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LA Symposium > LA Complications > Flashcards

LA Complications Flashcards

1
Q

List features of the LA lidocaine (3)

A
  1. Amide type
  2. Lidocaine HCL 2%
  3. Vasoconstrictor:
    With adrenaline 1: 80,000
    Plain (none)
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2
Q

List features of the LA Citanest (3)

A
  1. Amide type
  2. Prilocaine HCL 3%
  3. Vasoconstrictor:
    With Octapressin
    Plain
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3
Q

List features of the LA Articaine

A
  1. Amide type
  2. 4% with adrenaline
  3. Comes in a variety adrenaline concentrations
    1: 100,000
    1: 200,000
    1: 400,000
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4
Q

Uses of:
Lidocaine
Citanest
Articaine

A

Infiltrations

Blocks

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5
Q

Does Mepivicaine 3% plain contain a vasoconstrictor?

A

No

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6
Q

Mepivicaine working time for infiltration?

A

20 mins

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7
Q

Mepivicaine working time for a block?

A

40 mins

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8
Q

Mepivicaine working time for soft tissue anaesthesia

A

2 hours

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9
Q

Does lignocaine 2% HCl contain a vasoconstrictor?

A

1:80,000

Adrenaline

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10
Q

Lignocaine working time for infiltration?

A

60 mins

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11
Q

Lignocaine working time for a block?

A

90 mins

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12
Q

Lignocaine working time for a soft tissue anaesthesia

A

3-5 hours

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13
Q

Does articaine 4% HCl contain a vasoconstrictor?

A

Adrenaline
1:100,000
1:200,000
1;400,000

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14
Q

Articaine working time for infiltration?

A

Up to 120 mins

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15
Q

Articaine working time for a block?

A

75 mins

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16
Q

Articaine working time for soft tissue anaesthesia

A

3-5 hours

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17
Q

Does Prilocaine HCl 3% contain a vasoconstrictor?

A

Octapressin

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18
Q

Prilocaine working time for infiltration?

A

30-45 mins

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19
Q

Prilocaine working time for a block?

A

60 mins

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20
Q

Prilocaine working time for a soft tissue anaesthesia?

A

3-6 hours

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21
Q

List systemic complications of LA (6)

A
  1. Psychogenic
  2. Interaction with other drugs
  3. Cross infection
  4. Allergy
  5. Collapse
  6. Toxicity
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22
Q

List the main psychogenic/stress complications of LA (7)

A
  1. Fainting
  2. Palpitations
  3. Cold sweat
  4. Restlessness
  5. Excitation
  6. Trembling
  7. Weakness
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23
Q

Whats the reason for psychogenic/stress complications?

A

Lack of oxygenated blood to the brain

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24
Q

What clinical features can present with psychogenic complications (6)

A
  1. Lightheadedness
  2. Pallor
  3. Beads of sweat
  4. Bradycardia (slow pulse)
  5. Nausea
  6. Pupil dilation
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25
Q

How are these psychogenic complications managed? (4)

A
  1. Lay flat and raise legs
  2. Loosen neck clothing
  3. Improve room ventilation
  4. Sweet drinks
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26
Q

List some examples of other drugs LA may interact with (3)

A
  1. B blockers
  2. Cocaine - increased adrenergic activity
  3. Tricyclics - risk of hypertension
27
Q

What are most allergic reactions to LA due to?

A

Mostly due to preservatives

28
Q

List some toxicity complications with LA (4)

A
  1. Convulsions
  2. Loss of consciousness
  3. Respiratory depression
  4. Circulatory collapse
29
Q

How can toxic effects of LA be reduced? (2)

A
  1. By use of an aspirating technique

2. Rate of introduction (injection) should be slow, thereby decreasing the chance of overload

30
Q

Max dose of Mepivicaine 3%

A

3 mg/kg

31
Q

Mgs within a Mepivicaine 3% cartridge

A

66 mgs

32
Q

Max number of Mepivicaine cartridges (70kg adult)

A

6

33
Q

Max dose of Lignocaine 2%

A

5 mg/kg

34
Q

Mgs within a Lignocaine 2% cartridge

A

44 mgs

35
Q

Max number of Lignocaine cartridges (70kg adult)

A

7

36
Q

Max dose of Articaine 4%

A

7 mg/kg

37
Q

Mgs within Articaine 4% cartridge

A

88 mgs

38
Q

Max number of Articaine cartridges (70kg adult)

A

5

39
Q

Max dose of Prilocaine 3%

A

8 mg/kg

40
Q

Mgs within Prilocaine 3% cartridge

A

66 mgs

41
Q

Max number of Prilocaine cartridges (70kg adult)

A

8

42
Q

List the effects of adrenaline on the heart (4)

A

Via B1

  1. Rate increases
  2. Force increases
  3. Output increases
  4. Excitability increases
43
Q

List the effects of adrenaline on the vessels (3)

A

Via B2

  1. Coronary dilation
  2. Skin contraction
  3. Muscle dilation
44
Q

Give the effects of adrenaline on the blood pressure (2)

A
  1. Systolic pressure increases
  2. Diastolic pressure decreases

Overall - little effect

45
Q

Give the effects of adrenaline on the lungs

A

Via B2

Bronchial muscle - relaxation

46
Q

List some dangers of adrenaline in LA (4)

A
  1. CVD
  2. Hyperthyroidism
  3. Hypertension
  4. Drug interactions
47
Q

List some local complications of LA (7)

A
  1. Failure to achieve anaesthesia
  2. Prolonged anaesthesia
  3. Pain during/after injection
  4. Trismus
  5. Haematoma
  6. Blanching
  7. Soft tissue damage
48
Q

Give some causes of prolonged anaesthesia with LA (3)

A
  1. Direct trauma from needle
  2. Multiple passes with same needle
  3. Chemical trauma for direct injection

Different depending on LA used

49
Q

How does trismus affect the patient

A

Muscular spasm so can’t open mouth very wide and this can be very frightening for the patient

50
Q

Describe the presentation of trismus

A

Within a few hours of IAN block it may severely restrict opening and it may last for weeks or months

51
Q

List the causes of trismus (3)

A
  1. Damage to medial pterygoid
  2. Injection too low
  3. Injection too rapid
52
Q

Describe the management used for trismus (3)

A
  1. Reassurance (after diagnosis)
  2. Muscle relaxant
  3. Anti inflammatories
53
Q

Describe the presentation of facial palsy from LA

A

Usually complete unilateral motor nerve paralysis within minutes of inferior dental blocks

54
Q

How does LA induced palsy present?

A

LA has been deposited in an area that affects all facial nerves so they can’t move that side of their face at all

55
Q

How does a stroke present?

A

During a stroke they may not be able to use muscles in lower half of the face but can wrinkle forehead and close eye

Upper spares upper
(If patient has an upper motor neurone defect - stroke it spares the upper branches of the facial nerve)

56
Q

How does LA injection lead to facial palsy?

A

LA into parotid gland as

injection was too far posteriorly instead of touching the bone

57
Q

How is LA facial palsy diagnosed?

A

Testing the 5 branches of the facial nerve

58
Q

How is a case of LA facial palsy confirmed?

A

Temporal branch affected

Lower motor neurone distribution

59
Q

What is the management for LA facial palsy

A

Reassurance _ cover eye with pad until blink reflex returns

60
Q

List the effects of intravascular infection due to LA (3)

A
  1. Skin blanching
  2. Visual disturbance
  3. Aural disturbances
61
Q

What LA technique could result in an intra-vascular injection

A

IAN dental block

62
Q

How is intra-vascular injection with LA avoided? (4)

A
  1. By careful technique
  2. Aspirating system
  3. Slow drug introduction
  4. Safe quantity
63
Q

Symptoms of intravascular LA injections (6)

A
  1. Palpitations
  2. Anxiousness
  3. Restlessness
  4. Sweating
  5. Headache
  6. Pallor

LA Symposium (3 decks)

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