Local Anesthetic Systemic Complications and Treatment.ppt

8/10/2019 Local Anesthetic Systemic Complications and Treatment.ppt

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LocalAnestheticSystemic

Complications and Treatment


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Adverse Drug Reactions

1) Side effects

2) Overdose reactions3) Local toxic effects (most common)

4) Allergic reactions


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Toxicity caused by alteration in

the recipient of the drug

1) Disease process

2) Emotional disturbances

3) Genetic aberrations

4) Idiosyncrasy


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Signs and Symptoms Toxic Reaction

to Local Anesthesia

Talkativeness

Slurred speech

Dizziness Nausea

Depression

Euphoria Excitement

Convulsions


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OverdoseReactions

Clinical signs and symptoms that

develop as a result of anover-administration of a drug


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Overdose Contributing Factors

Age

Weight

Other medications

Presence of disease

Genetics

Mental wellbeing


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Mild Overdose Reaction

Slow onset

Reassure patient

Administer oxygen

Monitor vital signs

Allow patient to recover as long asnecessary


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Slower Onset of Overdose

Reassure patient Administer oxygen

Monitor vital signs

Administer anticonvulsant

Call 911

After reaction, have patient examined by aphysician

Do not let patient leave alone


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Severe Overdose Reaction

Rapid onset (within one minute)

Remove syringe (if in the process of an injection)

Protect patient for trauma if convulsions are

present Call 911

Basic life support

Administer anticonvulsant

Allow patient to recover

Do not let patient leave alone


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Epinephrine Overdose

Very rare for patient to experience an

epinephrine overdose


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Signs and Symptoms of Epinephrine

Overdose Fear, anxiety

Tenseness

Restlessness

Throbbing headache

Tremor

Perspiration

Weakness

Dizziness

Pallor

Respiratory difficulty

Palpitations


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Management of Epinephrine Overdose

Terminate dental procedure

Sit patient upright in the dental chair

Reassure patient Monitor blood pressure

Administer oxygen


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Clinical Manifestations of an Allergy

Fever

Angioedema

Urticaria Dermatitis

Depression of blood-forming organs

Photosensitivity

Anaphylaxis


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Angioedema


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Urticaria (hives)


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Allergy

Incidents of allergy are low

Often allergic reaction is to one of the

ingredients within the cartridge, not the

local anesthesia itself


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How to Prevent An Allergic

Reaction

Take a thorough medical history

Dialogue the medical history with the

patient


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Common Questions to Ask

the Patient

Allergic to any medications?

Have you ever had a reaction to localanesthesia?

If yes, describe what happened Was treatment given? If so, what?


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Allergic Responses to local

anesthetic Dermatitis (hives)

Bronchospasm

Systemic anaphylaxis

Hypersensitivity to esters(atypical pseudo cholinesterase, PABA)


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Asthma Patient

Thorough medical and dental history

Avoid use of anesthesia that containepinephrine or levonordefrin because ofsulfites (may cause wheezing)

Asthma patient that is steroid dependantmay develop brochospasms

Establish rapport and calm environment


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Renal Disease

Common diseases associated with renal

failure are diabetes mellitus,

hypertension, or systemic lupus

erythematosus (SLE)

Kidneys are compromised


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Pregnancy Anesthesia crosses the placenta and could be toxic

to the fetus, but is not a known teratogen

No drug should be administered during pregnancy

especially the first trimester

If treatment is necessary, local anesthetics with

epinephrine are considered relatively safe for use

during pregnancy; check with patients physician

Educate patients to the potential risks (document)


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FDA Category of Prescription Drugs

Drug Category Use During

Pregnancy

Risk

Lidocaine B Yes -

Prilocaine B Yes -

Mepivacaine C Use with caution-

Consult physician

Fetal

bradycardia

Bupivacaine C Use with caution-

Consult physician

Fetal

bradycardia


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Hypertension Stress and anxiety may raise the patients blood

pressure (>160/100)

Thorough medical, dental and patient history Norepinephrine and levonordefrin should not be

used because of alpha1 stimulation

(2% Mepivacaine with 1:20,000 levonordefrin) Up to two cartridges of 2% lidocaine with

1:100,000 epinephrine is safe


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Contraindication for Local Anesthetic

with Epinephrine

Uncontrolled hypertension

Myocardial infarction (within 6 months)

Unstable angina

Coronary artery bypass graft (> 3 months)


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Quiz

1. Local anesthetics and vasoconstrictors do cross theplacenta in pregnant women; local anesthetics andvasoconstrictors are known teratogens (cause birthdefects).

a. The first part of the statement is true, the second

part is true.b. The first part of the statement is true, the

second part is false.

c. The first part of the statement is false, the second

part is false.

d. The first part of the statement is false, the second

part is true.


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2. What should you do when using local anesthesia on a patient with

controlled hypertension?

a. Take the BP before the injection and use Mepivacaine onlyb. Take the BP before the injection and use an anesthetic without a

vasoconstrictor

c. Take the BP before the injection and use anesthetic with a

vasoconstrictor judiciouslyd. Local anesthetics should not be used on patients with hypertension


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3. Since local anesthetics are excreted through the

kidneys, what is true concerning giving local

anesthesia to a patient with renal dysfunction?

a. Consult patients physician

b. Potential for overdose

c. Use anesthetics in minimal doses

d. All of the above


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Local Anesthetic Systemic Complications and Treatment.ppt

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