Local and Systemic Complications Flashcards
causes of needle breakage
- smaller needles
- bent needles
- defective needles
prevention of needle breakage
- do not bend
- do not insert the needle to its hub
- do not redirect the needle once it is inserted into the tissue
hub, shaft, bevel?
where are these?
hub - directly after the syringe adapter
then shaft
bevel at the end
hematoma example of?
systemic complicaton
most needle fractures occur during?
administration of IAN blocks
most needle fractures occur when using?
in who?
with a 30-gauge needles and in children who are reported to have moved suddenly and violently as the dentist gave the injection
should avoid burrying the needle up to…
the hub - so avoid burying any needle up to the hub
unless it is essential for the block
if you can see needle break / if you cant what do you do?
can see it – grasp the most proximal end of the needle fragment and remove it from tissue
cant see it – immediate refer patient to an apporpriate specialist
what types of needles should you not use in IAN?
30 - gauge or short needles
causes of pain on injection
- carelessness
- dull needle
- rapid deposition
- needles with barbs
prevention to limiting pain on injection
- proper technique
- sharp needles
- topical anesthesia
- inject slowly
- temperature of the solution should be at room temperature
causes of burning on injection
- pH of solution
- rapid injection
- contamination of the local anesthetic solution
- temperature of the solution
preventing burning on injection
- it is almost impossible to eliminate the mild burning sensation
- slowing the injection administration
- room temperature
- storage container without alcohol
ideal rate of administration
1ml/min
ideal rate of administration
1ml/min
Onpharma’s Onset
Designed for precisoin buffering of local anesthetic, which provides rapid onset of analgesia and less injection pain
sterile, nonpyrogenic solution of sodium bicarbonate (NaHCO3) in water for injection
Onpharma’s Onset added to?
Lidocaine with epinephrine as a neutralizing agent immediately prior to administration
causes of persistant anesthesia / paresthesia
- trauma to the nerve
- secondary chemical injury (alcohol contaminated cartridge)
- direct trauma with the needle
- LA
Paresthesia
persistent anesthesia
preventing Paresthesia
- Proper injection protocol
2. proper care and handling of dental cartridges
most paresthesia resolves when?
within approx. 8 weeks
most paresthesia involves what?
the tongue followed by the lip
- occurs more in tongue than lip
keys to patient management with Paresthesia
- be reassuring – speak to them, arrange appointemnt, record the incident in chart
- examine the pt.
- determine extend and degree - map out the affected area, record all findings - reschedule the patient
- consider referring the patient (if necessary)
articaine 4% used with lingual nerve block implication
had the most number of nerve injuries reported
conclusion from study
suggests that paresthesia occurs more commonly after use of 4% LA formulations
94/5% of problems occured with what block?
mandibular block
what not to use for IAN block?
why?
articaine or prilocaine
Articaine and prilocaine have higher incidence of injury
Because has a higher concentration of LA that could damage or be toxic to the nerve
trismus
defined as a prolonged, tetanic spasms of the jaw muscle by which normal opening of the mouth is restricted
MASSETER, TEMPORALIS, in MEDIAL PTERYGOID
most effected muscle in IAN?
medial pterygoid
causes of trismus
trauma to the muscles or blood vessels
intramuscular injection
hemorrhage
contaminated cartridges with alcohol
preventing trismus
- use a sharp needle
- do not store cartridges in alcohol
- aseptic technique – no infection
- atraumatic technique
- avoid repeated injections
- use minimum volumes
management of trismus
- arrange an appointment
- heat therapy
- warm saline rinses
- analgesic
- muscle relaxants
- physiotherapy
- record the incidence
no improvement after 48 hours - prescribe antibiotics
no improvement in trismus after 48 hours?
prescribe antibiotics
trismus due to infection or secondary to injection?
hard to tell so give antibiotics to treat
hematoma
effusion of blood into extravascular spaces
due to a trauma to a blood vessel
are there problems w/ hematoma
rarely produced significant problems
trismus and pain
becomes a problem if they do start bleeding - as airway could be compromised – so make note to this with patients that have bleeding issues
hematoma prevention
- knowledge of the anatomy
- minimize the number of needle penetrations
- never use needle to probe
- use a short needle for PSA nerve block
management of hematoma
- pressure
- ice
- time
- “do not apply heat”
causes of infection
- contamination of the needle prior to administration of the anesthetic
- injecting local anesthesia into the effected area
infection problem ?
relating to trismus and airway - this could be a problem
edema?
causes?
swelling of tissues causes 1. trauma 2. infection 3. allergy 4. hemorrhage 5. injection of an irritating solution
edema from LA results in …
pain and dysfunction
what if airway and breathing are compromised with edema?
- activate emergency protocol
- unconscious patient is placed in supine position
- basic life support
- active emergency medical service
- epinephrine – 0.3 mg adult
0.15 mg child
IM or IV q 5 minutes until respiratory distress resolves
edema – airway breathing are compromised … administer
antihistamine - for inflammation
corticosteroids
cricothyrotomy
cricothyrotomy vs treachostomy
trach-
cricothyro– emergency and needs to be fixed to a trach??
causes of facial nerve paralysis
local anesthetic is injected into the capsule of the parotid gland
prevention of facial nerve paralysis
correct your technique
management of facial paralysis
- explain
2. eyepatch
managemnt of facial nerve paralysis
- remove contact lenses
- record incident
- reschedule the patient
3 principles to systemic complications
- no drug ever exerts a single action
- no clinically useful drug is entirely devoid of toxicity
- the potential toxicity of a drug rests in the hands of the user
causes of adverse drug reactions
3 main ones
- toxicity caused by direct extension of the usual pharmacological effects of the drug
- toxicity caused by alteration in the recipient of the drug
- toxicity caused by allergic responses to the drug
- toxicity caused by direct extension of the usual pharmacological effects of the drug break down
- side effects
- overdose reactions
- local toxic effects
- toxicity caused by alteration in the recipient of the drug break down
- a disease process (hepatic dysfunction, CHF, renal dysfunction)
- emotional disturbances
- genetic aberrations (Atypical plasma cholinesterase, malignant hyperthermia)
is allergy dose dependent?
no
but signs symptoms are similar between this and overdoes
