Systemic Complications of Local Anesthesia

z
Systemic complications
of local anesthesia
z
INTRODUCTION
Local anesthetics are extremely safe drugs when used
as recommended. However, whenever any drug,
including a local anesthetic, is used, the potential for
unwanted and undesirable responses exists.
Overdose reactions, allergy, and idiosyncrasy are

important topics in relation to local anesthetics and
pain control in dentistry
z
CAUSES OF ADVERSE DRUG
REACTIONS
Toxicity caused by direct extension of the usual
pharmacologic
effects of the drug:
1. side effects
2. overdose reactions
3. local toxic effects
Toxicity caused by alteration in the recipient of the drug:
1. a disease process (hepatic dysfunction, heart failure,
renal
dysfunction)
2. emotional disturbances
3. genetic aberrations (atypical plasma cholinesterase,
malignant hyperthermia)
4. idiosyncrasy
Toxicity caused by allergic responses to the drug
•
z
OVERDOSE
 A drug overdose reaction is defined as those clinical

signs and symptoms that result from an overly high
blood level of a drug in various target organs and
tissues.
Causes
Elevated blood levels of local anesthetics may result from
one or more of the following:
1. Biotransformation of the drug is unusually slow.
2. The unbiotransformed drug is too slowly eliminated
from the body through the kidneys.
3. Too large a total dose is administered.
4. Absorption from the injection site is unusually rapid.
5. Intravascular administration.
Biotransformation and Elimination
z
PREDISPOSING FACTORS
 Patient factors  Drug factors
 Age  Vasoactivity
 Weight  Concentration
 Other drugs  Dose
 Presence of disease  Route of administration
 Genetics  Rate of injection
 Mental attitude and  Vascularity of injection site

environment  Presence of vasoconstrictors
z
Factors Adding to Increased Risk of
Local Anesthetic Overdose in Younger patients
 Treatment plan where all four quadrants are treated with local
anesthetic at one visit.
 Local anesthetic administered is a plain solution (no

vasoconstrictor).
 Full cartridges (1.8 mL) administered with each injection.
 Local anesthetic administered to all four quadrants at one time.
 Exceeding the maximum dose based on patient’s body weight.

z
Clinical manifestations
 MINIMAL TO MODERATE OVERDOSE LEVELS
SIGNS
Talkativeness,Apprehension,Excitability,Slurred speech Generalized stutter, leading to muscular
twitching and tremor,sweating,Vomiting,Failure to follow commands or be reasoned wiith
Disorientation,Loss of response to painful stimuli,Elevated blood pressure,Elevated heart
rate,Elevated respiratory rate
z
 MODERATE TO HIGH OVERDOSE LEVELS
Sign
Tonic-clonic seizure activity followed by:
Generalized central nervous system depression
Depressed blood pressure, heart rate, and respiratory rate

z
SYMPTOMS
 Light-headedness and
dizziness,Restlessness,nu
mbness,nervousness,metall
ic taste,visual
disturbance,Tinnitus,disorie
ntation,loss of
consiousness
z
MANAGEMENT
MILD OVERDOSE REACTION
The following are diagnostic clues to the presence of mild local anesthetic overdose:
onset approximately 5 to 10 minutes following drug administration,talkativeness,
increased anxiety,facial muscle twitching,increased heart rate, blood pressure, and
respiration.
Step 1: Terminate the dental procedure.
Step 2: P (position). The conscious patient is placed in a comfortable position.
Step 3: Reassurance of the patient.
Step 4: C → A → B (circulation-airway-breathing), basic life support (BLS) as needed.

Patency of the circulation, airway, and breathing must be assessed and implemented,
as needed.
z
Step 5: D (definitive care).
Step 5a: Administration of O2.
Step 5b: Monitor vital signs.
Step 5c: Administration of an anticonvulsant drug, if

needed. The administration of an anticonvulsant, such as
midazolam or diazepam.
Step 5d: Summoning of emergency medical assistance.
Step 6: Recovery and discharge. The patient should be

permitted to recover for as long as is necessary.
 SEVERE OVERDOSE REACTION
z
Step 1: P (position). The syringe should be removed from
the patient’s mouth (if applicable) and the patient placed
in the supine position with the feet elevated slightly.

Step 2: Summoning of emergency medical assistance.
Whenever a seizure develops during or after local anesthetic
injection, emergency assistance should be sought immeduately.
Step 3: C→A→B (circulation, airway, breathing), basic life support
(BLS), as needed.
Step 4: D (definitive care).
Step 4a: Administration of O2.
Step 4b: Protection of the patient. If seizures develop,
recommended management includes the prevention of injury
through protection of the arms, legs, and head.
z
Step 4c: Venipuncture and intravenous anticonvulsant administration. In certain

cases, however, securing a vein in a convulsing patient may prove difficult. In such
situations BLS should continue until emergency medical assistance arrives
Step 5: Postictal management.
Step 5a: C→A→B (circulation, airway, breathing), basic
life support (BLS), as needed.
Step 5b: Monitoring of vital signs.
Step 5c: Additional management considerations. If the
patient’s blood pressure remains depressed for an
extended period (>30 minutes) and emergency medical
assistance has not yet arrived, administration of
vasopressor to elevate blood pressure may be
considered.
Step 6: Recovery and discharge

Systemic Complications of Local Anesthesia

Uploaded by

Copyright:

Available Formats

Systemic Complications of Local Anesthesia

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Systemic Complications of Local Anesthesia

Uploaded by

Copyright:

Available Formats

z

Overdose reactions, allergy, and idiosyncrasy are

 A drug overdose reaction is defined as those clinical

 Patient factors  Drug factors

 Other drugs  Dose

 Presence of disease  Route of administration

 Genetics  Rate of injection

 Mental attitude and  Vascularity of injection site

 Local anesthetic administered is a plain solution (no

 Full cartridges (1.8 mL) administered with each injection.

 Local anesthetic administered to all four quadrants at one time.

 Exceeding the maximum dose based on patient’s body weight.

 MODERATE TO HIGH OVERDOSE LEVELS

Tonic-clonic seizure activity followed by:

Generalized central nervous system depression

Depressed blood pressure, heart rate, and respiratory rate

Step 1: Terminate the dental procedure.

Step 2: P (position). The conscious patient is placed in a comfortable position.

Step 3: Reassurance of the patient.

Step 4: C → A → B (circulation-airway-breathing), basic life support (BLS) as needed.

Step 5: D (definitive care).

Step 5a: Administration of O2.

Step 5b: Monitor vital signs.

Step 5c: Administration of an anticonvulsant drug, if

Step 5d: Summoning of emergency medical assistance.

Step 6: Recovery and discharge. The patient should be

the patient’s mouth (if applicable) and the patient placed

in the supine position with the feet elevated slightly.

Step 4c: Venipuncture and intravenous anticonvulsant administration. In certain

You might also like

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.