Patient Evaluation for Local Anesthesia Flashcards
Angina is?
Chest pain
Stable Angina?
Character, duration, intensity, resolution, precipitating events all constant over time
caution with: Stress, Epinephrine
Unstable Angina?
Change in anything from stable
Angina at rest
Treat in monitored setting
Myocardial infarction is?
Destruction of an area of heart muscle as the result of occlusion of a coronary artery
Recent MI (caution with?)
Stress
Epinephrine
Prolonged MI (more than 6 months ago)
Variable
uncomplicated: relatively low risk
complicated: caution with stress, epinephrine
newer literature reduces this time to 6-8 weeks
Coronary artery bypass surgery (CABG)
Recent: caution with stress, epinephrine
More than 3 months ago: variable, similar to MI
Arrhythmia is?
any variation from the normal rhythm in the heartbeat
One of the most difficult areas to assess
Need PCP/Caridiologist consultation
Controlled arrhythmia
caution with Epinephrine
Refractory/uncontrolled arrhythmia
Treat in monitored setting
Hypertension (controlled)
consider drug interactions, monitor pressure
(ex. ACE inhibitor, and Beta blocker)
May need to reduce EPI use
Hypertension (Severe, untreated, uncontrollable)
limit EPI use
consider monitored setting
Congestive Heart Failure (CHF)
controlled: low risk
Uncontrolled, untreated: stress, time in chair are major issues
Stroke (Cerebrovascular disease)
low risk, watch BP
Vatiable risk for recurrence:
monitor pressure, may need to reduce EPI
Diabetes (controlled)
no problem
Diabetes (uncontrolled)
monitor for other problems
Thyroid disease
controlled: no problem
Uncontrolled Hyperthyroidism
Defer treatment
avoid stress, epinephrine (important because patient is very sensitive to epinephrine)
Pheochromocytoma
Rare tumor
defer treatment
avoid EPI, stress
Coagulopathy is?
bloods ability to coagulate (form clots) is impaired
Coagulopathy
congenital or acquired
alter technique to avoid deep blocks (more chance to poke the blood vessels, so it will keep bleed, patient will have hematoma)
Methemoglobinemia
Avoid PRILOCAINE
Lidocaine may be a trigger but is lowest risk anesthetic
Methemoglobinemia is?
Dark brown blood: not a lot of oxygenated blood presents
Asthma
no problem
Chronic obstructive pulmonary disease (COPD)
Time in chair may be the issue
Liver disease
Unlikely to be a significant issue
(at the end of liver disease: amide is metabolized at the liver, liver is not functional then local anesthesia would not be metabolized and stay in the system)
Renal disease
Unlikely to be a significant issue
Dialysis patients
treat day after dialysis
Malignant Hyperthermia
No problem with AMIDE anesthetics
Atypical plasma pseudocholinesterase
delayed metabolism of esters
amide anesthetics are NOT a problem
Cocaine abuse (IMPORTANT)
avoid EPI, stress
defer treatment: 24 hours
Preganacy
limit care generally (2nd trimester is OK)
Local anesthetics are ok
Tricyclic antidepressants
Block neurotransmitter uptake
Monitor BP
MAO inhibitors
limited clinical significance
Monitor BP
Beta-blockers
selective: little concern
non-selective: monitor pressure with EPI use (can cause severe hypertension)
LA with Amide
allergic rxn very rare but POSSIBLE
LA with Esters
allergic rxn possible, but we aren’t injecting them anymore
Parabens?
WE DO NOT USE
Sulfites?
allergic rxn possible (in epi containing anesthetics)
