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
Drug Factors
Vasoactivity
Concentration
Dose
Route of administration
Rate of injection
Vascularity of the injection site
Presence of vasoconstrictors
Slow onset
Reassure patient
Administer oxygen
Monitor vital signs
Allow patient to recover as long as
necessary
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
Epinephrine Overdose
Very rare for patient to experience an
epinephrine overdose
Fear, anxiety
Tenseness
Restlessness
Throbbing headache
Tremor
Perspiration
Weakness
Dizziness
Pallor
Respiratory difficulty
Palpitations
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
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
Lidocaine (Xylocaine)
Prilocaine (Citanest)
Mepivacaine (Carbocaine, Polocaine)
Bupivacaine (Marcaine)
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)
Category
Use During
Pregnancy
Risk
Lidocaine
Yes
Prilocaine
Yes
Mepivacaine
Fetal
bradycardia
Bupivacaine
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
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.