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Local Anesthetic Systemic

Complications and Treatment

Adverse Drug Reactions


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

Toxicity caused by alteration in


the recipient of the drug
1) Disease process
2) Emotional disturbances
3) Genetic aberrations
4) Idiosyncrasy

Signs and Symptoms Toxic Reaction


to Local Anesthesia

Talkativeness
Slurred speech
Dizziness
Nausea
Depression
Euphoria
Excitement
Convulsions

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

Overdose Contributing Factors


Age
Weight
Other medications
Presence of disease
Genetics
Mental wellbeing

Drug Factors

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

Mild Overdose Reaction

Slow onset
Reassure patient
Administer oxygen
Monitor vital signs
Allow patient to recover as long as
necessary

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

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

Epinephrine Overdose
Very rare for patient to experience an
epinephrine overdose

Signs and Symptoms of Epinephrine


Overdose

Fear, anxiety
Tenseness
Restlessness
Throbbing headache
Tremor
Perspiration
Weakness
Dizziness
Pallor
Respiratory difficulty
Palpitations

Management of Epinephrine Overdose

Terminate dental procedure


Sit patient upright in the dental chair
Reassure patient
Monitor blood pressure
Administer oxygen

Allergic Reactions to Local


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

Clinical Manifestations of an Allergy

Fever
Angioedema
Urticaria
Dermatitis
Depression of blood-forming organs
Photosensitivity
Anaphylaxis

Angioedema

Urticaria (hives)

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

How to Prevent An Allergic


Reaction
Take a thorough medical history
Dialogue the medical history with the
patient

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?

Allergic Responses to local


anesthetic

Dermatitis (hives)
Bronchospasm
Systemic anaphylaxis
Hypersensitivity to esters
(atypical pseudo cholinesterase, PABA)

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

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

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

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

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 patients physician
Educate patients to the potential risks (document)

FDA Category of Prescription Drugs


Drug

Category

Use During
Pregnancy

Risk

Lidocaine

Yes

Prilocaine

Yes

Mepivacaine

Use with cautionConsult physician

Fetal
bradycardia

Bupivacaine

Use with cautionConsult physician

Fetal
bradycardia

Hypertension
Stress and anxiety may raise the patients 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

Contraindication for Local Anesthetic


with Epinephrine

Uncontrolled hypertension
Myocardial infarction (within 6 months)
Unstable angina
Coronary artery bypass graft (> 3 months)

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
part is true.

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

3. Since local anesthetics are excreted through the


kidneys, what is true concerning giving local
anesthesia to a patient with renal dysfunction?
a. Consult patients physician
b. Potential for overdose
c. Use anesthetics in minimal doses
d. All of the above

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

5. To prevent an overdose, what should the


maximum safe doses of anesthetic be based on?
a. The patients age
b. The patients weight
c. The patients physical status
d. The patients health
e. All of the above

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