Anesthesia for Dental and Oral Maxillofacial Surgery E-Book

Spencer D. Wade

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 410

Veröffentlichungsjahr: 2024

Beschreibung

Anesthesia for Dental and Oral Maxillofacial Surgery A comprehensive reference to anesthesia for dental, oral, and maxillofacial surgery Anesthesia for Dental and Oral Maxillofacial Surgery offers a comprehensive yet practical approach to anesthesiology for dentist anesthesiologists, oral and maxillofacial surgeons, and anesthesia providers in a dental environment. Taking a concise bulleted approach for fast access to information, the book covers all topics relevant to providing perioperative anesthetic management for the head and neck region. Coverage ranges from equipment, anatomy, physiology, and pharmacology to anesthetizing patients with specific conditions and for specific procedures. Designed for ease of use, the book makes it easy to find information relevant to cases ranging from common to rare. Anesthesia for Dental and Oral Maxillofacial Surgery readers will also find: * Images throughout to facilitate key points * A bulleted approach for easy reference * A practical, accessible style, making it easy to find information at point of care * Detailed coverage of preoperative aspects, pharmacology, key equipment, and more Anesthesia for Dental and Oral Maxillofacial Surgery provides anesthesia providers with all the information they need to confidently manage any case.

Leseprobe

Table of Contents

Cover

Table of Contents

Title Page

Copyright Page

Dedication Page

Editorial Board

Acknowledgments and Contributors

Preface

Oral/Written Boards

In‐Service Training Examination (ITE)

The Written Board Examination

The Oral Examination

Oral Board Examination Tips

Dentist Contributions to Anesthesiology

The History of Anesthesiology

Glossary of Abbreviations

Section 1: Statistics I Physics I Equipment

1.1 Statistics

Normal Distribution (Figure 1.1)

Variables

Basic Statistical Tests

Research Methodologies (Figure 1.2)

1.2 Anesthetic Monitoring Standards

Standard I (Figure 1.3)

Standard II (Figure 1.4)

1.3 Pulse Oximetry

Function

Clinical Considerations

1.4 Electrocardiography

Function

Clinical Considerations

1.5 Blood Pressure Monitors

Noninvasive Blood Pressure Cuff

Arterial Line

1.6 Temperature Monitoring

Function

Clinical Considerations

1.7 Ventilation Monitoring

Pretracheal/Precordial Stethoscope

Capnography

1.8 Capnograms (Figures 1.9 & 1.10)

1.9 Fluid and Gas Physics

Laminar Flow

1.10 Medical Gas

Characteristics (Figure 1.13)

Nitrous Oxide

Gas Supply Colors (Figure 1.14)

1.11 Mapleson Circuit

Characteristics (Figure 1.15)

1.12 Circle System

Humidifiers

Carbon Dioxide Absorbent

1.13 Anesthesia Machine Safety Features

1.14 Vaporizer

Vapor Pressure (Figures 1.18 & 1.19)

Safety Features

Desflurane Vaporizer

1.15 Ventilator

Common Ventilator Modes

Components and Safety Features

1.16 Infusion Pump

Components and Safety Features

References

Section 2: Anatomy I Physiology

2.1 Body Fluids

Fluid Compartments

2.2 Intravenous Fluids

Fluid Composition

Crystalloids

Colloids

2.3 Head and Neck Blood Supply (Figures 2.2 & 2.3)

2.4 Sensory Nerves (Figure 2.4)

2.5 Cranial Nerves

CN I (Olfactory)

CN II (Optic)

CN III (Oculomotor)

CN IV (Trochlear)

CN V (Trigeminal)

Ophthalmic Branch (V

1

)

Maxillary Branch (V

2

)

Mandibular Branch (V

3

)

CN VI (Abducens)

CN VII (Facial)

CN VIII (Vestibulocochlear)

CN IX (Glossopharyngeal)

CN X (Vagus)

CN XI (Spinal Accessory)

CN XII (Hypoglossal)

2.6 Neuromuscular Junction

Anatomy

Muscle Contraction

2.7 Parasympathetic Nervous System

Anatomy

Physiology (Figures 2.10 & 2.11)

Receptors

2.8 Sympathetic Nervous System

Anatomy

Physiology (Figures 2.12 & 2.13)

Receptors

2.9 Brain

Anatomy

Function

Cerebral Blood Flow (CBF)

Cerebral Blood Flow Regulation (Figure 2.15)

Innervation

Cerebrospinal Fluid

Anterior Pituitary Hormones

Posterior Pituitary Hormones

2.10 Spinal Cord

Anatomy

Function

Blood Flow

Innervation

Endocrine/Exocrine

2.11 Cardiac

Anatomy

Function

Cardiac Blood Flow (Figure 2.17)

Innervation

Cardiac Output (Figure 2.18)

Flow‐Volume Loop (Figure 2.20)

Conduction

Cardiac Action Potentials (Figures 2.21 & 2.22)

Endocrine/Exocrine

2.12 Pulmonary

Anatomy

Function

Pulmonary Blood Flow

Innervation

Ventilation

Shunts and Dead Space (Figure 2.23)

Oxygen–Hemoglobin Dissociation Curve (Figure 2.24)

Blood Oxygen Calculations (Figure 2.25)

Acid–Base Balance (Figure 2.26)

Endocrine/Exocrine

2.13 Renal

Anatomy

Function

Renal Blood Flow

Innervation

Renal Volume Management (Figures 2.27 & 2.28)

Urine Concentration (Figure 2.29)

Acid–Base Balance

Endocrine/Exocrine

2.14 Hepatic and Biliary

Anatomy

Function

Hepatic Blood Flow (Figure 2.30)

Innervation [6]

Endocrine/Exocrine

2.15 Gastrointestinal

Anatomy

Function

Blood Flow

Innervation

Endocrine

Exocrine

2.16 Pancreas

Anatomy

Function

Blood Supply

Innervation

Endocrine/Exocrine (Figure 2.31)

2.17 Thyroid

Anatomy

Function

Blood Supply

Innervation

Endocrine/Exocrine

2.18 Parathyroid

Anatomy

Function

Blood Supply

Innervation

Endocrine/Exocrine (Figure 2.33)

2.19 Adrenal Gland

Anatomy

Function

Blood Supply

Innervation

Endocrine/Exocrine

2.20 Vascular

Anatomy (Figure 2.35)

Function

Innervation

Blood Supply

Endocrine/Exocrine

Blood Pressure Regulation

2.21 Hematology

Anatomy (Figure 2.36)

Function

Blood Supply

Innervation

Endocrine/Exocrine

Platelet Plug and Coagulation Cascade

Endogenous Anticoagulants

References

Section 3: Preoperative Assessment

3.1 Psychology

Dental Fear and Anxiety

Nonpharmacologic Behavior Management [3]

3.2 Sedation Levels

Minimal Sedation

Moderate Sedation

Deep Sedation

General Anesthesia

3.3 ASA Physical Status Classification

ASA I

ASA III

ASA V

ASA II

ASA IV

ASA VI

NPO

NPO Guidelines [4]

Aspiration

3.4 Preoperative Cardiac Testing

Procedure

Metabolic Equivalent of Tasks (METs)

3.5 Preoperative Pulmonary Testing

Chest Radiography

Pulmonary Function Testing

Flow‐Volume Loops (Figure 3.10)

Diffusing Lung Capacity

3.6 Preoperative Labs

Blood Glucose

Hemoglobin A1c (HbA1c)

Basic Metabolic Panel (BMP) (Figure 3.11)

Arterial Blood Gas

Complete Blood Count (Figure 3.12)

Coagulation Study (Figure 3.13)

Liver Function Tests

Thyroid Testing

Pregnancy Testing

Type and Screen

Type and Cross

3.7 Airway Evaluation

Previous Airway/Intubations History

Presence/Suspicion of Obstructive Sleep Apnea (OSA) (Figure 3.15)

Clinical Airway Evaluation

Nasal Intubation Specifics

Predictors of Difficult Airway

References

Section 4: Outpatient Medications

4.1 Antibiotic Prophylaxis (Figures 4.1–4.6)

Infective Endocarditis

4.2 Smoking

Effects of Smoking

Smoking Cessation [6]

4.3 Substance Use Disorder Treatment

Varenicline

Acamprosate

Disulfiram

Naltrexone

Methadone

Buprenorphine [18]

4.4 Antiplatelets

Cyclooxygenase (COX) Inhibitors (NSAIDs)

Thienopyridines

4.5 Anticoagulants (Figure 4.9)

Direct Thrombin Inhibitors

Heparin

Warfarin

Direct Factor Xa Inhibitors

4.6 Antihypertensives

Angiotensin‐Converting Enzyme Inhibitors

Angiotensin Receptor Blockers

Calcium Channel Blockers (Dihydropyridines)

Nitrates

4.7 Diuretics

Thiazides

Loop Diuretics

Potassium Sparing Diuretics

4.8 Antidysrhythmics

β‐Blockers (Figures 4.12 & 4.13)

Digoxin

Calcium Channel Blockers (Non‐dihydropyridines)

4.9 Pulmonary

β

2

Receptor Agonists

Corticosteroids

Anticholinergics

Methylxanthines

Histamine‐1 Receptor Antagonists

Leukotriene Receptor Antagonists

5‐Lipoxygenase Inhibitors

4.10 Non‐Insulin Hypoglycemics

Biguanides

Sulfonylureas

Meglitinides

Thiazolidinediones (TZDs)

Sodium Glucose Cotransporter‐2 Inhibitors (SGLT2)

α‐Glucosidase Inhibitors

Dipeptidyl Peptidase‐4 Inhibitors (DPP‐4)

Glucagon‐Like Peptide 1 Receptor Agonists (GLP‐1)

4.11 Insulin

Rapid‐Acting Insulin

Regular‐Acting Insulin

Intermediate‐Acting Insulin

Long‐Acting Insulin

Insulin Pumps

4.12 Antidepressants

Tricyclics (TCAs)

Monoamine Oxidase Inhibitors (MAOIs)

Atypical Antidepressants

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

Selective Serotonin Reuptake Inhibitors (SSRIs)

4.13 Psychiatric

Antipsychotics

α

2

Adrenergic Agonists

Lithium

Amphetamines

Sleep Aids

4.14 Neurologic

Antiepileptics [51]

Dopaminergics

Cholinesterase Inhibitors

4.15 Gastrointestinal

H

2

Receptor Antagonists

Proton Pump Inhibitors (PPI)

Antacids

4.16 Glucocorticosteroids

Glucocorticosteroids

Steroid Equivalency Chart

4.17 Other Medications

Statins

Thyroid

Antiretrovirals

Ophthalmic

Herbal Medications

α

1

Adrenergic Antagonists

References

Section 5: The Perioperative Pharmacology

5.1 Inhalational Pharmacokinetics and Pharmacodynamics

Mechanism of Action

Minimum Alveolar Concentration (MAC)

Minimum Alveolar Concentration (Definitions)

Factors Affecting MAC (Figure 5.2)

Factors Affecting Inhalational Onset

Distribution

Metabolism

Elimination

5.2 Inhalational Agents

Nitrous Oxide

Isoflurane

Desflurane

Sevoflurane

5.3 Intravenous Pharmacokinetics and Pharmacodynamics

Factors Affecting Onset

Distribution

Hepatic Metabolism

Hepatic Clearance

Renal Clearance (Figure 5.11)

5.4 Intravenous Induction Agents

Propofol

Ketamine

Etomidate

Methohexital

5.5 Benzodiazepines

Diazepam

Midazolam

Remimazolam

Flumazenil

5.6 Opioids

Opioid Receptor

Equianalgesic

Morphine

Fentanyl

Hydromorphone

Remifentanil

Naloxone

Other Opioids

5.7 Non‐opioid IV Analgesics

Ketamine

Acetaminophen

Ketorolac

Dexmedetomidine

5.8 Neuromuscular Monitoring

Clinical Evaluation

Peripheral Nerve Stimulator

Train of Four

Nerves

Factors Affecting Neuromuscular Blockade (Figure 5.15)

Quantitative Neuromuscular Monitoring [60]

5.9 Neuromuscular Blocking Agents

Succinylcholine

Rocuronium

Vecuronium

Cisatracurium

5.10 Neuromuscular Reversal Agents

Sugammadex

Neostigmine

Atropine

Glycopyrrolate

5.11 Hypertensive Agents

Phenylephrine

Norepinephrine

Epinephrine

Ephedrine

Vasopressin

5.12 Antihypertensive Agents

Clevidipine

Esmolol

Metoprolol

Labetalol

Nicardipine

Hydralazine

Nitroglycerin

5.13 Antidysrhythmics

Adenosine

Amiodarone

Atropine

Diltiazem

Verapamil

References

Section 6: Adult Disease and Syndromes

6.1 Neurologic Disease

Epilepsy

Neurofibromatosis Type 1

Alzheimer's Disease

Parkinson's Disease

Huntington's Disease

Previous Stroke

6.2 Cardiac Disease

Stable Angina Pectoris

Congestive Heart Failure

6.3 Valvular Disease

Optimal Hemodynamic Goals

Mitral Valve Stenosis

Mitral Valve Regurgitation

Aortic Stenosis

Aortic Regurgitation

6.4 Bradydysrhythmias

Sinus Bradycardia

Sick Sinus Syndrome (Sinus Node Dysfunction)

6.5 Tachydysrhythmias

Sinus Tachycardia

Atrial Fibrillation

Multifocal Atrial Tachycardia

6.6 Cardiac Conduction Defects

Long QT Syndrome

Wolff–Parkinson–White Syndrome

First‐Degree AV Block

Second‐Degree AV Block: Mobitz Type I

Second‐Degree AV Block: Mobitz Type II

Third‐Degree AV Block

6.7 Cardiac Equipment and Transplants [51]

Implantable Cardioverter‐Defibrillator (Figure 6.20) (ICD)

Permanent Pacemaker (PPM)

Left Ventricular Assist Device (LVAD)

Denervated Heart

6.8 Vascular Disease

Systemic Hypertension

Pulmonary Hypertension [65]

Abdominal Aortic Aneurysm [70]

6.9 Pulmonary Disease

Asthma (Adult Patients)

Chronic Obstructive Pulmonary Disease

6.10 Neuromuscular Disease

Myasthenia Gravis

Spinal Cord Injury

6.11 Renal Disease

Chronic Kidney Disease (CKD)

6.12 Liver and Biliary Disease

Viral Hepatitis

Cirrhosis

6.13 Gastrointestinal Disease

Gastroesophageal Reflux Disease

Inflammatory Bowel Disease: Ulcerative Colitis and Crohn's Disease

6.14 Endocrine Disease

Diabetes Mellitus (DM) Type II

Hyperthyroidism

Hypothyroidism

Cushing's Syndrome

Adrenal Insufficiency (Addison's Disease)

6.15 Hematologic Disease

Sickle Cell Anemia

Hemophilia

Von Willebrand Factor (vWF) Disease

Factor V Leiden

6.16 Orthopedic Disease

Intervertebral Disk Disease

Osteoarthritis

Osteogenesis Imperfecta

6.17 Immune Disease

Acquired Immunodeficiency Syndrome (AIDS)

Multiple Sclerosis

Rheumatoid Arthritis

Systemic Lupus Erythematosus

6.18 Connective Tissue Disease

Marfan Syndrome

Ehlers–Danlos Syndrome

References

Section 7: Pediatric Disease and Syndromes

7.1 Pediatric Anatomy and Physiology

Airway

Fluid Management (Figure 7.1)

Cognitive Development (Piaget's Theory)

Central Nervous System

Cardiac

Pulmonary

Other Systems

7.2 Neonatal/Newborn Disorders

Premature Birth

Respiratory Distress Syndrome (RDS)

Bronchopulmonary Dysplasia (BPD)

Apnea of Prematurity (AOP)

Retinopathy of Prematurity (ROP)

Neonatal Abstinence Syndrome (NAS)

Esophageal Atresia/Tracheoesophageal Fistula (EA/TEF)

Tracheomalacia

Diaphragmatic Hernia

Omphalocele

Gastroschisis

Pyloric Stenosis

Necrotizing Enterocolitis (NEC)

Gastroesophageal Reflux Disease (GERD)

Germinal Matrix Hemorrhage and Intraventricular Hemorrhage (GMH‐IVH)

Cerebral Palsy (CP)

Cleft Lip and Cleft Palate

7.3 Congenital Heart Defects

Innocent Murmur

Patent Ductus Arteriosus (PDA)

Ventricular Septal Defect (VSD)

Atrial Septal Defect (ASD)

Tetralogy of Fallot

7.4 Childhood Disorders

Secondhand Smoke (SHS) Exposure

Upper Respiratory Tract Infection (URTI) (Common Cold)

Respiratory Syncytial Virus (RSV)

Croup (Laryngotracheobronchitis)

Acute Otitis Media (OM)

Asthma

Diabetes Mellitus (DM) Type 1 (Insulin‐Dependent DM)

Cystic Fibrosis (CF)

Adenotonsillar Hypertrophy/Sleep Disordered Breathing (SDB)

Duchene Muscular Dystrophy (DMD)

Autism Spectrum Disorder (ASD)

Attention Deficit Disorder With or Without Hyperactivity

7.5 Syndromes

Klinefelter Syndrome

Rett Syndrome

Pierre Robin Sequence

Down Syndrome

Angelman Syndrome

Prader–Willi Syndrome

Treacher Collins Syndrome

Beckwith–Wiedemann Syndrome

Cornelia de Lange Syndrome

Mitochondrial Disorders

Glucose‐6‐phosphate Dehydrogenase (G6PD) Deficiency

Methylenetetrahydrofolate Reductase (MTHFR) Mutation

References

Section 8: Perioperative Emergencies and Urgencies

8.1 Cardiac

8.2 Respiratory

8.3 Neuro

8.4 Metabolic

8.5 Other

Section 9: Dental Specifics

9.1 Common Drug Dosing

Minimal Sedation

Moderate Sedation

Deep Sedation/General Anesthesia

9.2 Local Anesthetics

Pharmacokinetics

Physiologic Effects

9.3 Topical Local Anesthetics

Types

9.4 Vasoconstrictors

9.5 Local Anesthesia for the Trigeminal Nerve (CN V)

Ophthalmic Nerve (V

1

)

Maxillary Nerve (V

2

)

Mandibular Nerve (V

3

)

9.6 Natural Guarded Airway (NGA)

Airway Barriers

Lost Objects

NGA Positioning

9.7 Noninvasive Oxygen Delivery Systems

Nasal Cannula (Figure 9.9)

Nasal Hood

Face Mask

High‐Flow Nasal Cannula [10]

Bag Valve Mask

9.8 Airway Adjuncts

Oral Pharyngeal Airways (OPA)

Nasopharyngeal Airways (NPA)

9.9 Supraglottic Airways

Face Mask Ventilation

Laryngeal Mask Airway (Figure 9.13)

King Airway

I‐gel

®

9.10 Endotracheal Tubes (Figure 9.14)

Head Movement and ETT Effect

Oral Endotracheal Tubes

Nasal Endotracheal Tubes

9.11 Laryngoscopy

Preoxygenation

Laryngoscopes

9.12 Fiberoptic Intubation (FOI)

Patient Preparation

Technique

Local Anesthesia for Awake Fiberoptics [15]

9.13 Submental Intubation

9.14 Deliberate Hypotensive Anesthesia

9.15 Legal Considerations

Terms

Statutes

Informed Consent

Negligence

Lawsuit

Liability Insurance

References

Section 10: Oral Maxillofacial Surgery

10.1 Odontogenic Infections

10.2 Orthognathic Surgery

10.3 Obstructive Sleep Apnea

10.4 Oral Reconstruction

Bone Grafting and Implant Restorations

10.5 Temporomandibular Joint Disorders

10.6 Trauma

Frontal Sinus Fracture (Figure 10.8)

Zygomaticomaxillary Complex (ZMC) Fracture (Figure 10.9)

Nasal‐Orbital‐Ethmoid (NOE) Complex Fracture (Figure 10.11)

Nasal Fracture (Figure 10.12)

Maxillary Fractures (Figure 10.13)

Mandibular Fractures (Figure 10.14)

10.7 Cricothyrotomy (Figure 10.15)

10.8 Tracheostomy

10.9 Facial Plastic Surgery

Rhytidectomy (Face Lift)

Blepharoplasty (Figure 10.16)

Rhinoplasty

Further Reading

References

Index

End User License Agreement

List of Tables

Chapter 2-15

Table 2.1

Table 2.2

List of Illustrations

Chapter 1-1

Figure 1.1

Figure 1.2

Chapter 1-2

Figure 1.3

Figure 1.4

Chapter 1-3

Figure 1.5

Chapter 1-4

Figure 1.6

Chapter 1-5

Figure 1.7

Figure 1.8

Chapter 1-8

Figure 1.9

Figure 1.10

Chapter 1-9

Figure 1.11

Figure 1.12

Chapter 1-10

Figure 1.13

Figure 1.14

Chapter 1-11

Figure 1.15

Chapter 1-13

Figure 1.16

Figure 1.17

Chapter 1-14

Figure 1.18

Figure 1.19

Chapter 1-15

Figure 1.20

Chapter 2-1

Figure 2.1

Chapter 2-3

Figure 2.2

Figure 2.3

Chapter 2-4

Figure 2.4

Chapter 2-5

Figure 2.5

Figure 2.6

Figure 2.7

Chapter 2-6

Figure 2.8

Figure 2.9

Chapter 2-7

Figure 2.10

Figure 2.11

Chapter 2-8

Figure 2.12

Figure 2.13

Chapter 2-9

Figure 2.14

Figure 2.15

Chapter 2-10

Figure 2.16

Chapter 2-11

Figure 2.17

Figure 2.18

Figure 2.19

Figure 2.20

Figure 2.21

Figure 2.22

Chapter 2-12

Figure 2.23

Figure 2.24

Figure 2.25

Figure 2.26

Chapter 2-13

Figure 2.27

Figure 2.28

Figure 2.29

Chapter 2-14

Figure 2.30

Chapter 2-16

Figure 2.31

Chapter 2-17

Figure 2.32

Chapter 2-18

Figure 2.33

Chapter 2-19

Figure 2.34

Chapter 2-20

Figure 2.35

Chapter 2-21

Figure 2.36

Figure 2.37

Figure 2.38

Chapter 3-4

Figure 3.1 Adapted from Fleisher et al. [7]

Figure 3.2 Adapted from Fleisher et al. [7]

Figure 3.3 Adapted from Fleisher et al. [7]

Figure 3.4 Adapted from Fleisher et al. [7]

Figure 3.5 Adapted from Fleisher et al. [7]

Figure 3.6 Adapted from Fleisher et al. [7]

Figure 3.7 Adapted from Fleisher et al. [7]

Figure 3.8

Chapter 3-5

Figure 3.9

Figure 3.10

Chapter 3-6

Figure 3.11

Figure 3.12

Figure 3.13

Chapter 3-7

Figure 3.14

Figure 3.15 Adapted from Nagappa et al. [14]

Figure 3.16

Figure 3.17

Chapter 4-1

Figure 4.1

Figure 4.2

Figure 4.3

Figure 4.4

Figure 4.5

Figure 4.6

Chapter 4-3

Figure 4.7

Chapter 4-4

Figure 4.8

Chapter 4-5

Figure 4.9

Chapter 4-6

Figure 4.10

Chapter 4-7

Figure 4.11

Chapter 4-8

Figure 4.12

Figure 4.13

Chapter 4-9

Figure 4.14

Chapter 4-10

Figure 4.15

Chapter 4-11

Figure 4.16

Chapter 4-15

Figure 4.17

Chapter 4-17

Figure 4.18

Chapter 5-1

Figure 5.1

Figure 5.2

Figure 5.3

Figure 5.4

Figure 5.5

Chapter 5-3

Figure 5.6

Figure 5.7

Figure 5.8

Figure 5.9

Figure 5.10

Figure 5.11

Chapter 5-4

Figure 5.12

Chapter 5-5

Figure 5.13

Chapter 5-8

Figure 5.14

Figure 5.15

Chapter 5-9

Figure 5.16

Chapter 5-11

Figure 5.17

Figure 5.18

Chapter 5-12

Figure 5.19

Chapter 6-1

Figure 6.1

Figure 6.2

Figure 6.3

Figure 6.4

Figure 6.5

Chapter 6-2

Figure 6.6

Figure 6.7

Figure 6.8

Chapter 6-4

Figure 6.9

Figure 6.10

Chapter 6-5

Figure 6.11

Figure 6.12

Figure 6.13

Chapter 6-6

Figure 6.14

Figure 6.15

Figure 6.16

Figure 6.17

Figure 6.18

Figure 6.19

Chapter 6-7

Figure 6.20

Figure 6.21

Figure 6.22

Figure 6.23

Figure 6.24

Figure 6.25

Chapter 6-8

Figure 6.26

Chapter 6-9

Figure 6.27

Chapter 6-10

Figure 6.28

Figure 6.29

Chapter 6-12

Figure 6.30

Figure 6.31

Chapter 6-13

Figure 6.32

Figure 6.33

Chapter 6-14

Figure 6.34

Figure 6.35

Figure 6.36

Figure 6.37

Figure 6.38

Chapter 6-15

Figure 6.39

Chapter 6-16

Figure 6.40

Figure 6.41

Figure 6.42

Chapter 6-17

Figure 6.43

Figure 6.44

Figure 6.45

Chapter 7-1

Figure 7.1

Figure 7.2 Adapted from Haque and Zaritsky [3].

Chapter 7-2

Figure 7.3

Figure 7.4

Figure 7.5

Figure 7.6

Figure 7.7

Figure 7.8

Figure 7.9

Figure 7.10

Chapter 7-3

Figure 7.11

Figure 7.12

Figure 7.13

Figure 7.14

Figure 7.15

Chapter 7-4

Figure 7.16

Figure 7.17

Figure 7.18

Figure 7.19

Figure 7.20

Figure 7.21

Chapter 7-5

Figure 7.22

Figure 7.23

Figure 7.24

Figure 7.25

Figure 7.26

Chapter 8-1

Figure 8.1

Figure 8.2

Figure 8.3

Figure 8.4

Figure 8.5

Figure 8.6

Chapter 8-2

Figure 8.7

Figure 8.8

Figure 8.9

Figure 8.10

Figure 8.11

Figure 8.12

Figure 8.13

Figure 8.14

Figure 8.15

Figure 8.16

Figure 8.17

Figure 8.18

Figure 8.19

Figure 8.20

Figure 8.21

Chapter 8-3

Figure 8.22

Figure 8.23

Figure 8.24

Figure 8.25

Figure 8.26

Chapter 8-4

Figure 8.27

Figure 8.28

Figure 8.29

Figure 8.30

Chapter 8-5

Figure 8.31

Figure 8.32

Chapter 9-2

Figure 9.1

Figure 9.2

Figure 9.3

Figure 9.4

Chapter 9-4

Figure 9.5

Chapter 9-5

Figure 9.6

Figure 9.7

Chapter 9-6

Figure 9.8

Chapter 9-7

Figure 9.9

Figure 9.10

Chapter 9-8

Figure 9.11

Figure 9.12

Chapter 9-9

Figure 9.13

Chapter 9-10

Figure 9.14

Figure 9.15

Figure 9.16

Chapter 9-11

Figure 9.17

Figure 9.18

Chapter 10-1

Figure 10.1

Chapter 10-2

Figure 10.2 Adapted from Bakathir et al. [2].

Figure 10.3

Figure 10.4

Chapter 10-3

Figure 10.5

Figure 10.6

Chapter 10-5

Figure 10.7

Chapter 10-6

Figure 10.8

Figure 10.9

Figure 10.10

Figure 10.11

Figure 10.12

Figure 10.13

Figure 10.14

Chapter 10-7

Figure 10.15

Chapter 10-9

Figure 10.16

Guide

Cover Page

Table of Contents

Title Page

Copyright Page

Dedication Page

Editorial Board

Acknowledgments and Contributors

Preface

Oral/Written Boards

Dentist Contributions to Anesthesiology

Glossary of Abbreviations

Begin Reading

Index

WILEY END USER LICENSE AGREEMENT

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Anesthesia for Dental and Oral Maxillofacial Surgery

Spencer D. Wade

Caroline M. Sawicki

Megann K. Smiley

Michael A. Cuddy

Steven Vukas

Paul J. Schwartz

Copyright © 2024 by John Wiley & Sons, Inc. All rights reserved.

Published by John Wiley & Sons, Inc., Hoboken, New Jersey.Published simultaneously in Canada.

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per‐copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, (978) 750‐8400, fax (978) 750‐4470, or on the web at www.copyright.com. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, (201) 748‐6011, fax (201) 748‐6008, or online at http://www.wiley.com/go/permission.

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Limit of Liability/Disclaimer of Warranty: While the publisher and author have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives or written sales materials. The advice and strategies contained herein may not be suitable for your situation. You should consult with a professional where appropriate. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.

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Library of Congress Cataloging‐in‐Publication Data

Names: Wade, Spencer D., editor.Title: Anesthesia for dental and oral maxillofacial surgery / [edited by] Spencer D. Wade, Caroline M. Sawicki, Megann K. Smiley, Michael A. Cuddy, Steven Vukas, Paul J. Schwartz.Description: Hoboken, New Jersey : Wiley‐Blackwell, [2024] | Includes bibliographical references and index.Identifiers: LCCN 2024005300 (print) | LCCN 2024005301 (ebook) | ISBN 9781394164899 (paperback) | ISBN 9781394164905 (ePDF) | ISBN 9781394164912 (ePUB) | ISBN 9781394164929 (oBook)Subjects: MESH: Anesthesia, Dental–methods | Oral Surgical Procedures | Tooth Diseases–surgery | Jaw–surgery | Face–surgery | Anesthetics–therapeutic useClassification: LCC RK510 (print) | LCC RK510 (ebook) | NLM WO 460 | DDC 617.9/676–dc23/eng/20240301LC record available at https://lccn.loc.gov/2024005300LC ebook record available at https://lccn.loc.gov/2024005301

Cover Design: WileyCover Image: © Spencer D Wade, fotograzia/Getty Images

To my beautiful daughter, Ava Kristina Wade, thank you for providing the inspiration behind this book and the motivation to finish.

Spencer D. WadeEditor‐in‐Chief

Editorial Board

Editor‐in‐Chief

SPENCER D. WADE, DDS, MSDentist AnesthesiologistDiplomate, American Dental Board of AnesthesiologyClinical Assistant ProfessorNew York University College of Dentistry, New York,New York, USAOral Health Center for People with Disabilities

Co‐Authors

CAROLINE M. SAWICKI, DDS, PhDPediatric DentistBoard Eligible, American Board of Pediatric DentistryClinical Assistant ProfessorUniversity of North Carolina Adams School of Dentistry,Chapel Hill, North Carolina, USADivision of Pediatric and Public Health

MEGANN K. SMILEY, DMD, MSDentist AnesthesiologistDiplomate, American Dental Board of AnesthesiologyColumbus, OhioNationwide Children’s Hospital, Columbus, Ohio, USADepartment of Anesthesiology and Pain MedicineThe Ohio State University College of DentistryDivision of Pediatric Dentistry, Columbus, Ohio, USA

MICHAEL A. CUDDY, DMDDentist AnesthesiologistDiplomate, American Dental Board of AnesthesiologyAssociate ProfessorUniversity of Pittsburgh School of Dental Medicine,Pittsburgh, Pennsylvania, USADepartment of Dental Anesthesiology

STEVEN VUKAS, DMD, MDOral and Maxillofacial SurgeonDiplomate, American Board of Oral and MaxillofacialSurgeryAssistant ProfessorUniversity of Pittsburgh School of Dental Medicine,Pittsburgh, Pennsylvania, USADepartment of Oral and Maxillofacial SurgeryDepartment of Dental Anesthesiology

PAUL J. SCHWARTZ, DMDOral and Maxillofacial SurgeonDentist AnesthesiologistDiplomate, American Board of Oral and MaxillofacialSurgeryDiplomate, American Dental Board of AnesthesiologyDiplomate, National Board of Dental AnesthesiologyAssistant ProfessorUniversity of Pittsburgh School of Dental Medicine,Pittsburgh, Pennsylvania, USADepartment of Oral and Maxillofacial SurgeryDepartment of Dental Anesthesiology

Content Editors

STEVEN GANZBERG, DMD, MSDentist AnesthesiologistDiplomate, American Dental Board of AnesthesiologyProfessor and Chair, RetiredThe Ohio State University, Columbus, Ohio, USADivision of Oral and Maxillofacial Surgery and DentalAnesthesiologyUniversity of California, Los Angeles, California, USADivision of Dental Anesthesiology

ANDREW HERLICH, DMD, MD, FAAP, FASAPediatric AnesthesiologistDiplomate, American Board of AnesthesiologyProfessor EmeritusUniversity of Pittsburgh School of Medicine, Pittsburgh,Pennsylvania, USADepartment of Anesthesiology and Perioperative MedicineUniversity of Pittsburgh School of Dental Medicine,Pittsburgh, Pennsylvania, USAProfessor and Interim Chair, Department of DentalAnesthesiology

M. CYNTHIA FUKAMI, DMD, MSDentist AnesthesiologistDiplomate, American Dental Board of AnesthesiologyPhoenix, Arizona, USA

JOEL M. WEAVER, DDS, PhDDentist AnesthesiologistDiplomate, American Dental Board of AnesthesiologyProfessor EmeritusThe Ohio State University College of Dentistry, Columbus,Ohio, USADivision of Oral and Maxillofacial Surgery and DentalAnesthesiologyThe Ohio State University College of Medicine, Columbus,Ohio, USADepartment of Anesthesiology

Acknowledgments and Contributors

DANIEL L. ORR II, DDS, MS Anesthesiology, PhD, JD, MDDentist AnesthesiologistOral and Maxillofacial SurgeonLawyerDiplomate, American Dental Board of AnesthesiologyDiplomate, American Board of Oral and Maxillofacial SurgeryDiplomate, American Board of Legal MedicineProfessor EmeritusUniversity of Nevada Las Vegas School of Dental MedicineLas Vegas, Nevada, USA

TIMOTHY M. ORR, DMD, JDDentist AnesthesiologistLawyerDiplomate, American Dental Board of AnesthesiologyDiplomate, American Board of Legal MedicineAustin, Texas, USA

KYLE J. KRAMER, DDS, MSDentist AnesthesiologistDiplomate, American Dental Board of AnesthesiologyClinical Associate ProfessorIndiana University School of DentistryIndianapolis, Indiana, USADepartment of Oral Surgery and Hospital Dentistry

Preface

Message From the Authors

Anesthesia for Dental and Oral Maxillofacial Surgery was developed to provide essential information in basic medical knowledge and anesthesia care. This valuable resource will act as a convenient perioperative reference and serve as an excellent study guide in preparation for written and oral board examinations in Dental Anesthesiology and Oral and Maxillofacial Surgery.

This text is not only designed for the resident or new graduate studying for their oral or written boards, but is also useful to those out in practice who want to refresh themselves on anesthetic concepts. It is set up in bullet point format to give you, the reader, high‐yield information at a glance and space to highlight, draw, and write in your own explanations to help connect the dots. This will personalize the book to your own learning style to enhance your learning experience.

This book is not going to be a substitute for residency experience and dedicated studying throughout your training. Many of the topics included here are covered in greater depth in other anesthesia textbooks. However, this text should give you solid foundational knowledge as well as guide your studying where knowledge deficits arise.

For questions regarding the content or if there are future topics you think would be beneficial, please email the Editor‐in‐Chief:

[email protected]

Disclaimer: This book is not a substitute for crafting an anesthetic plan on a specific patient/procedural basis.

Oral/Written Boards

It is a great honor and significant career accomplishment to earn a board certification in your chosen specialty. Board certification is certainly worth the time and sacrifice to achieve.

Time management is the most important aspect of preparation when it comes to an oral or written board certification examination. Having an efficient strategy for finding vital topics pertinent to the exam is critical to doing well. One way to demonstrate mastery of core skills and knowledge is to show that you understand how to use resources efficiently and appropriately.

In‐Service Training Examination (ITE)

These are secure examinations developed by specific specialty boards for residents in training. The content areas cover the breadth of the specialty with basic science and clinical questions. The exam tests your foundational knowledge in the entire training curriculum. These exams predominately function in gauging your knowledge among your peers, as well as track your progression in the curriculum.

The Written Board Examination

Passing this exam is a prerequisite for being able to sit for the Oral Examination.

Written Examinations are psychometrically valid computer‐based exams administered to test your knowledge in core principles of the specialty. Questions range from direct, factual information to specific clinical techniques, and span from basic to complex in breadth.

The Oral Examination

Once you have successfully completed the Written Examination, you are eligible to begin your application for the Oral Examination. This exam is designed to test your clinical judgment and ability to apply and verbalize the cognitive knowledge that was successfully demonstrated on the Written Examination.

The format of the Oral Examination allows you to demonstrate your ability to assess and manage patients presenting for treatment, as well as your ability to effectively communicate these relevant issues with both patients and colleagues.

The Oral Examination seeks to evaluate your ability to analyze and act appropriately and expediently in all situations. The exam encompasses several aspects of anesthesiology practice, including perioperative management and proper responses to urgent and emergency situations.

You will be given case scenarios and asked to interpret and discuss findings, make a clinical judgment, and defend your position. You may request additional information that is relevant to aid in your assessment and management.

The focus of each discussion can change as new issues develop in a given case. You will be evaluated throughout the preoperative, operative, and postoperative periods.

Oral Board Examination Tips

The Oral Examination, in Dental Anesthesiology and Oral and Maxillofacial Surgery can be intimidating and require intense preparation. Adequate preparation is measured in many months of study post‐residency. For most candidates, this will be the first oral exam they have ever encountered. Residents who participate in frequent verbal discussions with their attendings regarding clinical scenarios will find themselves better prepared to succeed in this type of exam, and such discussions are strongly encouraged throughout your training. Many residents and candidates also find it useful to take turns asking each other potential board questions to practice talking through the management of patients.

On the whole, it is wise to take the exam soon after completion of residency. You will be more likely to remember detailed information about complicated patients and surgical management. Once you enter private practice, your scope naturally narrows, and some of these minute details can get lost and forgotten.

General Tips

Your oral exam begins the moment you meet your examiners. Greet your examiners with a smile, look interested, pay attention to every detail of your examiner's instruction. You will be nervous and your examiners will do their best to put you at ease. They will do everything they can to help you relax and perform well.

Make sure to look and act professional. Business casual is appropriate for the oral exam.

Realize that your visual appearance and your body language are vital forms of communication during the exam. Your body language should be deliberate; it should exude confidence and communicate that you are happy to be there.

Make every attempt to answer questions as rapidly and completely as you can. The clearer and more concise you are, the more likely you are to finish the cases and positively impact your grade.

If you do not know the answer to a specific question, admit this but try to quickly offer information appropriate to the topic which demonstrates your knowledge of the subject and how you would address the situation.

Always be prepared to articulate your rationale and be prepared to defend your course of action.

It is important to verbalize your thought process for every stage of case management. Do not assume that the examiners know why you are ordering particular labs and tests, or how you reached a particular conclusion. When in doubt, talk it out.

The Board exam, especially the oral exam, has evolved considerably over time. They are no longer adversarial with intimidating examiners probing the candidates' cognitive and psychological limits. Specialty boards in both Dental Anesthesiology and Oral and Maxillofacial Surgery are directed by our brightest, most accomplished practitioners who truly care about presenting the exam that will fairly evaluate you to join the ranks of the specialty. To be board certified is an extraordinary accomplishment and identifies you as someone who meets the standards of training, education, and professionalism necessary to earn the title of Diplomate.

Dentist Contributions to Anesthesiology

For millennia, the fear of the pain of surgery was not worth the procedure

Death was often the preferred option to surgery

Early efforts included strangulation, freezing, alcohol, opiates, and hallucinogens; none were predictably safe or effective

Since the 1960s, a series of published articles documented dental outpatient GA safety. Initial mortality estimates of 1/400 000 are now at 1/720 000, supporting an astounding record of safety

The History of Anesthesiology

1799: Sir Humphry Davy published that N

2

O may be an advantage in surgery

1842: Crawford W. Long, MD, observed,

but did not make known

, the effects of N

2

O

1842: William E. Clark administered ether for a dental extraction,

but did not make known

1844: Horace Wells, DDS,

observed and made known

(“discovered”) the predictably safe and effective analgesic effects of N

2

O. Wells is the Discoverer of Anesthesia

1846: William T.G. Morton, DDS, used ether to assist with tooth extraction and, later that year, neck tumor removal

1847: First sexual assault by Parisian dentist convicted on two counts of assault on two anesthetized girls

1848: First published anesthesia death involving chloroform for ingrown toenail surgery

1865: William T.G. Morton, DDS, provides over 3000 ether anesthetics during the Civil War

1868: Alfred Coleman, DDS, invented the first CO

2

absorber

1883: G.V. Black, DDS, promoted the use of bromide of ethyl as an anesthetic

1902: Charles Teeter, DDS, introduced the first machine capable of delivering N

2

O/O

2

, ether, and chloroform. Later, Teeter was elected President of both the ASA and IARS

1912: Jay Heidbrink, DDS, first used color‐coded anesthesia gas tanks and invented the pin index safety system

1910: Edgar Rudolph Randolph “Painless” Parker, DDS, advocated for the routine use of local anesthesia in dentistry. The ADA did not recommend local anesthesia until the 1930s

1940: Adrian Orr Hubbell, DDS, introduced sodium thiopental as an effective agent for outpatient surgery

1944: Leonard Monheim, DDS, published “A,B,C” pre‐anesthesia risk categories

1963: The ASA published the Physical Status Classification

1963: Hoffmann‐La Roche introduced Diazepam. The oral formulation became the most prescribed drug in the world

1970s: Medicine begins to adopt half of the 1844 dental paradigm for outpatient anesthesia, i.e. allowing a patient to leave from and return to home after GA and surgery the same day

2010s: Medicine begins to adopt the other half of dentistry’s 1844 model, i.e. GA in facilities outside the OR

Glossary of Abbreviations

AA

Anesthesiologist assistant

AAOMS

American Association of Oral and Maxillofacial Surgeons

AAP

American Academy of Pediatrics

ABG

Arterial blood gas

ABO/Rh

Blood group classification

ABOMS

American Board of Oral and Maxillofacial Surgery

ACC

American College of Cardiology

ACE

Angiotensin‐converting enzyme

ACEi

Angiotensin‐converting enzyme inhibitors

ACLS

Advanced cardiac life support

ACTH

Adrenocorticotropic hormone

ADA

American Dental Association

ADBA

American Dental Board of Anesthesiology

ADH

Antidiuretic hormone or vasopressin

ADHD

Attention‐deficit/hyperactivity disorder

ADSA

American Dental Society of Anesthesiology

AED

Automated external defibrillator

AHA

American Heart Association

AHI

Apnea–hypopnea index

AIDS

Acquired immunodeficiency syndrome

AMA

American Medical Association

AMS

Altered mental status

AOP

Apnea of prematurity

APL

Adjustable pressure limiting

ARB

Angiotensin receptor blockers

ASA

American Society of Anesthesiologists

ASC

Ambulatory surgery center

ASD

Atrial septal defect

or

autism spectrum disorder

ASDA

American Society of Dentist Anesthesiologists

AV

Atrioventricular

AVNRT

Atrioventricular nodal reentrant tachycardia

AVRT

Atrioventricular reentrant tachycardia

BAR

Blunt autonomic response

BBB

Blood–brain barrier

BiPAP

Bilevel positive airway pressure

BMI

Body mass index

BMP

Basic metabolic panel

BMS

Bare metal stent

BNP

B‐type natriuretic peptide

BP

Blood pressure

BPD

Bronchopulmonary dysplasia

BSSO

Bilateral sagittal split osteotomy

BUN

Blood urea nitrogen

BW

Birth weight

°C

Celsius

CABG

Coronary artery bypass grafting

CAD

Coronary artery disease

CaO

2

Arterial oxygen content

CBF

Cerebral blood flow

CBC

Complete blood count

CC

Correlation coefficient

CCB

Calcium channel blocker

CD

Cluster of differentiation (CD4 cells)

CDC

Centers for Disease Control and Prevention

CHD

Congenital heart disease

CHF

Congestive heart failure

CI

Confidence interval

CKD

Chronic kidney disease

CL

Cleft lip

CLP

Cleft palate

cm

Centimeter

CMP

Comprehensive metabolic panel

CMRO

2

Cerebral metabolic oxygen consumption rate

CMS

Centers for Medicare and Medicaid Services

CN

Cranial nerve

CO

Cardiac output

CO

2

Carbon dioxide

COMT

Catechol‐O‐methyltransferase

COPD

Chronic obstructive pulmonary disease

COX

Cyclooxygenase

CNS

Central nervous system

CPAP

Continuous positive airway pressure

CPP

Cerebral perfusion pressure

CPR

Cardiopulmonary resuscitation

CRH

Corticotropin‐releasing hormone

CNRA

Certified Registered Nurse Anesthetist

CSF

Cerebral spinal fluid

CT

Computed tomography

CV

Cardiovascular

CVA

Cerebrovascular accident

CVR

Cerebrovascular resistance

DA

Dentist anesthesiologist

DAPT

Dual antiplatelet therapy

DASI

Duke Activity Status Index

DBP

Diastolic blood pressure

DDAVP

Desmopressin

DDS

Doctorate of Dental Surgery

DEA

Drug Enforcement Agency

DES

Drug eluting stent

DHEA

Dehydroepiandrosterone

dL

Deciliter

DMARD

Disease‐modifying antirheumatic drugs

DMD

Doctor of Medicine in Dentistry

DNA

Deoxyribonucleic acid

DO

Doctor of Osteopathic Medicine

DO

2

Oxygen delivery

DOS

Day of surgery

DPG

2,3 diphosphoglyceric acid

DPP‐4

Dipeptidyl peptidase‐4 inhibitors

DVT

Deep vein thrombosis

ECG

Electrocardiography

Echo

Echocardiogram

ED

Emergency department

EDV

End diastolic volume

EEG

Electroencephalogram

EGD

Esophagogastroduodenoscopy

ESRD

End‐stage renal disease

ESV

End systolic volume

ETCO

2

End tidal carbon dioxide

ETT

Endotracheal tube

FA

Alveolar concentration of anesthetic gas

FDA

Food and Drug Administration

FEV

1

Forced expiratory volume over one second

FGF

Fresh gas flow

FI

Inspired concentration of inhaled anesthetic

FIO

2

Fraction of inspired oxygen

FOI

Fiberoptic intubation

FRC

Functional residual capacity

FVC

Forced vital capacity

g

Gram

G6PD

Glucose‐6‐phosphate dehydrogenase

G

A

Gestational age

GA

General anesthesia

GABA

γ‐Aminobutyric acid

GER

Gastroesophageal reflux

GERD

Gastroesophageal reflux disease

GFR

Glomerular filtration rate

GI

Gastrointestinal

GLP‐1

Glucagon‐like peptide 1 receptor agonists

h

hour(s)

HAART

Highly active antiretroviral therapy

HbA1c

Hemoglobin A1c

HBF

Hepatic blood flow

HCL

Hydrochloric acid

HIV

Human immunodeficiency virus

HMG‐CoA

3‐hydroxy‐3‐methylglutaryl coenzyme A

HR

Heart rate

HTN

Hypertension

IANB

Inferior alveolar nerve block

ICD

Implantable cardioverter defibrillator

ICP

Intracranial pressure

IDDM

Insulin‐dependent diabetes mellitus

IE

Infective endocarditis

IM

Intramuscular

IN

Intranasal

INR

International normalized ratio

IV

Intravenous

IVH

Intraventricular hemorrhage

J

Joule

kg

Kilogram

l

Liter

LBW

Lean body weight

LFT

Liver function tests

LMA

Laryngeal mask airway

LMWH

Low molecular weight heparin

LR

Lactated ringer’s

LV

Left ventricle

LVAD

Left ventricular assist device

LVEF

Left ventricular ejection fraction

LVF

Left ventricular function

LVH

Left ventricular hypertrophy

m

Meter

m.

Muscle

MAC

Minimum alveolar concentration

or

monitored anesthesia care

MACE

Major adverse cardiac events

MAOIs

Monoamine oxidase inhibitors

MAP

Mean arterial pressure

MD

Doctor of Medicine

MDI

Metered dose inhaler

MET

Metabolic equivalent

mEq

Milliequivalent

MH

Malignant hyperthermia

MI

Myocardial infarction

MIO

Mean incisal opening

ml

Milliliter

mm

Millimeter

mm.

Muscles

MMA

Maxillary and mandibular advancement

MMF

Maxillomandibular fixation

mmHg

Millimeters of mercury

MRI

Magnetic resonance imaging

MRSA

Methicillin‐resistant staphylococcus aureus

MTHFR

Methylenetetrahydrofolate reductase

ms

Millisecond

mV

Millivolt

MV

Minute ventilation

n.

Nerve

N

2

O

Nitrous oxide

N/A

Not applicable

NAS

Neonatal abstinence syndrome

NEC

Necrotizing enterocolitis

NETT

Nasal endotracheal tube

NG

Nasal‐gastric

NGA

Natural guarded airway

NICU

Neonatal intensive care unit

NIDDM

Non‐insulin dependent diabetes mellitus

NIV

Noninvasive ventilation

NMB

Neuromuscular blockade

NMDA

N‐methyl‐D‐aspartate

NMJ

Neuromuscular junction

NNT

Numbers needed to treat

NOE

Nasal‐orbital‐ethmoid

NPA

Nasal pharyngeal airway

NPH

Neutral Protamine Hagedorn

NPO

Latin “Nil per os” or nothing by mouth

NSAID

Nonsteroidal anti‐inflammatory drugs

NYHA

New York Heart Association

OB

Obstetrics

ODD

Oppositional defiant disorder

OETT

Oral endotracheal tube

OG

Oral‐gastric

OM

Otitis media

OMS

Oral and maxillofacial surgeon

OPA

Oral pharyngeal airway

OR

Operating room

OSA

Obstructive sleep apnea

PaCO

2

Arterial partial pressure of carbon dioxide

PACU

Post‐anesthesia care unit

PaO

2

Arterial partial pressure of oxygen

P

A

O

2

Alveolar partial pressure of oxygen

PAP

Pulmonary arterial pressure

P

atm

Barometric pressure (760 mmHg)

PCI

Percutaneous coronary intervention

PDEi

Phosphodiesterase inhibitors

PE

Pulmonary embolism

PEA

Pulseless electrical activity

PEEP

Positive end‐expiratory pressure

PEG

Percutaneous endoscopic gastrostomy

PFO

Patent foramen ovale

PFT

Pulmonary function test

pH

Potential of hydrogen (Measuring degree of acidity)

PH

2

O

Partial pressure of water (47 mmHg)

PO

Latin “Per os” or by mouth

PONV

Postoperative nausea vomiting

PPE

Personal protective equipment

PPM

Permanent pacemaker

pRBCs

Packed red blood cells

PRN

Latin “Pro re nata” or as needed

PPIs

Proton pump inhibitors

PPV

Positive pressure ventilation

PSI

Pounds per square inch

PT

Prothrombin time

PTT

Partial thromboplastin time

PVC

Polyvinyl chloride

PVCs

Premature ventricular contractions

PVR

Pulmonary vascular resistance

pVT

Pulseless ventricular tachycardia

q

Latin abbreviation of “quaque” or every

RAD

Reactive airway disease

RAE

Right angle endotracheal

RBCs

Red blood cells

RBF

Renal blood flow

RDS

Respiratory distress syndrome

RQ

Respiratory quotient (Typically ~0.8)

Rh

Rh immunoglobulin

ROM

Range of motion

ROP

Retinopathy of prematurity

ROSC

Return of spontaneous circulation

RR

Respiratory rate

RSI

Rapid sequence induction

RSV

Respiratory syncytial virus

RV

Right ventricle

RVH

Right ventricular hypertrophy

RVOT

Right ventricular outflow tract

RVR

Rapid ventricular response

SA

Sinoatrial

SBP

Systolic blood pressure

SDB

Sleep disordered breathing

SGA

Supraglottic airway

SGL2

Sodium glucose cotransporter‐2 inhibitors

SHS

Secondhand smoke

SIDS

Sudden infant death syndrome

SL

Sublingual

SpO

2

Percent of oxygen‐saturated hemoglobin

SNRIs

Serotonin norepinephrine reuptake inhibitors

SSRIs

Selective serotonin reuptake inhibitors

SV

Stroke volume

SVR

Systemic vascular resistance

SVT

Supraventricular tachycardia

T&A

Tonsillectomy and/or adenoidectomy

T

3

Triiodothyronine

T

4

Thyroxine

TAAA

Thoracoabdominal aortic aneurysm

TCAs

Tricyclics

TIA

Transient ischemic attack

TIVA

Total intravenous anesthesia

TMJ

Temporomandibular joint

TSH

Thyroid‐stimulating hormone

TV

Tidal volume

TZDs

Thiazolidinediones

UPPP

Uvulopalatopharyngoplasty

UTI

Urinary tract infection

URI

Upper respiratory infection

URTI

Upper respiratory tract infection

VF

Ventricular fibrillation

V/Q

Ventilation/perfusion

VSD

Ventricular septal defect

VT

Ventricular tachycardia

VTE

Venous thromboembolism

vWF

von Willebrand factor

WBCs

White blood cells

WPW

Wolff–Parkinson–White

ZMC

Zygomaticomaxillary complex

Section 1Statistics I Physics I Equipment

1.1Statistics

Sampling

Samples are subsets of the population

Ideal samples are truly representative of the population

Probability

The possibility of an outcome from any random event

Numerical value between 0 and 1

Mean

The average value of a data set

Median

The middle value of a set of data which has been arranged in order of magnitude

Mode

The most frequent value in a data set

Standard Deviation

Quantifies the variability of values from the mean

Standard Error

Measures the accuracy of the sample mean to the population mean

Correlation Coefficient

The strength of linear relationship between two variables

Confidence Interval

A range of values defined that there is a specific probability that the true value of a parameter lies within it

Number Needed to Treat

The estimated number of patients that need to be treated to impact one patient

P‐value

The primary goal of any statistical test/analysis is to determine if a result is statistically significant which is done by a p‐value

A p‐value less than 0.05 is generally considered statistically significant

Normal Distribution (Figure 1.1)

Figure 1.1

Variables

Independent Variable

The variable being manipulated in a study

Typically on the X‐axis

Dependent Variable

The variable whose measurements depend on the independent variable

Typically on the Y‐axis

Continuous Variable