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Local Anesthetic Systemic Complications and Treatment

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What should you do when using local anesthesia on a patient with controlled hypertension? a. Take the BP ... – PowerPoint PPT presentation

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Title: Local Anesthetic Systemic Complications and Treatment


1
Local Anesthetic Systemic Complications and
Treatment
2
Adverse Drug Reactions
  • 1) Side effects
  • 2) Overdose reactions
  • 3) Local toxic effects (most common)
  • 4) Allergic reactions

3
Toxicity caused by alteration in the recipient of
the drug
  • 1) Disease process
  • 2) Emotional disturbances
  • 3) Genetic aberrations
  • 4) Idiosyncrasy

4
Signs and Symptoms Toxic Reaction to Local
Anesthesia
  • Talkativeness
  • Slurred speech
  • Dizziness
  • Nausea
  • Depression
  • Euphoria
  • Excitement
  • Convulsions

5
Overdose Reactions
  • Clinical signs and symptoms that
  • develop as a result of an
  • over-administration of a drug

6
Overdose Contributing Factors
  • Age
  • Weight
  • Other medications
  • Presence of disease
  • Genetics
  • Mental wellbeing

7
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8
Drug Factors
  • Vasoactivity
  • Concentration
  • Dose
  • Route of administration
  • Rate of injection
  • Vascularity of the injection site
  • Presence of vasoconstrictors

9
Mild Overdose Reaction
  • Slow onset
  • Reassure patient
  • Administer oxygen
  • Monitor vital signs
  • Allow patient to recover as long as necessary

10
Slower Onset of Overdose
  • Reassure patient
  • Administer oxygen
  • Monitor vital signs
  • Administer anticonvulsant
  • Call 911
  • After reaction, have patient examined by a
    physician
  • Do not let patient leave alone

11
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

12
Epinephrine Overdose
  • Very rare for patient to experience an
    epinephrine overdose

13
Signs and Symptoms of Epinephrine Overdose
  • Fear, anxiety
  • Tenseness
  • Restlessness
  • Throbbing headache
  • Tremor
  • Perspiration
  • Weakness
  • Dizziness
  • Pallor
  • Respiratory difficulty
  • Palpitations

14
Management of Epinephrine Overdose
  • Terminate dental procedure
  • Sit patient upright in the dental chair
  • Reassure patient
  • Monitor blood pressure
  • Administer oxygen

15
Allergic Reactions to Local Anesthetic Agents
  • Hypersensitive state as a result of exposure to
    an allergen
  • Re-exposure can heighten the initial reaction

16
Clinical Manifestations of an Allergy
  • Fever
  • Angioedema
  • Urticaria
  • Dermatitis
  • Depression of blood-forming organs
  • Photosensitivity
  • Anaphylaxis

17
Angioedema
18
Urticaria (hives)
19
Allergy
  • Incidents of allergy are low
  • Often allergic reaction is to one of the
    ingredients within the cartridge, not the local
    anesthesia itself

20
How to Prevent An Allergic Reaction
  • Take a thorough medical history
  • Dialogue the medical history with the patient

21
Common Questions to Ask the Patient
  • Allergic to any medications?
  • Have you ever had a reaction to local anesthesia?
  • If yes, describe what happened
  • Was treatment given? If so, what?

22
Allergic Responses to local anesthetic
  • Dermatitis (hives)
  • Bronchospasm
  • Systemic anaphylaxis
  • Hypersensitivity to esters
  • (atypical pseudo cholinesterase, PABA)

23
Latex Allergy
  • The cartridge opening into which the needle is
    inserted is aluminum with a very thin diaphragm
    of latex in the middle
  • Though patients with a latex allergy are at an
    increased risk, there are no known cases or
    reports of an allergic response from the latex on
    a local anesthetic cartridge

24
Asthma Patient
  • Thorough medical and dental history
  • Avoid use of anesthesia that contain epinephrine
    or levonordefrin because of sulfites (may cause
    wheezing)
  • Asthma patient that is steroid dependant may
    develop brochospasms
  • Establish rapport and calm environment

25
Renal Disease
  • Common diseases associated with renal failure are
    diabetes mellitus, hypertension, or systemic
    lupus erythematosus (SLE)
  • Kidneys are compromised

26
Drugs Metabolized by the Liver
  • Lidocaine (Xylocaine)
  • Prilocaine (Citanest)
  • Mepivacaine (Carbocaine, Polocaine)
  • Bupivacaine (Marcaine)
  • Appear to be safe for use on patients with liver
    disease when used in appropriate amounts

27
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)

28
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
29
Hypertension
  • Stress and anxiety may raise the patients blood
    pressure (gt160/100)
  • Thorough medical, dental and patient history
  • Norepinephrine and levonordefrin should not be
    used because of alpha1 stimulation
  • (2 Mepivacaine with 120,000 levonordefrin)
  • Up to two cartridges of 2 lidocaine with
    1100,000 epinephrine is safe

30
Contraindication for Local Anesthetic with
Epinephrine
  • Uncontrolled hypertension
  • Myocardial infarction (within 6 months)
  • Unstable angina
  • Coronary artery bypass graft (gt 3 months)

31
Quiz
  • 1. Local anesthetics and vasoconstrictors do
    cross the placenta in pregnant women local
    anesthetics and vasoconstrictors are known
    teratogens (cause birth defects).
  • 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.

32
  • 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 only
  • b. 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 judiciously
  • d. Local anesthetics should not be used on
    patients with hypertension

33
  • 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

34
  • 4. What is the most common reason for allergies
    to
  • local anesthetic solutions?
  • a. Asthma
  • b. The anesthetic solution itself
  • c. The other added ingredients to the
    solution
  • d. The vasoconstrictor

35
  • 5. To prevent an overdose, what should the
  • maximum safe doses of anesthetic be based
    on?
  • a. The patients age
  • b. The patients weight
  • c. The patients physical status
  • d. The patients health
  • e. All of the above
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