©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Anesthesia and Sedation Chapter 20

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Anesthetics and Sedation Reduce pain Relieve anxiety Different levels of sedation can be achieved based on procedural need and patient response

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Conscious Sedation Causes altered state of consciousness Patient can still communicate May experience headache, nausea, or brief periods of amnesia

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. IV Sedation Administered directly into bloodstream Patient may be conscious, but in deeply relaxed state Patient has no memory of events taking place while sedated

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Oral Sedation Prescription taken before appointment May make patient calm and drowsy or calm and relaxed

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Inhalation Sedation Odorless and colorless gases Inhaled through mask Patient does not remember much of procedure

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Intramuscular Sedation Injection into muscle of upper arm or thigh Not commonly used Takes 20 to 30 minutes to take effect

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. General Anesthesia Creates unconscious state Must be carefully controlled Feeling and sensation lost

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Topical Anesthesia Numbs particular area Used prior to local anesthetic Desensitizes oral mucosa © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Local Anesthesia Produces deadened or pain-free area Sensory impulses temporarily blocked Affects nerve fibers carrying messages to brain © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Topical Anesthetics Used for the following: –Subgingival scaling –Root planing –Seating crowns –Placing matrix bands –Periodontal probing –Preparing for local sedation –Repressing gag reflex

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Placing Topical Anesthetic © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Local Anesthetics Used to manage pain Can be short, intermediate, or long in duration Vasoconstrictor

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Possible Complications of Local Anesthetics Toxic reactions –Patient becomes ill –Many factors Paresthesia –Numbness does not go away as expected

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Check A state of calmness or the process of reducing nervous excitement is termed: –Sedation

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Types of Injections Local infiltration –Injection near small terminal nerve branches © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Types of Injections Field block –Injection near large terminal nerve branches © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Types of Injections Nerve block –Injection near main trunk nerve © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Maxillary Arch Injection Sites © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Mandibular Arch Injection Sites © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Check Which injection will affect the hard palate and soft tissues covering the hard palate from the distal of the canine posteriorly? –Greater palatine nerve block

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Anesthetic, Syringes, and Needles © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Aspirating Syringe © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Components of a Needle © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Needle Care and Handling Maximum of four penetrations Stick protection Caps and shields Proper disposal OSHA guidelines Sharps container Procedure if stick occurs OSHA Bloodborne Pathogens protocol

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Anesthetic Cartridge Components © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Preparing the Anesthetic Syringe 1.Select disposable needle and specified anesthetic 2.Remove sterilized syringe 3.Fully retract piston rod 4.Place cartridge in syringe

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Preparing the Anesthetic Syringe 5.Engage harpoon 6.Remove protective cap from syringe and secure needle onto hub 7.Holding upright, expel a few drops to ensure syringe is functioning properly 8.Replace protective cap over needle

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Retracting Harpoon © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Loading Cartridge into Syringe © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Engaging Harpoon © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Placement of Needle into Syringe © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Passing the Syringe © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Disassembling the Syringe © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Check What do you need to do in the event of a needlestick? –Wash the wound with soap and water –Notify the dentist and determine the patient on which instrument was used –Review the patient’s medical history –Follow CDC and OSHA protocols

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Intraosseous Anesthesia Cancellous bone injected directly Special equipment required Anesthetizes the following: –Bone –Soft tissue –Root –Teeth –Single or multiple teeth

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Periodontal Ligament Injection Used for pulpal anesthesia of one or two teeth in a quadrant May be adjunct to another injection where patient is partially anesthetized Aids in diagnosing abscessed teeth

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Periodontal Ligament Injection System © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Intrapulpal Injection Delivered directly into nerve chamber Procedures: –Root canal therapy –Severe abscess

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Electronic Anesthesia Used with nitrous oxide, provides better effect Used in the following procedures: –Placing restorations –Muscle relaxation –Determination of centric occlusion

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Computer-Controlled Local Anesthesia Delivery System Pain-free injections Used for all traditional infiltration and block injections

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Nitrous Oxide Safe, stable, non- flammable gas Relaxes and comforts patient © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Nitrous Oxide Contradictions –Blocked nasal passage –Emotional instability Drug users –First trimester of pregnancy –Risk of bone marrow suppression –In-vitro fertilization procedures –Neurological complaints

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Check Why might nitrous oxide be used for dental treatment? –Reduce anxiety –Provide relaxation