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Local Anesthesia

Contraindications and Complications for Local Anesthetics

Medical Problem: Documented L.A. allergy. All L.A's of that type (esters or amides): Absolute: L.A. of other type (amide, esters)
Medical Problem: Malignant Hyperthermia Amides: Relative: Use amides judiciously
Medical Problem: Atypical Pseudocholinesterase Esters: Relative: Amides
Medical Problem: Significant Liver Dysfunction Amides: Relative: Use amides judiciously
Medical Problem: Renal Dysfunction Esters and Amides: Relative: Amides or esters, but use judiciously
Medical Problem: Methemoglobinemia Prilocaine and Benzocaine: Relative: Any other Anesthetics
Medical Problem: Patient taking Acetaminophens (long term basis may cause Methemoglobinemia) : Prilocaine and Benzocaine: Relative: Any other anesthetics
Medical Problem: Patient taking Cimetadine (Tagamet, Zantac) on a regular basis Amides: Relative: Reduce dosage by one half. Drug reduced liver's capacity to metabolize amide anesthetics.
Medical Problem: Significant Cardiovascular Disease High Vasoconstrictor concentrations of local anesthetics: Relative: 3% Mepicacaine 4% Prilocaine Plain 4% Prilocaine w/ 1:200,000 epi
Medical Problem:Clinical Hyperthyroidism High vasocontrictor concentrations: Relative: 3% Mepicacaine 4% Prilocaine Plain 4% Prilocaine w/ 1:200,000 epi
Medical Problem:Hypothyroidism All L.A.: Relative: Normal dosages could produce overdose since metabolism is significantly diminished
Medical Problem: Antianxiety drugs Benzodiazepines Ex. Vallium All L.A. : Relative: Minimize dosages of all anesthetics
Complication: Fainting Form of shock-sometimes due to seeing the needle. Low BP, pallor, coolness of skin, perspiration, light-headedness, nausea: Lower chair so legs are elevated, have ammonia ampule handy: Keep pt. as calm as possible, keep needle out of view
Complication: Muscle Trismus Trauma to muscle during needle insertion. Hemorrhage. Multiple needle penetrations: Muscle soreness. Limited movement of mandible: Heat therapy 20 min/hr. Analgesics-Ibuprofen. Gum chewing: Watch landmarks. Good technique. Limit # of injections in area
Complication: Pain (hyperesthesia) : Poor technique, rapid depositions, needle w/ barbs: Pain: Reassure pt: Topical. Change needle every 3-4 injections
Complication: Infection Unsterile instruments: Low grade inflammation resulting in trismus: Penicillin or erythromycin: Aseptic Technique
Complication: Broken Needle Sudden, unexpected movement: Instruct pt. to not move. Keep hand in pt.s mouth. Remove w. cotton pliers, if lost refer to oral surgeon: Do not force against resistance. Know landmarks. Do not insert needle past sight.
Complication: Hematoma Torn blood vessel: Swelling, discoloration, soreness: Direct pressure for 10 min, Ice pack, Heat 4-6 hrs (20 min/hr): Good Technique, occur w/ proper technique
Complication: Parethesia Trauma to nerve, contaminated solutions, hemorrhage: Persistent anesthesia for hours, days or long term: Examine, reassure pt., refer to oral surgeon after 1 yr: Technique, # of injections in one area, do not store carps by cleaning solutions
Complication: Facial Nerve Paralysis : Injecting into parotid gland capsule: Loss of motor function, dehydration of cornea: Reassure pt., anesthesia to wear off, manually close eyes: Technique, contact bone prior to injection
Complication: Post Anesthetic Intraoral Lesions Trauma to oral tissues: Recurrent apthous stomatitis: Tx. symptoms: No prevention, more suseptable than others
Complication: Burning Rapid injection, ph low, warm solution, contaminated: Trismus, edema paresthesia: no tx given: Inject slowly, La w. vaso has lower pH, no contaminated solution
Complication: Toxicity Inadvertent IV injection. Slow biotransformation and elimination: High BP, pulse, respiration, pt. becomes apprehensive,depression, low BP, pulse, respiration, convulsion, unconsciousness: Discontinue tx, maintain airway: through patient evaluation
Complication: Allergic Reaction antigen-antibody reaction: rash, urticaria: Antihistamines: Thorough medical history
Complication: Anaphylatic Allergic Reaction severe form of allergy: sudden onset rash, wheezing: prompt action, administer epi, 911: thorough medical history
Complication: Idiosyncrasy (any reaction that cannot be classified as toxic or allergic) genetic aberration, specific drug that induces bizarre clinical manifestation: impossible to outline in advanced: basic life support: do not expose pt. to anything w/ past reaction
Complication: Contamination rare: local tissue irritation: none: double check for debris, inject slowly, buy from reliable maker
Complication: Sloughing of Tissue Topical anesthetic for prolonged time: epithelial desquamation: reassure pt: use properly, use low concentrations
Complication: Edema trauma during injection, infection or allergy: pain, dysfunction, compromised airway: decrease swelling soon, analgesics or antihistamine: good technique, aseptic technique, thorough medical history
Complication: Lip/Soft Tissue Injury biting one self while anesthetized: trauma, pain, swelling: analgesics for pain, salkine rinses, lubricated: warn pt. good communication, short acting anesthetic
Blood Pressure Classification: Normal 120/80 Tx modifications usually not needed, routine management, recheck in six months
Blood Pressure Classification: Prehypertension 120-139 or 80-89 Routine tx ok discuss guidelines w/ pt.
Blood Pressure Classification: Stage I Hypertension 140-159 or 90-99 Routine tx ok consider sedation for complex dental or surgical procedures; refer for medical consult
Blood Pressure Classification: Stage II Hypertension 160-100 (95) Restrict Vasocontrictor Use
160-179 or 100-109 Routine tx ok, restrict vasoconstrictor use consider sedation for complex dental or surgical procedures; refer for medical consult
180-209 or 110-119 No dental tx with out medical consultation refer for prompt medical consult/ medical tx
210-120 no dental tx refer for emergency medical tx
ASA Classifications: I: Normal Healthy Individual Tx modifications usually not needed No abnormalities found, tolerant of stress Normal BP 120-80
ASA Classifications: II: Pt. w/ mild to mod. systemic disease well-controlled epilepsy, asthma, non-insulin-dependent diabetes, and thyroid disorders otherwise healthy pt. will allergies or extreme dental fears prehypertension, adult w/ BP of 120-139/80-89
ASA Classifications: III: Pt w. severe systemic disease that limits activity but is not incapacitating stable angina pectoris 6 months past MI exercise induced asthma, COPD, well controlled insulin dependent diabeties Stage I hypertension: adult BP 140-159/90-99
ASA Classifications: IV: pt w/ severe systemic disease that limits activity and is a constant threat to life Myocardial infarction or CVA within the last 6 months uncontrolled epilepsy, diabetes, COPS with o2 stage 2 hypertension, BP 160-100
ASA Classifications V: Moribund pt. not expected to survive 24 hrs w. or w/o an operation Terminal cancer end-stage renal disease, hepatic disease and infectious disease
Relative Contraindication: Pt. taking Tricyclic antidepressants (Triavil, Elavil, Norpramin, Tofranil, Aventyl, Vivetil, etc) Increases the effects of epi. Levonordefrin should be avoided completely. Both may cause acute hypertension and cardiac dysrhythmia.
Relative Contraindication: Patient taking Phenothaiazides (Tindal, Thorazine, Trilafon, Vesprin, Mellaril, etc.) Increases risk of hypertension resulting in rebound bradycardia potential cardiac arrest
Relative Contraindication: Patient taking Non selective beta blockers (indural, Corgard, etc) increased hypertension resulting in rebound bradycardia potential cardiac arrest
Relative Contraindication: Cocaine abusers may lead to myocardial infarction
Relative Contraindication: Glaucoma causes increased ocular pressure
Relative Contraindication: Controlled Diabetes Especially Type I Vasoconstrictors directly opposes effect of insulin, possible changes in blood levels of glucose
Relative Contraindication: Controlled Hypertheyroidism Vasocontrictors effect increased
Relative Contraindication: Controlled high blood pressure Very controversial, risks associated with vasoconstrictors, increase in blood pressure.
Created by: daisenmurray