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