Recent advancement to treat Bupivacaine's cardiac toxicity

 # Bupivacaine is known to cause rapid and resistant cardiac toxicity when administered in high concentrations and volumes. What is the recent advancement to treat its cardiac toxicity?

A. Buffered local anesthetics

B. Addition of mannitol to local anesthetic solution

C. Use of lipid emulsions to reverse the cardiotoxicity of local anesthetics

D. Addition of another anesthetic to bupivacaine

The correct answer is C. Use of lipid emulsions to reverse the cardiotoxicity of local anesthetics.

Cardiovascular collapse from accidental local anesthetic toxicity is rare but the long-acting amide local anesthetics bupivacaine, levobupivacaine, and ropivacaine have differential cardiac toxicity, but all are capable of causing death with accidental overdose. In recent times, the discovery that lipid emulsion may improve the chance of successful resuscitation has led to recommendations that it should be available in every location where regional anesthesia is performed. 

Best method of intubation in patient undergoing treatment for oral surgery under GA is:

 # Best method of intubation in patient undergoing treatment for oral surgery under GA is:

A. LMA

B. Orotacheal tube

C. Laryngeal mask airway

D. Naso-endotube

The correct answer is D. Naso-endotube.

Solution: 

The sine qua non for intubation since the twentieth for general anesthesia patients is pharyngeal laryngoscopy and oral intubation. But here the question is about oral surgery treatment. In such cases, nasal intubation is often preferred in patients for unrestricted direct access to the mouth and pharynx regions.  In cases where the direct intubation cannot be done, blind methods such as combitube, LMA can be used. They however interfere with oral surgical procedures. 

If the question is asked about maxillofacial injuries in general then the answer is oral intubation. If the question is about oral surgical procedures, the answer is nasal intubation. 

Which of the following is not a feature of torus mandibularis?

 # Which of the following is not a feature of torus mandibularis?

A. Common in mongoloids

B. Present on the lingual surface of mandible below the mylohyoid line

C. Usually bilateral

D. May or may not be associated with torus palatinus

The correct answer is B. Present on the lingual surface of mandible below the mylohyoid line.

The torus mandibularis is an exostosis or outgrowth of bone found on the lingual surface of the mandible. This growth on the lingual surface of the mandible occurs above the mylohyoid line, usually opposite the bicuspid teeth. Although the mandibular tori are usually bilateral, they are seen as a unilateral condition in about 20% of the cases. Both unilateral and bilateral protuberances may be single or multiple, and they are frequently visible on dental periapical radiographs. There is no correlation in the frequency of simultaneous occurrence of torus palatinus and torus mandibularis, according to the

studies of Kolas and coworkers, suggesting that the two conditions are not related. Suzuki and Sakai reported a highly significant correlation in the frequency of simultaneous occurrence of the two tori, however. 

Gardner syndrome does not include:

 # Gardner syndrome does not include:

A. Osteomas

B. Epidermoid cysts

C. Osteosarcoma

D. Impacted permanent teeth

The correct answer is C. Osteosarcoma.

Gardner syndrome is also characterized by the occurrence of multiple impacted supernumerary teeth. This syndrome consists of: 

1. multiple polyposis of the large intestine,

2. Osteomas of the bones, including long bones, skull, and jaws,

3. Multiple epidermoid or sebaceous cysts of the skin, particularly on the scalp and back,

4. Occasional occurrence of desmoid tumors, and

5. Impacted supernumerary and permanent teeth 

Osteosarcoma is not a feature of Gardner Syndrome.