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Questions and Answers
What is the most common systemic complication encountered in a dental office during local anesthesia?
What is the most common systemic complication encountered in a dental office during local anesthesia?
Which of the following is NOT a predisposing factor for syncope?
Which of the following is NOT a predisposing factor for syncope?
Which stage of syncope includes symptoms such as coldness of hands and feet, nausea, and dizziness?
Which stage of syncope includes symptoms such as coldness of hands and feet, nausea, and dizziness?
What position should be used to manage a patient experiencing syncope?
What position should be used to manage a patient experiencing syncope?
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Which clinical manifestation is associated with the syncope stage?
Which clinical manifestation is associated with the syncope stage?
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What is one method to stimulate the respiratory system during vasodepressor syncope?
What is one method to stimulate the respiratory system during vasodepressor syncope?
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What is NOT a symptom during the postsyncope stage?
What is NOT a symptom during the postsyncope stage?
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What is the primary cause of syncope?
What is the primary cause of syncope?
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What is the definition of an allergy?
What is the definition of an allergy?
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Which of the following substances is commonly recognized as an allergen?
Which of the following substances is commonly recognized as an allergen?
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What is a common dermatological sign of an allergy?
What is a common dermatological sign of an allergy?
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Which symptom is NOT typically associated with generalized tonic-clonic seizures?
Which symptom is NOT typically associated with generalized tonic-clonic seizures?
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Which of the following is NOT a respiratory reaction to an allergy?
Which of the following is NOT a respiratory reaction to an allergy?
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In the management of immediate-onset skin signs, which of the following should NOT be done?
In the management of immediate-onset skin signs, which of the following should NOT be done?
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What is a primary management step in response to local anesthetics overdose toxicity?
What is a primary management step in response to local anesthetics overdose toxicity?
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Which position is recommended for a patient experiencing vasoconstrictor overdose toxicity?
Which position is recommended for a patient experiencing vasoconstrictor overdose toxicity?
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What is a common cardiovascular symptom of an allergic reaction?
What is a common cardiovascular symptom of an allergic reaction?
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What distinguishes idiosyncrasy from an allergic reaction?
What distinguishes idiosyncrasy from an allergic reaction?
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What is the first step in the management of anaphylaxis?
What is the first step in the management of anaphylaxis?
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Which of the following is a sign of vasoconstrictor overdose toxicity?
Which of the following is a sign of vasoconstrictor overdose toxicity?
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Which of these is NOT a sign of neurologic manifestation during an allergic reaction?
Which of these is NOT a sign of neurologic manifestation during an allergic reaction?
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Which of the following complications may arise from an overdose of local anesthetics?
Which of the following complications may arise from an overdose of local anesthetics?
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What immediate action should be taken to manage a patient with vasoconstrictor overdose toxicity?
What immediate action should be taken to manage a patient with vasoconstrictor overdose toxicity?
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Which drug is NOT typically administered for local anesthetics overdose?
Which drug is NOT typically administered for local anesthetics overdose?
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What immediate action should be taken when a patient becomes conscious after experiencing syncope?
What immediate action should be taken when a patient becomes conscious after experiencing syncope?
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Which of the following is a cause of toxicity due to intravascular injection?
Which of the following is a cause of toxicity due to intravascular injection?
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Which local anesthetic is noted as the most toxic among those mentioned?
Which local anesthetic is noted as the most toxic among those mentioned?
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What is NOT a recommended prevention method for local anesthetic toxicity?
What is NOT a recommended prevention method for local anesthetic toxicity?
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How does the presence of a vasoconstrictor affect drug absorption in local anesthesia?
How does the presence of a vasoconstrictor affect drug absorption in local anesthesia?
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Which of the following is an early symptom of local anesthetic overdose?
Which of the following is an early symptom of local anesthetic overdose?
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What aspect of drug administration can significantly reduce the risk of a severe overdose reaction regarding lidocaine?
What aspect of drug administration can significantly reduce the risk of a severe overdose reaction regarding lidocaine?
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Which patient condition could slow biotransformation of a local anesthetic, leading to potential toxicity?
Which patient condition could slow biotransformation of a local anesthetic, leading to potential toxicity?
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Study Notes
Systemic Complications of Local Anesthesia
- Local anesthetics can cause systemic complications including syncope, toxicity (overdose), idiosyncrasy, and allergy.
Syncope
- Definition: Sudden transient loss of consciousness secondary to cerebral ischemia.
- Incidence: Most common complication in dental offices.
- Synonyms: Psychogenic syncope, vasodepressor attack, vasovagal syncope, fainting.
- Predisposing Factors (Psychogenic): Anxiety, severe pain, emotional stress, sight of blood/surgical instruments.
- Predisposing Factors (Physical): Prolonged standing, exhaustion/starvation, hot/crowded environments.
- Clinical Manifestations (Presyncope): Paleness, sweating, visual disturbances, restlessness, coldness in hands/feet, nausea, and dizziness.
- Clinical Manifestations (Syncope): Low blood pressure, bradycardia, thready pulse, pupillary dilation, irregular breathing, loss of consciousness.
- Clinical Manifestations (Postsyncope): Weakness, short-period mental confusion/disorientation, gradual reestablishment of vital signs.
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Management:
- Terminate the procedure
- Call medical assistance/activate emergency code
- Place patient in Trendelenburg position (supine with head below legs)
- Acquire vital signs (blood pressure, respiratory rate, pulse, temperature, blood glucose)
- Monitor vital signs continuously
- Management of Vasodepressor Syncope: Inhalation of aromatic ammonia spirit, administration of 6L/min oxygen via mask/nasal hood.
Toxicity (Overdose)
- Definition: Clinical manifestations resulting from an overly high blood level of a drug in various target organs/tissues.
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Causes:
- Intravascular Injection: Inadvertent injection leading to rapid, serious overdose reactions (prevented by aspiration test)
- Rapid Absorption: Local anesthetics, used in dentistry often have vasodilating properties, leading to rapid absorption into the cardiovascular system, potentially leading to shorter procedure duration/increased blood levels and toxicity. The faster the injection, the quicker toxicity will occur.
- Vasoconstrictor Presence: Reduces systemic absorption of the drug because of slowed absorption, therefore reducing potential toxicity
- Too large dose: Using a larger dose than required.
- Slow biotransformation: Slow biotransformation resulting from plasma pseudocholinesterase deficiency or hepatic disease.
- Slow elimination: Slow elimination due to renal dysfunction.
- Most toxic local anesthetic: Bupivacaine (long-acting).
- Prevention: Aspiration test, use of vasoconstrictors, attention to recommended dosages, use small amount of topicals, preoperative evaluations.
Idiosyncrasy
- Definition: Any response to a local anesthetic that is different from expected and cannot be attributed to overdose or allergy.
- Cause: Genetic mechanism.
Allergy
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Definition: Exaggerated or inappropriate immune response to a substance normally harmless to most people.
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Allergens: Esters (related to para-amino-benzoic-acid metabolism products), sodium bisulfite/metabisulfite (anesthetics used as antioxidants for vasoconstrictors), methylparaben (no longer used in dental cartridges).
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Prevention: Adequate preanesthetic evaluation, avoid drugs reported in patient history as causing allergic reactions, refer for local anesthetic allergy testing.
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Signs:
- Dermatological Reactions (Skin Signs): Urticaria (smooth, elevated skin patches with intense itching), Angioedema (sudden swelling under skin, around eyes/lips).
- Respiratory Reactions: Bronchospasm (dyspnea, wheezing, cyanosis, sweating), Laryngeal Edema (larynx obstruction), Cardiovascular Symptoms (tachycardia, palpitations, hypotension, cardiac arrest), Neurologic Manifestations (lightheadedness, anxiety, impending doom), Gastrointestinal Manifestations (malaise, nausea, vomiting, abdominal cramps), Genitourinary Manifestations (urinary incontinence), Skin Reactions (urticaria).
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Management of Immediate-onset skin signs (erythema, urticaria, pruritus): Stop the current medication, get immediate medical assistance; administer an antihistamine (IM or IV); administer a corticosteroid; monitor vital signs; consult a physician; Observe for 1 hour
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Management of Anaphylaxis (With/Without skin signs): Immediately stop procedure, clear airway of materials, call for help, place patient supine (semi-reclined if lower respiratory involvement), administer epinephrine.
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Description
This quiz explores the systemic complications associated with local anesthesia, particularly focusing on syncope. Understand the definition, incidence, predisposing factors, and clinical manifestations of syncope that may occur in dental settings. Test your knowledge of this crucial topic in anesthetic practice.
