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49 Cards in this Set
- Front
- Back
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How did Wells contribute to founder of anesthesia
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-saw person on nitrous hit table and feel no pain
-gave himself nitrous while another dentist took out wisdom teeth -demonstrated at Harvard but student cried out |
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How did Morton contribute to foundation of anesthesia
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-followed up Wells, went to Harvard med and administered ether while surgery was performed
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What are some factors that can modify someone's pain threshold
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-emotional state
-fatigue -age -fear -past experience -drugs |
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What are the four conceptual ways to control pain
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block pathway - local anesthesia
raise threshold - analgesic, N2O modify reaction to pain - CNS depression (tranquilizers) psychosomatic methods - iatrosedation, hypnosis (used w/other methods) |
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What does local anesthesia block and not block
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-eliminates pain but not pressure, noise, or visual sensations
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How does nitrous help with pain control
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-decreases patient's perception of local anesthesia injection and other stimuli
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What is conscious sedation
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-sedating a patient who is still capable of a rational response to a command and has protective reflexes intact including ability to clear and maintain airway
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What are the 5 objectives/goals of nitrous sedation
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-gain confidence of the patient
-break fear of dental treatment -demonstrate that dental tx is not unpleasant -provide calm atmosphere that benefits patient, dentist and staff -comfort 'normal' patient during painful procedures |
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T/F - nitrous oxide has an odor
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-false = tasteless, odorless, colorless, inorganic
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How is nitrous oxide stored
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-97% pure, blue cylinder, (650-800 psi)
-30% in liquid form in cylinder |
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What are common impurities of nitrous oxide
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-nitrogen, ammonia
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T/F - nitrous oxide is flammable
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-false, it is non-flammable, non-explosive, but can combust
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How is oxygen stored?
-how is the tank read |
-green tank
-full tank = 2000, half full = 1000, empty = 0 |
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How is nitrous oxide stored?
-how is the tank read |
-blue tank
-full = 750, half full = 750, 20% full = 750, empty = 0 -this is because of the liquid in the tank |
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N2O Pharmacology:
-strength as a GA -MAC -analgeic strength -highest safe concentration |
-weak GA
MAC = 105% -powerful analgesic -65-70% |
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What is MAC
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minimum alveolar concentration - concentration required to keep 50% of humans from respondign to a surgical incision
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What % of nitrous oxide is equal to 10-15 mg of morphine
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-20% N2O
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What is the optimal analgesic concentration for nitrous
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35% N2O and 65% oxygen
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What two things are affected for the patient
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-ability to interpret noxious stimuli as painful
-changes patients attitude toward pain |
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T/F - N2O reacts in the body
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-false, no chemical reactions take place
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T/F - nitrous oxide is poorly soluble in blood and tissue
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-true
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Why is there such a rapid induction of analgesia
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-because nitrous oxide is so poorly soluble
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What is the tissue saturation with N2O after 5 min
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90%
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What are the CV effects from nitrous
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-slight depression of myocardial contractility
-slight decrease in peripheral resistance with resultant cutaneous vasodilation -blood pressure stable, can decrease as sedation continues |
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What are the respiratory effects from nitrous?
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-increase in respiratory minute volume
-minimal effect on rate -non-irritating to respiratory epithelium |
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How is nitrous eliminated from the body
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-primarily through the lungs
-mostly within 3-5 min after termination of delivery |
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What is diffusion hypoxia and what may cause it
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-due to rapid diffusion of nitrous oxide and dilution of oxygen coming in
-so give 100% O2 for 3-5 min after nitrous is turned off |
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T/F - nitrous should be used for patients who are overly apprehesive
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-false, should give them IV sedation
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T/F - it is appropriate to use nitrous on the very young, mentally retarded or psychiatric patient who is unable to communicate verbally
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-false
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What are 4 indications for nitrous oxide sedation
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-mildly apprehensive pt not involving a long procedure
-child who is not used to dental treatment -medically compromised pt requiring a light sedation -pts with a hyperactive gag reflex |
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List 6 absolute contraindications to nitrous oxide
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-active upper airway infection
-severe COPD -sickle cell anemia -any condition that does not allow use of LA -significant cardiac decompensation -uncooperative patient |
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List 7 "relative" contraindication to nitrous oxide
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-severe asthma
-alcohol/drug dependence -age extremes -pregnancy -patients who are afraid of losing control -patient who wants to be asleep -claustrophobic patient |
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List 3 "situational" contraindications to nitrous oxide
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-patient with a full stomach (should be NPO for 4 hours)
-acute anxiety -no escort |
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What should you do before treating a patient with nitrous
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-determine physical condition
-define their emotional state, anxiety level -determine if sedation is needed |
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What should patients be told about nitrous before appointment
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-that the pt will not be asleep, just relaxed
-NPO for 4 hours -pt will need an escort |
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What is the technique for administering nitrous
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-get informed consent
-record baseline vitals -place pt in semi-reclined position -fit nasal hood -start oxygen at 8 L/min -turn on nitrous and increase by 1 L/min (decrease O2 by 1 L/min) so overall flow is 8 L/min -encourage steady breathing, not deep breathing |
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When should you first evaluate pt sedation level
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-at 30% nitrous/70% oxygen
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At what concentrations do unpleasant sensation occur
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50% nitrous
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When is LA given
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-when baseline level of sedation is achieved
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What are the signs/symptoms in response to N2O at the following levels:
10-20% 20-30% 30-40% |
10-20 = body warmth, tingling of hands and feet
20-30 = circumoral numbness, numbness of thighs 30-40 = numbness of tongue, hands, feet, droning sounds, hearing distinct but distant, mild sleepiness, analgesia, euphoria, feeling of heaviness or lightness, dissociation |
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What % of N2O is max analgesia
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35%
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What are the signs/symptoms of N2O at the following concentrations:
30-50 40-60 50 and up |
30-50 = sweating, nausea, amnesia, sleepiness
40-60 = dreaming, laughing, giddiness, increased N/V, increased sleepiness 50 and up = unconsciousness and light GA |
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What are the three C's to monitor is regard to sedation
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-level of conciousness
-level of comfort -level of cooperation |
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What are some indications to decrease the concentration of nitrous
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-pt feels uncomfortable
-nausea -pt is poorly responsive to verbal commands -pt makes uncoordinated movements -pt is uncooperative |
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What vitals should be monitored while on nitrous
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-respiratory rate
-heart rate -blood pressure -oxygen saturation |
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What are common complications of nitrous
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N/V - <1% at conc of <50%
diaphoresis - secondary to peripheral vasodilation and stimulation of sweath glands -hypoxia |
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What are predisposing factors to nausea/vomiting
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-full stomach
-kid -hypoxia ->50% nitrous |
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What are the signs of hypoxia
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-cyanosis, tachycardia, tachypnea, bradycardia, restlessness, drowsiness, unconciousness, N/V, distress
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What are the effects of chronic exposure to nitrous
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-spontaneous abortion
-congenital abnormalities -hepatic/renal disease -neurlogic disease -hematologic disease |
