Anesthesia Techniques Flashcards

A 68-year-old patient on warfarin requires local anesthetic infiltration for a dental extraction. The primary concern regarding epinephrine use is:

Answer: Risk of hematoma formation at the injection site

Anticoagulated patients have increased risk of hematoma formation, particularly with regional nerve blocks; infiltration is preferred and pressure should be applied post-injection.

The buccal nerve block is MOST commonly used as a supplemental injection to which primary mandibular block?

Answer: Inferior alveolar nerve block

The buccal (long buccal) nerve is not anesthetized by the IAN block, so it is routinely added when buccal soft tissue anesthesia is needed for mandibular molar procedures.

During monitored anesthesia care (MAC), the anesthesia assistant notes the patient's respiratory rate has fallen to 6 breaths per minute. The MOST appropriate immediate action is:

Answer: Perform jaw thrust and apply positive pressure ventilation if needed

Airway positioning and assisted ventilation take priority before pharmacologic reversal; naloxone is used if opioid-induced respiratory depression is confirmed and ventilation is inadequate.

Which pH-related factor makes local anesthetics LESS effective in infected or inflamed tissue?

Answer: Low pH of infected tissue increases ionization of the anesthetic, reducing membrane penetration

Infected tissue has a lower pH, causing more local anesthetic molecules to exist in the ionized (cationic) form, which cannot cross the nerve membrane to block sodium channels.

The recommended maximum epinephrine dose for a healthy adult dental patient in a single appointment is:

Answer: 0.2 mg

The standard recommendation allows up to 0.2 mg of epinephrine per appointment for healthy adults, approximately equivalent to 11 cartridges of 1:100,000 epinephrine.

When performing a posterior superior alveolar (PSA) nerve block, over-insertion of the needle increases the risk of which complication?

Answer: Hematoma of the pterygoid plexus

The pterygoid venous plexus lies in the infratemporal fossa; over-insertion of the PSA needle into this area can puncture vessels and cause a significant hematoma.

A patient's SpO2 drops from 98% to 91% during IV sedation with midazolam and fentanyl. After repositioning the airway and increasing oxygen flow, SpO2 remains at 91%. The next step is to administer:

Answer: Naloxone 0.1–0.2 mg IV titrated

Persistent hypoxia after airway maneuvers in a patient receiving opioids warrants titrated naloxone to reverse opioid-induced respiratory depression without precipitating acute pain.