ADBA Dental Anesth cheat sheet

Minimum alveolar concentration (MAC) is the end-tidal concentration at which 50% of patients do not move in response to a standardized surgical stimulus; MAC is inversely related to potency and is additive when agents are combined (0.5 MAC of two agents ≈ 1 MAC total).

Local anesthetic maximum recommended doses (mg/kg, with epinephrine where noted): lidocaine 7 (with epi), mepivacaine 6.6 (plain) or 7 (with levonorgestrel-free vasoconstrictor), bupivacaine 2.5-3 (with epi), articaine 7 (with epi), prilocaine 8 (with epi). Absolute mg = % concentration × 10 × mL.

pKa determines onset: anesthetics with pKa closest to physiologic pH (7.4) have the most rapid onset (mepivacaine/articaine > lidocaine > bupivacaine). Protein binding and lipid solubility govern duration and potency respectively.

The ASA Physical Status classification (I-VI) plus E for emergency is the standard perioperative risk descriptor; ASA III-IV and Class 3-4 Mallampati airways are the principal triggers for escalated anesthesia planning and monitoring.

Malignant hyperthermia is a pharmacogenetic ryanodine receptor (RYR1) disorder triggered by volatile anesthetics and succinylcholine; dantrolene 2.5 mg/kg IV titrated is the specific antidote, with active cooling and hyperventilation on 100% O2.

Anesthetic depth monitors: BIS and entropy target 40-60 for general anesthesia; end-tidal CO2 (capnography) of 35-45 mmHg and SpO2 ≥ 95% are standard intraoperative targets.

Airway assessment mnemonics (LEMON, MOANS, Mallampati I-IV, thyromental distance > 6 cm / three fingerbreadths, mouth opening > 3 cm) predict difficult mask ventilation and laryngoscopy.

Pharmacokinetic core: propofol induction 1.5-2.5 mg/kg IV; succinylcholine 1-1.5 mg/kg IV; ketamine 1-2 mg/kg IV or 4-6 mg/kg IM; midazolam 0.05-0.1 mg/kg IV; reversal of benzodiazepines with flumazenil 0.2 mg IV titrated.

NPO fasting intervals per ASA: 2 h clear liquids, 4 h breast milk, 6 h light meal/non-human milk, 8 h fatty meal - the same rules apply to pediatric sedation cases.

Case-defense framework: state the problem list (ASA class, airway, comorbidities, procedure invasiveness), then the anesthetic plan (technique, agents, monitoring), then contingency plans (failed airway, aspiration, anaphylaxis, MH).

For a patient with a difficult airway or high aspiration risk, the plan should shift to an awake fiberoptic or videolaryngoscopy intubation, RSI with cricoid pressure, or an LMA with a clear rescue algorithm.

For pediatric sedation, defend the choice of agent (nitrous oxide, midazolam, ketamine, or propofol) by matching it to the child's cooperation, fasting status, and procedure length, and specify rescue and monitoring (pulse oximetry, capnography, pre-tracheal auscultation).

Local anesthetic systemic toxicity (LAST) defense: recognize perioral numbness, tinnitus, seizures, and cardiovascular collapse; treat with airway support, benzodiazepines for seizures, and 20% lipid emulsion 1.5 mL/kg bolus then 0.25 mL/kg/min infusion.

For a patient on anticoagulants, defend timing of dental extraction and regional block by drug half-life (e.g., hold DOACs 24-48 h, warfarin with INR ≤ 3.0 for simple extractions) and avoid deep blocks (inferior alveolar, pterygomandibular) when bleeding risk is high.

For an obese or OSA patient, defend the plan with preoxygenation, ramped positioning, opioid-sparing multimodal analgesia, and extended post-anesthesia monitoring (apnea-free observation ≥ 60 min, continuous pulse oximetry).

For a patient with a history of anaphylaxis to latex or antibiotics, defend premedication (H1/H2 blockers, corticosteroids), latex-free environment, and epinephrine 0.3-0.5 mg IM ready at the chairside.

For a medically complex cardiac patient (recent MI, severe aortic stenosis, pacemaker), defend the choice of anesthesia (avoid epinephrine-containing local in severe AS, defer elective care 6 months post-MI, use bipolar cautery with pacemaker).

Documentation and consent defense: state the pre-anesthetic evaluation (history, airway, ASA), the informed consent for anesthesia/sedation, and the post-anesthesia discharge criteria (Aldrete score ≥ 9) in the oral case presentation.