AAPD Guidelines & Relevant Pediatric Dentistry Readings
UPDATED ACTUAL Questions and CORRECT Answers
diminution or elimination of pain and anxiety in a analgesia/ anxiolysis (AAPD 204)
conscious patient. The patient responds normally to
verbal commands. All vital signs are stable, there is no
significant risk of losing protective reflexes, and the
patient is able to return to preprocedure mobility.
What affect does nitrous oxide have on the CNS? causes depression and euphoria (AAPD 204)
Nitrous oxide has two mechanisms of action. Describe Analgesic effect: "appears to be initiated by neuronal release of endogeneous
MOA that creates the analgesic effect and the MOA that opioid peptides with subsequent activation of opioid receptors and descending
creates the anxiolytic effect. Gamma-amniobutyric acid type A (GABBA) receptors and noradrenergic
pathways that modulate nociceptive processing at the spinal level"
Anxiolytic effect: "activation of the GABAA receptor either directly or indirectly
through the benzodiazepine binding site" (AAPD 204)
Describe the solubility of nitrous oxide Although the AAPD describes nitrous as 34 times more soluble than nitrogen;
nitrous is relatively insoluble which is the reason it can quickly diffuse in and out of
the human body/blood. (AAPD 204)
Describe the effect of nitrous on the cardiovascular Nitrous oxide causes minor depression in cardiac output while peripheral
system? (Include effect on cardiac output, peripheral resistance is slightly increased, thereby maintaining the blood pressure. (AAPD
resistance and blood pressure) 204)
How rapid is Nitrous Oxide recovery two to three minutes (AAPD 204)
What is the effect of Nitrous Oxide on the cough reflex? Minimal impairment to any reflex including the cough reflex (cough reflex is
preserved) (AAPD 204)
The most common adverse effects of nitrous oxide are 0.5 percent; a higher incidence is noted with longer administration of nitrous
nausea and vomiting which occur in what percentage of oxide/oxygen, fluctuation sin nitrous oxide levels, and increased concentrations
patients? of nitrous oxide (AAPD 206)
According to the study by Leelataweewud in 2000, what 1) No differences in pulse rate, oxyhemoglobin saturation (did find small increase
were the relevant effects of incorporating N2O/O2 to a in respiratory rate in N2O/O2 group)
conscious sedation of 1.5 mg/kg meperidine (demerol) 2) N2O/O2 did not increase risk of desaturation but did increase frequency of
(narcotic sedative), 50 mg/kg chloral hydrate and 25 mg desaturation events
hydroxyzine pamoate vs. that same triple cocktail with 3) N2O/O2 deepened level of sedation (so can deepen when added to a narcotic
just O2? sedation regimen)
4) if you are going to include N2O/O2 - must monitor with heightened vigilance
What is the nonselective, competitive, alpha-adrenergic phentolamine mesylate
antagonist used to reverse the effects of adrenergic
agonists like epinephrine?
, What is the proposed mechanism of action for phentolamine mesylate is a vasodilator and the increased local blood flow
phentolamine mesylate with respect to local anesthesia accelerates the clearance of local anesthetic from the submucosal tissue to the
reversal bloodstream
T/F Injection of phentolamine mesylate at the same site true: "We observed a 55.6 percent reduction in median time to return of normal
as the local anesthetic was injected can cut the time to lip sensation and a 60 percent reduction in median time to return of normal
return of normal lip sensation and normal tongue tongue sensation (Tavares JADA 2008)
sensation in half
Which are better at suppressing awareness? A) Potent A) Potent inhaled vapors, midazolam (versed), propofol
inhaled vapors, midazolam (versed), propofol
B) nitrous oxide and opioids
In the study by Watts et al. what was the effect of giving "Patients who were not given intraoperative local anesthesia were more likely to
local anesthesia during a general anesthesia case on vital experience vital sign fluctuation requiring anesthesiologist intervention" (Watts,
signs vs. no local anesthesia Pediatric dentistry, 2009)
A drug-induced depression of consciousness during Moderate sedation (old terminology = "conscious sedation" or
which patients respond purposefully to verbal commands "sedation/analgesia") (AAPD 210)
either alone or accompanied by light tactile stimulation.
For older patients, this level of sedation implies an
interactive state; for younger patients, age-appropriate
behaviors like crying occur and are expected. Reflex
withdrawal is accompanied by a purposeful response
(like pushing away). No intervention required to maintain
a patent airway, spontaneous ventilation is adequate.
Cardiovascular function is usually maintained.
Drug induced state during which patients respond Minimal sedation (old terminology "anxiolysis") (AAPD 210)
normally to verbal commands. Although cognitive
function and coordination may be impaired, ventilatory
and cardiovascular functions are unaffected
A drug-induced depression of consciousness during Deep sedation (old terminology "deep sedation/analgesia") (AAPD 210)
which patients cannot be easily aroused but respond
purposefully after repeated verbal or painful stimulation
(eg pushing away noxious stimuli). Ability to
independently maintain ventilatory function may be
impaired. Patients may require assistance in maintaining a
patent airway, and spontaneous ventilation may be
inadequate. Cardiovascular function is usually maintained.
May be accompanied by partial or complete loss of
protective airway reflexes
A drug-induced loss of consciousness during which General anesthesia (AAPD 211)
patients are not arousable, even by painful stimulation.
Ability to independently maintain ventilatory function is
often impaired. Patients often require assistance in
maintaining a patent airway and positive-pressure
ventilation may be required because of depressed
spontaneous ventilation or drug induced depression of
neuromuscular function. Cardiovascular function may be
impaired.
UPDATED ACTUAL Questions and CORRECT Answers
diminution or elimination of pain and anxiety in a analgesia/ anxiolysis (AAPD 204)
conscious patient. The patient responds normally to
verbal commands. All vital signs are stable, there is no
significant risk of losing protective reflexes, and the
patient is able to return to preprocedure mobility.
What affect does nitrous oxide have on the CNS? causes depression and euphoria (AAPD 204)
Nitrous oxide has two mechanisms of action. Describe Analgesic effect: "appears to be initiated by neuronal release of endogeneous
MOA that creates the analgesic effect and the MOA that opioid peptides with subsequent activation of opioid receptors and descending
creates the anxiolytic effect. Gamma-amniobutyric acid type A (GABBA) receptors and noradrenergic
pathways that modulate nociceptive processing at the spinal level"
Anxiolytic effect: "activation of the GABAA receptor either directly or indirectly
through the benzodiazepine binding site" (AAPD 204)
Describe the solubility of nitrous oxide Although the AAPD describes nitrous as 34 times more soluble than nitrogen;
nitrous is relatively insoluble which is the reason it can quickly diffuse in and out of
the human body/blood. (AAPD 204)
Describe the effect of nitrous on the cardiovascular Nitrous oxide causes minor depression in cardiac output while peripheral
system? (Include effect on cardiac output, peripheral resistance is slightly increased, thereby maintaining the blood pressure. (AAPD
resistance and blood pressure) 204)
How rapid is Nitrous Oxide recovery two to three minutes (AAPD 204)
What is the effect of Nitrous Oxide on the cough reflex? Minimal impairment to any reflex including the cough reflex (cough reflex is
preserved) (AAPD 204)
The most common adverse effects of nitrous oxide are 0.5 percent; a higher incidence is noted with longer administration of nitrous
nausea and vomiting which occur in what percentage of oxide/oxygen, fluctuation sin nitrous oxide levels, and increased concentrations
patients? of nitrous oxide (AAPD 206)
According to the study by Leelataweewud in 2000, what 1) No differences in pulse rate, oxyhemoglobin saturation (did find small increase
were the relevant effects of incorporating N2O/O2 to a in respiratory rate in N2O/O2 group)
conscious sedation of 1.5 mg/kg meperidine (demerol) 2) N2O/O2 did not increase risk of desaturation but did increase frequency of
(narcotic sedative), 50 mg/kg chloral hydrate and 25 mg desaturation events
hydroxyzine pamoate vs. that same triple cocktail with 3) N2O/O2 deepened level of sedation (so can deepen when added to a narcotic
just O2? sedation regimen)
4) if you are going to include N2O/O2 - must monitor with heightened vigilance
What is the nonselective, competitive, alpha-adrenergic phentolamine mesylate
antagonist used to reverse the effects of adrenergic
agonists like epinephrine?
, What is the proposed mechanism of action for phentolamine mesylate is a vasodilator and the increased local blood flow
phentolamine mesylate with respect to local anesthesia accelerates the clearance of local anesthetic from the submucosal tissue to the
reversal bloodstream
T/F Injection of phentolamine mesylate at the same site true: "We observed a 55.6 percent reduction in median time to return of normal
as the local anesthetic was injected can cut the time to lip sensation and a 60 percent reduction in median time to return of normal
return of normal lip sensation and normal tongue tongue sensation (Tavares JADA 2008)
sensation in half
Which are better at suppressing awareness? A) Potent A) Potent inhaled vapors, midazolam (versed), propofol
inhaled vapors, midazolam (versed), propofol
B) nitrous oxide and opioids
In the study by Watts et al. what was the effect of giving "Patients who were not given intraoperative local anesthesia were more likely to
local anesthesia during a general anesthesia case on vital experience vital sign fluctuation requiring anesthesiologist intervention" (Watts,
signs vs. no local anesthesia Pediatric dentistry, 2009)
A drug-induced depression of consciousness during Moderate sedation (old terminology = "conscious sedation" or
which patients respond purposefully to verbal commands "sedation/analgesia") (AAPD 210)
either alone or accompanied by light tactile stimulation.
For older patients, this level of sedation implies an
interactive state; for younger patients, age-appropriate
behaviors like crying occur and are expected. Reflex
withdrawal is accompanied by a purposeful response
(like pushing away). No intervention required to maintain
a patent airway, spontaneous ventilation is adequate.
Cardiovascular function is usually maintained.
Drug induced state during which patients respond Minimal sedation (old terminology "anxiolysis") (AAPD 210)
normally to verbal commands. Although cognitive
function and coordination may be impaired, ventilatory
and cardiovascular functions are unaffected
A drug-induced depression of consciousness during Deep sedation (old terminology "deep sedation/analgesia") (AAPD 210)
which patients cannot be easily aroused but respond
purposefully after repeated verbal or painful stimulation
(eg pushing away noxious stimuli). Ability to
independently maintain ventilatory function may be
impaired. Patients may require assistance in maintaining a
patent airway, and spontaneous ventilation may be
inadequate. Cardiovascular function is usually maintained.
May be accompanied by partial or complete loss of
protective airway reflexes
A drug-induced loss of consciousness during which General anesthesia (AAPD 211)
patients are not arousable, even by painful stimulation.
Ability to independently maintain ventilatory function is
often impaired. Patients often require assistance in
maintaining a patent airway and positive-pressure
ventilation may be required because of depressed
spontaneous ventilation or drug induced depression of
neuromuscular function. Cardiovascular function may be
impaired.
