Complication of local anesthesia Flashcards
what percent of local anesthesia causes temporary paresthesia? permanent?
- 0.54%: temporary
- 0.01% permanent
what percentage of paresthesias are the lingual nerve? inferior alveolar?
- lingual nerve: 79%
- inferior alveolar: 21%
why is lingual nerve more affected inferior alveolar
- less likely to deflect by needle
- mouth open -> tissue is more taut
- more unifasicular than multifasicular bundle
what are regional complications of local anesthesia
- paresthesia
- needle trauma
- volume of solution
- repeat injection
what are common theories about paresthesia
- direct trauma to nerve
- intraneural hematoma
- neurotoxicity from anesthesia
what causes pain in injections
- rapid delivery of solution
- dull needle
what does contamination of needle cause
infection
when do hematomas occur
- PSA (posterior superior alveolar) injection
- IA (inferior alveolar injection)
what is the potential complication with the IA injection
potential airway complication
describe electric shock
- 7% occur during mandibular block
-40% associated with lingual paresthesia - no direct correlation in severity of nerve injury
describe facial nerve paralysis and symptoms
- capsule of parotid gland
- symptoms: inability to close ipsilateral eye, corneal reflex intact
what is the treatment for facial nerve paralysis
- supportive care
- usually last few hours
what are the possible ocular complications
- diplopia
- temporary vision loss
- hematoma
what is the possible cause of ocular complications
anesthesia travels to maxillary artery -> opthalmic artery
what is the treatment of ocular complications
- rare but if cocurs, opthalmology consult
- aspiration when provide local anesthesia
describr trismus and causes
- common occurs after inferior alveolar block
- causes: hematoma, multiple/traumatic injections
- excessive volume anesthetics
what is the management of trismus
- moist heat
- anti-inflammatory agents
- range of motion exercises
- most cases resolve within 6 weeks (4-20 weeks)
describe allergic reactions
less than 1% for amide local anesthesia
describe adverse reactions
- caused by fear and anxiety
- intravascular administration
- toxic overdose
what are regional complications of local anesthesia
- paresthesia
- pain
- contamination
-hematoma - electrical shock
- facial nerve paralysis
-ocular complications - trismus
what are systemic complications
- allergic reaction
-adverse reaction - sulfites
- type I anaphylactic allergic reaction
- ## methemoglobinemia
describe sulfite complications
- antioxidants to stabilize epinephrine
- intravascular administration
- toxic overdose
describe type I anaphylactic allergic reaction
- skin (erythema, urticaria)
- GI (muscle cramping)
- respiratory (coughing, wheezing, dyspnea)
- cardiovascular (palpitations, tachycardia)
what is the treatment for type I anaphylactic allergic reaction
- diphenhydramine 25-50mg
- epinephrine 0.3mg IM and further medical treatment
describe methemoglobinemia
- iron atom in hemoglobin is oxidized (ferrous Fe2+ to ferric Fe3+)
- prilocaine, benzocaine, EMLA cream
what are the signs and symptoms of menthemoglobinemia
- will not appear 3-4 hours after LA administration
- clinical cyanosis - methemoglobin 10-20%
- dyspnea and tachycardia - methemoglobin 35-40%
54.9% of emergency situation arose:
- during the administration of the local anesthetic
- 5 minutes immediately after its adminstration
why reversal?
complaint of lingering numbness of soft tissue
- anesthesia/paresthesia up to 3-5 hours
how do you achieve atraumatic injection
- good technique and good communication with patient
what are the functional aspects of reversal
- lisping, asymmetric smile, drink, drooling
- self inflicted soft tissue injury
what are the sensory aspects of reversal
discomforting and inconvenient
what are perceptual aspects of reversal
distorted body parts- swollen lips
what ages are more likely to have lip injury following inferior alveolar nerve block
- children
- mentally handicapped adult
- geriatric patient with dementia
what is a popular trend in anesthesi
- patient wants pulpal anesthesia but not soft tissue anesthesia
what technique is gaining popularity
- PDL injection
- intraosseous injection
whats the down side to intraosseous injections
- added injections increases chances of undesirable residual post surgical numbness
how do you reduce residual STA
- increase blood flow
- transcutaneous electrical nerve stimulations (TENS)
- vasodilating med is key
describe transcutaneous electrical nerve stimulations (TENS)
- electrodes to stimulate skeletal muscle
- increase muscle stimulation
- increase perfusion
describe phentolamine
- alpha adrenergic receptor antagonist
- alpha 1 and 2 antagonist
- stimulates beta receptors in heart and lung (small dosage)
- lower BP ~ normal ~ larger doses
what is phentolamine approved by the FDA for
- dx of pheochromocytoma
- HTN associated with pheochromocytoma
- prevent necrosis after nor-epi extravasation
- management of impotence (erectile dysfunction)
- safety unknown for pregnancy - category C
what is OraVerse
- FDA approved dental injectable phentolamine mesylate (2008)
- 1/12 concentration compare to medicine counterpart
what are results of OraVerse
presence of upper lip and mandibular anesthesia occurs faster but doesnt last as long
what are adverse reactions related to OraVerse
- diarrhea
- facial swelling
- HTN
- injection site reactions
- jaw/oral pain
- paresthesia
- pruritis
- tenderness
- upper abdominal pain
- vomiting
what is the dose of oraverse compared to LA cartridges
1 cartride = 1mg OraVerse
what are potential candidates for OraVerse
- 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…
what are the unique properties of articaine
- amide + ester with thiophene ring
- increase lipid solubility
- increased lipid solubility = increased diffusion
what are the claims to articaine
- increased success rates
- diffuse soft/ hard tissue reliably
- infiltration of mandible resulted pulpal and lingual anesthesia
- controlled study failed to corroborate these claims
when is articaine contraindicated
- 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
what is the down side to articaine
prior to introduction of articaine, prilocaine accounted for 51% of paresthesia in the US, while being used for 13% of injections
articaine and prilocain resulted in more ____ paresthesias than all the local anesthetics
non- surgical
what is the difference in post injection adverse event between articaine and lidocaine
none
what is the relative risk for success in articaine vs lidocaine
1.31 articaine vs 1.05 lidocaine
does articaine or lidocaine have a higher pain score
articaine
which is more effective in molar anesthesia: articaine or lidocaine
articain
is 4% too concentrated
- animal studies show increased neurological deficits with 4% lidocaine
what is the closest to the ideal intermediate duratino local anesthetic
2% lidocaine with 1:100,000 epi
what is Kovanaze
- new product
- nasal spray dental anesthetic
- approved by FDA in 2016
- administering dental anesthesia without needle
what is in kovanaze
- tetracaine HCL and oxymetazoline HCL
- odorless, simply feels like water mist
what is kovanaze good for
pulpal anesthesia for restorative treatment
- teeth 4-13 and/or A to J for children greater than 40kg
how long does kovanaze last
median duration was 11 minutes but could be as long as 43 minutes
how is kovanaze packages
prefilled sprayers doses of 0.2ml
how do you apply kovanaze
- 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
what is the limitation of kovanaze
- proceudre can be done on one side of the mouth
- wait 24 hours or complete resolution of the block
what is the storage ofkovanaze
36-46 degree refrigerator
what are some things to watch out for with kovanaze
- hypertension and thyroid disease: do not use in these patients
- epistaxis: frequent nose bleeds greater than 5 per month
- dysphagia
- menthemoglobinemia
- anaphylactic reaction
what are the drug interactions with kovanaze
- MAOi, nonselective beta blocker, tricyclic antidepressant: may cause HTN
- oxymetazoline containing product: discontinue use 24 hours prior to kovanaze administration
what are challenges in local anesthesia
- difficulty in getting proper mandibular teeth anesthesia in a reasonable time
- variable success rate in getting inferior alveolar nerve anesthetized
what is the success of inferior alveolar nerve block
30-97%
what can IANB be paired with
+ intraligamentary or intraosseous - first molar anesthesia reported 100%
+ buccal infiltration has same result
why is buccal infiltration for molar anesthesia not usually used
- dense cortical bone
- difficulty in diffusion of anesthetic solution
what is the success rate of IANB (4% articaine) + buccal infiltration with 4% articaine and 2% lidocaine
- 4% articaine: 88% success rate
- 2% lidocaine: 71% success rate
IANB + buccal is _______ than IANB alone
more successful
