complications of local anaesthesia Flashcards
local complications
at the site/surrounding area of administration
systemic complications
affects anywhere else in the body
local complications
needle breakage
nerve injury/parasthesia
infection/inoculation of microorganisms
trismus
soft tissue injuries
pain during administration
haematoma
sloughing of tissue
lack of action
facial nerve paralysis
systemic complications
allergy
toxicity/overdose
needle breakage
Use the appropriate needle size and length.
Avoid insertion of the entire needle till its hub, the hub is the weakest point.
Avoid redirecting the needle while inserted into tissue.
Avoid excessive lateral forces while needle is inserted.
Prevent unexpected movement of the patient by reassuring the patient about the injection.
Withdraw the needle almost completely before redirecting the needle.
nerve injury/parasthesia
Use the correct administration technique.
Avoid injecting blindly into tissues.
Palpate and identify the anatomical landmarks before administration.
Avoid soaking the cartridges in alcohol and sterilizing solution.
trismus
practicing atraumatic insertion and injection technique
avoid repeated and multiple injection
slow rather than fast injecting of LA
avoid excessive lateral forces while needle is inserted
prevent unexpected movement of the patient by reassuring the patient about the injection
infection
ensure cartridges are stored in a clean environment
avoid touching storage containers with contaminated glove
aseptic technique when using syringes and loading them
avoid reusing needles. discard after every visit
soft tissue injuries
Use a local anesthetic with a duration of action that is appropriate for the length of the procedure.
Advise the patient, parent or guardian about the possibility of self-inflicted injuries if the patient sucks, bites or chews the cheeks, lips or tongue.
In children consider placing a cotton roll in the buccal sulcus or placing a sticker on the forehead.
Provide a mouthwash if soft tissue injuries are suspected.
hematoma
Use the appropriate size of needles.
Practicing atraumatic insertion and injection techniques.
Avoid repeated and multiple injections.
Avoid excessive lateral forces while inserted.
Prevent unexpected movement of the patient by reassuring the patient about the injection.
sloughing of tissue
Avoid leaving topical anesthetics on the mucosa for prolong periods of time.
Use the appropriate amount that is required to achieve proper anesthesia.
If this does occur, the patient needs to be reassured.
Antiseptic mouth rinses and analgesics can be prescribed for symptomatic relief.
These are self-limiting lesions and will resolve in 7-14 days.
facial nerve paralysis
This happens when the injection is given too far posteriorly, and the local anaesthetic is injected into the parotid substance. This happens because the deep lobe extends around the posterior ramus of the mandible and projects forward on the medial surface of the ramus.
Practice atraumatic injection techniques.
Avoid over insertion of the needle.
For the inferior alveolar nerve block, do not inject unless bone has been contacted at the appropriate depth.
toxicity/overdose (systems most commonly affected)
Central nervous system – Dizzy, Drowsy, light-headed, Loss Of Consciousness
Cardiovascular system – chest pain, short of breath, palpitations, syncope
This reaction usually manifests with signs such as over excitation, excessive talking and tremors
The late signs of toxicity are central nervous system depression which eventually results in respiratory depression and death
Therefore, it is important to calculate the maximum dosage using the patient. weight and recommend dosage
Aspirating before administering the anaesthetic can prevent systemic toxicity.
allergy and hypersensitivity
This is a reaction that occurs when the body is exposed to an allergen which results in an altered bodily reactivity. The local anesthetics have preservatives and other additives that could cause an allergic reaction. Also, the local anesthetic itself has the potential of causing an allergic reaction.
Fever
Angioedema (local swelling of tongue, lips, pharynx and larynx)
Urticaria (hives)
Dermatitis
Anaphylaxis – all above + abdominal cramps, nausea and vomiting, cyanosis, loss of consciousness, hypotension, cardiac arrest
management of allergic reaction
It is important to take a good history prior to the administration of any medication.
Terminate procedure
Constant reassurance
Basic life support (Monitor Vitals until Patient is OK!)
Controlled use by medical professional of adrenaline and antihistamine and corticosteroids.
If any of the signs of an allergic reaction is noticed, then the patient needs to be reassured and taken to the emergency room as soon as possible.
management of overdose
Determined by onset, intensity and severity – may need Medical Assistance
Terminate the procedure
Reassure the patient
Position patient in a comfortable position
Administer oxygen
Provide basic life support – Protect patient from injury during seizure and administer anticonvulsant
Monitor Vital Signs while you wait or transport to Medical Facility
the A’s of treating anaphylaxis
AIRWAY – 8 – 10L / min
ADRENALINE 1:1000 SUBCUTANEOUSLY/im 0.2-0.5ml for 2 to 3 x every 10-15 min
ANTIHISTAMINE – Diphenhydramine 1-2mg/kg iv up to 50mg max
ADRINOCORTICOSTERIODS – 5mg/kg or 250mg hydrocortisone iv or 20mg prednisone orally if mild
AMBULANCE / ASSISTANCE
ADJUNCT IV FLUID THERAPY – 500ml – 1L to restore venous return
phentolamine mesylate
Tradename: Regitine
Dosage: 0.4mg in 1.7ml cartridge
O.2mg in children > 15kg and < 30kg (half amp)
Children >30kg upto age 12, 0.4mg (1 amp)
Given 1:1 ratio with the LA with adreneline
Nonselective α-adrenergic antagonist - Vasodialator
Metabolised in the liver
Toxic levels not known
Alpha-adrenergic receptor antagonist that is used to reverse the effects of LA that contain adrenaline (reverses vasoconstriction)
Not recommended < 6 yrs old or < 15kg weight and Patients with history of angina, coronary heart disease, and myocardial infarction
