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Local Anesthesia CH. 18 Sytemic Comlications PG. 303-331

Whenever any drug is administered, two types of actions may be observed. What are these? Desirable actions, which are clinically sought and beneficial and undesirable actions that are not sought.
Before administering any drug, the doctor must ask the patient what? Specific questions about his or her medical and drug history.
Overdose Reactions Clinical signs and symptoms that manifest as a result of an absolute or relative over administration of a drug which can lead to elevated blood levels.
Local anesthetics are drugs that act to depress excitable membranes like what? CNS (Central Nervous System) and Myocardium (CVS- Cardiovascular System)
Toxic reactions is a synonym for what? Overdose
Allergy Is a hypersensitive state acquired through exposure to a particular allergen (a substance capable of inducing altered bodily reactivity), re-exposure to which brings about a heightened capacity to react.
Overdose reaction to develop what must happen? Large enough amount of the drug must have been administered so that excessive blood levels occur in the target organs or tissues.
T/F Overdose reactions are dose related? True
T/F Allergic reaction are not dose related? True
Idiosyncrasy abnormal unexpected response to a drug, differing from its pharmacological actions and thus resembling hypersensitivity.
What is the treatment of Idiosyncrasy reactions? Symptomatic positioning, airway, breathing, circulation, and definitive care.
What must occur for an Overdose Reaction to occur? The drug must first gain access to the circulatory system in quantities sufficient to produce adverse effects on various tissues of the body.
Target Organs Level of a drug in the blood sufficiently high to produce adverse effects in various organs and tissues of the body in which the drug exerts a clinical actions.
Who is more susceptible to an Overdose Reaction due to a compromised absorption, metabolism, and excretion? Young and Elderly people.
You may have an increased local anesthetic blood levels and thus may experience toxic actions of the local anesthetic at lower administered doses because of protein binding competition? Patient's taking meperidine (Demerol), phenytoin (Dilantin), quinidine (anti-dysrhythmic), desipramine (tricyclic antidepressant)
During pregnancy what happens to the renal function? May be disturbed, leading to impaired excretion of certain drugs, their accumulation on the blood, and increased risk of an overdose.
Hepatic and Renal dysfunction Impair body's ability to break down and excrete the local anesthetic, leading to an increased anesthetic blood level.
Congestive heart failure decreases liver perfusion ( the volume of blood flow through the liver during a specific period) thereby increasing the half-life of amide local anesthetic and increasing the risk of an overdose.
Serum Pseudocholinesterase Enzyme produced in the liver, circulates the blood and biotransforms the ester local anesthetics.
What happens with a Pseudocholinesterase deficiency? Can prolong the half-life of an ester local anesthetic and increase blood level.
Apprehensive Patient Overreacts to stimulation (experiencing pain when gentle pressure is applied) is more likely to receive a larger dose of local anesthetic.
Vasodilating Effects Increases perfusion leading to increased rate of drug absorption form the site of injection into the cardiovascular system resulting in shorter duration and increased blood levels.
T/F The lowest concentration of a given drug that is clinically effective should be selected for use. True
T/F The smallest dose of a given drug that is clinically effective should be administered. True
Terminating pain control of a local anesthetic is done how? Diffusion of the drug out of the nerve tissue, and its absorption into the CVS and removal from the area of injection.
What is the single most important factor in local anesthetics? Rate at which the drug is injected.
Vascularity of Injection Site More rapid absorption of the drug from that area into the circulation.
What are some areas in the oral cavity that are less well perfused (i.e no vascularity)? Gow Gates Injection Site.
What are some areas in the oral cavity that are well perfused (i.e. vascularity)? Inferior Alveolar, and Posterior Injection Sites.
Presence of Vasoconstrictors Produces a decrease in the perfusion of an area and a decreased rate of systemic absorption of the drug. Decreases the clinical toxicity of the local anesthetic.
What type of anesthetic as a group undergoes more rapid biotransformation in the liver and blood? Esters
Plasma pseudocholinesterase hydrolyzes Esters to what? PABA (paraaminobenzoic acid)
Atypical pseudocholinesterase Relative contraindication to the administration of ester local anesthetics. Amides may used without risk of an overdose.
Amides Biotransformed in the liver by hepatic microsomal enzymes.
History of liver disease ASA II or III Amide local anesthetics may be used judiciously (relative contraindication).
T/F A percentage of all anesthetics is eliminated unchanged through the kidneys. True
Renal dysfunction Delay elimination of the active local anesthetic form the blood. Gradual increase in the level of active local anesthetic in the blood.
What is the MRD dependent on? Patient's age, physical status, and weight.
T/ F Maximum recommended dose of local anesthetics should be determined after consideration of the patient's age, physical status, and body weight. True
T/F Vasoconstrictors increase the duration of anesthesia and reduce systemic toxicity of most local anesthetics by delaying their absorption into the CVS. True
What happens if you rapidly administer and IA injection? Retrograde (directed or moving backward) blood flow in the artery as the drug is deposited, thus producing a overdose reaction. Blood flow is reversed due to high pressure produced by the rate of an injection.
How can you prevent an intravascular injection? Use an aspirating syringe.
T/F Use a needle no smaller than a 25 gauge. True
Why would you not want to use a smaller gauge needle in aspirating? Increase in resistance to the return of blood into the lumen of smaller gauge needles resulting in an unreliable aspiration test.
T/F Aspirate in at least two planes before injection. True
T/F Slow injection is the most important factor in preventing adverse drug reactions even more so than aspiration. True
What is the minimum time to deposit anesthetic? 60 Seconds (1 minute).
Blood or plasma level of a drug amount absorbed into the circulatory system and transported in plasma throughout the body.
CNS depression happens when? Local anesthetics cross the blood-brain barrier.
What are signs of CNS toxicity? Cortical sensitivity, agitation, talkativeness, and irritability.
What are the signs of CVS toxicity? Minor alteration on the electrocardiogram, myocardial depression, decreased cardiac output, and peripheral Vasodilation.
What are the signs of Major CVS toxicity? Massive peripheral vasodilation, marked reduction in myocardial contractility, severe bradycardia, and cardiac arrest.
T/F Rarely are drugs other than oxygen necessary to terminate a local anesthetic overdose. True
What are signs of a mild overdose reaction? Retention of consciousness, talkativeness, and agitation along with increased heart rate, blood pressure, and respiratory rate 5-10 minutes after injection.
What is the algorithm used in management of all medical emergencies? Position, Airway, Breathing, Circulation, Definitive care
What position is not recommended in management of an epinephrine overdose of a patient and why? Supine position, accentuates (make more noticeable or more prominent) the CVS effects.
What are the common clinical manifestations of epinephrine overdose? Anxiety and restlessness
What is the more correct position for a patient in management of an epinephrine overdose and why? Semisitting or erect position to minimize further elevation in cerebral blood pressure.
Cross-allergenicity occurs with what type of local anesthetics? Esters
Allergy to what has a common relationship to fruits and vegetables? Sodium Bisulfite
What can happen to a patient that is allergic to Sodium Bisulfite? Bronchospasm
T/F Sodium Bisulfite is found in all dental local anesthetic cartridges that contain a vasoconstrictor, but is not found in plain local anesthetic solutions. True
What are some local anesthetics you could use if there is a sodium bisulfite allergy? mepivacaine 3% and prilocaine 4%
T/F Allergy to epinephrine can occur in a patient. False
What do you do if a patient states they are allergic to local anesthetics? Assume the patient is truly allergic, do not use any drug until it is disproved. Do a dialogue history and consultation and test for allergy to local anesthetics.
What is the most important question to ask if the patient states they are allergic to a local anesthetic? Describe exactly what happened.
What drugs are used in management of allergic reactions? Vasopressors ( epinephrine), Histamine Blockers (Benadryl), Corticosteroids (hydrocortisone sodium succinate)
What drug is used in treatment of seizures due to an overdose of local anesthetics? Anticonvulsants such as diazepam
Aromatic ammonia is used for what? Treatment of syncopal episodes
What position is recommended as being the best tolerated for the administration of all local anesthetic injections? Supine position
What are the four emergency protocols in an alleged allergy patient? No treatment of an invasive matter, an appointment for immediate consultation and allergy testing; use of general anesthesia; Histamine blockers as a local anesthetic; electronic dental anesthesia or hypnosis.
If a patient is allergic to an Ester, what local anesthetic could you administer? Amides
If a patient is allergic to an amide, what local anesthetic could you administer? Other amide local anesthetics could be give due to no cross-allergenicity between amides exist.
Immediate reactions (Type I, II, and III) develop within seconds to hours of exposure. (I.e. anaphylaxis)
Delayed reactions (Type IV) develop hours to days after exposure.
Urticaria wheals, which are smooth, elevated patches of skin. Intense itching.
Angioedema Localized swelling
T/F Bronchospasm is the classic respiratory allergic response. True
What is the most dramatic and acutely life-threatening allergic reaction? Generalized Anaphylaxis
What are the two items that are only to be administered with an acute phase of the anaphylactic reaction? Epinephrine and Oxygen
What should be done immediately if the patient loses consciousness and no signs of allergy is present? Place the patient is the supine position with the legs slightly elevated.
What is the name for a patient passing out but has no sign of allergy? Vasopressor syncope due to psychogenic reaction.
What should you never do after administering a local anesthetic to a patient? Leave the patient alone.
Created by: daisenmurray
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