complications Flashcards
what type of LA is lidocaine?
amide
what vasoconstrictors are used in lidocaine?
none
1:80,000 adrenaline
what is lidocaine used for?
infiltration, blocks, others
where is lidocaine metabolised and excreted?
liver, kidney
describe the onset of lidocaine
rapid, 2-3 mins
what % lidocaine is used?
2%
what type of LA is priloccaine?
amide
what vasoconstrictors are used in prilocaine?
none felypressin (octapressin) 1.2 micogms
what are the uses of prilocaine?
infiltrations, blocks, others
what % pilocaine is used?
3%
what is the brand name of prilocaine?
citanest
what type is articaine?
amide
what % articaine is used?
4%
what vasoconstrictor is used in articaine?
adrenaline
1: 100,000
1: 200,000
1: 400,000
what is articaine most commonly used for?
infiltrations
where is articaine metabolised & excreted?
liver and plasma
kidney
describe the onset of articaine?
rapid
2-3 mins
what is 1.5x more potent than lidocaine?
articaine
what are the possible systemic complications of LA?
psychogenic interactions with other drugs cross infection allergy collapse toxicity
describe the psychogenic complication
lack of oxygenated blood to brain
fainting, palpitations, cold sweat, restlessness, excitation, trembling, weakness
lightheaded, pallor, sweat
bradycardia, nausea, pupil dilation
management: lay flat, raise legs, loosen neck clothing sweet drink
what drugs interact with LA?
cocaine- increased adrenergic activity
B blockers
non potassium sparing diuretics- lowers K
tri-cyclics - hypertension risk- limit 2 cartridge
M.A.O.I - anti-depressants
what are most allergic reactions caused by?
preservatives/antioxidant
-methylparaben/sodium bisulphite
what allergic reactions can occur?
skin reactions, respiratory reactions, anaphylaxis
-not treated in general practice
what are the symptoms of toxicity?
convulsions
loss of consciousness
respiratory depression
circulatory collapse
what can induce labour?
octapressin
what technique reduces toxic effects?
aspirating
slow injection
what is the max dose of lignocaine?
5mg/kg
how many mgs in a lignocaine cartridge?
44
what effect does adrenaline have on the heart?
rate, force, output, excitability increase
what effect does adrenaline have on bv?
coronary dilation
skin contraction
muscle dilation
what effect does adrenaline have on bp?
increase systolic
decrease diastolic
what effect does adrenaline have on lungs?
bronchial muscle relaxation
what conditions should adrenaline be limited/avoided?
hyperthyroidism
phaechromocytoma (hypertension)
what local complications can happen?
failure prolonged pain trismus haematoma intra-vascular injection blanching facial paresis broken needle infection soft tissue damage contamination
what can cause prolonged anaesthesia?
direct trauma from needle
multiple passes with same needle
chemical trauma for direct injection
different depending on LA used
how do you know if you are too close to a nerve?
jump/electric shock
what is the 1st drug of choice in LA blocks?
lidocaine 2% w/ adr
describe the presentation of trismus
w/i a few hours of IDB may severely restrict opening
can be weeks/months
what is the cause of trismus?
damage to medial pterygoid
injection too low
too forcefeul/rapid
what is the management of trismus?
reassurance after diagnosis
muscle relaxant
anti-inflammatory
how to differentiate between palsy and stroke?
stroke can use upper half of face muscles
LA palsy- all facial nerves cant move muscles on one side
what is the presentation of facial palsy?
unilateral motor nerve paralysis w/i mins of inferior dental blocks
how to confirm facial palsy?
temporal branch affected
what is the cause of facial palsy?
local into parotid gland
-injected too far posteriorly
what is the management of facial palsy?
reassurance
cover eye with pad until blink reflex returns
describe intra-arterial injection
skin blancing
visual disturbance
aural distrubance
when do intra-venous injections usually occur?
inferior dental block
what are the features of intra-venous injection?
adrenaline effect
palpitation
also can be anxious, restless, headache, sweating, pallor
what is the max dose of mepivicaine 3%?
3mg/kg
how many mgs in a cartridge of mepivicaine 3%?
66
what is the max dose of articaine 4%?
7mg/kg
how many mgs in a cartridge of atricaine?
88
what is the max dose of prilocaine 3%?
8mg/kg
how many mgs in a cartridge of prilocaine?
66
