Managing Systemic Diseases Flashcards

A dental patient with Type 1 diabetes mellitus scheduled for morning sedation is MOST at risk for which perioperative complication?

Answer: Hypoglycemia due to fasting and insulin effects

Type 1 diabetic patients who fast for NPO requirements may develop hypoglycemia, especially if they took their usual insulin dose without eating.

For a patient on warfarin therapy, the dental team should review which laboratory value before a procedure involving significant bleeding risk?

Answer: International normalized ratio (INR)

The INR quantifies the anticoagulant effect of warfarin. An INR at or below 3.5 is generally acceptable for most dental procedures.

A patient with severe obstructive sleep apnea (OSA) presents for IV sedation. The primary concern during sedation is:

Answer: Exaggerated upper airway obstruction and respiratory depression sensitivity

OSA patients have anatomically compromised upper airways and are highly sensitive to opioids and sedatives, greatly increasing the risk of airway obstruction during sedation.

A patient with a known latex allergy requires dental sedation. The anesthesia team must:

Answer: Ensure the environment is latex-free, including gloves, IV tubing, and mask components

Latex allergy requires a completely latex-free environment. Many medical devices - gloves, IV bags, tubing, blood pressure cuffs - may contain latex.

Which modification is indicated for a patient with severe aortic stenosis (AS) scheduled for elective dental sedation?

Answer: Consult the cardiologist; sedation may require advanced monitoring or hospital-based care

Severe AS represents high cardiac risk. These patients tolerate neither hypo- nor hypertension well. Cardiology consultation is essential before elective sedation.

A patient with chronic renal failure on hemodialysis presents for sedation. Which pharmacokinetic alteration is most clinically important?

Answer: Reduced protein binding and accumulation of renally-cleared drug metabolites

Renal failure reduces plasma protein (albumin) binding, increasing free drug fraction, and allows accumulation of active metabolites normally excreted renally.