Terms in this set (97)
Permissible practices of a dental hygienist; Must be currently certified in Basic Life Support (CPR) at all times while administering N20-02 minimal sedation.
The dental hygienist is able to initiate, adjust, __________ and terminate nitrous oxide sedation.
When the supervising dentist has evaluated the patient and prescribed the use of N202-02 minimal sedation.
When can a dental hygienist administer nitrous oxide?
The supervising dentist
Who must approve the use of N20-02 minimal sedation immediately prior to each instance of administration?
How many patients can the dental hygienist administer N20-02 minimal sedation at any given time?
Who approves the discharge of the patient?
considered the founder of modern anesthesia (first to demonstrate the medical use of N20) 1844
First to publish scientific document of the use of general anesthetic effects of ether.
1 1/2 times
Nitrous is ____ times heavier than air
N20 = 15,899 L; O2 = 6,600L
N2) = 1,590 L; O2 = 660 L
= amount of gas present
Universal Gas Law
Not applicable for Nitrous when it is stored in liquid form.
Drug induced loss of consciousness resulting in the loss of pain perception and protective reflexes.
Drug induced state of consciousness with reduced level of agitation and irritability.
Normal response to veral stimuli
Reduced state of consciousness where an individual may fall asleep but is easily aroused with verbal stimuli.
Reduced state of consciousness where an individual does not respond to verbal or tactile stimuli but will respond to painful stimuli.
Anti anxiety meds
anxiolytic, sedative, analgesic, occasionally as an adjunct to general anesthesia in surgical procedures.
Purposes for Nitrous Oxide
Most important function of Nitrous Oxide.
Most widely used of the volatile inhalation anesthetics.
Nitrous oxide use in the dental office is intended to place the patient in the "_________" category of sedation.
Most patients will remain at minimal sedation with concentrations of ____%.
consists of the oral and nasal cavities and the 3 parts of the pharynx (Nasopharynx, Oropharynx, Larangopharynx.
Larynx, Trachea, bronchi, bronchioles, and alveoli
Gases diffuse between blood, tissues, and pulmonary alveoli due to differences in their ______.
Nitrous oxide does not bind to hemoglobin but is transported solely as fee molecules in the _____________.
Contraindication where when severe, patient needs to be put on pulse oximeter because they may experience hypoventilation/hypoxemia.
The only way to gauge remaining nitrous which is adjusted for the tare weight of the cylinder itself.
In a Nitrous Oxide cylinder, the vapor pressure which remains constant at room temperature until liquid evaporates.
Nitrous oxide is not biotransformed (metabolized) by tissues and is largely eliminated unchanged through the ______.
insoluble and soluble
What are the two physical states that gases are transported in plasma?
maintained by providing a steady concentration supplied to the lungs; establishes partial pressure.
relative equilibrium and does not exert a partial pressure because it involves actual solution in plasma.
blood: gas coefficient
The ratio of the amount of soluble gas to insoluble gas.
The more soluble an agent is in plasma, the _________ the onset of its physiological effects and the ______ its eventual elimination from the body.
The less soluble an agent is in plasma, the _________ the onset of its physiological effects and the ______ its eventual elimination from the body.
What is responsible for Nitrous Oxide having a rapid onset of action and rapid elimination?
The blood:gas coefficient of Nitrous Oxide.
The potency of an inhalation agent is expressed as its
Represents the amount of anesthetic gas required to produce surgical anesthesia in 50% of a given patient population.
expressed as the percentage of anesthetic gas in a mixture with oxygen.
Percentage of MAC Value (high) for nitrous oxide which demonstrates it is a very weak general anesthetic.
Minimum oxygen flow requirements for oxygen established for dental delivery units.
It is estimated that a ____ concentration of Nitrous oxide (delivered by full face mask) has the analgesic equivalency of 10 to 15 mg of morphine.
endorphins and enkephalins
Nitrous oxide appears to stimulat the release of the body's own endogenous opioids (____________ and _________) which then bind to opioid receptors.
opioid antagonists which reverses the analgesic effects of opiods and Nitrous oxide.
In theory, if the operator were to discontinue the flow of Nitrous oxide and immediately place a patient on room air (O2 of about 20%) this rapid diffusion of Nitrous oxide into the lungs will dilute the available oxygen concentration leading to ___________.
34 times greater
Nitrous oxide enters the body's cavities at a rate of __________ than what nitrogen can exit.
34 times less
Nitrogen has a blood: gas coefficient _________ than Nitrous oxide.
sinus congestion or middle ear pathology
Relative contraindications for Nitrous oxide use which involves an increase in pressure due to the displacement of nitrogen by Nitrous oxide.
All anesthetic gases _________ respiratory rate and __________ tidal volume.
Nitrous oxide stimulates the respiratory system so that it overcomes the tidal volume deficit and actually produces a net increase in _________________
peripheral hypoxemic drive
Nitrous oxide depresses the CNS hypercapnic drive but to a much greater degree the _________________.
CNS hypercapnic drive
Sensitive to HIGH levels of blood CO2
peripheral hypoxemic drive
sensitive to LOW levels of blood O2.
peripheral hypoxemic drive
COPD patients rely heavily on which drive to stimulate respiration?
Nitrous oxide and all other inhalation agents ______ myocardial contractility and therefore stroke volume. However, nitrous oxide does so to much less an extent.
Nitrous oxide stimulates the release of what endogenous hormone which stimulate B1 receptors?
The positive inotropic effects of B1 stimulation offset the inherent negative inotropic effects of nitrous and therefore only a mior net loss in ___________ is seen in a healthy patient.
Nitrous oxide, at higher concentrations, may produce a slight ___________ in BP due to norepinephrine's effects on blood vessels.
A CHF patient receiving opiod analgesics, which block the release of norepinephrine, may demonstrate the effects of significant myocardial _____________.
blood dyscrasias, neurologic impairment, infertility and spontaneous abortion
Effects of chronic toxicity of nitrous oxide.
What enzyme does nitrous oxide inhibit which accounts for its basis for toxicity?
methionine synthetase is a key element in the synthesis of _______ and therefore affects tissues that contain cells with a high turnover rate such as blood forming tissues, reproductive tissues and the neuroglia.
Which hormone does methionine synthetase inhibit which accounts for decreased fertility?
diminishes uterine perfusion
How does Nitrous oxide effect spontaneous abortion?
common mixing valve
Most newer nitrous delivery units have a _______________ that permits the clinician to alter the percentages of the oxygen and nitrogen without changing the pre-established minute volume.
the gases are only delivered by the machine and do not capture unused or exhaled gases.
DISS (Diameter indexed safety system)
Extablishes a specific diameter and thread size for each coupling which prevents attaching a hose to the wrong outlet.
automatically obstruct the flow of nitrous oxide if the oxygen flow falls below 30%.
oxygen flush capability
Allows operator to purge nitrous oxide from the system and deliver a high oxygen flow to the patient.
After treatment, 100% oxygen for _____ minutes should be administered before nasal hood is removed from patient.
American Conference of governmental Industrial Hygienists (ACGIH)
Recommend a threshold value of 50 ppm limit on environmental exposure to nitrous oxide.
Preoperative baseline vital signs
Before administration of nitrous oxide, what must be done first?
How long does it take to achieve initial equilibrium of systemic nitrous oxide gas tension (face mask) to produce peak effects on mental and psycomotor performance?
How long does it take to achieve initial equilibrium of systemic nitrous oxide gas tension (nasal hood) to produce peak effects on mental and psycomotor performance?
What is the recommended initial nitrous oxide flow percentage?
What percent increments should the titrate of nitrous oxide be increased from the baseline value (allow 1-2 min.) until patient comfort is reached?
Percent of nitrous oxide that produces body warmth and tingling of hands and feet.
Percent of nitrous oxide that produces circum-oral numbness
Percent of nitrous oxide that produces numbness of tongue andextremities distant hearing, droning sounds,
analgesia, euphoria, mild sleepiness, heaviness or lightness of body,
beginning of dissociation
Percent of nitrous oxide that produces sweating, dysphoria, amnesia, increased sleepiness
Percent of nitrous oxide that produces dreaming, laughing, giddiness, further sleepiness, stupor, increased dysphoria
Percent of nitrous oxide that produces potential delirium, unconsciousness, light general anesthesia
Recommended time following nitrous oxide exposure before patient engage in any activity requiring fine motor skills.
Recommended time following nitrous oxide exposure before patient operate a motor vehicle.
The greatest incidence of adverse effects related to the use of nitrous oxide thereapy
hypoglycemia and too much stomach contents
Can contribute to dysphorea during treatment with nitrous oxide.
eat a light meal a few hours before treatment.
What should patients be instructed to do before coming to an appointment where nitrous oxide will be used?
Too rapid induction or too high concentrations
Causes of adverse effects of nitrous oxide
Signs of excessive nitrous oxide sedation
Repeated mouth closing
nausea and vomiting
constant fixed staring
dizziness with eyes closed
Is Nitrous oxide a contraindication for someone with Acute Sickle Cell Anemia?
Is Nitrous oxide a contraindication for someone with coronary artery disease?
Is Nitrous oxide a contraindication for someone with severe pulmonary disease?
Is Nitrous oxide a contraindication for Schizophrenia or acute paranoia?