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Intro to OS and Pain Management > Complication of local anesthesia > Flashcards

Complication of local anesthesia Flashcards

1
Q

what percent of local anesthesia causes temporary paresthesia? permanent?

A
  • 0.54%: temporary
  • 0.01% permanent
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2
Q

what percentage of paresthesias are the lingual nerve? inferior alveolar?

A
  • lingual nerve: 79%
  • inferior alveolar: 21%
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3
Q

why is lingual nerve more affected inferior alveolar

A
  • less likely to deflect by needle
  • mouth open -> tissue is more taut
  • more unifasicular than multifasicular bundle
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4
Q

what are regional complications of local anesthesia

A
  • paresthesia
  • needle trauma
  • volume of solution
  • repeat injection
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5
Q

what are common theories about paresthesia

A
  • direct trauma to nerve
  • intraneural hematoma
  • neurotoxicity from anesthesia
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6
Q

what causes pain in injections

A
  • rapid delivery of solution
  • dull needle
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7
Q

what does contamination of needle cause

A

infection

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8
Q

when do hematomas occur

A
  • PSA (posterior superior alveolar) injection
  • IA (inferior alveolar injection)
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9
Q

what is the potential complication with the IA injection

A

potential airway complication

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10
Q

describe electric shock

A
  • 7% occur during mandibular block
    -40% associated with lingual paresthesia
  • no direct correlation in severity of nerve injury
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11
Q

describe facial nerve paralysis and symptoms

A
  • capsule of parotid gland
  • symptoms: inability to close ipsilateral eye, corneal reflex intact
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12
Q

what is the treatment for facial nerve paralysis

A
  • supportive care
  • usually last few hours
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13
Q

what are the possible ocular complications

A
  • diplopia
  • temporary vision loss
  • hematoma
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14
Q

what is the possible cause of ocular complications

A

anesthesia travels to maxillary artery -> opthalmic artery

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15
Q

what is the treatment of ocular complications

A
  • rare but if cocurs, opthalmology consult
  • aspiration when provide local anesthesia
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16
Q

describr trismus and causes

A
  • common occurs after inferior alveolar block
  • causes: hematoma, multiple/traumatic injections
  • excessive volume anesthetics
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17
Q

what is the management of trismus

A
  • moist heat
  • anti-inflammatory agents
  • range of motion exercises
  • most cases resolve within 6 weeks (4-20 weeks)
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18
Q

describe allergic reactions

A

less than 1% for amide local anesthesia

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19
Q

describe adverse reactions

A
  • caused by fear and anxiety
  • intravascular administration
  • toxic overdose
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20
Q

what are regional complications of local anesthesia

A
  • paresthesia
  • pain
  • contamination
    -hematoma
  • electrical shock
  • facial nerve paralysis
    -ocular complications
  • trismus
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21
Q

what are systemic complications

A
  • allergic reaction
    -adverse reaction
  • sulfites
  • type I anaphylactic allergic reaction
  • ## methemoglobinemia
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22
Q

describe sulfite complications

A
  • antioxidants to stabilize epinephrine
  • intravascular administration
  • toxic overdose
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23
Q

describe type I anaphylactic allergic reaction

A
  • skin (erythema, urticaria)
  • GI (muscle cramping)
  • respiratory (coughing, wheezing, dyspnea)
  • cardiovascular (palpitations, tachycardia)
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24
Q

what is the treatment for type I anaphylactic allergic reaction

A
  • diphenhydramine 25-50mg
  • epinephrine 0.3mg IM and further medical treatment
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25
Q

describe methemoglobinemia

A
  • iron atom in hemoglobin is oxidized (ferrous Fe2+ to ferric Fe3+)
  • prilocaine, benzocaine, EMLA cream
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26
Q

what are the signs and symptoms of menthemoglobinemia

A
  • will not appear 3-4 hours after LA administration
  • clinical cyanosis - methemoglobin 10-20%
  • dyspnea and tachycardia - methemoglobin 35-40%
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27
Q

54.9% of emergency situation arose:

A
  • during the administration of the local anesthetic
  • 5 minutes immediately after its adminstration
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28
Q

why reversal?

A

complaint of lingering numbness of soft tissue
- anesthesia/paresthesia up to 3-5 hours

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29
Q

how do you achieve atraumatic injection

A
  • good technique and good communication with patient
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30
Q

what are the functional aspects of reversal

A
  • lisping, asymmetric smile, drink, drooling
  • self inflicted soft tissue injury
31
Q

what are the sensory aspects of reversal

A

discomforting and inconvenient

32
Q

what are perceptual aspects of reversal

A

distorted body parts- swollen lips

33
Q

what ages are more likely to have lip injury following inferior alveolar nerve block

A
  • children
  • mentally handicapped adult
  • geriatric patient with dementia
34
Q

what is a popular trend in anesthesi

A
  • patient wants pulpal anesthesia but not soft tissue anesthesia
35
Q

what technique is gaining popularity

A
  • PDL injection
  • intraosseous injection
36
Q

whats the down side to intraosseous injections

A
  • added injections increases chances of undesirable residual post surgical numbness
37
Q

how do you reduce residual STA

A
  • increase blood flow
  • transcutaneous electrical nerve stimulations (TENS)
  • vasodilating med is key
38
Q

describe transcutaneous electrical nerve stimulations (TENS)

A
  • electrodes to stimulate skeletal muscle
  • increase muscle stimulation
  • increase perfusion
39
Q

describe phentolamine

A
  • alpha adrenergic receptor antagonist
  • alpha 1 and 2 antagonist
  • stimulates beta receptors in heart and lung (small dosage)
  • lower BP ~ normal ~ larger doses
40
Q

what is phentolamine approved by the FDA for

A
  • dx of pheochromocytoma
  • HTN associated with pheochromocytoma
  • prevent necrosis after nor-epi extravasation
  • management of impotence (erectile dysfunction)
  • safety unknown for pregnancy - category C
41
Q

what is OraVerse

A
  • FDA approved dental injectable phentolamine mesylate (2008)
  • 1/12 concentration compare to medicine counterpart
42
Q

what are results of OraVerse

A

presence of upper lip and mandibular anesthesia occurs faster but doesnt last as long

43
Q

what are adverse reactions related to OraVerse

A
  • diarrhea
  • facial swelling
  • HTN
  • injection site reactions
  • jaw/oral pain
  • paresthesia
  • pruritis
  • tenderness
  • upper abdominal pain
  • vomiting
44
Q

what is the dose of oraverse compared to LA cartridges

A

1 cartride = 1mg OraVerse

45
Q

what are potential candidates for OraVerse

A
  • conservative dental treatment
  • nonsurgical periodontics: root planning and curettage
  • pediatric patients: not under 6 years or under 33 lb
  • geriatric patients
  • special needs patients
  • medically compromised patient: DM…
46
Q

what are the unique properties of articaine

A
  • amide + ester with thiophene ring
  • increase lipid solubility
  • increased lipid solubility = increased diffusion
47
Q

what are the claims to articaine

A
  • increased success rates
  • diffuse soft/ hard tissue reliably
  • infiltration of mandible resulted pulpal and lingual anesthesia
  • controlled study failed to corroborate these claims
48
Q

when is articaine contraindicated

A
  • patient allergic to amide type anesthesia
  • sulfite sensitivity
  • caution with hepatic disease
  • patient with significant impairments in cardiovascular function
  • children less than 4 years old
49
Q

what is the down side to articaine

A

prior to introduction of articaine, prilocaine accounted for 51% of paresthesia in the US, while being used for 13% of injections

50
Q

articaine and prilocain resulted in more ____ paresthesias than all the local anesthetics

A

non- surgical

51
Q

what is the difference in post injection adverse event between articaine and lidocaine

A

none

52
Q

what is the relative risk for success in articaine vs lidocaine

A

1.31 articaine vs 1.05 lidocaine

53
Q

does articaine or lidocaine have a higher pain score

A

articaine

54
Q

which is more effective in molar anesthesia: articaine or lidocaine

A

articain

55
Q

is 4% too concentrated

A
  • animal studies show increased neurological deficits with 4% lidocaine
56
Q

what is the closest to the ideal intermediate duratino local anesthetic

A

2% lidocaine with 1:100,000 epi

57
Q

what is Kovanaze

A
  • new product
  • nasal spray dental anesthetic
  • approved by FDA in 2016
  • administering dental anesthesia without needle
58
Q

what is in kovanaze

A
  • tetracaine HCL and oxymetazoline HCL
  • odorless, simply feels like water mist
59
Q

what is kovanaze good for

A

pulpal anesthesia for restorative treatment
- teeth 4-13 and/or A to J for children greater than 40kg

60
Q

how long does kovanaze last

A

median duration was 11 minutes but could be as long as 43 minutes

61
Q

how is kovanaze packages

A

prefilled sprayers doses of 0.2ml

62
Q

how do you apply kovanaze

A
  • spray position for first spray is horizontal
  • wait 4 minutes
  • spray position for second spray is 45 degree angle
  • wait 10 minutes
  • do test drill
63
Q

what is the limitation of kovanaze

A
  • proceudre can be done on one side of the mouth
  • wait 24 hours or complete resolution of the block
64
Q

what is the storage ofkovanaze

A

36-46 degree refrigerator

65
Q

what are some things to watch out for with kovanaze

A
  • hypertension and thyroid disease: do not use in these patients
  • epistaxis: frequent nose bleeds greater than 5 per month
  • dysphagia
  • menthemoglobinemia
  • anaphylactic reaction
66
Q

what are the drug interactions with kovanaze

A
  • MAOi, nonselective beta blocker, tricyclic antidepressant: may cause HTN
  • oxymetazoline containing product: discontinue use 24 hours prior to kovanaze administration
67
Q

what are challenges in local anesthesia

A
  • difficulty in getting proper mandibular teeth anesthesia in a reasonable time
  • variable success rate in getting inferior alveolar nerve anesthetized
68
Q

what is the success of inferior alveolar nerve block

A

30-97%

69
Q

what can IANB be paired with

A

+ intraligamentary or intraosseous - first molar anesthesia reported 100%
+ buccal infiltration has same result

70
Q

why is buccal infiltration for molar anesthesia not usually used

A
  • dense cortical bone
  • difficulty in diffusion of anesthetic solution
71
Q

what is the success rate of IANB (4% articaine) + buccal infiltration with 4% articaine and 2% lidocaine

A
  • 4% articaine: 88% success rate
  • 2% lidocaine: 71% success rate
72
Q

IANB + buccal is _______ than IANB alone

A

more successful

73
Q
A

Intro to OS and Pain Management (9 decks)

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