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BDS2 LA > Complications of LA > Flashcards

Complications of LA Flashcards

1
Q

What are some examples of systemic complication of LA?

A
  • psychogenic/stress
  • interaction with other drugs
  • cross infection
  • allergy
  • collapse
  • toxicity
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2
Q

What is the most common type of LA complication?

A

psychogenic/stress complications

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3
Q

What is meant by psychogenic/stress complication? (examples)

A
  • fainting
  • palpitations
  • cold swear
  • restlessness
  • excitation
  • trembling
  • weakness
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4
Q

What causes psychogenic/stress complications?

A

lack of oxygenated blood to the brain

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5
Q

What are some clinical features of psychogenic complications?

A
  • lightheadedness
  • pallor
  • beads of sweat (lips, nose, temple)
  • bradycardia
  • nausea
  • pupil dilation
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6
Q

How is a patient who experiences a psychogenic complication to LA managed?

A
  • lay flat and raise legs
  • loosen neck of clothing
  • improve room ventilation
  • sweet drink (might be caused due to lack of food)
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7
Q

What are some examples of drugs that can interact with LA?

A
  • MAOI
  • Tri-cyclics
  • beta blockers
  • non-potassium sparing diuretics
  • cocaine
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8
Q

How common is a true allergy to LA?

A

very rare

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9
Q

What were LA allergies historically due to?

A

the latex bung (no-longer made from latex)

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10
Q

What are most LA allergies due to now?

A

the preservatives/antioxidant

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11
Q

What are the clinical signs of toxicity complications of LA?

A
  • convulsions
  • loss of consciousness
  • respiratory depression

-circulatory collaps
always make sure you work out the max dose correctly

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12
Q

What LA’s should you avoid in pregnant women? why?

A

LA’s that contain oxtapressin (vasoconstrictor) as theoretically it could induce labour

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13
Q

What is the maximum safe does of LA based/calculated on?

A

a fit healthy adult

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14
Q

Each max dose calculation should be done on what basis for the p?

A

An individual basis

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15
Q

Toxic effects of LA can be reduced by using what technique?

A

Aspirating technique

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16
Q

What is the max safe dose of lignocaine ?

A

5mg/kg (check - might be 4.4)

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17
Q

What is the safe dose of 2% lignocaine in a 70kg man (cartridges)? [assuming max dose = 5mg/kg]

A

2% = 2g/100ml (2000mg/100ml) = 20mg/1ml
Each cartridge is 2.2ml so will have 44mg actuve component per cartridge
70kg x 5mg = 350mg
350mg/44 = approx 7 cartridges

18
Q

What is the max dose of Mepivicaine 3% (plain - no vasoconstrictor) ?

A

3mg/kg

19
Q

What is the max safe dose of Articaine with adrenaline ?

A

7mg/kg

20
Q

What is the max dose of prilocaine with octapressin?

A

8mg/kg

21
Q

What are the effects of adrenaline on the heart? What receptors on the heart does adrenaline bind to in order to produce these effects?

A

Increase in: -heart rate -force -output -excitability
Through Beta 1 receptors

22
Q

What are the effects of adrenaline on blood vessels? (and therefore skin and muscle) What are the receptors?

A
  • coronary dilation
  • skin contraction
  • muscle dilation

alpha beta-2

23
Q

What are the effects of adrenaline on systolic, diastolic and overall blood pressure?

A

Systolic = increase Diastolic = decrease Overall = little effect

24
Q

What are the effects of adrenaline on the lungs? What receptors are responsible?

A

Bronchial muscle relaxation
Beta 2 receptors

25
Q

What are some dangers of adrenaline?

A
  • Possible danger with cardio-vascular disease
  • hyperthryoidism
  • pheochromocytoma (hypertension)
  • drug interactions
26
Q

What are some possible local complications of local anaesthesia?

A
  • failure to achieve anaesthesia
  • pronlonges anaesthesia
  • pain during or after injections
  • trismus
  • haematoma
  • intra-vascular injection
  • blanching
  • facial paresis
  • broken needle
  • infection
  • soft tissue damage
  • contamination
27
Q

Why might there be prolonged anaesthesia?

A
  • direct trama from needle
  • multiple passes with same needle (can become blunt after using the needle more than once)
  • chemical trauma from direct injection
  • different depending on LA used
28
Q

With what LA should caution be used when performing an ID block?

A

Articaine (some suggestions that it may cause more nerve damage)

29
Q

What is the first-line drug of choice for LA blocks?

A

Lidocaine 2% with adrenaline

30
Q

Describe the presentation of trismus? What block is it normally associated with?

A

Within a few hours of inferior dental block there may be severe restriction of opening which may last for weeks or months

31
Q

What is the cause of trismus?

A

Probably damage to the medial pterygoid due to injection being too ‘low’ or too forceful/rapid

32
Q

How is trismus managed?

A

-reassurance -muscle relaxant ? -anti-inflammatory

33
Q

Describe the presentation of LA induced facial palsy.

A

-usually complete one sided face palsy -Unilateral nerve paralysis within minuted of INF dental blocks

34
Q

Confirm??

A

-temporal branch affected i.e. lower motor neurone distribution

35
Q

What causes LA induced facial palsy?

A

LA injected into parotid gland - injected toot far posteriorly

36
Q

How is LA induced facial palsy diagnosed?

A

test branches of VII nerve (facial nerve)

37
Q

How is LA induced facial palsy managed?

A

-reassurance and cover eye with pad until blink reflex returns

38
Q

What are some clinical symptoms/signs of intra-arterial injection? How common is it?

A

-skin blanching -visual disturbance -aural disturbances
It is very rare

39
Q

How are intra-arterial injections managed?

A

All are transitory but persistence requires rapid specialist referral

40
Q

What type of LA injection most commonly results in intra-venous injections?

A

Block injections - most often inferior dental block

41
Q

How can intra-vascular injections be avoided?

A

by careful technique: -aspirating system -slow drug introduction -safe quantitiy

42
Q

What are the features of an intra-vascular injection?

A

Adrenaline effects most frequently noted: -most likely palpitation
Can also include anxiousness, restlessness, headache, swearing, pallor

BDS2 LA (4 decks)

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