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Complications of Local Anesthetics
Terms in this set (50)
what is the mortality rate of regional anesthesia in the oral cavity
what is the % morbidity of: single injection, multiple injections?
why is there a high chance of overdose in dentistry
the oral cavity is highly vascularized
max dose: lido w/ epi (both)
max dose: articane w/ epi (both)
max dose: mepivacaine & mepivacaine w/ epi
max dose: prilocaine and prilocaine w/ epi
max dose: bupivacaine w/ epi
___ nerves are more responsive than ___ nerves
neurological ____ followed by ____
what are CNS symptoms of an overdose?
Tinnitus, blurred vision
Nystagmus, muscle fasciculation
Tonic-clonic seizures (grand-mal seizures)
when may it occur?
resolution? why or why not?
-Overdose may occur several hours after administration
-The slower the onset the less severe the reaction
--Same with any drug reaction
-Most reactions will resolve with time and do not need treatment
Except for seizures
Myocardial depression from local anesthetics does not occur until plasma levels are past the _____ ____
_____ potency local anesthetics are more cardiotoxic
CNS and CVS symptoms will _____
Dose dependent decrease in ____ ___
Low doses may be _____
how do you manage an overdose?
-Discontinue the procedure
-Monitor vital signs
-Benzodiazepines IV for seizures
-5-10 mg. diazepam (Valium®)
-3-5 mg. midazolam (Versed®)
-Airway, breathing, circulation
what kind of drug-drug interactions have a significant rating?
-Local anesthetics + local anesthetics
-Local anesthetics and opioid sedation
what is the primary mechanism for toxic reactions with large doses of LA?
who is it more likely in? why?
More likely in children
Negative aspiration is not a guarantee
what can be used to treat cardiac arrhythmias? and how?
why is this a bad idea?
Lidocaine injected intra-venously
-Vasoconstrictors increase toxicity
-Can produce lethal arrhythmias
What happens if you inject intra-arterially
Normal flow of blood through the branches of the external carotid artery should reduce toxicity
how to manage an intra-vascular injection
Rapid onset - instantaneous, minutes
Short duration < 30 minutes
Arterial distribution: artery, brain/tissues (redistribution), muscle, fat
Venous distribution: vein, right heart, lungs, left heart, systemic circulation
Plasma levels fall rapidly
Palliative support, monitor vital signs
what are the vasocontrictor effects
-This is a mild, predictable response; not an allergic reaction!
what is an allergy
Allergy represents an OVERREACTION by the bodies immune system to a foreign substance (allergen)
describe a delayed allergic reaction
-S & S develop slowly (>60 min)
-Reaction involves skin
describe a immediate allergic reaction
-S & S develop within minutes of exposure
-Reaction involves respiratory a/o cardiovascular systems
how do you treat a rapid onset skin reaction (no cvs, respiratory involvement)?
Parenteral histamine blocker:
--IV...onset within minutes
--IM...onset within 10 minutes, peak in 30 mins
Do not permit patient to leave until S & S resolve
abnormal flushing of the skin due to vasodilation
itching of skin
hives or rash
what is the usual progression of anaphylaxis
skin --> eyes, nose, GI --> respiratory system --> cardiovascular system
what is the proper anaphylaxis management?
-q5m until recovery or help arrives
-multiple doses usually required
why do you use epinephrine during an anaphylactic reaction?
Reverses 2 components of anaphylaxis which lead to death:
-bronchospasm...epi is a bronchodilator
-hypotension...epi is a vasopressor
-IM vastus lateralis within 1-2 minutes
what are the 3 components of an allergic reaction
-Bronchoconstriction, wheezing - asthmatic type reactions
-Bronchospasm - severe asthmatic reaction
-Laryngeal edema - swelling of the larynx
how to manage an asthma flare up during dental treatment?
Subsequent dental care
Discharge of patient
when to summon EMS if your pt has an asthma flareup during dental treatment?
episode is refractory to
2 doses of bronchodilator
& Administer Epinephrine
define syncope and its physiology
transient loss of consciousness
-cerebral ischemia, blood flow shunted peripherally (sympathetic vasodilation)
what is the signs and symptoms of syncope? management?
-hyperventilation, pallor, sweating, tachycardia, nausea, weakness
-supine position, oxygen, ABC's, monitor vitals
signs and symptoms?
Definition - Abnormal respiratory rate at rest, causing lowering of carbon dioxide levels
Signs and symptoms - Increased RR, pallor, excitation, carpal pedal spasm, unconsciousness
Management - Paper bag, hands over face, breathing circuit
increased quantities of hemoglobin with iron oxidized to the ferric form (Fe3+).
High concentrations appear chocolate brown.
Normal levels 0-2%, Cyanosis 10-30%, Lethargy and Respiratory distress 30-60%, Death >70%.
what are the 2 kind of methemoglobinemia? what can cause it? treatment?
acquired and induced
-Acquired: NADH cytochrome b5 reductase deficiency.
-Induced: nitrates, sulfonamides, benzocaine or prilocaine.
-Prilocaine's primary metabolite, ortho-toluidine, induces methemoglobinemia.
-Treatment: Oxygen and methylene blue 1-2 mg/kg i.v. infusion.
-Direct nerve injury
-Incidence < 1%, ~2% with articaine
--Foramen containing nerves
--Paresthesia, dysethesia, hyperesthesia
--Total anesthesia for 3 mo.
The inability to open the mouth
-Damage to the medial pterygoid muscle
-Symptoms - Pain, myospasm, limited mouth opening
--Masticatory forces decreased up to 30% for 14 days
--Onset 1-3 days, duration up to 6 weeks
-Management - Analgesics, warm saline rinses, warm compresses, suspect infection
-Hemorrhage, trauma, facial space infection
-Local anesthetics are especially toxic to skeletal muscle
mucosal irritation can be caused by?
Ischemia = necrosis
Local blood supply
how can a needle break?
-Needle inserted to the hub
-Treatment - Removal, radiology, surgery
how can a cartridge break?
Excessive force, patient biting
what are common self inflicted injuries?
-Biting, chewing, or scratching of tongue, cheek, or lips
-Most likely in children
-Most often when multiple areas of mouth are anesthetized
what are the symptoms of a hematoma? management?
Symptoms - Swelling, fullness, discomfort, asymmetry, trismus
Arterial or Venous?
-Ice then heat
how does a patient get an infection from an injection? management
-Injection through existing infection
how can a person achieve an undersirable nerve block?
what can happen?
-Lack of anatomical knowledge
-Unusual pattern of distribution
-Most typical in Cranial Nerve VII
--Will knock out muscles of facial expression
--Can occur in ocular muscles
-Can induce a Bell's Palsy
-Management - Time, may need to tape the eye shut to prevent it from drying out
what can cause excess pain on injection?
-Cold anesthetic solution
-Too rapid an injection
-Presence of inflammation or infection
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