Clinical Practice. Unit VII. Anesthesia

Transcription

1 Clinical Practice Unit VII Anesthesia

2 Anesthesia Terms: Anesthesia absence of pain Anesthetic agents that create a pain free state Analgesia reduction of stimulation and pain

3 Types of Anesthesia General Anesthesia A chemical induced controlled state of unconsciousness Loss of reflexes, including airway Muscular relaxation Pain insensitivity

4 Types of Anesthesia General anesthesia achieved w/ gases or IV agents 4 stages

5 Types of Anesthesia Stage I - analgesia relaxed conscious euphoria breathes on own

6 Types of Anesthesia Stage II - excitement Less aware of surroundings Excitable Nausea/vomiting

7 Types of Anesthesia Stage III - general anesthesia no pain or sensations Stage IV - respiratory failure/cardiac arrest reverse quickly or- death

8 Types of Anesthesia Intravenous Agents Increments to keep in stage III Inhalation Type Unconscious: general Halothane Conscious: nitrous oxide

9

10

11

12

13 Elixar Types of Anesthesia Anti-anxiety drugs Produce sleep, sedation or anesthesia Mentally challenged Very young: - Nortec

14 Topical Types of Anesthesia Liquid/gel Applied to mucous membranes

15 Mirror, Cotton Swab w/topical, 2x2

16

17 Infiltration Types of Anesthesia Injected into vestibule near apex Absorbed through bone at site Use - single tooth All max. teeth

18 Infiltration Sites A= Local B=Field Block C=Nerve Block

19 Types of Anesthesia Infiltration: Maxillary ASA anterior superior alveolar nerve For: central, lateral &cuspid

20 Types of Anesthesia Infiltration: Maxillary MSA middle superior alveolar nerve 1st & 2nd bicuspids MB root 1st molar

21 Types of Anesthesia Infiltration: Maxillary PSA posterior superior alveolar nerve DB & L roots 1st molar 2nd &3rd molars

22 Types of Anesthesia Infiltration: Mandibular Incisive Nerve Mand. incisors & cuspids Mental Nerve 2nd bicuspid to midline

23 Types of Anesthesia Infiltration Periodontal Ligament Injection Injected under pressure into PDL XS needle (30xs) PeriPress, N-Tralig, Ligajet, Citojet

24 Types of Anesthesia Nerve Block Near large branch/trunk of nerves Close to foramen

25 Types of Anesthesia Nerve Block: Max. Nasopalatine Palatal Infraorbital-oral surgeon

26

27 Types of Anesthesia Nerve Block: Mandibular Inferior Alveolar Long Buccal Mental Lingual Incisive

28 Types of Anesthesia Nerve Block: Mand. Inferior Alveolar Nerve-IA large trunk from angle mand. to midline 1/2 of mouth All structures

29 Types of Anesthesia Nerve Block: Mand. Long Buccal Nerve soft tissues gingiva/cheek Lingual Nerve soft tissues gingiva & 1/2 tongue

30 Types of Anesthesia Nerve Block: Mand Mental Nerve 2nd bicuspid to midline Incisive Nerve mandibular incisors & cuspids

31

32 Types of Anesthesia Osseous Injection: Stab-A-Dent CA Drill hole in buccal plate Regular injection is placed in hole Anesthetic delivered Minimal discomfort

33 TENS Types of Anesthesia Trans Electrical Neuro Stimulation Interrupts nerve pathway Adhesive Strip Band-aid type strip - no needles Dento Patch or Transoral delivery system

34

35 Wand Comfort Control syringe

36 Types of Anesthesia Audio Analgesia Music as sensory stimulation

37 Anesthetic Agents and Associated Drugs Drugs to dull pain w/o unconsciousness Mild Analgesics Relieves low intensity Ibuprofen - Motrin or Advil Acetaminophen - Tylenol Acetaminophen - Aspirin

38 Anesthetic Agents and Associated Drugs Moderate Analgesics Relieves moderate pain Sm. amt. codeine + acetaminophen Tylenol III

39 Anesthetic Agents and Associated Drugs Strong Analgesics High intensity relief Narcotics Codeine Percodan Demerol Morphine Vicodin Percocet Hydrocodone

40 Nerve Innervation Trigeminal Nerve - V Largest of cranial nerves Branches into 3 divisions: Opthalmic Max Mand

41 Nerve Innervation Trigeminal Nerve Opthalmic Smallest of three Skin of forehead, scalp Upper eyelid, lining of sinuses

42 Nerve Innervation Trigemincal Nerve Max Superior alveolar nerve All max teeth & gingiva Membranes of sinus Hard/soft palate & uvula Tonsils & pharynx

43 Nerve Innervation Trigeminal Nerve Mandibular Inferior Alveolar Nerve - IA Largest division Supplies 1/2 of mand region to midline Left or right 5 small branches

44 Nerve Innervation Trigeminal Nerve Mylohyoid Dental Branch bicuspids through apex Incisive Branch cuspids to incisors Mental Branch bicuspids (?)

45 Nerve Innervation Trigeminal Nerve Buccal Nerve cheek/gingival tissue in molar areas Lingual Nerve mucous membranes in floor of mouth/tongue

46 Nerve Innervation Facial Nerve VII muscles of mastication sense of taste anterior 2/3 tongue muscles of expression

47 Nerve Innervation Glossopharyngeal Nerve - IX upper portion of pharynx Sense of taste posterior 1/3 tongue

48 Nerve Innervation Vagus Nerve - X lower portion pharynx & vocal cords Epiglottis

49 Evaluation of Patient & Premedications Pre-medicate Signs Anxious, can t relax Nervous or fidgeting Talkative or interrupting Perspiring

50 Evaluation of Patient & Premedications History fear complications

51 Evaluation of Patient & Premedications Candidates Children Apprehensive Extensive work

52 Evaluation of Patient & Premedications Procedure Before tx, so relaxed Night before Few hrs before tx Right before

53 Evaluation of Patient & Chart Entries Premedications Record all premeds Condition of patient Record all anesthetics Area of injection Save carpules until after tx

54 Evaluation of Patient & Chart Entries Premedications 2% xylocaine (most common) 1:100,000 with epinephrine 2% Xylocaine 1:100k w/epi 3.6 ml WNL (x) number of carpules given Each carpule (cartridge) 1.8 ml

55 Local Anesthesia Modes of Action deposited near nerve closest to tx. Induction time Length of time from injection to effective blockage

56 Local Anesthesia Duration Length of time anesthetic lasts until reversal completed Short acting: 30 minutes Medium acting: 60 minutes Long acting: 90 minutes Ex-long acting: up to 12 hours

57 Local Anesthesia Anesthetic Choices: Age Geriatrics - 3/4 usual adult dose Pediatrics - Clarks rule weight of the child in lbs 150 = dose Weight Official dose calculation lb adult

58 Local Anesthesia Anesthetic Choices Sex Females less Does not metabolize drugs quickly Females require less

59 Local Anesthesia Anesthetic Choices Physical Condition vasoconstrictors = dose time medical history important check for hypertension, heart or thyroid conditions

60 Local Anesthesia Anesthetic Choices Amount of Anesthetic to be Given desired effect: total interruption of nerve signal no usual or customary amt 2-3 carpules wnl

61 Local Anesthesia Reasons for using local anesthetics non-irritating to tissues minimal toxicity rapid onset excellent agent }blocks nerve impulse sufficient duration reversible

62 Local Anesthesia Anesthetics Grouped by Duration Generic Name: Brand Name: Vaso: Lidocaine: Octocaine 2% 1:100k w epi Xylocaine 2% 1:100k or 1: 50k w epi Mepivicaine: Carbocaine 2% 1:20k w neocobefrin Carbocaine 3% none Isocaine 2% 1:20k w levonordefrin Prilocaine: Citanest Forte 4% or Plain 4% Bupivacaine: Marcaine 1:200k w epi the lower the 2nd number - higher % of vasoconstrictor

63 Local Anesthesia Anesthetics Grouped by Duration Epinephrine Adrenaline A vasoconstrictor or vasodialator Depends on need

64 Local Anesthesia Anesthetics Groups by Duration Vasoconstrictor Constricts or narrows blood vessels Decreases bleeding Holds anesthetic longer Increases duration of anesthetic Stimulant: speeds up heart

65 Local Anesthesia Anesthetics Groups by Duration Vasodilator Blood vessels expand Increases circulation Potential bleeding

66 Local Anesthesia Anesthetics Groups by Duration Uses local anesthetic gingival retraction cord post surgical procedures reduces blood flow severe allergic reaction cardiac stimulant

67 Local Anesthesia Anesthetics Grouped by Duration Common Types of Vasoconstrictors: Epinephrine Neocobrefrin or Levonordefrin Generic form (base) of vasoconstrictors Ratio: smaller the # higher the vaso 1:20,000, 1:50,000, 1:100,000, 1:200,000

68 Local Anesthesia Anesthetics Grouped by Duration Nor-epinephrine Short acting anesthetic Duration minutes No vasoconstrictors Assimilate quickly For children & short procedures

69 Local Anesthesia Preparing the Patient for Anesthesia Explain steps Where How tissue will feel Show/describe topical Flavor choice?

70 Local Anesthesia Preparing the Patient for Anesthesia Topical Anesthetic Numbing of nerve endings Oral mucosa Gag reflex for x-rays

71 Local Anesthesia Preparing the Patient for Anesthesia Topical Anesthetic gel, liquid or spray dry tissue w/2x2 swab tissue place in area leave for 30 seconds

72 Local Anesthesia Techniques in Administration warm anesthetic carpule distract patient wiggle cheek or lip hold tissue taut

73 Local Anesthesia Possible Complications Syncope fainting Infected Area not effective into infection Temporary Numbness biting cheek or tongue

74 Paraesthesia: Local Anesthesia persistent anesthesia} nerve damage 6-8 weeks to forever consent form Injecting into Blood Vessels aspirate Toxic or Allergic Reaction contact dermatitis

75 Local Anesthetic Assemble the Syringe Syringe: Aspirating Needle placed into tissue Injects slightly -then aspirates Pulling back on thumb ring Blood in carpule if in vessel Dr. must see carpule adjust before pass

76 Local Anesthetic Assemble the Syringe Anesthetic Carpules Glass cartridge w 1.8 ml of solution Rubber stopper-latex Aluminum cap w/rubber diaphragm

77

78 Local Anesthetic Assemble the Syringe Carpules: Rubber Stopper Color coding :brand/type learn colors - always double check Harpoon seated in rubber stopper

79 Local Anesthetic Assemble the Syringe Carpules: Aluminum Cap w Rubber Diaphragm Rubber diaphragm is puncture by needle

80 Local Anesthetic Assemble the Syringe Cartridge Precautions check expiration date look for: red, green, black, white lines or combo on glass) precipitate or air bubbles - frozen chips or cracks rubber stopper bulging

81 Local Anesthetic Assemble the Syringe Selection of the Needle depend on area Needle Hub plastic self threading metal pre-threaded

82

83 Local Anesthetic Assemble the Syringe Needle Length 1 short (blue) - infiltration M/M ant. 15/8 long (yellow) - blocks Mand. Post. 1/2 ex short (blue w/white) - secondary anesthetic PDL

84

85 Local Anesthetic Assemble the Syringe Hypothesis Needle bevel angled toward alveolus Anesthetic deposited directly & accurately Easily & quickly absorbed

86 Local Anesthetic Assemble the Syringe Gauge Diameter of needle Larger # =smaller diameter

87

88 Local Anesthetic Assemble the Syringe Gauge Common Gauges: 25 long 27 short & long 30 short 30 ex-short

89 Local Anesthetic Assemble the Syringe Gauges Most Common Gauge Used: mand: 27L-yellow Max: 30S-blue Each doctor has preference

90 Local Anesthetic Assemble the Syringe (cont) Methods of Correct Assembly 2 ways: ******Needle attached 1 st******** Carpule inserted 1 st Both correct

91 Local Anesthetic Passing in the Static Zone Pass behind headrest-fear Patients head tipped up Pass over pt towel Place thumb ring on thumb Hold hand to stabilize Remove cap-hand still in place Remove stablizer Passing doctor preference

92 Local Anesthetic Passing in the Static Zone - Recappers OSHA regulation - never recap using two handed method one handed scoop, re-capper or guard Needle Stick Injury Report immediately Seek medical care Baseline blood test/injection/file claims

93

94 Local Anesthetic Disassembling the Syringe Remove re-capper, then needle Place in closest sharps container Remove cartridge Place in sharps container Do not bend needles

95 Local Anesthetic Sharps Containers Rigid Red Polyurethane Leak proof Lid

96 Local Anesthetic Post Operative Instructions (POI) Time: how long for anesthetic Fat sensation Eating Area Be careful: smoking or drinking Explain expectations of wearing off