complication of local anesthesia

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complication of local anesthesia

  1. 1. DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY SEMINAR PRESENTED ON; COMPLICATIONS OF LOCAL ANESTHESIA PRESENTED BY; NISHTHA SINGHAL BDS FINAL YEAR
  2. 2. LOCAL COMPLICATIONS OF ANAESTHETICS A)COMPLICATIONS ARISING FROM DRUGS OR CHEMICAL USED 1.SOFT TISSUE INJURY 2.SLOUGHING OF TISSUES B)COMPLICATIONS ARISING FROM INJECTION TECHNIQUES 1)NEEDLE BREAKAGE 2)HEMATOMA 3)FAILURE TO OBTAIN LOCAL ANESTHESIA 4)POST-INJECTION HERPETIC LESIONS C)COMPLICATIONS ARISING FROM BOTH 1)PAIN ON INJECTION 2)BURNING ON INJECTION 3)TRISMUS 4)BLANCHING OF SKIN 5)EDEMA 6)PERSISTENT PARATHESIA OR ANESTHESIA 7)INFECTION 8)PERSISTENT PAIN 9)NEUROLOGICAL SYMPTOMS FACIAL N. PARALYSIS VISUAL DISTURBANCES
  3. 3. 1)SOFT TISSUE INJURY CAUSES PREVENTION MANAGEMENT -SELF INFLICTED -APPROPRIATE -ANALGESICS FOR PAIN TRAUMA TO LIPS DURATION LA -ANTIBIOTICS ,TONGUE WHILE STILL -COTTON ROLLS -LUKEWARM SALINE NUMB BETWEEN LIPS AND RINSES TO AID IN -SEEN IN CHILDREN TEETH DECREASE ANY AND MENTALLY AND -WARN THE PATIENT SWELLING THAT MAY PHYSICALLY AND GUARDIAN BE PRESENT DISABLED AGAINST -PETROLEUM JELLY AS -SOFT TISSUE EATING,DRINKING HOT LUBRICANT ANESTHESIA LASTS FLUIDS AND BITING ON LONGER THEN PULPAL LIPS OR TONGUE TO TEST FOR ANESTHESIA 2)SLOUGHING OF TISSUES i)EPITHELIAL -DO NOT USE HIGH DEPEND ON INJURY DEQUAMATION CONC. LA WITH -SYMPTOMATIC- -TOPICAL ANESTHETIC VASOCONSTRICTOR ANALGESICS,ORABASE FOR PROLONGED (NOREPINEPHRINE -RESOLVES WITHIN 1-2 PERIOD 1:30,000 NOT WEEKS -HIGHTENED PRESCRIBED) -AN ESTABLISH LESION SENSTIVITY OF TISSUE MAY REQUIRE TO LA REACTION IN INCISION AND AREA OF TOPICAL DRAINAGE ANESTHETICS ii)STERILE ABSCESS -PROLONGED --ISCHEMIA DUE TO VASOCONSTRICTOR -DEVELOPS ON HARD PALATE
  4. 4. B)COMPLICATIONS ARISING FROM INJECTION TECHNIQUES 1)NEEDLE BREAKAGE CAUSES PRIMARY CAUSE- UNEXPECTED MOVEMENT OF PATIENT SECONDARY CAUSE-  INAAPROPRIATE THICKNESS OF NEEDLE  PREVIOUSLY BENT  REDIRECTION OF NEEDLES ONCE INSERTED INSIDE TISSUE  MANUFACTURE DEFECT(RARE)  FORCING NEEDLE AGAINST RESISTENCE  NEEDLE ENGAING THE PERIOSTEUM PREVENTION  INFORM THE PATIENT  USE PROPER GAUZE NEEDLE(FOR N. BLOCK-25 GAUZE,FOR INFILTRATION-27,25,30 GAUZE  USE PRESTERLIZED DISPOSABLE NEEDLES  ENTIRE LENGTH SHOULD NOT BE INSERTED(FEW MM AWAY FROM HUB)  DO NOT REDIRECT IF EMBEDDED  USE GOOD QUALITY NEEDLE  GENTLE MANIPULATION-NO EXCESSIVE FORCE  DO NOT PERMIT THE NEEDLE TO ENGAGE THE PERIOSTEUM  STABILISATION OF JAW  NEEDLE SHOULD ALWAYS BE KEPT DURING INSERTION  AVOID MULTIPLE PENETRATIONS MANAGEMENT CALM,DO NOT PANIC INFORM PATIENT IF VISIBLE-USE HEMOSTAT OR MAC GILLS TUBE IF NOT-FLOUROSCOPE,FOLLOW UP,SURGERY
  5. 5. 2)HEMATOMA THE EFFUSION OF BLOOD INTO EXTRAVASCULAR SPACES CAN RESULT FROM INADVERTENTLY NICKING A BLOOD VESEL(ARTERY OR VEIN)DURING THE INJECTION OF LA NICKING OF ARTERY-HEMATOMA INCRESE RAPIDLY IN SIZE NICKING OF VEIN-MAY OR MAY NOT RESULT IN FORMATION CAUSE NICK→BLOOD EFFUSES FROM VESSELS UNTIL EXTRAVASCULAR PRESURRE EXCEEDS INTRAVASCULAR→CLOTTING OCCURS PREVENTION  MODIFY INJECTION TECHNIQUE AS DICTATED BY PATIENT  USE SHORT NEEDLE(APPROPRIATE LENGTH)  MINIMIZE NO. OF PENETRATION  NEVER USE NEEDLE AS A PROBE ON TISSUE MANAGEMENT IMMEDIATE-DIRECT PRESSURE AT SITE OF BLEEDING FOR NOT LESS THAN 2 MINS BLOCK PRESSURE SITE CLINICAL MANIFESTATION IANB MEDIAL ASPECT OF INTRAORAL MANDIBULAR RAMUS DISCOLORATION AND PROBABLE TISSUE SWELLING ON MEDIAL ASPECT OF MANDIBULAR RAMUS INFRAORBITAL INFRAORBITAL DISCOLORATION OF FORAMEN SKIN BELOW THE LOWER EYELID MENTAL N. BLOCK MENTAL FORAMEN DISCOLORATION OF SKIN OVER THE MENTAL FORAMEN OR SWELLING IN THE MUCOBUCCAL FOLD IN REGION OF MENTAL
  6. 6. FORAMEN PSA N BLOCK SOFT TISSUE IN COLORLESS SWELLING MUCOBUCCAL FOLD APPEAR ON SIDE OF AS FAR AS POSSIBLE AS FACE (USUALLY A FEW DISTALLY AS CAN BE MINUTES AFTER THE TOLERATED BY INJEVTION IS PATIENT COMPLETED)→DAYS INFERIOR AND ANTERIOR TOWARD THE LOWER ANT. REGION OF CHEEK IN PSA HEMATOMA EARLIER IN PTERYGOID VENOUS PLEXUS ACCORDING TO SICHER –PSA ARTERY OF SORENESS DEVELOPS –ADVISE THE PATIENT TO TAKE ANALGESIC DO ON APPLY HEAT OVER FOR AT LEAST 4-6 HOUR(VASODILATION- INCREASES IN SIZE) HEAT APPLIED ON NEXT DAY-ACTS AS A)ANALGESIC AND B) VASODILATOR↑RATE AT WHICH BLOOD ELEMENTS ARE RESORBED IN FORM OF WARM MOIST TOWELS TO THE AFFECTED AREA FOR 20 MIN EVERY HOUR RESOLVE S WITHIN 7-14 DAYS. 5)FAILURE TO OBTAIN ANESTHESIA CAUSES A)OPERATOR DEPENDENT i)LA AGENT(TYPE,DOSE) ii)IMPROPER SURGICAL TECH. iii)INJ OF WRONG SOLN. iv)I.V v_I.M B)PATIENT DEPENDENT i)ANATOMICAL-ADDITIONAL INNERVATION ii)PSYCHOLOGICAL –UNCOOPRATIVE,MOVEMENT iii)PATHOLOGICAL-INFECTION ADDITIONAL INNERVATION ‘CUTANEOUS COLLI NERVE’ (CERVICAL CUTANEOUS NERVE)-(A BRANCH OF 3RD CERVICAL NERVE)-ENTERS A SMALL FORAMEN ON
  7. 7. LINGUAL ASPECT OD RAMUS AND SUPPLIES INNERVATION TO MANDIBULAR TEETH. IN CASE OF FAILURE IN OBTAINING OPERATIVE ANESTHESIA AFTER A MANDIBULAR INJ. ,A SUPPLEMENTAL INJ.CAN BE GIVEN TO CERVICAL CUTANEOUS NERVE.THIS IS DONE BY INSERTING THE NEEDLE LINGUALLY BETWEEN 2 BICUSPID TEETH,AT THE REFLECTION OF MUCOUS MEMBRANE AND DIRECTING IT POSTERIORLY,ABOUT HALF OF THE NEEDLE IS INSERTED AND ABOUT 0.5ML OF SOLN. IS INJECTED. 4)POST INJECTION HERPETIC LESIONS CAUSE  REACTIVATION OF DORMANT HERPES VIRUS  H/O RECUURENT HERPES LABIALIS  IN TERMINAL BRANCHES OF TRIGERMINAL NERVE PREVENTION-DELAY SURGICAL INTERVENTION IN THE ACTIVE STAGE MANAGEMENT-ANTIVIRAL DRUGS C)COMPLICATIONS ARISING FROM BOTH CAUSES PREVENTION MANAGEMENT 1)PAIN ON -PROPER TECH. NOT REQUIRED INSERTION -SHARP NEEDLE- -CARELESS TECH. INSERT LA SLOWLY -BLUNT NEEDLE -USE STERILE LA SOLN. -RAPID INSERTION OF -USE TOPICAL LA B4 LA SOLN. CAN CAUSE -SOLN. AT ROOM TEMP. TISUE DAMAGE -HIGH TEMP. OF SOLN. 2)BURNING -SLOW INJ. NOT REQUIRED SENSATION -SOLN. AT ROOM TEMP. -RAPID INJ. -CONTAMINATED NEEDLE CARTRIDGE -HIGH TEMP. LA SOLN. ALTERED PH OF SOLN. (PH PLAIN-5 APP,WITH
  8. 8. VASOCONSTRICTOR-3 APP) 3)INFECTION -PROPER PREP. OF SITE -ANALGESICS -CONTAMINATION OF PRIOR TO -ANTIBIOTICS NEEDLE PENETRATION -PHYSIOTHERAPY -IMPROPER PREP. OF -CAREFUL HANDLING -MUSCLE RELAXANTS SITE OF NEEDLES (AVOID -NEEDLE PASSING TOUCHING NON- THROUGH AN AREA OF STERILE SURFACE) INFECTION -LA SOLN DEPOSITED UNDER PRESSURE ,AS IN PDL INJ.→TRANSPORT BACTERIA 4)EDEMA -PREOP ASSESMENT -FIND OUT CAUSE -TRUAMA -CAREFUL HANDLING -ALLERGY-(A,B,C,D) -INFECTION OF LA -ALLERGY ARMAMENTARIUM -HEMORRHAGE -ATRAUMATIC TECH. -INJ OF IRRITATING SOLN. 5)TISSUE -USE ASPIRATION -TRANSIENT BLANCHING TECH. PHENOMENON -TRAUMA TO BLOOD -AVOID -NO T/T REQUIRED VESSEL BY NEEDLE INTRAARTERIAL -I.V. ADMINISTRATION ADMINISTRATION 6)TRISMUS CAUSES PRIMARY CAUSE-TRAUMA TO MUSCLE ,BLOOD VESSELS IN INFRATEMPORAL FOSSA SECONDARY CAUSES- #INJECTION OF LA CONTAINING IRRITATING SOLN.(ALCOHOL,COLD STERILISING SOLN.) #LA HAVE MILD MYOTOXIC PROPERTIES (AIDS TO PROGRESSIVE NECROSIS OF EXPOSED MUSCLE FIBRES) # HEMATOMA –(LEADS TO IRITATION OF MUSCLE FIBRES # LOW GRADE INFECTION
  9. 9. # EXCESSIVE DEPOSITION OF LA-DISTENSION OF TISSUES-POST INJ TRISMUS #THE BARB OCCURRED WHEN THE NEEDLE COME INTO CONTACT WITH THE MEDIAL ASPECT OF THR MANDIBULAR RAMUS,WITHDRAWL OF THE NEEDLE FROM TISSUE INCREASED THE LIKELIHOOD OF INVOLVEMENT OF THE LINGUAL OR IANB AND DEVELOPMENT OF TRISMUS PROBLEMS AVG. INTERINCISAL OPENING IN ACSES OF TRISMUS IS 13.7MM IN CHRONIC HYPOMOBILTY- • IF T/T NOT GIVEN • SECONDARY TO ORGANISATION OF HEMATOMA WITH SUBSEQUENT FIBROSIS AND SCAR CONTRACTURE • INFECTION –INCRESED PAIN-INCRASED TISSUE REACTION(IRRITATION AND SCARRING). PREVENTION  USE SHARP,STERILE,DISPOSABLE NEEDLE  USE ASEPTIC TECH.  ATRAUMATIC TECH.  AVOID MULTIPLE PENETRATION  USE MINM EFFECTIVE VOL. OF LA MANAGEMENT 1)HEAT THERAPY-HOT MOIST TOWELS TO AFFECTED AREA FOR 20 MINS EVERY HOUR 2)WARM SALINE RINSE-HELD IN THE MOUTH ON THE INVOLVED SITE AND SPIT OUT 3)ANALGESICS ASPIRIN(325MG) 4)MUSCLE RELAXANTS- CHLOROXAZONE (250 mg IN 2 TO 3 DIVIDED DOSE) OR DIAZEPAM (5-10 mg BID) OR MEMEPROBAMATE(1.2g IN 3-4 DIVIDED DOSES) 5)PHYSIOTHERAPY-OPENING AND CLOSING THE MOUTH ,AS WELL AS LATERAL EXCURSIONS OF THE MANDIBLE FOR 5 MINS EVERY 3 TO 4 HOURS.
  10. 10. 6)CHEWING GUMS (SUGARLESS)-TO PROVIDE LATERAL MOVEMENT OF TMJ 7)ANTIBIOTICS AVOID FURTHER DENTAL T/T IN INVOLVED REGION UNTIL SYMPTOMS RESOLVE AND PATIENT IS COMFORTABLE. IF DENTAL CARE HAS TO BE CONTINUED –THAN ALTERNATE METHOD OR TECH. FOR ACHIEVING LA MAY BE EMPLOYED. THE AKINSI MANDIBULAR N. BLOCK PROVIDES RELIEF FORM THA MOLAR DYSFUNCTION AND ALLOWS THE PATIENT TO OPNE THE MOUTH AND PERMITS ADMINSTARTION OF APPROPRIATE ADDITIONAL INJ. IF REQUIRED. COMPELTE RESOLUTION OD POST INJ. TRISMUS TAKES APPROXIMATELT 6 WEKS ,WITH A RANGE OF 4 TO 20 WEEKS. 7)NEUROLOGICAL SYMPTOMS A)VISUAL DISTURBANCES i)SQUINT ii)DIPLOPIA iii)TRANSIENT AMAUROSIS iv)PERAMNENT BLINDNESS i)DIPOPIA OR DOUBLE VISION  LA SOLN. INFILTRATING INTO THE ORBIT TO ANESTHETIC THE EXTRINSIC OCULAR MUSLCES OF THE YES.  INTAARTERIAL INJ.-UNCOMMON VASCULAR PATTERNS-(ORBIT IS SUPPLIED EITHER WHOLLY OR PARTLY BY MIDDLE MENINGEAL ARTERY.)  NO MANAGEMENT REQUIRED (RESOLVES WITHIN 3 HOURS,OR WHEN EFECT ENDS) ii)TRANSIENT SQUINT AND DOUBLE VISION  PARALYSIS OF EXTRINSIC MUSCLES LA DIFFUSED INTO ORBIT FROM PTERYPALATINE GANGLION AND INFRATEMPORAL FOSSA VIA INFRAORBTAL FISSURE,EFFECTING OCCULOMOTOR,TROCHLEAR,ABDUCENS NERVE.  NO TREATMENT REQUIRED
  11. 11. CAUSES PREVENTION MANAGEMENT FACIAL NERVE FOLLOW STANDARD EXPLAIN, REASSURE PARALYSIS PROTOCOL PATIENT -UNILATERAL LOSS OF MOTOR FUNCTION- DIRECTLY LA TRANSIENT DEPOSITION IN -EYE DRESSING GIVEN VICINITY OF 7TH -CONTACT LENSES SHOULD CRANIAL NERVE BE REMOVED 1)INFRAORBITAL N. BLOCK 2)PARAPERIOSTEAL OF MAXILLARY CANINE INDIRECTLY-INTO DEEP LOBE OF PAROTID GLAND IN IANB 8)PERSISTENT -FOLLOW STANDARD -REASSURE THE PATIENT PARATHESIA OR PROTOCAL - VIT B1,B6,B12 -CAREFUL SURGICAL -IF DOES NOT RESOLVE ANAESTHESIA TECH. THAN REFER FOR SURGERY -INJECTING -PROPER HANDLING OF CONTAMINATED CARTRIDGE LA SOLUNTION -TRAUMA TO N. SHEATH -HEMORRAHGE AROUND N. 9)PERSISTENT -GOOD SURGICAL TECH. -SYMPTOMATIC PROLONGED PAIN -AVOID NEEDLE WITH -POOR SURGICAL BARBS TECH.(IN -USE SUPRAPERIOSTEAL VASOCONSTRICTORS TEARING VOL.) WITH MAXIMUN -NEEDLE TIP BARBS DILUTION -ISCHEMIC -AVOID MULTIPLE NECROSIS PENETRATION -MULTIPLE PENETRATIONS
  12. 12. SYSTEMIC COMPLICATIONS OF LA CAUSES OF ADVERS EDRUG REACTION TOXICITY CAUSED BY DIRECT EXTENSION OF THE USUAL PHARMACOLOGICAL EFFECTS OF DRUGS- 1.SIDE EFFECTS 2.OVERDOSE 3.LOCAL TOXIC EFFECTS TOXICITY CAUSED BY ALTERATION IN RECIPIENT OF THE DRUG 1.A DISEASE PROCESS(HEPATIC DYSFUNCTION,CHF,RENAL DYSFUNCTION) 2.EMOTIONAL DISTURBANCES 3.GENETIC ABBERATIONS(ATYPICAL PLASMA CHOLINESTERASE,MALIGNANT HYPERTHERMIA) TOXICITY CAUSED BY ALLERGIC RESPONSES TO THE DRUGS
  13. 13. OVERDOSE A DRUG OVERDOSE REACTIONS HAS BEEN DEFINED AS THOSE CLINICAL SIGNS AND SYMPTOMS THAT RESULT FROM AN OVERLY HIGH BLOOD LEVEL OF A DRUG IN VARIOUS TARGET ORGANS AND TISSUES PREDISPOSING FACTOR PATIENT FACTORS,DRUG FACTORS PATIENT FACTOR DRUG FACTOR AGE VASOACTIVITY WEIGHT CONC. OTHER DRUGS DOSE SEX ROUTE OF ADMINISTRATION PRESENCE OF DISEASE RATE OF INJ. GENETICS VASCULARITY OF INJ SITE MENTAL ATTITUDE AND PRESENCE OF VASOCONSTRICTOR ENVIRONMENT CLINICAL MANIFESTAIOTNS OF OVERDOSE MINIMAL TO MODERATE OVERDOSE LEVELS SIGNS SYMPTOMS  TALKATIVENESS  LIGHTHEADENESS AND DIZZINESS  APPREHENSION  RESTLESSNESS  EXCITABILITY  NERVOUSNESS  SLURRRED SPEECH  NUMBNESS  EUPHORIA  SENSATION  DYSARTHIA  METALLIC TASTE  NYSTAGMUS  VISUAL DISTURBANCES  VOMITTING  AUDITORY DISTURBANCES  DISORIENTATION  LOSS OF CONSCIOUNESS  LOSS OF RESPONSE TO PAINFUL  DROWSINESS AND STIMULI DISORIENTATION  ↑BP  ↑HR  ↑RR
  14. 14. MODERATE TO HIGH OVERDOSE LEVELS  SEIZURE  CNS DEPRESSION  ↓BP  ↓HR  ↓RR LIDOCAINE LEVEL CVS 1.8-5.0 ug/ML ANTIDYSRRTHMIC ACTIONS 5.0-10.0 MYOCARDIAL DEPRESSION 10.0PLUS MASSIVE PERIPHERAL VASODILATION,MYOCARDIAL DEPRESSION CARDIAC ARREST CNS 0.5-4 ANTICONVULSANT ACTION 4.5-7 CNS DEPRESSION,EXCITATION 7.5-10.0 CNS DEPRESSION ,SEIZURE 10.0 PLUS GENERALIZED CNS DEPRESSION CVS EFFECTS LA (VASODILATOR) ↓ PERIPHERAL RESISTANCE ↓ ↓BP(BP=PR*CO) FURTHER IN LA CONC. AFFECT N. CONDUCTION OF HEART ↓ MYOCARDIAL CONTRACTILITY ↓ C.O.(CO=HR*SV) HEART’S NEURONAL CONDUCTION SYS. IS INHIBITED OR COMPLETELY BLOCKED BY LA. AT TOXIC LEVELS,DEPRESSION OF INTRACARDIAC N. CONDUCTION CAN RESULT IN ATRIOVENTRCULAR DISSOCIATION,VENTRICULAR RHYTHM ,VENTRICULAR FIBRILLATION AND ULTIMATELY CARDIAC ARREST.
  15. 15. CNS EFFECTS THE CONDUCTION OF INHIBITORY NEURONS ID USUALLY BLOCKED BY LA AGENTS AS THEY REACH TOXIC LEVELS-RESULTING IN UNMODIFIED ACTION OF FACILITATORY NEURONS(IE,CONVULSIVE-LIKE MOVT.)AS THE DOSE INCREASES,FACILITATORY NEURONS ARE ALSO BLOCKED RESULTING IN CESSATION OF FUNCTION. CERTAIN AMIDE TYPE AGENTS(IE LIDOCAINE)-EFFECT PRIMARILY FACILATORY NEURONS,HENCE DEPRESSION IS SEEN RATHER THAN EXCITATION. MANAGEMENT 1)MILD OVERDOSE RETENTION OF CONCIOUSNESS,TALKATIVENESS,AGITATION, ↑HR,↑BP. ↑RR(5-10 MIN)→← P→A→B→C→D DEFINITIVE CARE i)REASSURE THE PATIENT ii)ADMINISTER OXYGEN VIA NASAL CANULA TO PREVENT ACIDOSIS iii)MONITOR AND RECORD VITAL SIGNS iv)ESTABLISH i.v. INFUSION v)USE OF ANTICONVULSANTS –NOT USUALLY INDICATED DIAZEPAM-5mg.MIN i.v. MIDAZOLAM-1mg/MIN 2)SEVERE OVERDOSE UNCONSCIOUSNESS WITH OR W/O CONVULSIONS RAPID ONSET(WITHIN 1 MINUTE) i)PROTECT PATIENTS ARMS,LEGS AND HEAD LOOSEN TIGHT CLOTHES ii)IMMEDIATELY SUMMON EMERGENCY MEDICAL ASSISTENCE. iii)CONTINUE BLS iv)ADMINISTER ANTICONVULSANT DIAZEPAM –i.v -5mg/min IF VENEPUNCTURE NOT FEASIBLE MIDAZOLAM-im -1mg IF HYPOTENSION PERSISTS(30 MINS)-VASOPRESSOR (PHENYNEPHRINE OR METHAOXAMINE)IM
  16. 16. EPINEPHRINE OVERDOSE CLINICAL MANIFESTATIONS SIGNS-↑BP. ↑HR,CARDIAC DYSRTHYMIAS SYMPTOMS-FEAR,ANXIETY,THROBBING HEADACHE,PERSPIRATION,WEAKNESS,PALLOR,RESP. DIFFICULTY,PALPITATION EPINEPHRINE mg/ml Mg/CARTRIDGE MAX NO. OF CARTRIDGES 1:50,000 0.02 0.036 5(H),1(C) 1:100,000 0.01 0.018 10(H),2© 1:200,000 0.005 0.009 20(H),4© MANAGEMENT P→A→B→C→D P-SEMISITIING OR ERECT POSITION( ↓CEREBRAL BP) i)REAASURE THE PATIENT ii)MONITOR VITAL SIGNS iii)OXYGEN ADMINISTERE IF NECESSARY( C/I IN HYPERVENTILATION) iv)RECOVERY
  17. 17. ALLERGY ALLERGY IS A HYPERSINSITIVE STATE,ACQUIRED THROUGH EXPOSURE TO A PARTICULAR ALLERGEN,REEXPOSURE TO WHICH PRODUCE HEIGHTENED CAPACITY OT REACTION. PREDISPOSING FACTORS  METHLYPARABEN  SODIUM BISULPHITE ALLERGY  EPINEHRINE  LATEX ALLERGY  TOPICAL ANESTHETIC ALLERGY PREVENTION-PROPER HISTORY ALLERGY TESTING 0.1ML OF EACH(INTRAVENOUS)  0.9%NACL  1% OR 2% LIODCAINE,  3%MEPIVACAINE  4%PRILOCAINE(W/O METHYL PARABEN,BISULPHITE,VASOPRESSORS. INTRAORAL CHALLENGE TEST 0.9 ML OF LA SOLN. SUPRAPERIOSTEAL INFILTRATION ATRAUMATIC(BUT W/O TOPICAL LA)ABOVE A MAXILLARY RIGHT OR LEFT PREMOLAR OR ANT. TOOTH. DENTAL MANAGEMENT IN CASE OF PRESENCE OF LA ALLERGY:  NO T/T OF AN INVASIVE NATURE CARRIED OUT  IF EMERGENCY –THEN UNDER GENERAL ANESTHESIA  IF GA NOT AVAILABLE –HISTAMINE BLOCKER DIPPHENHYDRAMINE HCL IN 1 % SOLN. WITH 1:100,000 EPINEPHRINE(30 MIN OF PULPAL ANESTHESIA)  NITORUS OXIDE  ALTERNATIVES-ELECRONIC DENTAL ANESTHESIA
  18. 18. CLINICAL MANIFESTATIONS OF ALLERGY DERMATOLOGICAL REACTIONS- URTICARIA-WHEAL ANGIOEDEMA-LOCALISED SWELLING INVOLVING FACE,HANDS,FEET,GENITILIA,LIPS,TONGUE. RESPIRATORY REACTIONS- BRONNCHOSPASM RESP. DISTRESS DYSPNOEA,WHEEZING,FLUSHING,CYANOSIS,PERSPIRATION,TACHYCARDI A,INCREASED ANXIETY,LARYNGEAL EDEMA GENERALISED ANAPHYLAXIS SKIN REACTION- PRURITIS,ERYTHEMA,URTICARIA,CONJUCTIVITIS,RHINITIS GIT DISTURBANCE RESP STMPTOMS-WHEEZING,DYSPNOEA CVS-PALLOR,TACHYCARDIA,HYPOTENSION,CARDIAC DYSARRTHYMIA,UNCONCIOUSNESS,CARDIAC ARREST MANAGEMENT P→A→B→C→D i)ADMINISTER EPINEPHRINE 0.3mg IM/SC OR HISTAMINE BLOCKER-50mg DIPHENHYDRAMINE OR 10 mg CHLORPHENIRAMINE ii)MEDICAL CONSULTATION FROM PHYSICIAN iii)OBSERVE THE PATIENT (60MIN) iv)PRESCRIBE ORAL HISTAMINE BLOCKER 50 mg CAP-TDS FOR 3-4 DAYS BRONCHSPASM P→A→B→C→D i)TERMINATE T/T ii)ADMINISTER OXYGEN (5-6 L/MIN) iii)ADMINISTER EPINEPHRINE 0.3 mg IM/SC iv)ADMINISTER HISTAMINE BLOCKER TO MINIMIZE RELAPSE HISTAMINE BLOCKER-50mg DIPHENHYDRAMINE OR 10 mg CHLORPHENIRAMINE
  19. 19. v)MEDICAL CONSULTATION LARYNGEAL ODEMA P→A→B→C→D i)ADMINISTER EPINEPHRINE 0.3 mg IM/SC ii)EMERGENCY MEDICAL SERVICE iii)MAINTAIN AIRWAY iv)ADDITIONAL DRUGS HISTAMINE BLOCKER -50mg DIPHENHYDRAMINE OR 10 mg CHLORPHENIRAMINE CORTICOSTEROID- 100mg HYDROCORTICOSONE IM/IV GENERALIZED ANAPHYLAXIS P→A→B→C→D i) EMERGENCY MEDICAL SERVICE ii) EPINEPHRINE (0.3ML OF 1:1000) IM/IV iii) OXYGEN AND VITAL SIGNS iv) IF DOES NOT IMPROVE SECOND DOSE OF EPINEPHRINE IN 10 MIN v) ADDITIONAL DRUGS HISTAMINE BLOCKER -50mg DIPHENHYDRAMINE OR 10 mg CHLORPHENIRAMINE CORTICOSTEROID- 100mg HYDROCORTICOSONE IM/IV vi)CPR THANK YOU 

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