Local Anaesthetics: Complications Flashcards
List the systemic complications associated with local anaesthetic.
Psychogenic - faint (vasovagal response)
Allergy
Drug interactions
Toxicity - overdose
Cross infection
What is the most common systemic complication?
Vasovagal response - faint
What are the clinical features of a vasovagal response?
Palor Lightheadedness Sweating Bradycardia - slow pulse Nausea Pupil dilation
How do you manage a patient who has fainted?
Lay them flat
Elevate the legs
Loosen clothing around the neck
Give them glucose
What component of LA are patients usually allergic to?
The preservatives
methylparaben/propylparaben
What are the clinical features of an allergy to LA?
Skin rash
Respiratory issues
Anaphylaxis
Describe the response that occurs in a patient experiencing LA toxicity?
Convulsions
Circulatory collapse
Respiratory depression
Loss of consciousness
What response is similar to the LA toxicity?
Fainting
What vasoconstrictor must you avoid in pregnancy?
Octapressin/felypressin.
If a patient complains of an “allergy to local anaesthetic” what are they usually referring to?
Adrenaline response
What occurs in the adrenaline response?
Adrenaline increases the heart rate, cardiac output, force of contraction, excitability of cardiac muscle.
What medically compromised patients must be considered when administering a LA with a vasoconstrictor?
Patients with;
Cardiovascular disease
Hyperthyroidism
Hypertension
Patient who take drugs i.e. cocaine (drug interaction)
What drugs interact with Local anaesthetics?
Beta blockers
Diuretics (non-potassium sparing)
Tricyclics
Cocaine
List the local complications of local anaesthetic. (11)
Failure to achieve anaesthesia
Prolonged anaesthesia
Pain during and after
Trismus
Haematoma - bleed after injection
Iv injection
Fractured needle
Contamination
Facial paresis
Soft tissue damage
Infection
Why would a patient failure to be anaesthetised after LA?
Bad technique
Infection is present
What would occur during administering LA that would cause the effects to be prolonged?
Direct image to the nerve by the needle - tear or sever the nerve
Chemical damage to the nerve - solution injected into the near quickly.
What would cause LA be painful during and after treatment?
If the solution was injected too quickly
What could occur whilst administering LA that could cause trismus?
Injecting into the medial pterygoid.
How long can trismus last after LA trauma?
weeks - months
How can Trismus induced by LA trauma be treated?
Anti-inflammatory medication
Muscle relaxants i.e diazepam
How do you detect if your injection has accidentally become intra-vascular?
Aspirate once inserting the needing.
if IV - blood will enter the cartridge and turn pink/red.
What would the patient experience if the LA containing a vasoconstrictor became intra-vascular?
Palpitations
Sweating
Headache
Anxious
(all effects of adrenaline)
In terms of administering LA, how would facial paresis be causes?
The needle enters the parotid gland and anaesthetic is injected around the facial nerve
How do you differentiate between a stroke and temporary facial paresis?
Stroke:
Ability to wrinkle the forehead.
Ask the patient to grab your fingers with both hands - with a stroke there is reduced function in the arm.
(FAST) - Face, arm, speech etc.
Facial paresis - total unilateral paresis of face.
