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124 Cards in this Set

  • Front
  • Back
What is Analgesia?
The diminution or production of incresed tolerance to pain in the conscious patient.
Define Direct Supervision?
The dentist is responsible for the sedation/anesthesia procedure shall be physically present in the office and shall be continuously aware of the physical status and well-being.
What is Nitrous Oxide / Oxygen Inhalation Conscious Sedation?
The patients ability to independently and countinously maintain an airway and respond appropriately to physical stimulation and/or verbal command.
Personal Supervision
The dentist is responsible for the sedation/anesthesia procedure shall be physicallaly present in the room with the patient at all times during the induction and maintenance of the procedure.
To be certified to monitor you should have?
Current CPR in basic cardiac life support.

Must pass a written certification examination prepared and administered by the TSBDE.
What is the Central Storage System?
Larger gas cylinders(G or H cylinders) are stored in a dedicated are away from the operatory. The cylinders are connected to the opt by copper tubing. The machine is connected to the wall outlet for a gas supply in each opt. This machine may be fixed to the wall or in a cabinet of the opt. The major ADVANTAGE of this system is the continued cost efficiency of gas purchase. The DISADVANTAGE is the initial cost of the machine.
Oxygen is stored in the cylinder as a ?
The gas is compressed under pressure between?
2000-2200 PSI (pounds per square inch of pressure.
As oxygen is used from the cylinder, the pressure will drop and therefore?
can be used as a "GAUGE" of the amount remaining in the tank.
What % is Nitrous Oxide stored as a gas?
About 30%
What occurs when gas is used?
Liquid is converted to more gas.
The pressure of the gas remains at what PSI until the majority of the liquid is gone?
750 PSI
Oxygen delivery equipment are?
Continuous flow types and the safest.
What does the flowmeter measure?
The quantity of the gas delivered.
The gas flow is measured in?
liters per minute (L/min)
What is the reservoir bag made of?
rubber or silicone and may range in size from 1-8 liter(s)capacity
What size of reservoir bag is commonly used for an adult?
3 liter size.
What size of reservoir bag is commonly used for an child?
1 liter
What is the purpose of the reservoir bag?
The purpose is to even gas flow during various respiratory demands which prevents wide swings in gas concentrations.
What means would the reservoir bag be used for?
To assist or control respiration in the event of an emergency.
What type of pressure is the reservoir bag?
What is the most commonly used apparatus in the dental office?
Nasal Hood
What is the difference between the hood and the full mask?
The hood covers only the nose and is not as efficent as the full mask in gas delivery but it rarely produces patient anxiety and obviously provides for work to easily occur in the mouth.
What is minimum Oxygen flow?
Many machines will only function if a minimum oxygen flow exists.
Explain the oxygen fail safe?
Modern machines are required to have a mechanism which shuts off or prevents nitrous oxide deliverery without oxygen flowing.
What is the mechanism called used to shut of the machine if there is no oxygen?
Fail Safe
What is an O 2 flush?
It is utilized to get a large volume of oxygen to the reservoir bag or patiently quickly. You would turn off nitrous and turn oxygen to 100%
What could occur if oil or grease are present?
Oxygen and nitrous are not flammable but will support?
What does the conduction system provide?
It provides transport of air(oxygen and other gases) from outside of the body to the respiratory area of the lungs and for the transport of waste gases(carbon dioxide) from the respiratory are of the lungs to the outside
What are the parts of the conductive system?
Nose, mouth, pharynx,larynx, trachea, bronchi, and bronchioles.

Excluding respiratory bronchioles
What complicatons can occur with the external nose?
External deformity of the nose may indicate internal obstruction on one or both sides, which alter the amount of sedation the patient is getting
What can occur with the internal nose?
A congenital condition exists, called choanal arresia,which is a blockage of the posterior openings of the nasal cavity.
What is choanal arresia?
Blockage of the posterior openings of the nasal cavity.
What is the purpose of the mouth (TONGUE) ?
The purpose of routine inhalation conscious sedation procedures. the mouth is an accessory respiratory passage.
What is oropharyngeal obstruction by the tongue?
Blockage of the airway where the tongue and pharynx touch.
Oropharyngeal obstruction may occur?
When a person who experiences routine sleep or in a patient who falls asleep in the chair or becomes sedated.
Explain nasopharynx?
The nasopharynx begins at the posterior opening of the nose, and extends to the superior portion of the soft palate. It is the ara that adenoid lymphatic tissue.
What can affect the sedation procedure for children?
Often, children will be present with hyperplasia of the adenoid lymphatic tissue which may partially or completely obstruct this part of the conducting airway. This factor could influence the nasal inhalation conscious sedation procedure.
Where is the Larynx located?
It begins at the base of the tongue and ends at the beginning of the trachea.
What is the function of the epiglottis?
It acts as a valve over the conductive airway by closing during swallowing. It prevents food, liquid or foreign objects from entering the airway.
What is a laryngospasm?
It is when you are in a deeply sedated or excitable state, the laryngeal muscles controlling vocal cord movement may spasm.
What will laryngospasm prevent?
this spasm will prevent air flow in the conducting airway which is obviously an emergent problem.
What is aspiration?
A sedated state and in a semi-reclined position, the swallowing refelex may be depressed.
What is the trachea?
Is a cartilage ring and membranous tube structure beginning at the inferior and the larynx, descending in the chest anterior to the esophagus, and ending at the carina.
What if a patient has bronchitis or bronchiolitis?
They may experience obstruction to adequate air flow. This factor may make some a poor candidate for an inhalation conscious sedation procedure.
Explain gas exchange or respiratory system?
The gas exchange area of the lung actually begins with the respiratory bronchioles and ends at the pulmonary alveolus.
What is tidal volume(500 m/l)?
amount of air normally inspired or expired.
What is Inspiratory Reserve Volume(3000m/l)?
the amount of air that can be inspired over and above the tidal volume.
What is Expired Reserve Volume(1100m/l)?
amount of air that can be expired over and above the tidal volume.
A patient who is sedated may have?
a decreased minute respiratory volume (respiratory depression) b/c of a tidal volume or a decreased respiratory rate.
What is hypoxia?
Low oxygen levels in the tissue.
What will happen if a patient become hyper or excited?
A patient who becomes hyperactive or excitable while under sedation will increase respiratory rate(hyperventilation) and may decrease their tidal volume.
What is diffusion?
The exchange of new air.
A depression of the control center by a?
Central Nervous System Depression (CNS) secondary to the inhalation conscious sedation will obviously affect the respiration.
What drugs are respiratory depressants?
Narcotics, barbiturates. In combination one must be aware that respiratory depression and decreased minute ventilation may occur.

The monitor must closely observe respiration when a pretreatment medication has been used by the patient.
What is dyspnea?
shortness of breath
What is cyanosis?
Is the bluish color of the skin,
What is tachpnea?
excessive respiration,shallow breathing
What are the basic pharmacology facts?
Nitrous oxide diffuses readily to and from the blood and body tissues.
It doesnot change it's form in this process.
The majority of the gas is exhaled from the body within 3-5 minutes after termination
What is Anesthesia?
Anesthesia may be accomplished by putting the brain itself to sleep as in GENERAL ANESTHESIA or by totally blocking the neural pathway to the brain as in local anesthesia.
What does general anesthesia?
when the brain puts itself to sleep.
What is local anesthesia?
total blocking the neural pathway to the brain.
How does nitrous oxide work?
It works by stimulating the release of inhibitory neurotransmitters at the neuropathway junction located within the brain
The concentration of oxygen should never go below what %?
How long should you give an o 2 flush?
3-5 minutes of oxygen
Most dental analgesia is obtained between what percent of nitrous oxide?
25-50%. Sometimes your dentist may find it necessary to exceed the 50% N2O concentration to achieve the desired level of analgesia.
What type of condition is diffusion hypoxia?
It is a condition that occurs at the termination of the nitrous oxide inhalation conscious sedation procedure.
What would you do in an emergency?
Always decrease or terminate the nitrous oxide while increasing the oxygen concentration.
How would you prevent diffusion hypoxia?
You would administer 100% oxygen for 3-5 minutes after the termination of the nitrous oxide.
What has a strong correlation to diffusion hypoxia?
The occurrence of headaches,nausea, and lethargy after a nitrous oxide inhalation conscious sedation procedure.
Explain the maintenance phase?
This phase begins when the desired level of sedation is obtained, continues for the indicated duration of the procedure, and terminates as the nitrous oxide is turned "off" position
What is stage 2- Delirium or exitement?
This stage begins at the loss of consciousness and ends at the onset of a regular pattern of respiration and disappearance of the eyelid reflex. During this stage the patient may experience irregular respiration, agitation, dilated pupils, and active or purposeless muscular activity,
Explain Plane 1- Modern Sedation/Analgesia?
Plane 1 may be expected. Initial patient symptoms may consist of a tingling sensation of the fingers, toes, and other areas, which are usually followed by a sense of relation and decrease of anxiety. This plane is considered normal and safe during the maintenance phase of the procedure.
Name a objective symptoms (signs) that may be associated with the inhalation sedation procedure?
Eyelid "blink" is decreased
What is pre-treatment phase?
The dentist shall maintain a current history and limited physical evaluation on all dental patients.
What is the rule on any new patient on the initial visit should have?
a complete medical history and a limited physical examination performed and recorded in the chart?
What are some medical factors?
Age, prior general health, time since last visit, and anticipated procedure to be performed.
What are physiologic vital sign?
heart rate and rhythm, respiratory rate and blood pressure.
In a stable patient how often should you check vital signs and record them?
Every 15 minutes while the inhalation conscious sedation procedure is in progress.
When does Post-Treatment Phase begin?
When the dental procedure is completed and the nitrous oxide gas is turned off at the machine.
Post-Treatment Phase has the potential for?
The potential for hypoxia is realted to the age of the patient, the duration of the sedation procedure, and the oxygen saturation.
What should the monitor observe during post treatment phase?
The respiratory status of the patient and look for hyperventilation.
If the patient has slurred or incoherent speech they are considered?
What should you do if a patient has an irregular rhythm in pre-treatment phase?
It should be brought to the dentist attention b/c this could be a problem requiring medical consultation and clearance. THE DECISION SHOULD BE LEFT UP TO THE DENTIST.
What should you do if a patient develops an irregular rhythm during pre-treatment phase?
It should be considered as a potential emergency requiring the immediate attention of the dentist. Sudden death may occur if the abnormality is severe.
What is a decreased heart rate?
What happens when you palpate a pulse?
You are feeling the wave transmission and not a "spurt" of blood going through that artery.
What is a possibility of a weak or thready pulse
It may be indicative of a decrease in the stroke volume as seen in hypotension, syncope,cardiac failure or shock.
What is a possibility of a bounding pulse?
It may indicate an increase in stroke volume as seen in exertion or an emotional state or a decrease in vascular compliance as seen in rigidity of the arteries.
What will a cuff smaller than indicate produce?
A higher reading in the blood pressure.
What will a cuff larger than indicated produce?
a larger cuff will produce a lower reading.
What size of cuff would you use on a 1-4 yesr old?
6-7 cm
If your diastolic pressure is >115 mm Hg you would have?
How do you classify hypertensive?
The blood pressure must be measured and averaged 2 or more times on 2 separate occasions.
Increased temperature is usally the result of?
increased cellular metabolism with the cause of being :infection"
A baseline temperature of 101 degrees or greater should be?
medical evaluated prior to a dental procedure by the dentist
What are the positive factors of nitrous?
safe with few side effects and
Agent has analgesia properties
Name three minor complications?
Excessive perspiration
Increased Expectoration
What do some patients exhibitunder N2O sedation?
What are normal finding during nitrous?
Paresthesia, Numbness, tingling in the fingers,toes and perioral areas
Some people exhibit HYPEREXCITABLE due to?
FEAR, hyperventilation, and excess movement.
What are the symptoms to be aware of that could indicate oversedation?
Hyperexcitable, Fear and excessive movement.
What is the treatment for a patient who has fear, hyperventilation, and excessive movement?
You would include reassurance and a reduction in nitrous oxide concentration or its termination.
What is a psychological affect?
Euphoria (scared)
What is cortical (brain) stimulus?
What is Cortical Stimulation?
2nd to hypoxia is the leading cause of nausea and vommiting during sedation procedures.
What do you do if nausea is detected?
DECREASE the nitrous oxide by 10-20%and observe the patient's response for several minutes.
What are the classic triad signs?
increased heart rate(tachycardia) tachypnea and cyanosis
What if a patient has a increased heart rate(tachycardia) tachypnea, and cyanosis?
It is a medical emergency and should be referred for prompt care after initial management.
Define Hypoxia?
The need of oxygen to the tissue.
What would be considered as severe hypoxia?
During the maintenance phase of nitrous oxide sedation the patient must?
Define Conscious?
means awake and alert and is the ability to respond to verbal stimulation with an appropriate response.
Conscious sedation does not include?
"falling Asleep" with sonorous respiration
What is the best prevention of oversedation?
Your close observation of the patient.
Define HYPERVENTILATION(Respiration Rate)?
A increase above the required alveolar ventilation which, is above 35
What is the BEST management for a adverse reaction?
Is a reassurance and calming of the patient.1st you must obtain and re-focus the patients attention to you. It is important to ask the patient to SLOW their breathing by taking a "SLOW DEEP BREATH". Attempt to talk slowly and calmly to the patient.
What do you do if hyperventilation continues?
Have the patient breathe into a bag or some other re-breathing device. As the concentration of exhaled carbon dioxide increases in the air breathed, and respiratory alkalosis will be minimized.
Explain the pressure-volume effect?
Nitrous oxide has a much faster diffusion ratio than nitrogen. This fact is significant in closed air spaced such as the middle ear. The difference is referred to as the pressure-volume effect
If a patient has tubes in ears or PAIN IN THE EAR do to pressure in the middle ear you should?
Terminate the nitrous oxide and notify the dentist
Under OSHA guidelines, the accepted level of nitrous oxide in the dental opt should not exceed?
50 ppm (parts per million)
When N2O is administered w/out scavenging of the nasal hood, levels of nitrous oxide may reach?
300-6000 ppm in the dental opt
How is air mixing utilized?
by placing a fan in the opt, then the levels will drop up to 25ppm