Anesthesia and Infection Control
What this domain tests
Questions combine technique with safety: which block to use, what can go wrong, and how to sterilise, disinfect and protect yourself and the next patient.
Core rules
- Inferior alveolar nerve block targets the pterygomandibular space; the Gow-Gates and Vazirani–Akinosi techniques are alternatives when the conventional block fails or access is limited.
- Maxillary anaesthesia: posterior superior alveolar for molars, middle superior alveolar for premolars, anterior superior alveolar (infraorbital) for incisors, greater palatine for the palate, nasopalatine for the anterior palate.
- Complications include positive aspiration, intravascular injection, haematoma, trismus, prolonged paraesthesia and needle breakage. Use a short needle, aspirate in two planes, and never force a bent needle.
- Spaulding classification: critical items (surgical instruments, forceps) must be sterile; semicritical items (mirrors, handpieces) need sterilisation or high-level disinfection; non-critical items need low-level disinfection.
- Steam autoclave: 121 °C at 15 psi for 15–20 minutes, or 134 °C for 3–4 minutes. Wrap and date packs, use biological and chemical indicators, and never cold-sterilise critical items.
- Standard precautions apply to every patient: hand hygiene at the WHO five moments, gloves, eye protection, masks, safe sharps disposal and correct waste segregation.
- Needlestick injury: encourage bleeding, wash with soap and water, do not suck, report immediately, and assess HIV, HBV and HCV post-exposure prophylaxis within the hour.
Worked example
During an inferior alveolar block the patient suddenly reports a metallic taste and palpitations. Reasoning: this suggests intravascular injection of epinephrine-containing solution. Stop the injection, reassure and monitor; do not re-inject into the same site immediately. Aspirate in two planes on the retry and consider a plain or lower-vasoconstrictor solution.
Traps
Cold disinfection of surgical instruments; assuming a positive aspiration cannot happen with a short needle; failing to sterilise handpieces between patients; delaying post-exposure reporting.