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BDS2 LA Symposium > Complications with LA > Flashcards

Complications with LA Flashcards

1
Q

what type of LA in lidocaine

A

amide

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2
Q

liddocaine strength

A

lidocaine HCl 2%

can also get 3% plain

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3
Q

types of vasoconstrictor available with lidocaine

A

plain (none)

1:80,000 adrenaline

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4
Q

ratio of adrenaline in lidocaine preparations

A

1:80,000

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5
Q

3 uses of lidocaine

A

infiltrations

blocks

others

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6
Q

pharmacology of lidocaine

A

greeted in kidney

metabolised in liver

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7
Q

citanest strength

A

Prilocaine HCl 3%

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8
Q

type of LA citanest is

A

amide LA

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9
Q

types of vasoconstricor available in citanest

A

plain

felypressin (octapressin)
- 1.2micogms

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10
Q

3 uses of citanest

A

infiltrations

blocks

others

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11
Q

3 common LA preparations

A

lidocaine

citanest

articaine

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12
Q

type of LA articaine

A

amide type LA

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13
Q

strength of articaine preparation

A

4% with adrenaline

1: 100,000
1: 200,000
1: 400,000

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14
Q

ratio of adrenaline in articaine

A

1: 100,000
1: 200,000
1: 400,000

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15
Q

2 uses of articaine

A

infiltration

blocks

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16
Q

pharmacology of articaine

A

greeted in kidney

metabolised in liver and plasma

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17
Q

block onset comparison of articaine and lidocaine

A

articaine more rapid block onset than lidocaine

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18
Q

potency comparison of articaine and lidocaine

A

articaine is 1.5x more potent than lidocaine

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19
Q

vasoconstrictor in Mepivacaine 3% plain

A

nil

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20
Q

vasoconstrictor in ligocaine HCl 2%

A

1:80,000 Adrenaline

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21
Q

vasoconstrictor in articaine HCl 4%

A

adrenaline

1: 100,000
1: 200,000
1: 400,000

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22
Q

vasoconstrictor in prilocaine HCl 3%

A

felypressin (octapressin)

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23
Q

infiltration time for pulpal anaesthesia for Mepivacaine 3% plain

A

20mins

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24
Q

infiltration time for pulpal anaesthesia for ligocaine HCl 2%

A

60mins

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25
infiltration time for pulpal anaesthesia for articaine HCl 4%
up to 120mins
26
infiltration time for pulpal anaesthesia for prilocaine HCl 3%
30-45mins
27
block onset time for pulpal anaethesia for Mepivacaine 3% plain
40mins
28
block onset time for pulpal anaethesia for ligocaine HCl 2%
90mins
29
block onset time for pulpal anaethesia for articaine HCl 4%
75mins
30
block onset time for pulpal anaethesia for prilocaine HCl3 %
60mins
31
soft tissue anaesthesia onset time for Mepivacaine 3% plain
2hrs
32
soft tissue anaesthesia onset time for ligocaine HCl 2%
3-5hrs
33
soft tissue anaesthesia onset time for articaine HCl 4%
3-5hrs
34
soft tissue anaesthesia onset time for prilocaine HCl 3%
3-6hrs
35
6 systemic complications of LA
Psychogenic Interaction with other drugs Cross infection Allergy Collapse Toxicity
36
complications of LA can be either
systemic or local
37
what is the most common complication of LA
systemic psychogenic/stress related reactions especially in anxious patients
38
examples of psychogenic/stress related reactions as complications to LA
Fainting, palpitations (heart bounding), cold sweat, restlessness, excitation, trembling, weakness (natural response, oxygenated blood to central organs)
39
cause of psychogenic/stress related reactions as complications to LA
lack of oxygenated blood to the brain
40
clinical features of psychogenic/stress related reactions as complications to LA
Lightheadness Pallor Beads of sweat (lip, nose, temple) Bradycardia (slow pulse) Nausea Pupil dilation
41
management of psychogenic/stress related reactions as complications to LA
lay flat and raise legs loosen neck clothing improve room ventilation sweet drink potentially (glucose)
42
5 drugs that LA can systemically interact with
MAOI monoamine oxidase inhibitors tri-cyclics beta blockers non potassium sparing diuretics cocaine
43
Systemic interaction of LA with MAOI (monoamine oxidase inhibitors)
Most exogenous adrenaline is metabolised via catechol | - A-methyl transferase system. MAO system of lesser significance
44
Systemic interaction of LA with tri-cyclics
Theoretical risk of hypertension due to inhibition of uptake of adrenaline at sympathetic nerve terminals May be prudent to limit quantity to 2 cartridges of 1:80,000 (i.e. 50mcg)
45
Systemic interaction of LA with beta blockers
pressor increase as vasodilatory Beta-2 adrenergic receptors blocked again may be wise to restrict quantity
46
Systemic interaction of LA with non potassium sparing diuretics
relatively low K+ may be further enhanced by adrenaline’s potassium lowering action
47
Systemic interaction of LA with cocaine
increased adrenergic action
48
systemic allergy reaction to LA
True allergy very rare - Common physiological reaction to adrenaline misbelieved as Historically due to latex bung Most are now due to preservatives/antioxidant - Methylparaben/sodium bisulphite - Skin rashes - Anaphylaxis Go for patch testing if true allergy Cannot be treated in GDP, go to special LA allergy services
49
systemic toxicity reaction to LA
Convulsions Loss of consciousness Respiratory depression Circulatory collapse - Important to differentiate from fainting
50
systemic reaction to certain LA if pregnant
``` Avoid oxtapressin (vasoconstrictor in citanest) as this has the potential to induce labour - Same drug as oxytocin ``` Check MHx
51
what is the max safe dose calculated base on
fit, healthy adult - if not suit to pt, change calculation accordingly calculation should be made for each patient on an individual basis - frail old lady with diseases compared to 70kg fit healthy individual
52
max safe dose of LA presumes (2)
toxic effects can be reduced by use of an aspirating technique. rate of introduction (injection) should be slow - thereby decreasing chance of overload.
53
max safe dose for LA preparation is in regards to
LA active component vasoconstrictor can be just as dangerous - bear in mind
54
example of max safe dose calculation for ligocaine 2% with adrenaline 5mg/kg for 70kg male
2% = 2g/1000ml = 20mg/ml Each cartridge will have 44mg (2.2ml cartridge) Safe dose = 5mg/kg in a 70kg male =350mg 350/44 = approx. 7 cartridges
55
example of max safe dose calculation for articaine 4% solution in 70kg male
4%=4g/100ml = 40mg/ml Each cartridge will have 88mg (2.2ml cartridge) Safe dose = 7mg/kg In 70kg male = 490mg 490/88 = approx. 5 cartridges
56
max dose for Mepivacaine 3% plain
3mg/kg
57
Mgs within a cartridge of Mepivacaine 3% plain
66mg
58
max number of cartridges (70kg adult) for Mepivacaine 3% plain
6
59
max dose for lignocaine 2% Adr 1:80,000
5mg/kg
60
Mgs within a cartridge of lignocaine 2% Adr 1:80,000
44mg
61
max number of cartridges (70kg adult) for lignocaine 2% Adr 1:80,000
7
62
max dose of articaine 4% Adr:1:100,000
7mg/kg
63
Mgs within a cartridge of articaine 4% Adr:1:100,000
88mg
64
max number o cartridges (70kg adult) for articaine 4% Adr:1:100,000
5
65
max dose of prilocaine 3% octapressin
8mg/kg
66
Mgs within a cartridge of prilocaine 3% octapressin
66mg
67
max number of cartridges (70kg adult) prilocaine 3% octapressin
8
68
4 areas of the body that adrenaline effects
heart blood vessels blood pressure lungs
69
4 effects of adrenaline on heart
increase rate increase force increase output increase excitability
70
what receptors in the sympathetic nervous system does adrenaline trigger in the heart to cause the 4 effects
beta 1
71
3 effects of adrenaline on blood vessels
coronary dilation skin contraction muscle dilation
72
skin contraction of BV by adrenaline is due to stimulation of which SNS receptors
alpha
73
muscle dilation of BV by adrenaline is due to which SNS receptors
beta 2
74
Effect of adrenaline on blood pressure
increase systolic and decrease diastolic so overall little effect
75
effect of adrenaline on lungs
bronchial muscle realaxation
76
bronchial muscle relaxation in the lungs by adrenaline is die to stimulation of which SNS recpetors
beta 2
77
4 dangers of adrenaline use
cardio-vascular disease - best to avoid or use less than three 2.2ml cartridges if better LA available hyperthyroidism (thyroid crisis) pheochromocytoma (hypertension) drug interactions - mono amine oxidase inhibitors - tricyclic antidepressants - Beta blockers - Non-potassium sparing diuretics - Halothane (G.A. Agent) - Cocaine
78
6 drug interactions adrenaline has
- mono amine oxidase inhibitors - tricyclic antidepressants - Beta blockers - Non-potassium sparing diuretics - Halothane (G.A. Agent) - Cocaine
79
11 local complications of LA
failure to achieve anaesthesia prolonged anaesthesia pain during injection trismus Haematoma intra-vascular injection blanching facial paresis broken needle infection of soft tissue damage contamination
80
why would a local failure to achieve anaesthesia be due to
variety of causes | - technique, swelling, infection
81
local pain during or after injection can be due to
injecting too fast or pt has muscular spasm
82
local trismus due to LA is because of
given LA and pt has muscular spasm in area so cannot open mouth wide - frightening for pt
83
haematoma local complication due to LA because of
hit BV when giving LA so bleed | - can lead to trimus
84
local blanching due to LA due to
intra-vascular injection stops BV in the area | - can be frightening for pt
85
how would you solve a broken needle from LA injection
unlikely but worrisome | - need surgery
86
prolonged anaesthesia after IDB can be due to (4)
Direct trauma from needle Multiple passes with same needle - Tip becomes blunt when hit bone - Get a new needle if need to give second IDB Chemical trauma for injection - Directly injected into the nerve - Pt jumps, electric shock ----Withdraw, aspirate and give LA Don’t give straight away – force into nerve cause issues Different depending on LA used
87
presentation of trismus
Within a few hours of inferior dental block may severely restrict opening may last for weeks or months
88
cause of trimus
probably damage to medial pterygoid | - injection too low or too forceful/rapid
89
3 management techniques of trismus
Reassurance (after diagnosis) Muscle relaxant Anti-inflammatory
90
true facial palsy
Tend to have bleed within the brain Causes facial muscle fibres not to work properly Right hand brain affects left hand face - Cross inverting Tend to get sparing of upper facial muscle (wrinkle forehead) - Upper spares upper Upper motor neuron defect spares upper facial nerve muscles
91
LA facial palsy
LA cannot move any muscles on that side Lower motor neuron – LA injury in parotid gland where CNVII branches pass All paralysed
92
how to differentiate upper facial palsy from lower facial palsy
True facial palsy Tend to get sparing of upper facial muscle (wrinkle forehead) - Upper spares upper Upper motor neuron defect spares upper facial nerve muscles LA cannot move any muscles on that side - Lower motor neuron – LA injury in parotid gland where CNVII branches pass - All paralysed
93
presentation of LA facial palsy
Usually complete unilateral motor nerve paralysis within mixtures of INF dental blocks
94
confirm LA facial palsy
Temporal branch affected i.e. lower motor neurone distribution
95
cause of LA facial palsy
LA into parotid gland | - Injection too far posteriorly
96
diagnosis of LA facial palsy
Test branches of CN VII (facial nerve)
97
management techniques of LA facial palsy
Reassurance, apologise, better in a few hours Cover with eye pad – until blink reflex returns (prevent dry out)
98
features seen of intra-vascular LA injection
Adrenaline effect | - palpitation, anxiousness, restlessness, headache, sweating, pallor
99
intra-arterial LA injection
rare - Profound Skin blanching - Visual disturbances - Aural (hearing) disturbances All are transitory but persistence requires rapid specialised referral
100
what type of LA injection is likely to breach intra-venous
block - most often IDB
101
3 ways to avoid intra-vascular LA injections
Aspirating system Slow drug introduction Safe quantity
102
risk rating of different brands of LA
articaine most risky - lidocaine is 1 in million - Prilocaine 1 in 600,00 - Articaine 1:440,000
103
standard LA used in GDH
lidocaine 2% with Adr is drug of first choice | - good anaesthesia levels with less risks
104
where would inject for mental block
Apices of lower 4 and 5 Anaesthetise sensation to: - skin over chip and lip - buccal mucosa lower 4 to central - teeth
105
where would inject for infraorbital block
Mid papillary line, beneath infraorbital ring below eye Foramen comes out – termination of CV2 anaesthetise sensation to: - Lateral aspect of nose - Skin in area - Feeling to central, lateral and canine teeth
106
posterior superior alveolar block
Block further back of CNV2 Anaesthetise to all teeth on right side, skin on nose, cheek and lip area Difficult
107
where inject for inferior alveolar block
Insert needle across premolar on contra lateral sign

BDS2 LA Symposium (4 decks)

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