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Local Anesthetic Systemic Complications and Treatment

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Presentation on theme: "Local Anesthetic Systemic Complications and Treatment"— Presentation transcript:

1 Local Anesthetic Systemic Complications and Treatment

2 Adverse Drug Reactions
1) Side effects 2) Overdose reactions 3) Local toxic effects (most common) 4) Allergic reactions

3 Toxicity caused by alteration in the recipient of the drug
1) Disease process 2) Emotional disturbances 3) Genetic aberrations 4) Idiosyncrasy

4 Signs and Symptoms – Toxic Reaction to Local Anesthesia
Talkativeness Slurred speech Dizziness Nausea Depression Euphoria Excitement Convulsions

5 Overdose Reactions Clinical signs and symptoms that develop as a result of an over-administration of a drug

6 Overdose Contributing Factors
Age Weight Other medications Presence of disease Genetics Mental wellbeing


8 Drug Factors Vasoactivity Concentration Dose Route of administration
Rate of injection Vascularity of the injection site Presence of vasoconstrictors

9 Mild Overdose Reaction
Slow onset Reassure patient Administer oxygen Monitor vital signs Allow patient to recover as long as necessary

10 Slower Onset of Overdose
Reassure patient Administer oxygen Monitor vital signs Administer anticonvulsant Call 911 After reaction, have patient examined by a physician Do not let patient leave alone

11 Severe Overdose Reaction
Rapid onset (within one minute) Remove syringe (if in the process of an injection) Protect patient for trauma if convulsions are present Call 911 Basic life support Administer anticonvulsant Allow patient to recover Do not let patient leave alone

12 Very rare for patient to experience an epinephrine overdose

13 Signs and Symptoms of Epinephrine Overdose
Fear, anxiety Tenseness Restlessness Throbbing headache Tremor Perspiration Weakness Dizziness Pallor Respiratory difficulty Palpitations

14 Management of Epinephrine Overdose
Terminate dental procedure Sit patient upright in the dental chair Reassure patient Monitor blood pressure Administer oxygen

15 Allergic Reactions to Local Anesthetic Agents
Hypersensitive state as a result of exposure to an allergen Re-exposure can heighten the initial reaction

16 Clinical Manifestations of an Allergy
Fever Angioedema Urticaria Dermatitis Depression of blood-forming organs Photosensitivity Anaphylaxis

17 Angioedema

18 Urticaria (hives)

19 Allergy Incidents of allergy are low
Often allergic reaction is to one of the ingredients within the cartridge, not the local anesthesia itself

20 How to Prevent An Allergic Reaction
Take a thorough medical history Dialogue the medical history with the patient

21 Common Questions to Ask the Patient
Allergic to any medications? Have you ever had a reaction to local anesthesia? If yes, describe what happened Was treatment given? If so, what?

22 Allergic Responses to local anesthetic
Dermatitis (hives) Bronchospasm Systemic anaphylaxis Hypersensitivity to esters (atypical pseudo cholinesterase, PABA)

23 Latex Allergy The cartridge opening into which the needle is inserted is aluminum with a very thin diaphragm of latex in the middle Though patients with a latex allergy are at an increased risk, there are no known cases or reports of an allergic response from the latex on a local anesthetic cartridge

24 Asthma Patient Thorough medical and dental history
Avoid use of anesthesia that contain epinephrine or levonordefrin because of sulfites (may cause wheezing) Asthma patient that is steroid dependant may develop brochospasms Establish rapport and calm environment

25 Kidneys are compromised
Renal Disease Common diseases associated with renal failure are diabetes mellitus, hypertension, or systemic lupus erythematosus (SLE) Kidneys are compromised

26 Drugs Metabolized by the Liver
Lidocaine (Xylocaine) Prilocaine (Citanest) Mepivacaine (Carbocaine, Polocaine) Bupivacaine (Marcaine) Appear to be safe for use on patients with liver disease when used in appropriate amounts

27 Pregnancy Anesthesia crosses the placenta and could be toxic to the fetus, but is not a known teratogen No drug should be administered during pregnancy especially the first trimester If treatment is necessary, local anesthetics with epinephrine are considered relatively safe for use during pregnancy; check with patient’s physician Educate patients to the potential risks (document)

28 FDA Category of Prescription Drugs
Use During Pregnancy Risk Lidocaine B Yes - Prilocaine Mepivacaine C Use with caution- Consult physician Fetal bradycardia Bupivacaine

29 Hypertension Stress and anxiety may raise the patient’s blood pressure (>160/100) Thorough medical, dental and patient history Norepinephrine and levonordefrin should not be used because of alpha1 stimulation (2% Mepivacaine with 1:20,000 levonordefrin) Up to two cartridges of 2% lidocaine with 1:100,000 epinephrine is safe

30 Contraindication for Local Anesthetic with Epinephrine
Uncontrolled hypertension Myocardial infarction (within 6 months) Unstable angina Coronary artery bypass graft (> 3 months)

31 Quiz 1. Local anesthetics and vasoconstrictors do cross the placenta in pregnant women; local anesthetics and vasoconstrictors are known teratogens (cause birth defects). a. The first part of the statement is true, the second part is true. b. The first part of the statement is true, the second part is false. c. The first part of the statement is false, the second part is false. d. The first part of the statement is false, the second

32 2. What should you do when using local anesthesia on a patient with
controlled hypertension? a. Take the BP before the injection and use Mepivacaine only b. Take the BP before the injection and use an anesthetic without a vasoconstrictor c. Take the BP before the injection and use anesthetic with a vasoconstrictor judiciously d. Local anesthetics should not be used on patients with hypertension

33 3. Since local anesthetics are excreted through the
kidneys, what is true concerning giving local anesthesia to a patient with renal dysfunction? a. Consult patient’s physician b. Potential for overdose c. Use anesthetics in minimal doses d. All of the above

34 4. What is the most common reason for allergies to
local anesthetic solutions? a. Asthma b. The anesthetic solution itself c. The other added ingredients to the solution d. The vasoconstrictor

35 5. To prevent an overdose, what should the
maximum safe doses of anesthetic be based on? a. The patient’s age b. The patient’s weight c. The patient’s physical status d. The patient’s health e. All of the above

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