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Complications Of Dental Local Anesthesia
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Complications Of Dental Local Anesthesia Presentation Transcript

  • 1. Luqman - 14 COMPLICATIONS OF LOCAL ANESTHESIA - Hesham El-Hawary
  • 2. COMPLICATIONS OF LOCAL ANESTHESIA Dr. Hesham El-Hawary Lecturer OMFS Faculty of Oral & Dental Medicine Cairo University COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 3. Complications Any deviation from the normally expected pattern during or after securing local analgesia COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 4. Complications Any deviation from the normally expected pattern during or after securing local analgesia Classifications     Primary or Secondary Mild or Sever Transient or Permanent Attributed to solution or needle insertion COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 5. Complications from local Anesthesia I. Complications associated to the absorption of the solution used II. Complications associated with needle insertion COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 6. Complications associated with absorption of the anesthetic solution 1. Systemic drug reactions due to the local anesthetic agent: 1. 2. 3. 4. Toxicity Allergy Anaphylactic reactions Idiosyncrasy 2. Local reactions: 1. 2. Infections due to contaminated solutions Local tissue irritation COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 7. Complications associated with needle insertion 1. Fainting and syncope 2. Muscle trismus 3. Pain 4. Edema 5. Infection 6. Broken needles 7. Prolonged anesthesia 8. Haematoma formation 9. Sloughing and ulceration 10. Bizarre Neurological symptoms COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 8. Keep in mind • A: Airway » » Clear Adequate Respiration • B: Bleeding » » Stopped Achieve inlet to vessels • C: Circulation » Fluids if needed • D: Drugs to treat the present condition COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 9. Keep in mind • Call medical emergency service • The patient position • • • • • – Placed in horizontal position on his back – Tilt the patient in a slightly head down position or – elevate the legs to help increase cerebral circulation Adequate oxygenation Check the patient's cardiac and cardiovascular status Start I.V. fluids (e.g. 5% dextrose in H2O) Drugs according to the condition If complete circulatory standstill – IV injection of atropine – Stimulation of the heart by introducing a needle directly into it – Intracardiac injection of epinephrine 0.1 ml of 1.1000 solution COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 10. Complications due to absorption of the injected solution Systemic complications 1. 2. 3. 4. Toxicity Idiosyncrasy Allergy Anaphylaxis COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 11. • • • • • Definition Etiology Clinically (Signs & Symptoms) Prevention Treatment COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 12. Toxicity COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 13. Definition It refers to the symptoms manifested as a result of overdosage or excessive administration of the solution COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 14. Etiology • • • • Large dose of drug Accidental intravenous injection High concentration of a drug Unusually slow detoxification as a result of severe liver disease • Slow elimination as a result of kidney trouble • Use of highly toxic drugs whose margin of safety is narrow • Injection of solution in highly vascular area without the addition of vasoconstrictor substance COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 15. Clinically I. Early C.N.S. stimulation symptoms 1) Cerebral Cortex 2) Medulla 1. Talkative 1. Lethargy 2. Restlessness 2. Sleepiness 3. Apprehensive 3. Unconscious 4. Excited 5. Convulsive COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 16. Clinically II. Late C.N.S. Depression symptoms 3) Cerebral Cortex 4) Medulla 1. Increased blood pressure 1. Dropped blood pressure 2. Increase pulse rate 2. Decreased pulse rate 3. Increase respiratory rate 3. Decreased heart rate 4. Nausea & vomiting 4. Respiratory depression 5. unconsciousness COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 17. N.B. Death usually occur due to respiratory depression and hypoxia and its subsequent effect on the cardiovascular system COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 18. Prevention 1. 2. 3. 4. 5. 6. 7. Pre-analgesic evaluation of the patient Use the weakest possible concentration Use vasoconstrictor whenever possible Use of the least possible volume Aspirate before injection Slow injection Monitor the patient carefully after injection COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 19. Treatment • Mild Stimulation – No treatment – Stop further injection • Moderate stimulation • Convulsions phase • Depression phase COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 20. Treatment • Mild Stimulation • Moderate stimulation – IV injection of Barbiturates • 0.2% solution of sodium thiopental • Secobarbital (Seconal) – Oxygen inhalation • Convulsions phase • Depression phase COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 21. Treatment • Mild Stimulation • Moderate stimulation • Convulsions phase – Anticonvulsent 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 inhalation • Depression COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 22. Treatment • • • • Mild Stimulation Moderate stimulation Convulsions phase Depression phase – Artificial Respiration – IV fluids – Sympathmemetic drugs COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 23. Vasoconstrictor Toxicity COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 24. • Definition • Etiology • Clinically – Palpitation – Tachycardia – Hypertension – Headache – Apprehension – Restlessness – N.B. Difficult to differentiate from those of L.A. Agent • Prevention and treatment COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 25. Idiosyncrasy COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 26. Definition • Abnormal reaction 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 susceptible patient reacts adversely to a volume or concentration of the drug that would not affect the typical patient • Nontoxic – Non Allergic condition COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 27. Etiology • Unknown • Enzymopathy – Congenital – Acquired • Psychogenic COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 28. Clinically 1. 2. 3. 4. 5. Pallor Tachycardia Hypotension Decreased Heart rate Collapse COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 29. Prevention 1. Do not use any drug, which the patient gives you a history of previous reactions to it 2. Inject slowly and observe the patient closely during injection COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 30. Prevention 1. Do not use any drug, which the patient gives you a history of previous reactions to it 2. Inject slowly and observe the patient closely during injection Treatment • The same as the depression stage of toxic overdose • Barbiturates are ineffective in the treatment prevention of this condition COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary or
  • 31. Allergy and Anaphylaxis COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 32. Definition • • Allergy is a hypersensitive reaction that occurs through exposure to an antigen (Ag) such as a drug ( as L.A. agent) which the pt. has been previously exposed to it creating an Ag - Ab reaction Anaphylaxis is a severe form of allergic reactions occurs suddenly & end fatally in which sudden violent loss of vasomotor tonus COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 33. Definition • • Allergy is a hypersensitive reaction that occurs through exposure to an antigen (Ag) such as a drug ( as L.A. agent) which the pt. has been previously exposed to it creating an Ag - Ab reaction Anaphylaxis is a severe form of allergic reactions occurs suddenly & end fatally in which sudden violent loss of vasomotor tonus COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 34. Clinically Allergy 1. 2. 3. 4. 5. 6. 7. Rashes Urticaria Fever Dermatitis Angioneurotic edema Bronchial asthma Anaphylaxis( anaphylactic shock) COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 35. Clinically Anaphylaxis 1. 2. 3. 4. Drop in B.P. (↓B.P.) Weak rapid pulse Inadequate respiration (↓Respiratory rate) Death COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 36. Management 1. Antihistaminic (benadryl 20 - 40 mg IV or IM.) 2. Epinephrine 1:1000 concentration 0.3 mg SC. or IM. 3. Bronchodilator via inhaler 4. Corticosteroid 100mg IV. hydrocortisone hemisuccinate COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 37. Complications due to absorption of the injected solution Local Reactions 1. Infection 2. Tissue irritation COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 38. Infection Infection from contaminated L.A. solutions are uncommon due to high standard of asepsis during manufacturing Tissue Irritation Local tissue irritation through the use of non isotonic L.A. solutions are uncommon due to high standard of manufacturing COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 39. Complications associated with needle insertion COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 40. Fainting or Syncope • It is due to temporary cerebral ischemia as a result of dilation of the splanchnic B.V. & reduced cardiac output • Signs &symptoms: 1. Pallor 2. Cold 3. Sweaty 4. Dizzy 5. Nausea 6. Loss of consciousness COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 41.  Management: • Stop dental procedure • Place pt. in supine position with slight head down or elevate the legs ( to ↑ cerebral circulation) or • Place the hands of the pt. behind his head and bend him forward until 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. • Aromatic spirit (ammonia) held under the nose of the pt. for several breath COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 42. Muscle Trismus • Inability to open the mouth normally • Etiology: – – – – Injecting into muscles or ligaments Needle borne infection Contaminated irritating solutions Haematoma formation in the muscle • Prevention: COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 43.  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 infection this needs antibiotics 1. 2. 3. 4. Heat therapy Warm saline rinses Analgesics Muscle relaxant COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 44. Pain • •  1. 2. Etiology: – Injection into a muscle or ligament, parotid gland, T.M.J. – Using a non-isotonic solution – Very cold solutions – Contaminated solutions – Too rapid injection resulting in tissue distention – Numerous needle punctures Prevention Management: Assure the pt. Analgesics COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 45. Edema • It is usually a symptom • Etiology: – – – – Trauma Infection Allergy Hemorrhage • Treatment and prevention depends upon the cause COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 46. Infections • Etiology: – Contaminated Non-sterile needles or solutions – Carrying surface bacteria from non-sterile mucous membrane into the deeper structures with the tip of the needle are the causative factors – Injection into infected area • Prevention  Management: – Antibiotics – Antinflammatory drugs COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 47. Broken needles • Do not use old or dull needles • Do not use short needles for nerve block • Do not attempt to force the needle against resistance • Do not change the direction of the needle while it is embedded in the tissues, always remove it and redirect it • Do not use a needle of a too fine gauge COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 48. • Warn the patient against any movement during injection and ask him to stay still till you finish the injection • Do not surprise the patient with a sudden unexpected needle insertion • Do not insert the needle so far that it is out of sight in tissues • Needles should not be sterilized by flaming because the tamper of their alloy will be destroyed and they break easily COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 49. On most occasions accidental breakage takes place at the hub This enables the operator to remove the broken needle by grasping the portion remaining in view COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 50. Prolonged Anesthesia • Etiology: – – – Contamination of the anesthetic solution with alcohol or some other germicidal solution Needle trauma to nerve tissue • This is manifested at the time of injection, the patient reports immediately feeling a hot sharp pain flushing to the terminal branches of the nerve trunk contacted Trauma and swelling of the soft tissue in proximity to the nerve  Management: 1. Assure the pt. 2. It takes some time to disappear COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 51. Haematoma and Ecchymosis • The effusion of blood into the tissues as a result of punctured B.V. leading to haematoma formation • Common sites: maxillary tuberosity region  Management: 1. No attempt should be made to aspirate the contents of the haematoma 2. It will absorb with time (7 – 14) days 3. Ice packs may be applied initially to act as analgesic & a vasoconstrictor to reduce size of haematoma COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 52. Sloughing and Ulceration • Traumatic ulcers – Appear on the palate from excessive amount of solution injected into the dense mucoperiosteal tissue of the palate • • • Chewing the lip following a mandibular injection Pinching of the lip between the forceps and the teeth Application of topical anesthetic may cause irritation to m.m. lead to sloughing & ulceration  Management: Usually resolves within a few days or one week without any intervention COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 53. Bizarre Neurological Symptoms • Very rare – – – – Facial paralysis Crossed eyes Muscular weakness Temporary blindness • The best method of preventing these complications is to follow closely the accepted techniques described above COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary
  • 54. Thank You COMPLICATIONS OF LOCAL ANESTHESIA Hesham El-Hawary