Complications Flashcards
Describe the nature of most LA side effects
Most side effects are minor and reversible
What information about medical and drug history should you obtain before an injection (4)
- Previous problems with LA
- Systemic conditions
- Drugs which may interact
- Anxiety/ nervous patients
Name some susceptible groups to LA (3)
- Elderly
- Children
- Medically compromised
Name some unwanted effects of LA (8)
- Physical trauma
- Chemical trauma
- Bleeding
- Spread of infection
- Toxicity
- Allergy
- Drug interactions
- Inappropriate site of deposition
What are the 4 ways unwanted effects may occur?
- Injecting an inappropriate solution
- Injecting too much solution
- Injecting into wrong site
- Bad luck
Name some potential allergens in LAs ()
- Esters
- Preservatives (previously)
- Reducing agents (those with sulphur allergies)
- Adrenaline supersensitivyfy
Name some drug groups that may interact with LA agents (5)
- Anticonvulsants
- Antimicrobials
- Benzodiazepines
- Beta-adrenergic blockers
- Calcium channel blockers
Name some drug groups that may interact with vasoconstrictors (4)
- Beta-adrenergic blockers
- Calcium channel blockers
- Diuretics
- CNS drugs
Name some CNS drugs that may interact with vasoconstrictors (4)
- Anti-Parkinson drugs
- Antidepressants
- General anaesthetics
- Drugs of abuse
Why is injecting too much solution particularly relevant to children?
Particularly in children as the toxic dose is weight related
What is an early sign of LA toxicity?
Why does this occur?
Excitability as the inhibitory actions of the brain are the first to be depressed
What follows excitability in signs of LA toxicity
Signs of central nervous system depression that can lead to unconsciousness
What is the cause of death from LA overdose?
Respiratory depression
Why is it not possible to change to another LA after maximum dose of one has been given?
The effects of local anaesthetic are cumulative
What is the main organ that metabolises LA?
Liver
What are the 3 sites that causes problems if LA is wrongly injected into?
- Intra-arterial
- Intraveous
- Intraneural
How can you reduce the chances of injecting into a blood vessel?
Use of aspirating syringes
Intravascular injection may cause what? (4)
- Pain
- Localised blanching
- Cranial effects (ie blindness)
- Systemic effects (ie tachycardia)
Injecting into the parotid gland can cause what?
Facial nerve palsy
Is facial palsy caused by LA in the parotid gland permanent?
Paralysis will resolve as the effect of the anaesthetic wears off
If someone has facial palsy as a result of LA in the parotid gland what advice would you give regarding their eye?
The eye must be protected until motor function is restored
Nerve trunk damage. caused by an injection can lead to what? (3)
- Long term anaesthesia (lack of sensation)
- Paraesthesia (‘pins and needles’)
- Dysaesthesia (pain) of sensory nerves
What can cause bleeding form an injection?
Which technique can mainly cause this?
- Penetration of both sides of a blood vessel
- Inferior alveolar nerve blocks
What are the best ways to avoid complications? (5)
- Take a good medical history/drug history
- Use an aspirating syringe
- Limit the use of regional block anaesthesia
- Use the min volume of LA possible
- Inject the appropriate solution slowly (1ml over 30 seconds)
