ANES MIDTERMS

Cards (214)

  • Dosage
    Varies and depends on the area to be anesthetized, the vascularity of the tissues, individual tolerance and the technique of anesthesia
  • Administer the lowest dosage

    Needed to provide effective anesthesia even if the computation will give you up to 11 cartilages (that doesn't mean you are going to finish the entire 11 cartilages)
  • Prevention of toxicity
    • Local anesthetics
    • Vasoconstrictors
  • Re-assurance and psychological support
    • Essential and will increase the patient's confidence in his dentist
  • INFORMED CONSENT

    GPA -> vital signs -> patient ready for procedure -> prepare patient psychologically to reassure, explain what you need to do (step by step) and even complications that may arise when you are doing the injection or procedure -> get consent of the patient (sign)
  • Patient receiving local anesthetic injections
    Should be situated in a physiologically sound position prior to and during the injection. Feet are elevated slightly, aiding the return of blood to the heart
  • Lessen the complication
    Vasodepressor syncope (common faint)
  • Position of the patient
    May vary slightly according to the dentist's preference, a patient's medical status and different injection technique
  • If patient has a heart condition or cardiovascular disease like elevated BP
    Cannot position them in the physiologically sound position, positioned in a supine position would cause more elevation of the BP
  • If patient has respiratory disease having difficulty in breathing
    Cannot position them in the physiologically sound position, positioned in a more upright position
  • Position of the clinician
    Depends on the injection to be given - upper or lower, left or right side move around the patient
  • Straight back
    Whatever position you're in
  • Never in a palm down position

    Because the elbow is raised or elevated and you lose control
  • Position of the clinician
    • 8:00
    • 9:00
    • 10:00
    • 11:00
    • 12:00
  • Disposable needles
    Sharp on first use
  • With succeeding penetration of the tissue
    Sharpness diminishes
  • Barbed needles
    Cause increased pain on penetration and increased postanesthetic tissue discomfort
  • Recommended to change disposable needles
    After every 3 to 4 tissue penetrations
  • Multiple injection
    Needle is exposed to the environment and it gets contaminated if you are going to use it multiple times then you are risking infection also
  • Needle is beveled
    As it touches bone then the tendencies for it is to become barbed (lumiliko yung dulo) -> barbed needle when you enter it to the tissue has resistance -> withdraw it from the tissue (merong sumasabit -> cause pain on tissue penetration and even on post injection the px will have soreness. (nag-wear off na yung anesthesia and then the patient will feel sore parang nabugbog yung area after the injection because of trauma to the soft tissue because of the use of barbed needles
  • Gauge and length of the needle

    Determined by the injection to be given
  • Check the flow of local anesthetic solution
    After properly loading the local anesthetic cartridge into the syringe and with the aspirator tip embedded in the rubber stopper, expel a few drops of the solution from the cartridge
  • Before you use it to the patient
    Check for any bubbles -> expel few drops of solution
  • Topical antiseptic
    Used to prepare the tissues at the site of injection. It is placed on the site of injection for about 15 to 30 seconds or is gargled for about 30 seconds
  • Purpose of topical antiseptic
    To lessen microorganisms that may be introduced in the soft tissues, producing either inflammation or infection
  • Topical antiseptics
    • Iodine 1%
    • Chlorhexidine 0.12%
    • Chlorhexidine 0.2%
  • Hyperthyroid patient
    Don't use Povidone Iodine
  • Epinephrine
    Not recommended if they have active hyperthyroidism
  • Pre-injection topical anesthesia
    1. Dry the tissue in and around the injection site
    2. Lip or cheek should be retracted to obtain adequate visibility
    3. Benzocaine 20%
    4. Lidocaine 5%,10%,15%
    5. Apply on a dry mucosa
    6. Permit to remain for a minimum of 1 and preferably 2 minutes
  • Topical anesthesia
    Only for needle insertion, once you start injecting, the patient will already feel
  • Make the tissue taut
    1. Stretch the tissues at the site of injection prior to injection
    2. Use your non working hand to retract and stretch the tissue
    3. Stretching permits the sharp, stainless steel needle to cut through the mucous membrane with minimum resistance - less painful, less traumatic
  • Loose tissues
    Pushed and torn by the needle as it is inserted producing more discomfort on injection and more postoperative soreness
  • Passing of syringe
    1. Never show your needle to your patient
    2. If working with an assistant - assistant can pass it over the chest of the patient (don't use if female patient use the other way behind the head of the patient)
    3. Working without an assistant - once you uncover the needle then immediately place it over the shoulder of the patient, out of sight. Never place it below the elbow or below the waist
  • Needle insertion and aspiration
    1. The needle should be inserted gently and directly in one continuous movement to the target area
    2. Before injection, control aspiration must always be made. The tip of the needle must remain unmoved neither pushed forward nor pulled out of the tissue. Pull the thumb ring of the syringe backward approximately 1 to 2 mm
  • Venous penetration
    Reposition the needle and then aspirate until you get an (-) aspiration. Do not need to remove and change
  • Arterial penetration
    Need to change
  • Actual injection
    1. Injection should be given with as little pressure as possible except for palatal injections where some pressure is necessary
    2. Anesthetic solution is slowly deposited at the rate of 1 ml/min
    3. Communicate with the patient
    4. Take a look of the reaction of the patient -> frown -> pain -> pause -> tell patient to relax -> deposit again
    5. Take note of the hand (fist) and feet. Tell them to relax and do some sort of distraction
    6. Following completion of the injection, the syringe should slowly be withdrawn from the soft tissue and capped immediately with its plastic sheath
  • When you finish the recommended dose
    Withdraw the needle slowly and then always cover in a scoop up technique. Always document
  • Never leave the patient alone
    Allergic or other adverse reactions may occur
  • From the mouth, change the cartridge, and repeat the procedure
    ACTUAL INJECTION