
| T/F: A burning sensation during injection is normal due to the low pH in the solution? | True |
| Why is it important to reduce the systemic absorption of local anesthetic when it is used in dentistry? | It reduced the chance of systemic toxicity |
| Is anesthetic more basic or acidic? | acidic |
| Ester and amide based anesthetics are excreted after metabolism by A)brain B)GI tract C) kidneys D)gallbladder | C) kidneys |
| Vasoconstrictors such as epinephrine: A.bring more blood flow to the area injected B.keep blood flow away from the area injected C.has nothing to do with blood D.anesthetics don't contain vasoconstrictors | B.keep blood flow away from the area injected |
| A vasoconstrictor is added to the local anesthetic to: a)increase systemic absorption b)decrease systemic absorption c)decrease the depth of anesthesia d) decrease the duration of action | b)decrease systemic absorption |
| The maximal safe dose of epinephrine for the healthy patient is 0.2 mg and the cardiac patient is: A.0.4 mg B.0.0004 mg C.0.04 mg D.0.004 mg | C. 0.04 mg |
| T/F Large percent of the population does not have Middle Superior Alveolar nerve. | True |
| T/F Trismus is more likely to occur during Gow Gates injection and rarely during Inferior Alveolar injection. | False |
| Which anesthetic in our clinic has 1:200,000 epi in it? | Septocaine (Articaine) |
| Which common block is the least consistent because its location may be different depending on the person? | Inferior Alveolar Block |
| How many times should you aspirate during an injection? | If positive aspiration, then re-locate without taking needle out, if that one is positive as well then completely re-start, even if initial aspiration is negative, the clinician should re-aspirate several times when giving a full cartridge. |
| What is the pterygomandibular space formed by? What block does this injection site take place at? | Lateral pterygoid muscle, medial pterygoid muscle and mandibular ramus. Inferior Alveolar Block. |
| Why are some cartridges labelled 1.8 ml and others labelled 1.7 ml? | It’s the same amount in both, it is just a change in labelling law because if you have even a little bit less than 1.8, you now have to say 1.7 |
| What is the Akinousi Injection and what patients is it best to use on? | It is the “I can not see block” and it is good for patients with trismus. |
| Which block takes longer to get numb the IA or the Gow Gates? | The Gow Gates takes longer to get numb. |
| T/F When doing an NP should the bevel be up and toward the palatal bone? | True |
| What injection would you apply pressure to the injection site so that the teeth will get numb? a) IO b) PSA c) IA d) MI | d) MI |
| What is the most commonly used anesthetic in dentistry? a. Articaine b. Mepivicaine c. Lidocaine d. Septicaine | c. Lidocaine |
| Why is the vasoconstrictor added to anesthetic? a. Increase duration of anesthesia b. Makes anesthesia wear off quicker c. Makes the onset faster | a. Increase duration of anesthesia |
| T/F A problem with prilocaine can be methemaglobinemia | True |
| T/F Local anesthesia’s are divided into two groups, esters and amides | True |
| The only class of anesthetic used parenterally in dentistry is a. Esters b. Amides c. Topicals d. N2O | b. Amides |
| What is an alternative technique for Gow Gates? | Akinosis=( I can not see) |
| What is usually anesthetized during a infrorbital local anestetic block? | Lower eyelid, upper lip and lateral side of the nose. |
| What landmarks are used when administering a Gow Gates mandibular local ansethetic block? | Maxillary second molar. |
| To achieve the maxillary quadrant, which local anesthetic blocks needs to be administered along with the anterior superior alveolar, middle superior alveolar block? | Posterior superior alveolar block. |
| Most local anesthetic agents are divided chemically into two major groups. What are they? | amides and esters |
| True or False. A vasoconstrictor is added to the local anesthetic to reduce absorption | True |
| The vasoconstrictor in anesthetic does which of the following? A.Reduces the blood supply to the area B.Limits speed of systemic absorption C.Reduces systemic toxicity by reducing overall dosage needed D.All of the above | D.All of the above |
| True or False. Lidocaine is an ester. | False. Lidocaine is an amide. |
| Which of the following is T in regards to Articaine? excreted by the kidneys pt can tolerate twice as much lido as compared with articaine before the max dose is reached Articaine can cause permanent numbness All are true | E. All of the statements are true. |
| Anesthesia lasts longer with epinephrine because epinephrine constricts the blood vessels. a. Both are correct. b. Both are incorrect. c. True/ False d. Statement is incorrect, but rationale is correct. | a. Both statement and rationale are correct. |
| (T/F) The main difference between the needle sizes relates to flexibility. | True. They are all very similar as far as pain and ability to aspirate |
| (T/F) Blood pressure problems are contraindications for anesthesia. | True |
| Which is not an amide? a. Articaine b. Prilocaine c. Mepivicaine d. None of the above | D- They are all amides. |
| What’s the big difference between amides and esters? | Amides= amino which are hydrophilic= H2O- soluble, metabolized in Liver. Esters=aromatic; lipophilic=fat soluble, metabolized in plasma, which are Articaine and tetracaine=topical |
| Why should the needle be discarded after 3-4 penetrations? | due to dullness and possible barbs (bend in the needle tip) |
| What is the volume for most anesthetics? | 1.8 ml |
| Which recapping technique is used in our clinic? | the scooping technique |
| Dr. Dawson most commonly uses which anesthetic on the upper arch? | articaine |
| Anesthesia lasts longer with epinephrine because epinephrine constricts the blood vessels. a. Both correct. b. Both incorrect. c. Statement is correct, but rationale is not. d. Statement is incorrect, but rationale is correct. | a. Both statement and rationale are correct. |
| (T/F) There is no real difference between the needle sizes. | True. They are all very similar, even though there is technically a size difference |
| (T/F) Blood pressure problems are contraindications for anesthesia. | True |
| Which is not an amide? a. Articaine b. Prilocaine c. Mepivicaine d. None of the above | D- They are all amides. |
| T/F: Esters are largely metabolized in the plasma and amides in the liver | True |
| A vasoconstrictor is added to the local anesthetic To reduce absorption Reduces the blood supply to the area Limits speed of systemic absorption Reduces systemic toxicity by reducing overall dosage needed All of the above | All of the above |
| T/F Most common result of physical injury caused by injection technique is administration of an excessive volume too quickly to be accepted by the tissues and often results in a hematoma. | True |
| T/F: Amides have a much greater allergic potential than Esters. | F/ Esters have much greater allergic potential. |
| Which of the following is an Ester? articaine lidocaine tetracaine mepivacaine | tetracaine |
| What injection site do you not use Articaine (septocaine) 4% for? | Inferior Alveolar Block |
| What is the average length of the apex of molars? 19-22 mm 20-23 mm 23-25 mm 25-31 mm | 19-22 mm |
| What color of band does the most common anesthesia belong to? Blue Silver Red Gold | Red |
| Why would you see an increase of bleeding when lidocaine topical is used? | It is a vasodilator |
| T/F In terms of size, a 30 gauge needle is largest and a 25 gauge needle is smallest | False 30 gauge is smallest and 25 gauge is largest |
| How much of the needle should be visible at all times to maximize safety? ½ of the needle ¼ of the needle 1/3 of the needle None of the above | 1/3 of the needle |
| T/F When loading the syringe the needle should be placed before the cartridge. | False, Cartridge before needle |
| Which is the local anesthetic of choice when being used on a pregnant woman? Mepivacaine Articaine Lidocaine ( category B drug) Bupivacaine | Lidocaine ( category B drug) |
| How many carpules of articaine with epinephrine 1:200,000 can you give before you will exceed the cardiac dose? 1 3 2 4 | 4 |
| True or False: Chances of a hematoma with the ASA block are considered to be rare. | True |
| True or False: The Buccal injection anesthetizes both the teeth (molars) and the soft tissues buccal to the molars. | False, the buccal injection only anesthetizs the soft tissues, no teeth are anesthetized. |
| True or False: The structures affected by the M/I injection include the premolars to the midline of which ever side the injection is given. | True |
| T/F Bupivocaine is not avalable wiht epinephrine, instead uses neocobephrine | False |
| T/F Articaine can cause paresthesia after a mandibular block more frequently than other LAs. | True |
| T/F Overdose of only a few local anesthesic can result in convulsions and death | False |
| T/F Articaine has fast onset and deepest numbing | True |
| Tricyclic antidepresants and non selective B-blockers are clinically significant drug interactions of vasoconstrictors | True |
| How do you treat hematoma? | Ice for 2 minutes with reassurance |
| Why is Bupivicaine not recommended to children or handicapped patients? | Increased risk postoperative injury (Chewing on lip) |
| What does local infiltration anesthetize? Large area Small area The heart The lip | Small area |
| What does nerve block anesthetize? The nose Large area The eyes Small area | Large area |
| What are some complications of the PSA block? Possible external hematoma Incorrect angulation An eye infection Innervation of the tongue Both a & b All of the above | Both a & b |
| T/F Giving more than 3 cartridges in a particular area is ineffective because the anesthesia has a low pH already, therefore lowering the pH at the injection site, so multiple doses make the anesthetic ineffective. | True |
| T/F The maximum safe dose of epinephrine for the healthy patient is 0.2mg and for the cardiac patient is 0.04mg. | True |
| T/F:Articaine has fast onset and deepest numbing. | True |
| What is the peak anesthesia time for Mepivicaine? 5-10 min 10-20 min 20-30 min None of the above | B; 10-20 minutes. |
| T/F: The PH of the environment affects the anesthtic. | True; If the environment is too acidic, the anesthetic will not respond. |
| T/F: Elective dental treatment requiring medication should be rendered to a pregnant patient. | False; Lidocaine may be administered to a pregnant woman if dental treatment needed , but elective procedures should be avoided. |
| When a vasodialator is added to reduce absorption, the chance of toxicity is reduced. Both the reasoning and statement are true Both the reasoning and statement are false *The statement is false, but the reasoning is true | The statement is false, but the reasoning is true |
| These local anesthetics have a much greater allergic potential Amides *Esters Epinepherine All of the above None of the above | *Esters |
| T/F Amide local anesthetics precipitate malignant hyperthermia. | False |
| Salad bar syndrome is Going to a buffet and eating too much salad Could result from elective dental treatment given to pregnant women A hypersensitivity reaction to sulfites None of the above | A hypersensitivity reaction to sulfites |
| where do you move the needle if you hit bone on an IA when the needle has penetrated less than ¼ of the way on a block? | More laterally for ASA, PSA, MSA, IO,or MI. More medially for an IA |
| What are the land marks for MSA | Zygomatic process and Max Pre.Molars |
| T/F: GP anesthetises teeth? | False |
| An extra short needle may be used for infliltration T or F? | True |
| Advantage of Inflitration | Predictable and quick anesthesia in areas where bone is porous. |
| Disadvantages of Inflitration | More injections needed, Dentists are usually only working on 1 tooth, do infiltrations on the maxilla. Since deposition is closer to inflamed gingival tissues than if it were a block,injection may be less effective than a block due to low tissue ph |
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daisenmurray
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