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BDS2 CDS LA Symposium > 3. LA Complications > Flashcards

3. LA Complications Flashcards

1
Q

Features of lignocaine/lidocaine (4)

A

Amide
Standard - lidocaine HCl 2%
Vasoconstrictor - none/adrenaline (1:80,000)

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2
Q

Features of prilocaine/citanest (3)

A

Amide
Standard - prilocaine HCl 3%
Vasoconstrictor - plain/felypressin (octapressin - 1.2ug)

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3
Q

Features of articaine (4)

A

Amide
Standard - 4% with varying vasoconstrictor (1:100,000, 1:200,000, 1:400,000)
Uses - infiltration and blocks
Useful if patient has liver disease

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4
Q

Length of action of mepivicaine (3)

A

Infiltration - 20mins
Block - 40mins
Soft tissue - 2hrs

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5
Q

Length of action of lignocaine (3)

A

Infiltration - 60mins
Block - 90mins
Soft tissue - 3-5hrs

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6
Q

Length of action of articaine (3)

A

Infiltration - up to 120mins
Block - 75mins
Soft tissue - 3-5hrs

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7
Q

Length of action of prilocaine (3)

A

Infiltration - 30-45mins
Block - 60mins
Soft tissue - 3-6hrs

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8
Q

Systemic complications of LA (6)

A 
Psychogenic/stress
Interactions with other drugs
Cross infection
Allergy
Collapse
Toxicity
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9
Q

Psychogenic/stress includes (7)

A 
Fainting
Palpitations
Cold sweat
Restlessness
Excitation
Trembling
Weakness
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10
Q

Cause of psychogenic/stress

A

Lack of oxygenated blood to the brain

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11
Q

Clinical features of psychogenic/stress (6)

A 
Light-headedness
Pallor
Beads of sweat (lips/nose/temple)
Bradycardia (slow pulse)
Nausea
Pupil dilation
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12
Q

Management of psychogenic/stress (4)

A

Lay flat and raise legs
Loosen neck clothing
Improve room ventilation
Sweet drink potentially

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13
Q

LA interactions with other drugs (5)

A 
MAOI (mono amine oxidase inhibitors)
Tri-cyclics (theoretical risk of HTN)
B-blockers (BP increase_
Non-K sparing diuretics (adrenaline lowers K too)
Cocaine (increased adrenergic activity)
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14
Q

Features of LA allergy (2)

A

True allergy is rare

Most allergies are due to preservatives (methylparaben)

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15
Q

Toxicity features (4)

A

Convulsions
Loss of consciousness
Respiratory depression
Circulatory distress

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16
Q

LA and pregnancy (2)

A 
Avoid octapressin (prilocaine)
Has potential to induce labour
17
Q

Max. safe dose of mepivicaine, 3% (3)

A

Max dose - 3mg/kg
66mg/cartridge
6cartridges/70kg adult

18
Q

Max. safe dose of lignocaine, 2% (3)

A

Max dose - 5mg/kg
44mg/cartridge
7cartridges/70kg adult

19
Q

Max. safe dose of articaine, 4% (3)

A

Max dose - 7mg/kg
88mg/cartridge
5cartridges/70kg adult

20
Q

Max. safe dose of prilocaine, 3% (3)

A

Max dose - 8mg/kg
66mg/cartridge
8cartridges/70kg adult

21
Q

Adrenaline effects on B1-receptors (5)

A 
Increase HR
Increase force of heart contractions
Increase CO
Increase heart muscle excitability
Dilation of coronary BVs
22
Q

Adrenaline effects on B2-receptors (2)

A

Relaxation of bronchial smooth muscle

Muscle dilation

23
Q

Adrenaline effect on a-receptors

A

Skin contraction

24
Q

Adrenaline effects on BP (3)

A

Increases systolic BP
Decreases diastolic BP
Overall little effect on BP

25
Q

Adrenaline contraindications (4)

A

CVD
Hyperthyroidism (thyroid crisis)
Phaeochromocytoma (HTN)
Drug interactions

26
Q

Adrenaline action (3)

A

Works by redirecting blood flow (to heart, liver, skeletal muscle from non-essential organs during fight/flight)
Binds to B2 receptors causing vasodilation
Binds to a1 receptors causing vasoconstriction

27
Q

Local complications of LA (12)

A 
Failure to achieve anaesthesia
Prolonged anaesthesia
Pain during/after injection
Trismus (lockjaw)
Haematoma
Intra-vascular injection
Blanching
Facial paresis (weakness)
Broken needle
Infection
Soft tissue damage
Contamination
28
Q

Types of prolonged anaesthesia (3)

A

Direct trauma from needle
Multiple passes with same needle
Chemical trauma from direct injection

29
Q

Facial palsy presentation

A

Usually complete, unilateral nerve paralysis within minutes of IDB

30
Q

Facial palsy confirmation

A

Temporal branch affected (lower MND)

31
Q

Facial palsy cause

A

LA into parotid gland (injection too far posteriorly)

32
Q

Facial palsy diagnosis

A

Test branches of CNVII

33
Q

Facial palsy management

A

Reassurance, cover eye with paid until blink reflex returns

34
Q

Types of intra-vascular injection (2)

A

Intra-arterial

Intravenous

35
Q

Features of IA injection (5)

A 
Rare
Skin blanching
Visual disturbances
Aural disturbances
Transitionary, but persistence requires rapid specialist referral
36
Q

Features of IV injection (3)

A 
Block injections (IDB)
Avoided by careful technique (aspiration)
Palpitation, anxiousness, restlessness, headache, sweating, pallor

BDS2 CDS LA Symposium (5 decks)

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