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BDS2 LA Symposium > Complications of LA > Flashcards

Complications of LA Flashcards

1
Q

What type of LA is lidocaine?

A
  • Amide type
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2
Q

What is the % solution of lidocaine HCl?

A
  • 2%
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3
Q

What are the 2 possible forms of lidocaine?

A
  • Plain

- 1:80,000 Adrenaline

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4
Q

What injections is lidocaine used for? (3 points)

A
  • Infiltrations
  • Blocks
  • Others
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5
Q

What is another name for Prilocaine HCl?

A
  • Citanest
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6
Q

What is the % solution of prilocaine HCL?

A
  • 3%
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7
Q

What are the 2 forms of Prilocaine?

A
  • Plain

- Felypressin (octapressin) (1.2 micogms)

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8
Q

What injections is Prilocaine HCl used for? (3 points)

A
  • Infiltrations
  • Blocks
  • Others
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9
Q

What types of LA is Prilocaine?

A
  • Amide LA
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10
Q

What type of LA is Articaine?

A
  • Amide type LA
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11
Q

What % solution is Articaine?

A
  • 4%
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12
Q

What are the possible concentrations of adrenaline in Articaine? (3 points)

A
  • 1:100,000
  • 1:200,000
  • 1:400,000
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13
Q

What type of LA injection is Articaine used for?

A
  • Infiltrations
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14
Q

Is a vasoconstrictor used with Mepivicaine 3%?

A
  • No
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15
Q

How long does 3% plain Mepivicaine work for infiltration (pulpal anaesthesia)?

A
  • 20mins
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16
Q

How long does 2% Lignocaine HCl work for infiltration (pulpal anaesthesia)?

A

60 mins

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17
Q

How long does 4% Articaine HCl work for infiltration (pulpal anaesthesia)?

A
  • Up to 120 mins
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18
Q

How long does 3% Prilocaine HCl work for infiltration (pulpal anaesthesia)?

A
  • 30-45mins
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19
Q

How long does 3% plain Mepivicaine work for block (pulpal anaesthesia)?

A
  • 40 mins
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20
Q

How long does 2% Lidocaine HCl work for block (pulpal anaesthesia)?

A
  • 90 mins
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21
Q

How long does 4% Articaine HCl work for block (pulpal anaesthesia)?

A
  • 75 mins
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22
Q

How long does 3% Prilocaine HCl work for block (pulpal anaesthesia)?

A
  • 60 mins
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23
Q

How long does 3% plain Mepivicaine work for soft tissue anaesthesia?

A
  • 2hrs
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24
Q

How long does 2% Lidocaine HCl work for soft tissue anaesthesia?

A
  • 3-5hrs
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25
Q

How long does 4% Articaine HCl work for soft tissue anaesthesia?

A
  • 3-5hrs
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26
Q

How long does 3% Prilocaine HCl work for soft tissue anaesthesia?

A
  • 3-6hrs
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27
Q

What are possible systemic complications of LA? (6 points)

A
  • Psychogenic
  • Interactions with other drugs
  • Cross infection
  • Allergy
  • Collapse
  • Toxicity (if give patient too much)
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28
Q

What are common signs and symptoms of psychogenic/stress complications of LA? (7 points)

A
  • Fainting
  • Palpatations
  • Cold sweat
  • Restlessness
  • Excitation
  • Trembling
  • Weakness
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29
Q

What is the cause of psychogenic/stress complications of LA?

A

Lack of oxygenated blood to brain

30
Q

What are the clinical features of psychogenic/stress complications of LA? (6 points)

A
  • Lightheadedness
  • Pallor
  • Beads of sweat (lips, nose, temple)
  • Bradycardia (slow pulse)
  • Nausea
  • Pupil dilation
31
Q

What is the management of of psychogenic/stress complications of LA? (3 points)

A
  • 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
Q

What are the main drugs that could have possible interactions with LA? (5 points)

A
  • M.A.O.I
  • Tri-cyclics
  • Beta-blockers
  • Non potassium sparing diuretics
  • Cocaine
33
Q

What are most true allergies to LA to?

A
  • Most are due to preservatives/ antioxidants (methylparaben/ sodium bisulphate)
34
Q

What can toxicity of LA lead to? (4 points)

A
  • Convulsions
  • Loss of conciousness
  • Respiratory depression
  • Circulatory collapse
35
Q

What do you need to avoid in relation to LA with pregnant women?

A
  • Avoid oxtapressin as this has the potential to induce labour
36
Q

What can toxic effects of LA be reduced by? (2 points)

A
  • Reduced by the use of an aspirating technique

- Rate of injection should be slow - therefore decreasing the chance of overload

37
Q

What is the max dose (mg/kg) of Mepivicaine 3% Plain?

A

3

38
Q

What is the max dose (mg/kg) of Lidocaine 2% adrena line 1:80,000 ?

A

5

39
Q

What is the max dose (mg/kg) of Articaine 4% adrenaline 1:100,000?

A

7

40
Q

What is the max dose (mg/kg) of Prilocaine 3% octapressin?

A

8

41
Q

How many mgs of Mepivicaine 3% Plain are in a cartridge?

A

66

42
Q

How many mgs of Lidocaine 2% adrenaline 1:80,000 are in a cartridge?

A

44

43
Q

How many mgs of Articaine 4% adrenaline 1:100,000 are in a cartridge?

A

88

44
Q

How many mgs of Prilocaine 3% octapressin are in a cartridge?

A

66

45
Q

What is the max number of cartridges of Mepivicaine 3% Plain that you can give a 70kg adult?

A

6

46
Q

What is the max number of cartridges of Lidocaine 2% adrenaline 1:80,000 that you can give a 70kg adult?

A

7

47
Q

What is the max number of cartridges of Articaine 4% adrenaline 1:100,000 that you can give a 70kg adult?

A

5

48
Q

What is the max number of cartridges of Prilocaine 3% octapressin that you can give a 70kg adult?

A

8

49
Q

What effects does adrenaline have on the heart? (4 points)

A
  • Increase rate
  • Increase force
  • Increase output
  • Increase excitability
50
Q

What effects does adrenaline have on blood vessels? (3 points)

A
  • Coronary dilation
  • Skin contraction
  • Muscle dilation
51
Q

What effects does adrenaline have on blood pressure? (3 points)

A
  • Increase systolic
  • Decrease diastolic
  • Overall little effect
52
Q

What effect does adrenaline have on the lungs?

A
  • Bronchial muscle-relaxation
53
Q

What conditions should you be wary of for giving LA with adrenaline? (3 points)

A
  • CVD (avoid or use <3 x 2.2ml cartridges)
  • Hyperthyroidism
  • Phaeochromocytoma (hypertension)
54
Q

What are possible local complications of LA? (12 points)

A
  • 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
Q

Why might you get failure to achieve anaesthesia?

A
  • Might be cause technique isn’t very good, swelling or infection
56
Q

Why might a patient get prolonged anaesthesia?

A
  • Caused damage to the nerve itself, or wrong type of anaesthesia (too strong)
57
Q

Why might a patient get pain during or after an injection?

A
  • Can happen if giving injection to fast or if patient has muscle spasm
58
Q

Why might a patient get a haematoma after an LA injection?

A
  • Bleed when giving LA (can cause trismus)
59
Q

What can blanching be caused by?

A
  • An intravascular injection
60
Q

Why might a patient get prolonged anaesthesia? (3 points)

A
  • Direct trauma from needle
  • Multiple passes with same needle (needle may be blunt)
  • Chemical trauma for direct injection
61
Q

What are 4 examples of LA blocks?

A
  • Mental block
  • Infraorbital block
  • Inferior alveolar nerve block
  • Posterior superior alveolar nerve block
62
Q

What is the chosen LA in the dental hospital and why?

A
  • Lidocaine 2% with adrenaline

- Because it gives good anaesthesia without the risks that 4% Articaine brings

63
Q

What is the presentation of Trismus after an LA injection and how long does this take to occur?

A
  • Occurs within a few hours of inferior dental block may severely restrict opening which may last for weeks and months
64
Q

What is the likely cause of trismus due to LA injections?

A

Cause probably due to damage of the medial pterygoid muscle (injection may have been too low, forceful or rapid)

65
Q

How can you manage a patient with trismus due to an LA injection? (4 points)

A
  • Reassurance
  • Muscle relaxant (like diazepam)
  • Anti-inflammatory
  • Might have to provide them with some sort of device to prop the mouth open
66
Q

What is the difference between facial palsy due to a stroke compared to an LA injection?

A
  • 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
Q

How can you confirm that a facial palsy is due to an LA injection?

A
  • Temporal branch affected i.e. lower motor neurone distribution
68
Q

What is the cause of facial palsy due to LA?

A
  • Local into parotid gland injection too far posteriorly
69
Q

How would you manage facial palsy due to LA?

A
  • Reassurance cover eye with pad - until blink reflex returns
70
Q

Are true allergies to LA common or rare?

A

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BDS2 LA Symposium (3 decks)

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