Anesthesia chapter 1 & 2

What percentage of patients have reported to have had onset of dental anxiety by adolescence?

D. 50% to 85%

Which of the following are signs of moderate anxiety?

D. B & C history of frequently missed appointments and history of emergency appointments only

What is the most popular local anesthetic used in the United States today?

D. Lidocaine

myelin

(lipoprotein sheath) is composed of about 75% lipid, about 20% proteins and about 5% carbohydrates. myelin is made up of primary of a glycolipid called galactocerebroside and almost completely insulates the axon from the outside.

Polarization

(resting state) means that the electrical charge on the outside of the membrane is positive while the electrical charge on the inside of the membrane is negative.

In what year was the first local anesthetic introduced?

A. 1884

the threshold potential is the minimum magnitude needed to initiate an action potential. an action potential will trigger the opening of the voltage gated sodium (Na+) ion channel to cause rapid depolarization. a. both statements are true b both statements are not true c first statement is true, second is false d first statement is false, second is true

A. Both are true

All of the following are reasons why procaine was NOT as desirable as lidocaine for pain control EXCEPT one. Which one is the EXCEPTION?

A. Difficult to produce the dissed anesthetic result.

Articaine

1969, available in the year 2000 in the USA

Injectable amides are recommended over esters because there is:

A & B less risk of allergic reactions and increased potency

which fibers are the principle fibers in the transmission of sharp, bright dental pain? a A delta fibers b B fibers c C fibers d AB fibers c AY fibers

A delta fibers

Horace Wells

A dentist, tried nitrous oxide for dental pain control after attending a "laughing gas" parties. He practiced on himself by using nitrous oxide, which he considered safer than ether, and had a fellow dentist extract his tooth. He felt nothing during the procedure and discovered nitrous oxide to be an effective anesthesia.

What is pain perception?

A neurologic experience of pain related to the process of receiving pain stimuli and transmission of this pain to the brain that differs little among individuals

what is the definition of stress?

A physical and emotional response to a particular situation

Pain can be influenced by all of the following EXCEPT one. Which one Is the EXCEPTION?

D. Positive attitude

What is a visual analog scale VAS?

D. a measurement instrument that attempts to measure pain

It is best to schedule apprehensive patients for long appointments to complete as much work as possible. it is best to schedule these appointments in the morning.

D. the first statement is Not correct, the second statement is correct

What is pain?

D. the sensation of discomfort that the patient feels, ranging from mild to severe.

Dr. Henry Beecher

During WWII, he observed that seriously wounded soldieries reported much lower levels of pain than his civilian patients. Based on the interference that clinical pain was a compound of the physical sensation and a cognitive and emotional reaction component, he challenged laboratory s studies in healthy volunteers and argued that pain could only be legitimately studied in a clinical situation.

Albert Niemann & Francesco Di Stefano

Germany in the 1860, the first local anesthetic, cocaine, was isolated from coca leaves

William Clarke

In 1842, he administered ether, via towel, to a women as one of her teeth was being extracted by the dentist. type of gas inhalation

Nils Lofgren

In 1943 the initial amide local anesthetic, lidocaine was synthesized. lidocaine revolutionized pain control in density worldwide because it was both more potent and less allergenic than procaine.

What is pain reaction?

Personal interpretation and responses to the pain message that is highly variable among individuals

1959

Prilocaine

pain reaction

The personal interpretation and response to the pain message and is HIGHLY variable among individuals. pain reaction threshold is the moment when pain crosses the threshold of tolerance and at which point a reaction may occur. it may be influenced by the patients emotional state, fatigue, age, culture, and fear and apprehension.

1940s

a new group of of local anesthetic compounds, the amides, which we use today.

stress

a physical and emotional response to a particular situation. the response to stress is often termed fight or flight and occurs automatically.

Halothane

a safer and stable chemical for inhalation anesthesia, was introduced in 1956.

gate-control theory

a spinal cord mechanism that related the transmission of pain sensations between the peripheral nervous system and the brain

somatic nervous system

a subdivision of the efferent division of the PNS and controls the body's voluntary and reflex activities through somatic sensory and somatic motor components.

Visual Analog Scale (VAS)

a tool used to help a person rate the intensity of certain sensations and feelings such as pain. a VAS is a measurement instrument that attempts to measure pain beloved to range across a continuum of values that can't easily be directly measured. usually a horizontal line, 100 mm in length, anchored by word descriptors at each end is illustrated. is determined by merging in millimeters from the left hand end of the line to the point that the patient marks.

Nodes of Ranvier

along myelinated nerve fibers, gaps in the sheath between adjacent Schwann cells are called nodes or ranvier and occur at evenly spaced intervals.

Neuron

an excitable cell that is the basic functional unit of the nervous system, specialized in sending impulses and making all nervous system functions possible. neurons are the functional unit for communication between CNS and all parts of the body.

Pain

an unpleasant sensory and emotional experience and can be thought of as one of the oldest of all dental problems

neurotransmitters

are packaged into a synaptic vesicles that cluster beneath the membrane on the presynaptic side of a neuron.

1800s

both Europe and the U.S., there was an extended debate, over the ethics of operating on an unconscious person and whether or not the relief from pain might actually retard the health process. physicians used a calculus (measurement benchmark) determine which patients were of the correct sensibility (exhibiting overall health) and who needed to benefit the use of anesthesia.

When energy for conduction is derived from the nerve cell membrane itself and is no longer dependent on the stimulus for continuance, the conduction is considered to be: a. below the minimal threshold level b. above the minimal threshold level c. self propagating d. in the absolute refectory period

c. self propagating

efferent nerves

conduct signals away from the brain or spinal cord along motor neurons to their target muscles and glands (carry away)

afferent nerves

conduct signals from sensory neurons to the spinal cord or brain (carry toward)

afferent division

consists of all incoming information traveling along sensory or afferent pathways

efferent division

consists of all outgoing information along motor or efferent pathways.

mixed nerves

contain both efferent and afferent axons, and thus conduct both incoming sensory information and outgoing muscle commands in the same bundle.

Nerve

contains many cable-like bundles of peripheral axons (the long, slender projections of neurons), which are encapsulated together.

local anesthesia

creates a numbing feeling that eliminates the feeling of sensation in a specific area without loss of consciousness.

local anesthetic mostly have their effect on myelinated nerves in which way? a. all along the nerve membrane b. mostly at the synapse c. mostly at the cell bodies d. mostly at the node of Ranvier

d. mostly at the node of Ranvier

all or none principle

each neuron has a threshold level, or the point at which there is no holding back, called the all-or-none principle.

A fibers

fibers are the largest nerve fibers and can be either motor or sensory. In addition, these large fibers may require a stronger minimal stimulus compared with the smaller C fibers. They are myelinated and have the fastest conduction velocity. A fibers, primarily delta fibers, are responsible for sharp pain. All fibers below are subs of a fibers.

both A and C fibers

found abundantly in the oral cavity, with C fibers in greater distribution. larger-diameter A fibers require more anesthetic volume then smaller C nerve fibers to provide complete nerve blockade

Short acting anesthesia

generally administered intravenously

Human needs paradigm

helps dental hygienists understand the relationship between human need fulfillment and human behavior. a human need is a tension within a person. this tension expresses itself in some goal directed behavior that continues until the goal is reached.

Axon

if the axon hillock continues the impulse, it is then relayed from the periphery to the CNS by a thin, cable-like structure called the axon, which is made up of cytoplasm, or axoplasm, and is surrounded by a multilayer lipid membrane.

threshold potential

if the total strength of the signal exceeds the threshold potential of the axon hillock, the structure will fire a signal.

action potential

if the voltage changes by a large enough amount (threshold potential), an electrochemical pulse called an action potential is generated, which travels rapidly along the cell's axon and activities synaptic connections with other cells when it arrives.

Peripheral Nervous System (PNS)

includes the nerves tissues that lie in the periphery, or "outer regions" of the nervous system, consisting of 31 pairs of spinal nerves arising from the spinal cord and 12 pairs of cranial nerves arising from the brain.

saltatory conduction

is the propagation of action potentials along myelinated axons from one node of ranvier to the next node, opening the stimulus gated channels and allowing Na+ ions to rush into the cell, causing depolarization.

refractory period

is when the Na+ and K+ ions are returned to their original sides: Na+ on the outside and K+ on the inside

Alpha (a)

largest, fastest, responsible for muscle movement and light touch.

cell body

located at a distance from the axon in a sensory neuron and is not involved in impulse transmission. the cell body is responsible for protein synthesis and provide metabolic support for the neuron.

nonmyleinated fibers

long cylinder fibers with high electrical resistance cell membranes that have no myelin sheath. they are surrounded by low resistance extracellular fluid.

Pain control

mechanism that alleviates pain

action potential conduction

moves impulses at a much slower rate compared with myelinated nerve fibers.

Peripheral Fibers

nerve fibers that extend from the cell body away from the CNS

Central Fibers

nerve fibers that extend from the cell body toward the CNS

Pain perception

neurologic experience of pain. pain is perceived when painful stimuli are received and transmitted to the brain, pain perception differs little among individuals.

membrane channels

neurons posses protein "tunnels" known as membrane channels through which specific ions such as Na+ and K+ can pass. Na+ ions pass only through Na+ channels, and K+ ions pass only though K+ ion channels.

Repolarization

occurs once the peak of the action potential is reached and the membrane potential begins to move back toward the resting potential ( -70 mV).

1957

other amide local anesthetics (bupivacaine and mepivacaine )

Delta

pain and temperature

autonomic nervous system

pathways carry information to the autonomic or visceral effectors that control involuntary (without conscious control) smooth muscle, cardiac muscle, glandular tissue, and other involuntary tissue. the motor components controls smooth muscle contractions of viscera and blood vessels and the secretion of glands (salivary glands)

Beta (B)

proprioception (awareness of position/equilibrium)

Output zone (synaptic knobs)

the axon terminals contains synapses, or specialized structures where neurotransmitter chemicals are related for possible reception by a nearby neuron.

Dendritic (input) zone

the dendritic zone is the most distal section of the neuron and is an arborization of nerve endings.

parasympathetic nervous system

the division of the autonomic nervous system. coordinates the body's normal resting activities and is known as the "rest or digest" response.

sympathetic nervous system

the division of the autonomic nervous system. prepares the body to deal with an emergency situation and is involved with the "fight or flight" response.

absolute refractory period

the interval during which a second action potential absolutely cannot be initiated, no matter how large a stimulus is applied

relative refractory period

the interval immediately after the absolute refectory period and before complete reestablishment to the resting state, during which initiation of a second action potential is inhibited but not impossible if a larger stimulus is achieved to produce successful firing. the return to the resting potential marks the ned of the relative refractory period.

Axon hillock (summation zone)

the part of the axon where it emerges from the soma is called the axon hillock. the axon hillock decides whether or not to send the impulse further down the axon.

What is the definition of pain threshold?

the point at which a sensation starts to be painful and discomfort results

concentration gradient

the relationship between the relative amounts of ions inside and outside the nerve membrane.

Central Nervous System (CNS)

the structural and functional center the entire nervous system that includes the brain, contained within the skull, and the spinal cord, contained within the vertebral canal. The CNS is responsible for receiving sensory information, processing the Information, and initiating an outgoing response.

C fibers

these fibers are the most numerous and the smallest, they are usually unmylinated, and they are primarily responsible for dull, aching pain.

B fibers

these fibers have medium diameters, and they are lightly myelinated motor fibers

membrane potential

this difference in the electrical charge on the outside of the cell versus the inside of the cell is called membrane potential.

pain threshold

to the point at which sensation starts to be painful and discomfort results. this threshold varies among individuals and may be altered by some drugs such as local anesthesia.

Gamma (Y)

touch, pressure

Resting State /resting membrane potential RMP

when a neuron is not stimulated, it is sitting with no impulse to carry or transmit, and its membrane is considered polarized and in its resting state.

which of the following may be negatively influence the pain reaction threshold?

A. Fear

What drug did Horace Wells first introduce into dentistry for pain control?

A. Nitrous Oxide

What is the best method of managing an anxious patient?

A. Prevention

Which of the following is the personal interpretation and response to the pain message and is highly variable among individuals?

A. pain threshold

the absolute refectory period occurs during the faction of a millisecond when a nerve fiber can be excited only by a much stronger stimulus then the initial stimulus. the relative refectory period is the interval during which a second action potential absolutely can't be initiated to restimulate the membrane, no matter how large a stimulus is applied. a. both are true b. both are false c. first is true and second is false d. first is false and second is true

B. Both are false

Karl Koller

Cocaine was first used as a local anesthetic. He demonstrated the use during painless ophthalmologic surgery. Although effective as an anesthetic, it was addictive, and many of those pioneer researchers who first studied cocaine's effects on themselves became addicted.

What theory helps dental hygienists understand the relationship between human-need fulfillment and human behavior?

B. Human needs theory

local anesthetic work by: a penetrating the nerve to inhibit CL- influx b penetrating the nerve to inhibit Na+ influx c penetrating the nerve to inhibit K+ efflux d penetrating the nerve to inhibit Na+ efflux e penetrating the nerve to inhibit K+ influx

B. penetrating the nerve to inhibit Na+ influx

What potent drug used for pain control was derived from opium?

C. Morphine

Type A fibers comprise the most rapidly conducting axons. the minimal threshold stimulus required to excite a C fiber will also be sufficient to stimulate an A fiber. a. both are true b. both are false c. first is true, second is false d. first is false, second is true

C. first is true and second is false

1905

The ester procaine ( Novocaine) was created in Germany and when mixed with a proportion of epinephrine, was found to be effective and safe. procaine took a long time to produce the desired anesthetic result, wore off quickly, and was not as potent as cocaine.