local complication pt1
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Questions and Answers

What is the primary cause of syncope?

  • Rapid deposition of solution
  • Cerebral ischemia secondary to vasodilation or increase in peripheral vascular bed (correct)
  • Trauma to muscles or blood vessels
  • Use of dull needles from multiple injections

    • What is the recommended management for trismus?

  • Prescription of antibiotics for 7 days
  • Application of pressure to the site of bleeding
  • Moist heat 20 minutes every hour and physiotherapy
  • Heat therapy, analgesic, and muscle relaxation (correct)

    • What is the primary cause of needle breakage?

  • Trauma to muscles or blood vessels
  • Sudden, unexpected movement by the patient (correct)
  • Use of small gauge needles
  • Rapid deposition of solution

    • What is the recommended prevention for pain on injection?

    <p>Use of larger gauge needles and careful injection technique</p> Signup and view all the answers

    What is the primary cause of paresthesia?

    <p>Trauma to the nerve</p> Signup and view all the answers

    What is the recommended management for hematoma?

    <p>Immediate application of pressure to the site of bleeding</p> Signup and view all the answers

    What is the primary cause of burning on injection?

    <p>pH of the solution</p> Signup and view all the answers

    What is the recommended management for syncope?

    <p>Discontinue any procedure and reassure the patient</p> Signup and view all the answers

    What is the primary cause of infection?

    <p>Use of contaminated needle</p> Signup and view all the answers

    What is the average resolution time for paresthesia?

    <p>8 weeks</p> Signup and view all the answers

    What is the primary reason for using disposable needles in anesthesiology?

    <p>To prevent infection</p> Signup and view all the answers

    What is the maximum dose of 2% lidocaine without vasoconstrictor for a healthy adult?

    <p>4.4 mg/kg up to 300mg</p> Signup and view all the answers

    What is the cause of edema in local anesthesia?

    <p>All of the above</p> Signup and view all the answers

    What is the result of sloughing of tissues in local anesthesia?

    <p>All of the above</p> Signup and view all the answers

    Why is it necessary to add vasoconstrictors to local anesthetics?

    <p>To increase the duration of anesthesia</p> Signup and view all the answers

    What is the ideal rate of injection for local anesthetics?

    <p>1ml/1 minute</p> Signup and view all the answers

    What is the cause of facial nerve paralysis in local anesthesia?

    <p>All of the above</p> Signup and view all the answers

    What is the function of cholinesterase in the metabolism of ester-type local anesthetics?

    <p>To hydrolyze the local anesthetic</p> Signup and view all the answers

    What is the maximum dose of epinephrine for a healthy patient?

    <p>0.2 mg</p> Signup and view all the answers

    What is the consequence of rapid injection of local anesthetics?

    <p>Increased risk of systemic complications</p> Signup and view all the answers

    What is a potential complication of local anesthetics that can delay their elimination from the blood?

    <p>Renal impairment</p> Signup and view all the answers

    What is the first manifestation of a local anesthetic overdose?

    <p>Excitation</p> Signup and view all the answers

    What is the primary goal of management in bronchial asthma reactions to local anesthetics?

    <p>Terminating dental therapy</p> Signup and view all the answers

    What is the recommended treatment for laryngeal edema reactions to local anesthetics?

    <p>Administering 0.3ml of 1:1,000 epinephrine IV/IM</p> Signup and view all the answers

    What is the characteristic of idiosyncrasy reactions to local anesthetics?

    <p>An adverse drug reaction that cannot be explained by any known pharmacological or biochemical mechanism</p> Signup and view all the answers

    What is a sign of an epinephrine overdose?

    <p>Sharp elevation in blood pressure primarily systole</p> Signup and view all the answers

    What is the recommended management for severe local anesthetic toxicity?

    <p>Positioning the patient in a supine position with feet elevated</p> Signup and view all the answers

    What is the recommended anticonvulsant for local anesthetic toxicity?

    <p>Diazepam IV</p> Signup and view all the answers

    What is a dermatologic reaction to local anesthetics?

    <p>Urticaria</p> Signup and view all the answers

    What is the recommended management for mild to moderate local anesthetic reactions?

    <p>Reassuring the patient and administering oxygen</p> Signup and view all the answers

    Study Notes

    Local Complications of Anesthesia

    Syncope

    • Form of neurogenic shock caused by cerebral ischemia secondary to vasodilation or increase in peripheral vascular bed with a corresponding drop in blood pressure
    • Management:
      • Discontinue procedure
      • Place patient in semi-reclining position with legs and thorax slightly elevated
      • Check vital signs
      • Reassure patient
      • Determine degree and extent of paresthesia
      • Explain to patient that paresthesia normally persists for 2 months before resolution begins and may persist up to 1 year or longer
      • Reschedule patient for examination every 2 months
      • Record findings on patient's chart

    Trismus

    • Motor disturbance of the trigeminal nerve, especially spasm of the masticatory muscle, with difficulty in opening the mouth
    • Caused by trauma to muscles or blood vessels, injection of contaminated solution, hemorrhage, or low-grade infection
    • Management:
      • Heat therapy: moist heat 20 minutes every hour
      • Analgesic
      • Muscle relaxation: diazepam 10mg q 12 hours
      • Physiotherapy: opening and closing as well as lateral excursions of mandible for 5 min q 3-4 hours

    Needle Breakage

    • Extremely rare complication
    • Caused by sudden, unexpected movement by the patient as the needle penetrates the muscle or contracts periosteum
    • Prevention:
      • Use larger gauge needles (25 or 27 gauge)
      • Use long needles for injections requiring deep penetrations
      • Do not insert a needle into tissues to the hub
      • Do not redirect the needle once inserted into tissues

    Pain on Injection

    • Caused by careless injection technique and callus attitude, use of dull needle from multiple injections, and rapid deposition of solution
    • Increases patient anxiety and may lead to sudden, unexpected movement, increasing the risk of needle breakage
    • Management:
      • Reassure patient
      • Determine the degree and extent of paresthesia
      • Explain to patient that paresthesia normally persists for 2 months before resolution begins and may persist up to 1 year or longer

    Burning on Injection

    • Caused by pH of the solution, rapid injection, and injection of contaminated local anesthetic solution by sterilizing solution
    • If caused by pH of the solution, there is usually no residual sensitivity when the anesthetic action terminates
    • If caused by rapid injection and contaminated solution, tissue will be damaged with subsequent postanesthetic trismus, edema, or possibly paresthesia

    Paresthesia

    • Caused by trauma to the nerve, injection of contaminated solution, direct contact of nerve with needle, and hemorrhage into or around the neural sheath
    • Most cases resolve in approximately 8 weeks without treatment
    • Most cases involve the lingual nerve, with the inferior alveolar nerve a close second

    Infection

    • Extremely rare occurrence since the introduction of sterile, disposable needles and glass cartridges
    • Caused by use of contaminated needles, improper technique in handling LA equipment, and improper tissue preparation for injection
    • Prevention:
      • Use disposable needles
      • Recap the needle when not in use
      • Avoid multiple injections with the same needle
      • Use dental cartridges and store them aseptically in the original container, covered at all times
      • Cleanse the diaphragm with sterile, disposable alcohol wipes
      • Dry the tissue and apply topical antiseptic

    Overdose

    • Over administration of a drug produces elevated levels of the agent in the blood
    • Caused by too large a dose of local anesthetic agent
    • Maximum dose of local anesthesia (healthy adult):
      • 2% lidocaine: 4.4 mg/kg up to 300mg
      • 2% lidocaine with vasoconstrictor: 7 mg/kg up to 500mg
      • 3% mepivacaine: 6.6 mg/kg up to 400mg
      • 2% mepivacaine with vasoconstrictor: 6.6 mg/kg up to 400mg
      • 0.5% bupivacaine: 2mg/kg up to 175mg
      • 1.5% bupivacaine with vasoconstrictor: 2mg/kg up to 225mg

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