Scenario A 45 year old woman visits a dentist to have her lower molar extracted.

There is only the root left, but it is not wobbly. From history taking, it is revealed that she has a history of hypertension. On physical examination, her blood pressure is normal. The dentist chooses substances that anesthesia does not Contain vasoconstrictor agent to Prevent complication. The dentist also prefers to perform infiltration anesthesia before extracting the patient's tooth.

1. Clarify terms or concepts a. Wobbly: unsteady b. Vasoconstrictor agents: agents vasoconstriction c. Infiltration anesteshia: anesthesia infiltration anesthesia is one way 2. Define the problem a. Understanding anesthesia? b. Mention the kind of - kind of anesthesia? c. Each anesthesia can not combine? d. What indications and contra indications of anesthesia? e. What are the components of anesthesia? f. What is the difference of local and general anesthesia? What nerve in anesthesia? g. What conditions are ideal anesthetic agent? h. How dose it and what its complications? i. How is the working mechanism of anesthesia? j. How infiltration anesthesia technique? k. Limitation anatomy? l. Tools and materials used? m. Kind of - kind of hypertension? n. Anesthesia used in scenario? o. What every the same anesthetic systemic disease? p. Diagnose case scenario? q. Management case scenario?

3. Analyzing masalaha a. Understanding anesthesia i. A state of depression of certain nerve centers, is reversible, which bias results in loss of consciousness or without loss of consciousness ii. Anesthesia comes from the word's (not) and estesi (feeling) b. Kinds of kinds of anesthesia 1. General 2. Local a. Block: usually for the extraction b. Infiltration: usually used in children because bone formation in children and yet compact network. Infiltration is divided into two: i. Soft Tissue: deep infiltration, sub mucous ii. Bone tissue c. Superficial / Topical: abolishing pain on the surface of the tissue ii. Depth of anesthesia 1. Local 2. Consius 3. Deep 4. General iii. In chemistry 1. Ester (procaine, cocaine, tetracaine) 2. Amide (lidocaine, lipokain) 3. Esther, etc. c. Each anesthesia can not combine? i. Topical and infiltration: to reduce pain during infiltration when it will be done odontotektomi d. What indications and contra indications of anesthesia? i. Infiltration 1. Indication

a. Natal and neonatal teeth teeth b. Extensive caries c. Orthodontics deciduous teeth d. Persistence e. Impaction f. Supernumery teeth g. Periapical infection yan revocation must be made h. Ulcers dekubitas 2. Contraindicated a. Herpetic stomatitis b. Heart disease c. Systemic blood disorders d. Diabetes mellitus e. Malignant Tumor ii. Local anesthesia 1. Indication a. Slight changes in normal physiology in patients with weak b. The incidence of low morbidity c. Eliminate the pain in the teeth and supporting tissues 2. Contraindicated a. Inflammatory areas in anesthesia b. Under-age c. People with weak nerves d. Patients coward e. Periodontal ligament does not allow for anesthesia f. Allergy g. Mental Disorders

e. What are the components of anesthesia? 1. Sterile water + sodium chloride (to maintain osmotic balance between body tissues and fluids anesthesia 2. Buffer (sodium hydroxide and hydrochloride to adjust pH and oxidation reduction vasoconstrictor) 3. Antioxidants (sodium metabisulfite (antioxidant vasopresore) to prevent oxidation vasoconstriction) 4. Vasoconstriction a. The liquid sodium meta bisulfite + vasoconstrictor b. Ph Menrunkan local anesthesia c. Improving the effectiveness of local anesthesia d. Decrease the volume of local anesthetic e. Extend duration and have a scar that knows the area teranestesi bias ii. Local anesthetic solution 1. Local anesthetic agent 2. Vasoconstrictor a. Reducing toxic effects b. Limiting anesthetic agent c. Dry the work area 3. Sodium meta bisulfate 4. Methyl parabean 5. Sodium chloride f. What is the difference of local and general anesthesia? What nerve in anesthesia? i. Local 1. Without lost conscious 2. Can be injection and topical 3. Performed on the inferior alveolar nerve (n. mentalis, n. Incicivus, n. Lingual, n. Bucinator) ii. General 1. With loss of consciousness

2. Ordinary form of inhalation and intravenous and intramuscular injection g. What conditions are ideal anesthetic agent? i. Efficacious analgesic dam muscles ii. Chemical reaction with the network should be reversible iii. Duration long enough iv. Not increase bleeding v. No irritation vi. No damage to the nerves vii. The smell did not stimulate mucus membranes viii. Low Toxicity ix. Isotoinik of x. For general anestei: 1. Hypnotics 2. Analgesic 3. Relaksansia h. How dose it and what its complications? i. Infiltration 1. Lidocaine + adrenaline (1:80000, dose: 1.8 ml (lidocaine 2%)) 2. Prilokain (400mg) 3. Lidocaine 2% (max dose. 4.5 to 7 mg / kg bw) 4. Prilokain 2% (max dose. 5-8 mg / kg bw) 5. Mepifakain HCl 3% without vasoconstrictor (max dose. 4.5 to 7 mg / kg bw) 6. Procaine (max dose. 8-10 mg / kg bw) 7. Bupivacaine (max dose. 2.5 to 3 mg / kg bw) ii. Complication 1. Trismus 2. Parastesi

i. How is the working mechanism of anesthesia? i. Dideponirkan anesthetic solution on the membrane perimeural so hold afferent impulses coming to the cental. Blocking the nerve trunks in places between the brain and the operation of dams use this method to do when we encounter an infection in the surrounding tissue did not allow for infiltration ii. Local anesthesia by topical iii. Likal anesthesia by injection iv. Local anesthesia: the excitatory nerve impulses will increase the permeability of the surface membrane of the axon is short. Na + ions diffuse rapidly into the cell, exceeding sodium pump and polarity in the cell in relation to the outer suddenly changes. The flow of sodium ions into offset by outflows of k + ions. all anesthetic agents are generally formed from the combination of a weak base and a strong acid. Agan-an agent can be easily hydrolyzed in human jarinan bersif alkali (pH 7.4). To remove the alkaloid base which is bound by elements of fat in the nerve fibers, alkaloids can be defined as alkaline. Bases can prevent further nerve membrane permeability. Stabilization of the axonal membrane barrier will prevent flow into the na + ions and depolarization, and no impulse conduction. Local anesthetic solution with a low concentration of ionic motion will delay and may prevent high ionic motion. Because salt is hidrolorida anesthetic agent most often used, the process is in state dpat: B.HCl (salt anesthesia) + NaHCO3 B. (free base) + NaCl + H2CO3 j. How infiltration anesthesia technique? k. Limitation anatomy? i. Folds mukobukal ii. Anterior border of the ramus madibula iii. Crista oblique externa and interna iv. Retromolar trigone (fossa retromolaris) v. Pterygo ligament mandibuaris vi. Space pterygomandibularis l. Tools and materials used? 1. Syringes and injection needles 2. Anesthetic solution 3. Cotton roll 4. Povidone iodine 5. Handscoon, mask 6. Diagnostic tool

7. Alcohol 8. Citojet 9. Chlor ethyl ii. Tools and materials anesthetic infiltration 1. Syringe local anesthesia equipment is most commonly used in dental practice. Consists of a metal box and a plugger who united with spring hinge mechanisms. 2. CartridgeBiasanya made of alkali-free glass and pyrogen to avoid rupture and contamination of the solution. In most cartridges contain a 2.2 ml or 1.8 ml of local anesthetic solution. Cartridge with both sizes can be mounted on a standard syringe, but general anesthetic solution of 1.8 ml is sufficient for routine dental procedures. 3. JarumPemilihan needle must be adjusted to the depth of anesthesia to be performed. Syringe in dentistry are available in 3 sizes (standard American Dental Association = ADA), length (32 mm), short (20 mm, and superpendek (10 mm.) Short Syringes used for anesthesia infiltration usually have a length of 2 or 2.5 cm. needles used must be able to penetrate to the required depth before the entire needle inserted into the tissue. these precautions will make the needle does not go into the network, so if there is a fracture of the hub, the needle pieces can be pulled out with pliers or sonde. iii. m. Kind of - kind of hypertension? i. Primary (gentik, environment) ii. Secondary (lifestyle) iii. Malignant iv. Systolic v. Resistant n. Anesthesia used in scenario? i. Lidocaine 2% hypochlorite ii. Trilokain HCl 2% iii. HCl 3% mepivacaine without vasoconstriction o. What every the same anesthetic systemic disease? p. Diagnose case scenario? i. Radixes with hypertension q. Management case scenario?

i. Preventive 1. Controlling blood pressure 2. Selecting anesthetic agent ii. Curative 1. Healing of complaints 4. Conclusion

5. Setting learning objectives a. Understanding of each tingjatan anesthesia b. Indications and contraindications to anesthesia c. Nerves were blocked d. Complications of anesthesia e. Infiltration anesthesia technique f. What every the same anesthetic systemic disease? g. If there is a systemic illness and medication, the drug should be stopped right ketiaka anesthesia? h. The function of adrenaline? Diseases may not use adrenaline? i. In abscesses why should not direct anesthesia? If you can how? 6. Collect additional information (Self-learning) 7. Synthesize / test new information

a. Understanding of each tingjatan anesthesia 1. Local: only local / 1 point 2. Consius sedation: at about anesthesia 3. Deep sedation: deeper 4. General sedation: loss of consciousness ii. Stadium anesthesia 1. Stage 1: The stage induction / excitation volunteer, at the start of anesthesia until loss of consciousness pomberian 2. Stage 2: involuntary excitation stage, ranging from loss of consciousness to the beginning stages of surgery. A movement out of the will, irregular breathing, vomiting, hypertension, tachycardia. 3. Stage 3 a. Plane 1: breathing regular, short limbs, pedal reflex is still there b. Plane 2: thoraco abdominal respiration, labial ventro eyeballs, all muscles except the abdominal muscle relaxation c. Plane 3: regular respiration, eye ball to the middle, abdominal muscle relaxation 4. Stage 4: paralysis of the medulla oblongata / overdose, chest muscle paralysis, pulsus fast, pupil dilation b. Indications and contraindications to anesthesia i. Procaine 1. Indication a. Infiltration anesthesia b. Nerve block c. Epidural d. Caudal e. Spinal 2. Contraindicated a. Intravenous administration to patients with myasthenia gravis, because procaine produce the degree of neuromuscular block ii. Lidocaine

1. Indication a. Injection: infiltration anesthesia, nerve block, epidural anesthesia, caudal, spinal b. Anesthesia surface, corneal anesthesia c. Antiarrhythmic 2. Contraindicated a. Cardiac irritability iii. Benzocaine 1. Indication a. Anesthesia surface b. Relief of pain and itching iv. Benzyl alcohol 1. Indication a. Eliminate itching b. Tooth extraction 2. Contraindications a. Cardiac circulatory insufficiency b. Hypertension v. Dibukain 1. Indication a. Infiltration anesthesia vi. Epidural 1. Indication a. Anesthesia membrane lenders vii. Mepikain 1. Indication a. Infiltration anesthesia b. Regional nerve blockade

c. Spinal anesthesia 2. Contraindicated a. Liver disease b. Allergy amide c. Nerves were blocked i. General anesthesia 1. Central nervous system 2. By affecting the brain stem and cerebral cortex ii. Supraperiosteal injection / infiltration 1. Posterior superior alveolar nerve a. Molar inject three, two, distal and palatal roots molar One 2. Medial superior alveolar nerve a. Inject premolars and second molars mesial root One 3. Anterior superior alveolar nerve a. Injection in both canines usually menganestesi to six anterior teeth iii. Injection block 1. Zigomatik injection (posterior superior alveolar nerve) a. Menganestesi three and two upper molars, palatal root and root distobuccal molat the top b. Buccalis the nerve branches in the buccal tissue menginervasi molars also an teranestesi 2. Injection intra Orbiting a. Injected medial and anterior alveolar nerve, nerve terminal branches infraorbitalis b. Inject root mesiobukal and second molars, premolars, caninus, central and lateral incisors 3. Injection of mandibular a. Menganestesi inferior alveolar nerve b. Menganestesi all the teeth on the side of the injection except in the central and lateral incisors 4. injection mentalist a. menganestesi premolars and canines

d. Complications of anesthesia i. Central nervous system 1. Shock 2. Allergy 3. Syncope ii. Neuron toxicity 1. Spinal, excessive blockade iii. Cardiovascular 1. Tachycardia 2. Hypertension iv. Sistemdarah 1. Hematologic effects v. Local anesthesia 1. Trismus 2. Facial paralysis 3. Hematomas (ruptured blood vessels) 4. Thrush vi. Immunology 1. Allergy vii. Respiration 1. Bronchospasm e. Infiltration anesthesia technique i. By using gauze / cotton in place in the mucous membranes of the mouth and fingers, pull down on the upper jaw, lower jaw and up to the crease area to clarify mukobukal / mukolabial, limiting mucosal line moving and not moving can be clarified with the iodine mengulaskan the network. Mucous membrane color darker than mukoperiosteum. Suntiklah mucosal tissue in the crease with a bone needle and needle point to align the bone field. Continue charging through a needle puncture periosteum until the tip reaches as high as the roots of the teeth. Intuk avoid puffed on a tissue and reduce pain, deponirlah solution slowly. After proper needle position, deponirkan 1-2cc anesthetics f. What every the same anesthetic systemic disease

i. Cardiovascular 1. Prophylactic penicillin ii. Hypertension 1. Maximal 185 mmHg 2. Mepivacaine 2% 0.2 mg 3. Stop drug hipertensiny g. If there is a systemic illness and medication, the drug should be stopped right ketiaka anesthesia? i. COPD: bronchodilator ii. Hypertension 1. Tricyclic antidepressants 2. Immune oxide inhibitor 3. Anesthesia used pure lidocaine / without epinephrine h. The function of adrenaline? Diseases may not use adrenaline? i. Function 1. Accelerating effect 2. Prolong the duration 3. Avoid bleeding 4. Increasing systolic 5. Lowering diastole 6. Minimize toxicity ii. Effect 1. Anxiety, tremor, anxiety iii. Diseases may not use Adrenaline 1. Hypertension 2. Heart problems i. In abscesses why should not direct anesthesia? If you can how? i. If there is an abscess in the fear of infection will occur because there is a lot of bacteria on access

ii. If you will do eksodonsi, abscess incision drainse first with topical anesthesia, just after the new normal and healthy jarinagn anesthesia for eksodonsi