Complications Flashcards
What are the systemic complications of LA
1) syncope
2) local anesthetic overdose
3) epinephrine overdose
4) allergic rxn
5) any potential medical emergency
What is the cause of syncope
Drastic drop in BP
Emotion response to injection
What is prevention to syncope
Pre-anesthetic assesment - identify fearful patients
- hide needle
- supine position
What are symptoms of syncope
Sweating, naseua, pallor, increased HR and RR
What are the treatments for syncope
Supine position
Administer ammonia caspule/oxygen
- cool damp cloth on forehead/neck
- monitor vitals
- reassurance - no standing/sitign
What is cause of LA overdose
Injection into vessel - most common
Administering too large of dose
Metabolism/excretion of LA is slow
How do you prevent LA overdose
Aspirate in 2 planes
Calculate MRD based on pt weight
Pre-anesthetic assemnt for LA selection
What are symptoms of LA overdose (low and high)?
Low overdose = CNS excitation
high overdose = CNS and CV depression
What is treatment for LA overdrive
Determined by onset and severty
- most are mild rxns (no tx)
- moderate/sever = stablize (ABCs) and activate EMS
- rapid onset = more severe - activate EMS immediately
What is cause of epinephrine overdorse
1:50,000 concentration
IV injection
CV patients
What is epinephrine overdose prevention
Aspritae in 2 planes
Use lowest effective concentration
Pre-anesthetic assesment to identify CV patients
What are symptoms of epinephrine overdose
Fight or flight response - lasts 5-10 mins
What is the treatment for epinephrine overdose
Reassurance for healthy patients or
CV pts = prepare for medical emergency
What are causes of allergic reactions
Hypersensitivity rxn to:
- methylparaben (preservative used until 1980)
- sodium bisulfite (in vasoconstrictors)
- ester topical anesthetics
What is the prevention of allergic reactions
Pre-anesthetic assessment
What are the symptoms of allergic reactions
Delayed hypersensitivity (rash/itching)
Immediate hypersensitivity (anaphylaxis)
What is the treatment for allergic reactions
Delayed = antihistimine/document
Anaphlyaxis = immediate life-threatening rxn - stabilize pt (ABCs), activate EMS, document
What do local complications include
1) needle breakage
2) pain during injection
3) burning during injection
4) hematoma
5) facial paralysis (transient)
6) paresthesia
7) trismus
8) infection
9) edema
10) soft tissue injury
11) tissue sloughing
What is the cause of needle breakage
Sudden unexpected movement
Poor technique
What is prevention for needle breakage
Use 25 or 27g
Use long needle for IA block
Do not bed neelde
Do not insert needle to hub
Do not force needle
What is treatment for needle breakage
Keep hands in patients mouth
Remove needle if visible
Refer to oral surgeon
*document!
What is cause of pain during injection
Dull/barbed needle
Poor technique
What is prevention of pain during injections
Inject slowly
Use topical
Use sharp needle
Use anesthetic at room temperature
What is treatment for pain during injections
Reassure patient
Slow down delivery
What is cause of burning during injection
Contaminated/expired anestehtic
Poor technique
Haeted anestehtic solution
What is prevention of burning during injection
Inject slowly
Check cartridge before use
Store at room temp
What is treatment for burning during injection
Raeassure, slow down delivery
What is cause of hematoma
Puncture of blood vessel
Bad technique
Multiple needle penetrations
What is prevention of hematoma
Use 27 short for PSA
- know antomy
What is treatment for hematoma
Apply ice/pressure immediately
Inform patient of swelling/discoloration - 7-14 days
- document
What is cause of facial paralysis
LA deopisted in parotid gland
Bone not contacted during manidbular block
What is prevention for facial paralysis
Contact bone before depositing anesthetic
What is treatment for facial paralysis
Reassure patient
Document
(Maybe eye patch if cant close eye)
What is cause of paresthesia
-Trauma to nerve sheath (pt feels shock - but shock doesnt always meant this)
-Edema/hemmorhage near nerve
-Contaminated anesthetic (soaked in disinfectant)
-Possible association with articaine
What is prevention of paresthesia
Minimize needle movement within tissue
Do not soak carpules in disinfectant
What is treatment for paresthesia
Reassure pt and wait - 3 weeks to 3 months, possible a year
- document
What is cause of trismus
Muscle trauma from multiple needle insertions
Contaminated anesthetic
What is prevention of trismus
Use sahrp needle
Deposit anesthetic slowly
Store properly
What is treatment for trismus
Reassure patient - 2-3 days
Moist heat (20 min on/off)
Document
What is cause of infection
Contaminated needle/cartridge
Administering anesthetic through infected area (like swelling)
What is prevention of infection
Sterile needle - replace if contaminated
Store properly
Do not inject infected are
What is tx for infection
Antibiotics after 3 days
What is cause of edema
Trauma
Contaminated anesthetic
Allergic reaction to LA/sodium bisulfite
What is prevention of edema
Good technique
Pre anestehtic assement (ID allergies)
Store properly
What is treatment for edema
NONE - resolves within 3-4 days
What is cause of soft tissue injury
Self inflicted - usually children/special needs
What is prevention of soft tissue injury
Select LA with appropriate duration
Warn patients/parents
What is treatment for soft tissue injury
Analgesics (OTC)
Antibiotics if severe
Warm salt water rinses
Vaseline for lips
