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Oral surgery > 15. Complications during and after local anesthesia. Types of prevention. Basic principles of treatment > Flashcards

15. Complications during and after local anesthesia. Types of prevention. Basic principles of treatment Flashcards

1
Q

Maximum dose of local anesthetics

A
  • Lidocaine: 7mg/kg
  • Mepivacaine: 6.6 mg/kg
  • Prilocaine: 6.0 mg/kg
  • Articaine: 7.0 mg/kg
  • Procaine: 10mg/kg
  • Bupivacaine: 2.2 mg/kg
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2
Q

Effect of Epinephrine in La

A

🔹Vasoconstriction
🔹Reduced bleeding
🔹Prolonged anaesthesia

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3
Q

Effects of Epinephrine injection into vessel

A

🔷Systemic absorption-systemic toxicity
🔹Cardiovascular effects- tachycardia , Hypertension, arrhythmias
🔹CNS effects- dizziness, tremors, seizures
🔹Local tissue ischemia->necrosis

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4
Q

Epinephrine effect on heart

A

🔹Secreted by adrenal glands
🔹Binds to beta adrenergic receptors on heart muscle cells
🔹Increases HR and strength of contractions->increased blood supply
🔹Raises Bp

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5
Q

Role of epinephrine in allergic reactions

A

🔸Inhibits release of inflammatory mediators
🔸Histamine, leukotrienes

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6
Q

How epinephrine counteracts effects of vasodilation and increased vascular permeability during allergic reactions

A

🔸Induces vasoconstriction and reduces vascular permeability

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7
Q

Importance of bronchodilation during severe allergic reactions

A

🔸Improved airflow

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8
Q

Effects epinephrine has on cardiovascular system during allergic reactions

A

🔸Maintains blood pressure and cardiac output

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9
Q

How Articaine has better penetration into tissues than lidocaine

A

🔸Presence of ester group in its structure
🔸Allows better diffusion

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10
Q

Advantages of Articaines improved penetration

A

🔸More profound anaesthesia at lower doses

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11
Q

Main effects of epinephrine in allergy

A

🔸Vasoconstriction (reduces swelling)
🔸Bronchodilation (improved airflow)
🔸Cardiovascular effects
🔸Suppression of inflammatory mediators

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12
Q

Active ingredient of Ubistein

A

Articaine and epinephrine

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13
Q

Active ingredient of Scandonest

A

Mepivicaine and epinephrine

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14
Q

Active ingredient of xylodren

A

Lidocaine and epinephrine

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15
Q

Active ingredient of dentocain

A

Articaine and adrenaline

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16
Q

Active ingredient of septonest

A

Adrenaline and Articaine

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17
Q

Factors that affect intensity and duration of LA’s

A

🔸Tissue blood flow
🔸Activity of plasma cholinesterase
🔸Vasoconstrictor use
🔸pH of tissue
🔸Dose of La

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18
Q

How infection hinders effect of La

A

🔸Creates acidic environment->decreases pH of tissues
🔸Alters ionisation and ability to penetrate nerve fibres->
🔸Reduces the potency and duration of LAs

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19
Q

Strategies to overcome resistance of LA in infected tissues

A

🔸Antibiotics and anti inflammatory agents (reduce inflammation and acidity)
🔸Regional nerve blocks and intravenous sedation

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20
Q

Overdose of LAs can cause

A

🔹Severe hypotension (Vasodilation)
🔹Seizures
🔹Respiratory depression

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21
Q

Problems that may occur before administering anesthesia

A

* Fear of the Patient:
=>syncope (fainting) or collapse
* Reduces efficiency of the anesthesia.
* Collapse:=> Severe vascular insufficiency leading to a sudden drop in blood pressure.
* Impossibility to Introduce the Anesthetic Solution in the Right Place:
* Cant open mouth wide=>
* Inflammatory (trismus) or non-inflammatory contractures
* Ankylosis of the mandibular joints.

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22
Q

Syncope, and its main characteristics

A
  • Transient loss of consciousness and postural tone=>
  • Spontaneous recovery without neurological deficit
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23
Q

Most common cause of unconsciousness in a dental office setting

A

Vasovagal syncope

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24
Q

Psychogenic and non-psychogenic causes of vasovagal syncope

A
  1. Psychogenic=>
    * Fright
    * Anxiety
  2. Non-psychogenic=>
    * Prolonged standing and dehydration
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25
Q

What surgeon should consider when a patient experiences syncope

A
  • Usually a benign, self-limiting event=>
  • Rule out other more serious etiologies of unconsciousness
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26
Q

Cardiac causes of syncope

A

Obstructive outflow diseases such as aortic stenosis

27
Q

Neurogenic causes of syncope

A

Seizures, transient ischemic attack, migraines

28
Q

How orthostatic hypotension can lead to syncope

A
  • Patients with depleted intravascular volume=>
  • Side effect of drugs=> antidepressants and antihypertensives
  • Patients with autonomic instability=>
  • Diabetes mellitus
29
Q

Hypoglycemia relation to syncope

A

Rare cause of syncope

30
Q

Patients in which vasovagal or vasodepressor syncope generally the etiology

A

Young, healthy patients

31
Q

Stages of syncope and the symptoms

A
  1. Presyncopal Stage:
    * Blood pressure and heart rate drop
  2. Syncope Stage:
    * Irregular breathing
    * Pulse thready, blood pressure can drop to extremely low levels
    * Unconsciousness can last from seconds to several minutes after placement in the supine position
  3. Postsyncope Stage:
    * Rapid recovery
    * Pallor, nausea, disorientation may persist
32
Q

Management steps for syncope in an emergency situation

A
  • Stop the procedure immediately
  • Trendelenburg position and administer oxygen
  • If unconsciousness =>,basic life support protocol: call for help, assess airway, breathing, and circulation
  • Chin lift or jaw thrust to open the airway.
  • If breathing and circulation present=> crush an ampule of ammonia under the patient’s nose to hasten recovery
  • Call emergency medical services if unconsciousness lasts beyond 10-15 minutes.

Failure to lay the syncopal patient flat can result in brain damage or death.

33
Q

Collapse

A
  • Severe vascular insufficiency => to a sudden drop in blood pressure
  • Consciousness is preserved
  • Patient may feel weak, dizzy, have shallow breathing
    Management: Requires immediate medical treatment
34
Q

Complications during local anesthesia

A
  • **Allergic Reactions
  • Toxic Reactions:
  • Fracture of the Injection Needle:
  • Post-Injection Pain and Inflammatory** Complications:=>
  • High concentration anesthetics
  • Periosteum injury, tissue infection, or use of non-sterile solutions.
35
Q

Anaphylaxis and how does it occurs

A
  • Type I hypersensitivity reaction=> antigen binds to IgE antibodies on mast cells and basophils=>
  • Systemic release of immunologic mediators
36
Q

Common clinical presentations of anaphylaxis

A
  • Urticaria (hives) and/or angioedema (swelling)
  • Respiratory compromise and cardiovascular collapse=>
  • Usual causes of death in anaphylaxis
37
Q

Common causes of anaphylaxis in a surgical practice

A
  • Drugs such as penicillin and aspirin
  • Exposure to latex
38
Q

Conditions that must be differentiated from anaphylaxis

A
  • Vasodepressor syncope
  • Local anesthetic overdose
  • Panic attack, cardiac arrest, foreign body aspiration
39
Q

How initial signs and symptoms of anaphylaxis be managed

A
  • Procedure stopped immediately
  • Airway, breathing, circulation, and consciousness level assessed,
  • Epinephrine should be administered without delay
40
Q

Role of epinephrine in managing anaphylaxis, and how it should be administered

A
  • Intramuscularly or subcutaneously at a 1:1000 dilution (0.2–0.5 ml in adults or 0.01 mg/kg in children)
  • Injected into the lateral thigh, upper arm, or sublingually=.
  • Dose repeatable every 5 minutes as needed
41
Q

Position patient placed in during anaphylaxis and why

A
  • Trendelenburg position (lying flat with feet elevated)
  • Maximize cerebral blood flow
42
Q

Additional treatments that should be considered after initial epinephrine administration in anaphylaxis

A
  • Antihistamines (such as diphenhydramine) intramuscularly or intravenously at 1–2 mg/kg (up to 50 mg).
  • Albuterol for bronchospasm
  • Corticosteroids (such as hydrocortisone prevent recurrent or protracted anaphylaxis
43
Q

Why its important for all patients with anaphylaxis to be taken to an emergency department

A

Can recur

44
Q

Common causes of needle fractures during local anesthesia and their prevention

A
  • Incorrect Insertion
  • Sudden Movements
    Prevention Measures=>
    Avoid Full-Length Insertion:
  • Control Patient Movement: Ensure the patient remains still
  • Proper Technique:
45
Q

How a fractured needle managed if it occurs during an injection

A
  • Depends on whether the end of the needle is visible or not:
  • Visible End: grasped with a tool and carefully removed
  • Not Visible and No Complications=>
  • Not necessary to search for and remove it
  • Causing Complications=>
  • Muscle pain, contractures, or inflammatory processes=> located and removed by searching in depth
46
Q

Causes of post-injection pain and inflammatory complications and treatment

A
  • High Concentration Anesthetics:
  • Periosteum Injury:
  • Tissue Infection=>if needle tip touches teeth or mucosa before injection.
  • Non-Sterile Solutions

Administer antibiotics to control and prevent infection

47
Q

How injury to a blood vessel with a needle managed during local anesthesia

A
  • Common in the Superior posterior alveolar nerve block=>results in hematoma formation (plexus venosus
    pterygoideus)
  • Compression=> about 5 minutes in the area of the tuber maxillae to prevent hematoma growth
  • Cooling and Physiotherapy=> small hematomas, cool the area for the first 24 hours and follow up with physiotherapy for faster absorption
  • Antibiotics for Large Hematomas:
  • Suppuration Management: If suppuration occurs, make an incision, provide drainage, and treat as for an abscess

-For large hematomas or patients with concomitant diseases like diabetes, prescribe antibiotics to prevent inflammatory complications.

48
Q

Prevention of vessel injury

A
  • Knowledge and Technique
  • Aspiration Before Injection
49
Q

Reflex contracture

A
  • Limited lower jaw movement (N. alveolaris inferior) La
  • Needle Tip Bending: The needle tip bending upon bone contact.
  • Muscle Fiber Tear: =>
  • M. pterygoideus medialis=> pain and restricted jaw movement from hematoma, myositis, or scarring
50
Q

Reflex contracture treatement

A
  • Analgesics and Anti-inflammatory Drugs: To manage pain and inflammation.
  • Physiotherapy: To aid in recovery and restore movement.
51
Q

How aspiration or swallowing of an injection needle managed

A
  • Natural Discharge: The needle usually passes naturally through GIT in 2-3 days
  • X-rays: track the needle’s path.
  • Surgical Intervention: If the needle is not discarded within 4 days=> operative intervention.
  • Diet Management=>avoid peristalsis-enhancing or cleansing medications.
  • Asphyxia Management: If the needle is aspirated causing asphyxia=>
  • Coniotomy in case of stenotic asphyxia
  • Partial airway patency=> otolaryngologist-bronchoscopist and anesthesiologist urgently
52
Q

Prevention strategies for needle aspiration

A
  • Use of Gauze: Especially in children and restless patients=>
  • keep the needle attached to the syringe and in the operator’s hands
53
Q

Emphysema in the context of local anesthesia complications

A
  • Increased air content in tissues
  • Often=> upper jaw anesthesia from the vestibular side
  • Air pushed into the soft tissue during injection or needle removal
  • Swelling
  • Crepitation: => on palpation in the affected area
54
Q

Emphysema management in the context of local anesthesia complications

A
  • Press the Area=>about 5 minutes to stop further air ingress.
  • Resolution: The condition typically resolves within 2-3 days without special treatment.
55
Q

Causes of facial nerve paresis or paralysis during dental procedures

A
  • improper anesthesia => N. Alveolaris inferior.
  • Penetration of the injection needle behind the posterior edge of the mandibular ramus=> parotid gland
  • transient=>disappears after the anesthetic wears off
56
Q

How paresthesias or neuritis develop in dental procedures, and their clinical manifestations

A
  • Branches of the trigeminal nerve are damaged=>
  • Injection Techniques=
57
Q

Most common nerves injured

A

Inferior alveolar, Mental and lingual

58
Q

Symptoms of nerve injury

A

Burning sensation

  • Pins and needles
  • Biting of tongue and lips
  • Abnormal chewing
  • Burns when consuming food
59
Q

Conditions of nerve trauma

A
  • Anaesthesia
  • Hypesthesia
  • Paraesthesia
  • Dysesthesia
60
Q

Classifications of nerve injury

A
  • Neurapraxia
  • Axonotmesis
  • Neurotmesis

-

61
Q

Neurapraxia

A
  • Small contact w/ nerve
  • Favourable prognosis
  • Complete recovery→rapid
62
Q

Axonotmesis

A
  • Injury without anatomic severance of endoneurium
  • Slower recovery than neurapraxia(paraesthesia 6-8 weeks after injury)
  • Risk of remaining sensory disturbance
63
Q

Complications that can arise from infraorbital anesthesia, and how are they managed

A
  • Anesthetic solution penetrates into the orbit=>
  • Double vision (diplopia)=>
  • Transient and typically resolves without any long-term effects on vision
64
Q

causes and management of post-injection tissue necrosis in dental anesthesia

A
  • Rapid Subperiosteal Injection:
  • Excess Anesthetic Amount
  • Vasoconstrictors
  • =»>
  • Detachment of the periosteum from the underlying bone=>
  • Necrosis of soft tissues and underlying bone (sequestration of the hard palate)

Oral surgery (106 decks)

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