ADBA Dental Anesth flashcards

31 cards. Read the term and the definition here. The deck at the top of this page is optional.

MAC definition

The end-tidal concentration of an inhaled anesthetic at which 50% of patients do not move to a standardized surgical stimulus; it is inversely proportional to potency.

MAC additivity

When volatile agents are combined, their MAC fractions are additive; 0.5 MAC of one agent plus 0.5 MAC of another approximates 1.0 MAC total.

Local anesthetic maximum dose

The maximum recommended mg/kg dose limits systemic toxicity; for lidocaine with epinephrine it is 7 mg/kg, and absolute mg = % concentration × 10 × mL.

pKa and onset

Anesthetic pKa relative to physiologic pH determines the fraction of uncharged base available to cross the nerve membrane; pKa closest to 7.4 gives the fastest onset.

Protein binding and duration

The degree of plasma protein binding of a local anesthetic correlates with its duration of action; highly bound agents such as bupivacaine last longer.

ASA Physical Status I-VI

A six-tier perioperative risk classification (I = healthy, VI = brain-dead organ donor); the 'E' suffix denotes emergency surgery and elevates risk.

Malignant hyperthermia antidote

Dantrolene sodium 2.5 mg/kg IV titrated is the specific treatment for MH, a RYR1-mediated hypermetabolic crisis triggered by volatile agents and succinylcholine.

BIS target range

Bispectral index monitoring of anesthetic depth; a value of 40-60 corresponds to adequate general anesthesia and reduces awareness risk.

End-tidal CO2 target

Capnography measures exhaled CO2; a normal end-tidal value of 35-45 mmHg confirms adequate ventilation and tube placement.

Mallampati classification

A four-class airway assessment based on oropharyngeal visibility; Class III-IV predicts difficult laryngoscopy and intubation.

Succinylcholine dose

A depolarizing neuromuscular blocker given at 1-1.5 mg/kg IV for rapid sequence intubation; it is contraindicated in malignant hyperthermia susceptibility and hyperkalemia.

Propofol induction dose

An IV induction agent dosed at 1.5-2.5 mg/kg; it causes hypotension and apnea and requires airway support and monitoring.

Ketamine dose

A dissociative anesthetic at 1-2 mg/kg IV or 4-6 mg/kg IM; it preserves airway reflexes and respiratory drive but can cause emergence reactions.

Midazolam dose

A short-acting benzodiazepine at 0.05-0.1 mg/kg IV for sedation and anxiolysis; flumazenil 0.2 mg IV titrated reverses its effect.

NPO fasting intervals

ASA fasting guidance: 2 hours for clear liquids, 4 hours for breast milk, 6 hours for light meals and non-human milk, 8 hours for fatty meals.

Nitrous oxide MAC

Nitrous oxide has a MAC of approximately 105%, so it cannot produce surgical anesthesia alone at 1 atm but is used as an adjunct and for analgesia.

Case-defense problem list

The oral exam opening: state ASA class, airway assessment, comorbidities, and procedure invasiveness before proposing the anesthetic technique.

Difficult airway plan

For a predicted difficult airway, defend awake fiberoptic or videolaryngoscopy intubation, RSI with cricoid pressure, and a clearly stated rescue algorithm.

Pediatric sedation justification

Match agent (nitrous oxide, midazolam, ketamine, propofol) to the child's cooperation, fasting status, and procedure length, with pulse oximetry and capnography monitoring.

LAST recognition

Local anesthetic systemic toxicity presents with perioral numbness, tinnitus, seizures, and cardiovascular collapse; it requires airway support and lipid emulsion therapy.

Lipid emulsion dosing

For LAST, give 20% lipid emulsion 1.5 mL/kg IV bolus followed by 0.25 mL/kg/min infusion, repeated as needed until hemodynamic stability.

Anticoagulant management

Timing of dental extraction and regional blocks is defended by drug half-life: hold DOACs 24-48 hours and avoid deep blocks when bleeding risk is high.

OSA case planning

For obese or OSA patients, defend preoxygenation, ramped positioning, opioid-sparing analgesia, and extended post-anesthesia monitoring with continuous pulse oximetry.

Anaphylaxis preparedness

For patients with latex or antibiotic allergy, defend latex-free setup, H1/H2 blockers and steroids premedication, and epinephrine 0.3-0.5 mg IM ready.

Cardiac patient anesthesia

In severe aortic stenosis, avoid epinephrine-containing local anesthetics; defer elective care six months after MI and use bipolar cautery with pacemakers.

Aldrete discharge score

A post-anesthesia recovery score based on activity, respiration, circulation, consciousness, and oxygen saturation; a score of 9 or higher supports discharge.

Informed consent for sedation

The oral case defense must state that risks, benefits, and alternatives of sedation or anesthesia were discussed and documented before the procedure.

Inferior alveolar block risk

Deep blocks such as the inferior alveolar and pterygomandibular carry bleeding and nerve injury risk, so they are avoided in coagulopathic patients.

RSI indication

Rapid sequence intubation with cricoid pressure is defended for patients at high aspiration risk or with a full stomach before emergency dental anesthesia.

Rescue airway algorithm

The contingency plan in a case defense: state the sequence of mask ventilation, supraglottic airway, videolaryngoscopy, and surgical airway if intubation fails.

Epinephrine in local anesthetic

Vasoconstrictor in local anesthetic prolongs duration and reduces bleeding; it is avoided in severe aortic stenosis and uncontrolled hypertension.