Complications of LA Flashcards
1
Q
What type of LA is lidocaine?
A
- Amide type
2
Q
What is the % solution of lidocaine HCl?
A
- 2%
3
Q
What are the 2 possible forms of lidocaine?
A
- Plain
- 1:80,000 Adrenaline
4
Q
What injections is lidocaine used for? (3 points)
A
- Infiltrations
- Blocks
- Others
5
Q
What is another name for Prilocaine HCl?
A
- Citanest
6
Q
What is the % solution of prilocaine HCL?
A
- 3%
7
Q
What are the 2 forms of Prilocaine?
A
- Plain
- Felypressin (octapressin) (1.2 micogms)
8
Q
What injections is Prilocaine HCl used for? (3 points)
A
- Infiltrations
- Blocks
- Others
9
Q
What types of LA is Prilocaine?
A
- Amide LA
10
Q
What type of LA is Articaine?
A
- Amide type LA
11
Q
What % solution is Articaine?
A
- 4%
12
Q
What are the possible concentrations of adrenaline in Articaine? (3 points)
A
- 1:100,000
- 1:200,000
- 1:400,000
13
Q
What type of LA injection is Articaine used for?
A
- Infiltrations
14
Q
Is a vasoconstrictor used with Mepivicaine 3%?
A
- No
15
Q
How long does 3% plain Mepivicaine work for infiltration (pulpal anaesthesia)?
A
- 20mins
16
Q
How long does 2% Lignocaine HCl work for infiltration (pulpal anaesthesia)?
A
60 mins
17
Q
How long does 4% Articaine HCl work for infiltration (pulpal anaesthesia)?
A
- Up to 120 mins
18
Q
How long does 3% Prilocaine HCl work for infiltration (pulpal anaesthesia)?
A
- 30-45mins
19
Q
How long does 3% plain Mepivicaine work for block (pulpal anaesthesia)?
A
- 40 mins
20
Q
How long does 2% Lidocaine HCl work for block (pulpal anaesthesia)?
A
- 90 mins
21
Q
How long does 4% Articaine HCl work for block (pulpal anaesthesia)?
A
- 75 mins
22
Q
How long does 3% Prilocaine HCl work for block (pulpal anaesthesia)?
A
- 60 mins
23
Q
How long does 3% plain Mepivicaine work for soft tissue anaesthesia?
A
- 2hrs
24
Q
How long does 2% Lidocaine HCl work for soft tissue anaesthesia?
A
- 3-5hrs
25
How long does 4% Articaine HCl work for soft tissue anaesthesia?
- 3-5hrs
26
How long does 3% Prilocaine HCl work for soft tissue anaesthesia?
- 3-6hrs
27
What are possible systemic complications of LA? (6 points)
- Psychogenic
- Interactions with other drugs
- Cross infection
- Allergy
- Collapse
- Toxicity (if give patient too much)
28
What are common signs and symptoms of psychogenic/stress complications of LA? (7 points)
- Fainting
- Palpatations
- Cold sweat
- Restlessness
- Excitation
- Trembling
- Weakness
29
What is the cause of psychogenic/stress complications of LA?
Lack of oxygenated blood to brain
30
What are the clinical features of psychogenic/stress complications of LA? (6 points)
- Lightheadedness
- Pallor
- Beads of sweat (lips, nose, temple)
- Bradycardia (slow pulse)
- Nausea
- Pupil dilation
31
What is the management of of psychogenic/stress complications of LA? (3 points)
- Lay flat + raise legs
- Loosen neck clothing to improve ventilation room
- Sweet drink (might help if they have not had anything to eat or drink that day)
32
What are the main drugs that could have possible interactions with LA? (5 points)
- M.A.O.I
- Tri-cyclics
- Beta-blockers
- Non potassium sparing diuretics
- Cocaine
33
What are most true allergies to LA to?
- Most are due to preservatives/ antioxidants (methylparaben/ sodium bisulphate)
34
What can toxicity of LA lead to? (4 points)
- Convulsions
- Loss of conciousness
- Respiratory depression
- Circulatory collapse
35
What do you need to avoid in relation to LA with pregnant women?
- Avoid oxtapressin as this has the potential to induce labour
36
What can toxic effects of LA be reduced by? (2 points)
- Reduced by the use of an aspirating technique
| - Rate of injection should be slow - therefore decreasing the chance of overload
37
What is the max dose (mg/kg) of Mepivicaine 3% Plain?
3
38
What is the max dose (mg/kg) of Lidocaine 2% adrena line 1:80,000 ?
5
39
What is the max dose (mg/kg) of Articaine 4% adrenaline 1:100,000?
7
40
What is the max dose (mg/kg) of Prilocaine 3% octapressin?
8
41
How many mgs of Mepivicaine 3% Plain are in a cartridge?
66
42
How many mgs of Lidocaine 2% adrenaline 1:80,000 are in a cartridge?
44
43
How many mgs of Articaine 4% adrenaline 1:100,000 are in a cartridge?
88
44
How many mgs of Prilocaine 3% octapressin are in a cartridge?
66
45
What is the max number of cartridges of Mepivicaine 3% Plain that you can give a 70kg adult?
6
46
What is the max number of cartridges of Lidocaine 2% adrenaline 1:80,000 that you can give a 70kg adult?
7
47
What is the max number of cartridges of Articaine 4% adrenaline 1:100,000 that you can give a 70kg adult?
5
48
What is the max number of cartridges of Prilocaine 3% octapressin that you can give a 70kg adult?
8
49
What effects does adrenaline have on the heart? (4 points)
- Increase rate
- Increase force
- Increase output
- Increase excitability
50
What effects does adrenaline have on blood vessels? (3 points)
- Coronary dilation
- Skin contraction
- Muscle dilation
51
What effects does adrenaline have on blood pressure? (3 points)
- Increase systolic
- Decrease diastolic
- Overall little effect
52
What effect does adrenaline have on the lungs?
- Bronchial muscle-relaxation
53
What conditions should you be wary of for giving LA with adrenaline? (3 points)
- CVD (avoid or use <3 x 2.2ml cartridges)
- Hyperthyroidism
- Phaeochromocytoma (hypertension)
54
What are possible local complications of LA? (12 points)
- Failure to achieve anaesthesia
- Prolonged anaesthesia
- Pain during or after injection
- Trismus
- Haematoma
- Intra-vascular injection
- Blanching
- Facial paresis
- Broken needle
- Infection
- Soft tissue damage
- Contamination
55
Why might you get failure to achieve anaesthesia?
- Might be cause technique isn't very good, swelling or infection
56
Why might a patient get prolonged anaesthesia?
- Caused damage to the nerve itself, or wrong type of anaesthesia (too strong)
57
Why might a patient get pain during or after an injection?
- Can happen if giving injection to fast or if patient has muscle spasm
58
Why might a patient get a haematoma after an LA injection?
- Bleed when giving LA (can cause trismus)
59
What can blanching be caused by?
- An intravascular injection
60
Why might a patient get prolonged anaesthesia? (3 points)
- Direct trauma from needle
- Multiple passes with same needle (needle may be blunt)
- Chemical trauma for direct injection
61
What are 4 examples of LA blocks?
- Mental block
- Infraorbital block
- Inferior alveolar nerve block
- Posterior superior alveolar nerve block
62
What is the chosen LA in the dental hospital and why?
- Lidocaine 2% with adrenaline
| - Because it gives good anaesthesia without the risks that 4% Articaine brings
63
What is the presentation of Trismus after an LA injection and how long does this take to occur?
- Occurs within a few hours of inferior dental block may severely restrict opening which may last for weeks and months
64
What is the likely cause of trismus due to LA injections?
Cause probably due to damage of the medial pterygoid muscle (injection may have been too low, forceful or rapid)
65
How can you manage a patient with trismus due to an LA injection? (4 points)
- Reassurance
- Muscle relaxant (like diazepam)
- Anti-inflammatory
- Might have to provide them with some sort of device to prop the mouth open
66
What is the difference between facial palsy due to a stroke compared to an LA injection?
- Stroke = occurs on the opposite side of the face to the side of the brain affected, forehead no usually affected
- LA = side of face that was injected is affected and all of that side is affected (including forehead)
67
How can you confirm that a facial palsy is due to an LA injection?
- Temporal branch affected i.e. lower motor neurone distribution
68
What is the cause of facial palsy due to LA?
- Local into parotid gland injection too far posteriorly
69
How would you manage facial palsy due to LA?
- Reassurance cover eye with pad - until blink reflex returns
70
Are true allergies to LA common or rare?
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