AAPD Guidelines & Relevant Pediatric Dentistry Readings** Questions and Answers
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AAPD Guidelines & Relevant Pediatric Dentistry Readings** Questions and Answers
diminution or elimination of pain and anxiety in a conscious patient. The patient responds normally to verbal commands. All vital signs are stable, there is no significant risk of losing protective reflexes, and the pa...
AAPD Guidelines & Relevant Pediatric
Dentistry Readings** Questions and
Answers
diminution or elimination of pain and anxiety in a conscious patient. The patient
responds normally to verbal commands. All vital signs are stable, there is no significant
risk of losing protective reflexes, and the patient is able to return to preprocedure
mobility. - answer analgesia/ anxiolysis (AAPD 204)
What affect does nitrous oxide have on the CNS? - answer causes depression and
euphoria - intense excitement and happiness (AAPD 204)
Nitrous oxide has two mechanisms of action. Describe MOA that creates the analgesic
effect and the MOA that creates the anxiolytic effect. - answer Analgesic effect:
"appears to be initiated by neuronal release of endogeneous opioid peptides with
subsequent activation of opioid receptors and descending Gamma-amniobutyric acid
type A (GABBA) receptors and noradrenergic pathways that modulate nociceptive
processing at the spinal level"
Anxiolytic effect: "activation of the GABAA receptor either directly or indirectly through
the benzodiazepine binding site" (AAPD 204)
Describe the solubility of nitrous oxide - answer Although the AAPD describes
nitrous as 34 times more soluble than nitrogen; nitrous is relatively insoluble which is
the reason it can quickly diffuse in and out of the human body/blood. (AAPD 204)
Describe the effect of nitrous on the cardiovascular system? (Include effect on cardiac
output, peripheral resistance and blood pressure) - answer Nitrous oxide causes
minor depression in cardiac output while peripheral resistance is slightly increased,
thereby maintaining the blood pressure. (AAPD 204)
How rapid is Nitrous Oxide recovery - answer two to three minutes (AAPD 204)
What is the effect of Nitrous Oxide on the cough reflex? - answer Minimal impairment
to any reflex including the cough reflex (cough reflex is preserved) (AAPD 204)
The most common adverse effects of nitrous oxide are nausea and vomiting which
occur in what percentage of patients? - answer 0.5 percent; a higher incidence is
noted with longer administration of nitrous oxide/oxygen, fluctuation sin nitrous oxide
levels, and increased concentrations of nitrous oxide (AAPD 206)
According to the study by Leelataweewud in 2000, what were the relevant effects of
incorporating N2O/O2 to a conscious sedation of 1.5 mg/kg meperidine (demerol)
,(narcotic sedative), 50 mg/kg chloral hydrate and 25 mg hydroxyzine pamoate vs. that
same triple cocktail with just O2? - answer 1) No differences in pulse rate,
oxyhemoglobin saturation (did find small increase in respiratory rate in N2O/O2 group)
2) N2O/O2 did not increase risk of desaturation but did increase frequency of
desaturation events
3) N2O/O2 deepened level of sedation (so can deepen when added to a narcotic
sedation regimen)
4) if you are going to include N2O/O2 - must monitor with heightened vigilance
Contraindications for use of nitrous oxide/oxygen inhalation may include - answer 1.
Some chronic obstructive pulmonary diseases.
2. Severe emotional disturbances or drug-related de-
pendencies.
3. First trimester of pregnancy.
4. Treatment with bleomycin sulfate.
5. Methylenetetrahydrofolate reductase deficiency.
6. Cobalamin deficiency
bleomycin sulfate - answer common tx in cancer eg. lymphoma
Methylene tetrahydrofolate reductase (MTHFR) - answer is the rate-limiting enzyme
in the methyl cycle
rare disease
Cobalamin deficiency - answer Vitamin B12 deficiency
Anemia or nervous system injury -tingly, numbness, weakness
nitrous oxide flow rate - answer 5-6 L/min
adjusted after observing reservoirvor bag
what percent of nitrous oxide-oxygen inha-
lation sedation demonstrate that the typical patient requires
to achieve ideal sedation - answer from 30 to 40 percent nitrous oxide
T/F nitrous needs NPO - answer F: no fasting require, rec to have light meal 2 hours
before
hypoxia from nitrous - answer rapid release of nitrous oxide from the blood stream
into the alveoli, thereby diluting the concentration of oxygen. This may lead to headache
and disorientation and can be avoided by administering 100 percent oxygen after
nitrous oxide has been discontinued
What is the nonselective, competitive, alpha-adrenergic antagonist used to reverse the
effects of adrenergic agonists like epinephrine? - answer phentolamine mesylate
, What is the proposed mechanism of action for phentolamine mesylate with respect to
local anesthesia reversal - answer phentolamine mesylate is a vasodilator and the
increased local blood flow accelerates the clearance of local anesthetic from the
submucosal tissue to the bloodstream
T/F Injection of phentolamine mesylate at the same site as the local anesthetic was
injected can cut the time to return of normal lip sensation and normal tongue sensation
in half - answer true: "We observed a 55.6 percent reduction in median time to return
of normal lip sensation and a 60 percent reduction in median time to return of normal
tongue sensation (Tavares JADA 2008)
Which are better at suppressing awareness? A) Potent inhaled vapors, midazolam
(versed), propofol
B) nitrous oxide and opioids - answer A) Potent inhaled vapors, midazolam (versed),
propofol
In the study by Watts et al. what was the effect of giving local anesthesia during a
general anesthesia case on vital signs vs. no local anesthesia - answer "Patients
who were not given intraoperative local anesthesia were more likely to experience vital
sign fluctuation requiring anesthesiologist intervention" (Watts, Pediatric dentistry, 2009)
A drug-induced depression of consciousness during which patients respond
purposefully to verbal commands either alone or accompanied by light tactile
stimulation. For older patients, this level of sedation implies an interactive state; for
younger patients, age-appropriate behaviors like crying occur and are expected. Reflex
withdrawal is accompanied by a purposeful response (like pushing away). No
intervention required to maintain a patent airway, spontaneous ventilation is adequate.
Cardiovascular function is usually maintained. - answer Moderate sedation (old
terminology = "conscious sedation" or "sedation/analgesia") (AAPD 210)
Drug induced state during which patients respond normally to verbal commands.
Although cognitive function and coordination may be impaired, ventilatory and
cardiovascular functions are unaffected - answer Minimal sedation (old terminology
"anxiolysis") (AAPD 210)
A drug-induced depression of consciousness during which patients cannot be easily
aroused but respond purposefully after repeated verbal or painful stimulation (eg
pushing away noxious stimuli). Ability to independently maintain ventilatory function may
be impaired. Patients may require assistance in maintaining a patent airway, and
spontaneous ventilation may be inadequate. Cardiovascular function is usually
maintained. May be accompanied by partial or complete loss of protective airway
reflexes - answer Deep sedation (old terminology "deep sedation/analgesia") (AAPD
210)
A drug-induced loss of consciousness during which patients are not arousable, even by
painful stimulation. Ability to independently maintain ventilatory function is often
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