Complications Of Dental Local Anesthesia

7,923 views
7,603 views

Published on

Published in: Health & Medicine
0 Comments
46 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
7,923
On SlideShare
0
From Embeds
0
Number of Embeds
79
Actions
Shares
0
Downloads
1
Comments
0
Likes
46
Embeds 0
No embeds

No notes for slide

Complications Of Dental Local Anesthesia

  1. 1. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary COMPLICATIONS  OF  LOCAL   ANESTHESIA     Dr.  Hesham  El-­‐Hawary   Lecturer  OMFS   Faculty  of  Oral  &  Dental  Medicine   Cairo  University    
  2. 2. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Luqman    -­‐  14  | ۱٤ - ‫لقمان‬ ‫  سورة‬
  3. 3. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary ComplicaJons      Any  devia&on  from  the  normally  expected   paKern  during  or  aMer  securing  local   analgesia  
  4. 4. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary ComplicaJons      Any  devia&on  from  the  normally  expected   paKern  during  or  aMer  securing  local   analgesia   Classifica&ons     §  Primary  or  Secondary   §  Mild  or  Sever   §  Transient  or  Permanent   §  AKributed  to  soluJon  or  needle  inserJon  
  5. 5. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary ComplicaJons  from  local  Anesthesia     I.  ComplicaJons  associated  to  the     absorpJon  of  the  soluJon  used   II.  ComplicaJons  associated  with   needle  inserJon  
  6. 6. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary ComplicaJons  associated  with  absorpJon  of  the   anestheJc  soluJon   1.  Systemic  drug  reac&ons  due  to  the  local  anesthe&c  agent:   1.  Toxicity   2.  Allergy     3.  AnaphylacJc  reacJons   4.  Idiosyncrasy     2.  Local  reac&ons:     1.  InfecJons  due  to  contaminated  soluJons   2.  Local  Jssue  irritaJon  
  7. 7. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary ComplicaJons  associated  with  needle  inserJon     1.  FainJng  and  syncope   2.  Muscle  trismus   3.  Pain   4.  Edema   5.  InfecJon   6.  Broken  needles   7.  Prolonged  anesthesia   8.  Haematoma  formaJon   9.  Sloughing  and  ulceraJon   10. Bizarre  Neurological  symptoms  
  8. 8. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Keep  in  mind   •  A:  Airway     »  Clear     »  Adequate  RespiraJon   •  B:  Bleeding     »  Stopped     »  Achieve  inlet  to  vessels   •  C:  CirculaJon     »  Fluids  if  needed       •  D:  Drugs  to  treat  the  present  condiJon    
  9. 9. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Keep  in  mind   •  Call  medical  emergency  service     •  The  paJent  posiJon     –  Placed  in  horizontal  posiJon  on  his  back   –  Tilt  the  paJent  in  a  slightly  head  down  posiJon      or     –  elevate  the  legs  to  help  increase  cerebral  circulaJon   •  Adequate  oxygenaJon   •  Check  the  paJent's  cardiac  and  cardiovascular  status     •  Start  I.V.  fluids  (e.g.  5%  dextrose  in  H2O)   •  Drugs  according  to  the  condiJon     •  If  complete  circulatory  standsJll     –  IV  injecJon  of  atropine     –  SJmulaJon  of  the  heart  by  introducing  a  needle  directly  into  it     –  Intracardiac  injecJon  of  epinephrine  0.1  ml  of  1.1000  soluJon  
  10. 10. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary ComplicaJons  due  to  absorpJon  of  the   injected  soluJon   Systemic  complicaJons   1.  Toxicity   2.  Idiosyncrasy   3.  Allergy     4.  Anaphylaxis  
  11. 11. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary •  DefiniJon   •  EJology   •  Clinically  (Signs  &  Symptoms)   •  PrevenJon     •  Treatment    
  12. 12. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Toxicity  
  13. 13. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary DefiniJon    It  refers  to  the   symptoms  manifested  as  a  result  of   overdosage  or  excessive  administra&on  of  the  soluJon  
  14. 14. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary EJology     •  Large  dose  of  drug   •  Accidental  intravenous  injecJon     •  High  concentra&on  of  a  drug   •  Unusually  slow  detoxifica&on  as  a  result  of   severe  liver  disease   •  Slow  elimina&on  as  a  result  of  kidney  trouble   •  Use  of  highly  toxic  drugs  whose  margin  of  safety   is  narrow   •  InjecJon  of  soluJon  in  highly  vascular  area   without  the  addiJon  of  vasoconstrictor   substance  
  15. 15. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Clinically     I.  Early  C.N.S.  s&mula&on  symptoms       1) Cerebral  Cortex   1. TalkaJve   2. Restlessness   3. Apprehensive   4. Excited   5. Convulsive   2) Medulla   1. Lethargy   2. Sleepiness   3. Unconscious    
  16. 16. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Clinically     II.  Late  C.N.S.  Depression  symptoms       3) Cerebral  Cortex   1. Increased  blood  pressure   2. Increase  pulse  rate   3. Increase  respiratory  rate   4. Nausea  &  vomiJng   4) Medulla   1. Dropped  blood  pressure   2. Decreased  pulse  rate   3. Decreased  heart  rate   4. Respiratory  depression   5. unconsciousness  
  17. 17. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary      N.B.    Death  usually  occur  due  to  respiratory   depression  and  hypoxia  and  its  subsequent   effect  on  the  cardiovascular  system  
  18. 18. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary PrevenJon     1.  Pre-­‐analgesic  evalua&on  of  the  paJent   2.  Use  the  weakest  possible  concentraJon     3.  Use  vasoconstrictor  whenever  possible     4.  Use  of  the  least  possible  volume   5.  Aspirate  before  injecJon     6.  Slow  injecJon   7.  Monitor  the  paJent  carefully  aMer   injecJon  
  19. 19. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Treatment   •  Mild  S&mula&on   – No  treatment   – Stop  further  injecJon   •  Moderate  sJmulaJon   •  Convulsions  phase   •  Depression  phase  
  20. 20. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Treatment   •  Mild  SJmulaJon   •  Moderate  s&mula&on   – IV  injecJon  of  Barbiturates   •  0.2%  soluJon  of  sodium  thiopental     •  Secobarbital  (Seconal)   – Oxygen  inhalaJon     •  Convulsions  phase   •  Depression  phase  
  21. 21. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Treatment   •  Mild  SJmulaJon   •  Moderate  sJmulaJon   •  Convulsions  phase   – AnJconvulsent  IV  /  IM     •  Coramine  (150-­‐450  mg.  I.V.)   •  Metrazol  (100  mg  I.V.)  (Midazolam  or  Diazepam)     •  Wyamine  (7.5  mg  I.V.  or  15  mg  I.M.)  or  neosynephrine     – Oxygen  inhalaJon   •  Depression    
  22. 22. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Treatment   •  Mild  SJmulaJon   •  Moderate  sJmulaJon   •  Convulsions  phase   •  Depression  phase   – ArJficial  RespiraJon   – IV  fluids   – SympathmemeJc  drugs  
  23. 23. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Vasoconstrictor  Toxicity  
  24. 24. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary •  DefiniJon   •  EJology     •  Clinically   – PalpitaJon   – Tachycardia   – Hypertension   – Headache   – Apprehension   – Restlessness   – N.B.  Difficult  to  differenJate  from  those  of  L.A.  Agent   •  PrevenJon  and  treatment  
  25. 25. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Idiosyncrasy    
  26. 26. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary DefiniJon   •  Abnormal  reacJon  to  a  drug  or  group  of  drugs   exhibited  when  only  a  small  amount  or  a   nontoxic  dose  of  the  drug  has  been  used   •  This  means  that  the  suscepJble  paJent  reacts   adversely  to  a  volume  or  concentraJon  of  the   drug  that  would  not  affect  the  typical  paJent   •  Nontoxic  –  Non  Allergic  condiJon  
  27. 27. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary EJology     •  Unknown     •  Enzymopathy   – Congenital   – Acquired   •  Psychogenic    
  28. 28. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Clinically   1.  Pallor   2.  Tachycardia   3.  Hypotension   4.  Decreased  Heart  rate   5.  Collapse  
  29. 29. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary PrevenJon   1. Do  not  use  any  drug,  which  the  paJent  gives  you  a   history  of  previous  reacJons  to  it   2. Inject  slowly  and  observe  the  paJent  closely  during   injecJon  
  30. 30. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary PrevenJon   1. Do  not  use  any  drug,  which  the  paJent  gives  you  a   history  of  previous  reacJons  to  it   2. Inject  slowly  and  observe  the  paJent  closely  during   injecJon   Treatment       •  The  same  as  the  depression  stage  of  toxic  overdose   •  Barbiturates   are   ineffecJve   in   the   treatment   or   prevenJon  of  this  condiJon  
  31. 31. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Allergy  and  Anaphylaxis    
  32. 32. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary •  Allergy   is   a   hypersensi&ve   reac&on   that   occurs   through   exposure   to   an   an&gen   (Ag)  such  as  a  drug  (  as  L.A.  agent)  which   the  pt.  has  been  previously  exposed  to  it   creaJng  an  Ag  -­‐  Ab  reacJon   •  Anaphylaxis   is   a   severe   form   of   allergic   reacJons  occurs  suddenly  &  end  fatally  in   which   sudden   violent   loss   of   vasomotor   tonus     DefiniJon    
  33. 33. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary •  Allergy   is   a   hypersensi&ve   reac&on   that   occurs   through   exposure   to   an   an&gen   (Ag)  such  as  a  drug  (  as  L.A.  agent)  which   the  pt.  has  been  previously  exposed  to  it   creaJng  an  Ag  -­‐  Ab  reacJon •  Anaphylaxis   is   a   severe   form   of   allergic   reacJons  occurs  suddenly  &  end  fatally  in   which   sudden   violent   loss   of   vasomotor   tonus     DefiniJon    
  34. 34. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Allergy   1.  Rashes   2.  UrJcaria   3.  Fever   4.  DermaJJs   5.  AngioneuroJc  edema   6.  Bronchial  asthma   7.  Anaphylaxis(  anaphylacJc  shock)   Clinically  
  35. 35. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Anaphylaxis   1.  Drop  in  B.P.  (↓B.P.)   2.  Weak  rapid  pulse     3.  Inadequate  respiraJon  (↓Respiratory  rate)     4.  Death     Clinically  
  36. 36. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary 1.  An&histaminic      (benadryl  20  -­‐  40  mg  IV  or  IM.)   2.  Epinephrine  1:1000  concentraJon    0.3  mg  SC.  or  IM.   3.  Bronchodilator        via  inhaler   4.  Cor&costeroid        100mg  IV.  hydrocorJsone  hemisuccinate   Management    
  37. 37. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary ComplicaJons  due  to  absorpJon  of  the   injected  soluJon   Local  ReacJons   1.  InfecJon   2.  Tissue  irritaJon  
  38. 38. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary InfecJon   InfecJon   from   contaminated   L.A.   soluJons   are   uncommon   due   to   high   standard   of   asepsis   during   manufacturing   Tissue  Irrita&on    Local  Jssue  irritaJon  through  the  use  of  non   isotonic  L.A.  soluJons  are  uncommon  due  to  high   standard  of  manufacturing  
  39. 39. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary ComplicaJons  associated  with  needle   inserJon  
  40. 40. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary FainJng  or  Syncope     •  It  is  due  to  temporary  cerebral  ischemia  as  a   result  of  dilaJon  of  the  splanchnic  B.V.  &   reduced  cardiac  output   •  Signs  &symptoms:   1. Pallor   2. Cold   3. Sweaty   4. Dizzy   5. Nausea   6. Loss  of  consciousness  
  41. 41. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Ø  Management:   •  Stop  dental  procedure   •  Place  pt.  in  supine  posiJon  with  slight  head  down   or  elevate  the  legs  (  to  ↑ cerebral  circulaJon)    or   •  Place  the  hands  of  the  pt.  behind  his  head  and   bend  him  forward  unJl  his  head  is  in  between  the   knee(  to  produce  pressure  on  the  splanchnic  B.V.   to  replace  the  blood  that  drained  from  the  head   •  Reassure  pt.     •  AromaJc  spirit  (ammonia)  held  under  the  nose  of   the  pt.  for  several  breath  
  42. 42. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Muscle  Trismus   •  Inability  to  open  the  mouth  normally   •  EJology:   –  InjecJng  into  muscles  or  ligaments     –  Needle  borne  infecJon     –  Contaminated    irritaJng  soluJons   –  Haematoma  formaJon  in  the  muscle   •  Preven&on:  
  43. 43. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Ø  Management:          Depends  upon  the  cause   –  If  it  is  due  to  trauma  it  necessitates  slight  muscle   exercise  and  drug  therapy  to  relieve  pain  if  present   –  If  due  to  infecJon  this  needs  anJbioJcs   1.  Heat  therapy     2.  Warm  saline  rinses   3.  Analgesics   4.  Muscle  relaxant  
  44. 44. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Pain   •  E&ology:     –  InjecJon  into  a  muscle  or  ligament,  paroJd  gland,   T.M.J.       –  Using  a  non-­‐isotonic  soluJon   –  Very  cold  soluJons   –  Contaminated  soluJons     –  Too  rapid  injecJon  resulJng  in  Jssue  distenJon     –  Numerous  needle  punctures   •  PrevenJon   Ø  Management:   1.  Assure  the  pt.   2.  Analgesics  
  45. 45. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Edema   •  It  is  usually  a  symptom   •  EJology:   –  Trauma   –  InfecJon   –  Allergy   –  Hemorrhage   •  Treatment  and  prevenJon  depends  upon  the   cause  
  46. 46. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary InfecJons   •  EJology:   –  Contaminated  Non-­‐sterile  needles  or  soluJons   –  Carrying  surface  bacteria  from  non-­‐sterile  mucous   membrane  into  the  deeper  structures  with  the  Jp  of   the  needle  are  the  causaJve  factors   –  InjecJon  into  infected  area   •  PrevenJon   Ø  Management:   –  AnJbioJcs   –  AnJnflammatory  drugs    
  47. 47. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Broken  needles     •  Do  not  use  old  or  dull  needles   •  Do  not  use  short  needles  for  nerve  block   •  Do  not  aKempt  to  force  the  needle  against   resistance   •  Do  not  change  the  direcJon  of  the  needle   while  it  is  embedded  in  the  Jssues,  always   remove  it  and  redirect  it   •  Do  not  use  a  needle  of  a  too  fine  gauge  
  48. 48. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary •  Warn  the  paJent  against  any  movement  during   injecJon  and  ask  him  to  stay  sJll  Jll  you  finish  the   injecJon   •  Do  not  surprise  the  paJent  with  a  sudden  unexpected   needle  inserJon   •  Do  not  insert  the  needle  so  far  that  it  is  out  of  sight  in   Jssues   •  Needles  should  not  be  sterilized  by  flaming  because   the  tamper  of  their  alloy  will  be  destroyed  and  they   break  easily  
  49. 49. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary  On  most  occasions  accidental   breakage  takes  place  at  the  hub    This  enables  the  operator  to  remove   the  broken  needle  by  grasping  the   porJon  remaining  in  view  
  50. 50. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Prolonged  Anesthesia     •  EJology:   –  ContaminaJon  of  the  anestheJc  soluJon  with  alcohol  or  some  other   germicidal  soluJon   –  Needle  trauma  to  nerve  Jssue   •  This  is  manifested  at  the  Jme  of  injecJon,  the  paJent  reports   immediately  feeling  a  hot  sharp  pain  flushing  to  the  terminal   branches  of  the  nerve  trunk  contacted   –  Trauma  and  swelling  of  the  soM  Jssue  in  proximity  to  the  nerve   Ø  Management:   1.  Assure  the  pt.   2.  It  takes  some  Jme  to  disappear  
  51. 51. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Haematoma  and  Ecchymosis   •  The   effusion   of   blood   into   the   Jssues   as   a   result   of   punctured  B.V.  leading  to  haematoma  formaJon   •  Common  sites:  maxillary  tuberosity  region   Ø Management:   1. No  aKempt  should  be  made  to  aspirate  the  contents  of   the  haematoma   2. It  will  absorb  with  Jme  (7  –  14)  days   3. Ice  packs  may  be  applied  iniJally  to  act  as  analgesic  &  a   vasoconstrictor  to  reduce  size  of  haematoma  
  52. 52. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Sloughing  and  UlceraJon   •  Trauma&c  ulcers     –  Appear  on  the  palate  from  excessive  amount  of  soluJon  injected  into  the   dense  mucoperiosteal  Jssue  of  the  palate   •  Chewing  the  lip  following  a  mandibular  injecJon     •  Pinching  of  the  lip  between  the  forceps  and  the  teeth   •  ApplicaJon  of  topical  anesthe&c  may  cause  irritaJon  to  m.m.  lead   to  sloughing  &  ulceraJon   Ø  Management:     Usually   resolves   within   a   few   days   or   one   week   without   any   intervenJon  
  53. 53. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Bizarre  Neurological  Symptoms   •  Very  rare   –  Facial  paralysis   –  Crossed  eyes   –  Muscular  weakness   –  Temporary  blindness     •  The   best   method   of   prevenJng   these   complicaJons   is   to   follow   closely   the   accepted  techniques  described  above  
  54. 54. COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary Thank  You  Thank  You  

×