1. The document discusses various complications that can arise from local anesthesia (L.A.) administration including toxic overdose reactions, allergic reactions, and idiosyncratic responses.
2. Toxic overdose occurs when too high of a concentration of the drug reaches the bloodstream, potentially causing central nervous system or cardiovascular system effects like seizures, changes in heart rate and blood pressure, or cardiac arrest.
3. Allergic reactions involve a histamine response and can range from mild reactions like hives or swelling to life-threatening anaphylaxis. Proper allergy testing of patients is recommended.
The document discusses local anesthesia and its potential complications. It defines local anesthesia and lists local and systemic complications. It discusses the principles of drug toxicity and the role of the user in potential toxicity. It describes overdose reactions involving the central nervous system and treatments. It provides guidelines for safe administration of local anesthesia and managing complications like overdose reactions and allergic responses.
Anesthesia in birds and exotic pet animalsGangaYadav4
This document discusses anesthesia considerations for birds, exotic pets, rabbits, and ferrets. It covers:
- Common indications for anesthesia including surgery, imaging, transportation, and euthanasia.
- Pre-anesthetic evaluations and preparations like fasting, physical exams, and lab work.
- Common injectable and inhalant anesthetic drugs and doses used for induction and maintenance.
- Monitoring anesthesia with heart rate, respiration rate, temperature and other reflexes.
- Ensuring proper recovery with warmth, hydration, analgesia and other supportive care.
This document provides an overview of key concepts in veterinary anesthesia including:
- Definitions of terms like general anesthesia, local anesthesia, and premedication.
- Guidelines for patient preparation including fasting times and diagnostic testing.
- Considerations for developing anesthetic protocols based on factors like the procedure, patient characteristics, and health status.
- Descriptions of common pre-medications and anesthetic agents as well as equipment used.
- Details on intubation procedure, anesthetic machine components, and importance of monitoring patients during anesthesia.
The document discusses different types of hypersensitivity and anaphylaxis. It defines anaphylaxis and describes its incidence, substances that can trigger it, pathophysiology, clinical manifestations, diagnostic evaluation, and management. Nursing management focuses on maintaining airway, supporting circulation, preventing complications, and providing patient education. The document also discusses septicemia, defining it, outlining risk factors, etiology, pathophysiology, clinical signs, diagnostic tests, and treatment including antibiotics and supportive care. Nursing management of septicemia includes infection control, supporting tissue perfusion, and preventing complications.
The document discusses sedation, analgesia, and paralysis in the ICU. It describes the goals of sedation as patient comfort while allowing interaction. The challenges include assessing sedation and altered drug pharmacology. An ideal sedation agent would have rapid onset and offset and lack respiratory depression. Monitoring scales like the Richmond Agitation Scale are used to standardize treatment. Dexmedetomidine, propofol, opioids and paralytics may be used. The optimal sedation approach balances adequate treatment while avoiding oversedation risks.
Poisoning and Overdose have increased in recent times at exponential ratio, and most cases are with the initial attempt to harm oneself. this is very unfortunate. This presentation will help doctors and other health workers to be able to determine how to assist a patients who had overdosed on dangerous substances.
This document provides an overview of general anesthetics, including their definition, mechanisms of action, stages of anesthesia, classifications, and examples. It discusses inhalational anesthetics like nitrous oxide, halothane, sevoflurane and desflurane, outlining their properties such as potency, solubility, and side effects. It also reviews intravenous anesthetics including thiopental, propofol, ketamine and etomidate, noting their mechanisms, onsets, durations and side effect profiles. The document is intended to educate about the different types of general anesthetics used in surgery to induce reversible unconsciousness and muscle relaxation.
The document discusses local anesthesia and its potential complications. It defines local anesthesia and lists local and systemic complications. It discusses the principles of drug toxicity and the role of the user in potential toxicity. It describes overdose reactions involving the central nervous system and treatments. It provides guidelines for safe administration of local anesthesia and managing complications like overdose reactions and allergic responses.
Anesthesia in birds and exotic pet animalsGangaYadav4
This document discusses anesthesia considerations for birds, exotic pets, rabbits, and ferrets. It covers:
- Common indications for anesthesia including surgery, imaging, transportation, and euthanasia.
- Pre-anesthetic evaluations and preparations like fasting, physical exams, and lab work.
- Common injectable and inhalant anesthetic drugs and doses used for induction and maintenance.
- Monitoring anesthesia with heart rate, respiration rate, temperature and other reflexes.
- Ensuring proper recovery with warmth, hydration, analgesia and other supportive care.
This document provides an overview of key concepts in veterinary anesthesia including:
- Definitions of terms like general anesthesia, local anesthesia, and premedication.
- Guidelines for patient preparation including fasting times and diagnostic testing.
- Considerations for developing anesthetic protocols based on factors like the procedure, patient characteristics, and health status.
- Descriptions of common pre-medications and anesthetic agents as well as equipment used.
- Details on intubation procedure, anesthetic machine components, and importance of monitoring patients during anesthesia.
The document discusses different types of hypersensitivity and anaphylaxis. It defines anaphylaxis and describes its incidence, substances that can trigger it, pathophysiology, clinical manifestations, diagnostic evaluation, and management. Nursing management focuses on maintaining airway, supporting circulation, preventing complications, and providing patient education. The document also discusses septicemia, defining it, outlining risk factors, etiology, pathophysiology, clinical signs, diagnostic tests, and treatment including antibiotics and supportive care. Nursing management of septicemia includes infection control, supporting tissue perfusion, and preventing complications.
The document discusses sedation, analgesia, and paralysis in the ICU. It describes the goals of sedation as patient comfort while allowing interaction. The challenges include assessing sedation and altered drug pharmacology. An ideal sedation agent would have rapid onset and offset and lack respiratory depression. Monitoring scales like the Richmond Agitation Scale are used to standardize treatment. Dexmedetomidine, propofol, opioids and paralytics may be used. The optimal sedation approach balances adequate treatment while avoiding oversedation risks.
Poisoning and Overdose have increased in recent times at exponential ratio, and most cases are with the initial attempt to harm oneself. this is very unfortunate. This presentation will help doctors and other health workers to be able to determine how to assist a patients who had overdosed on dangerous substances.
This document provides an overview of general anesthetics, including their definition, mechanisms of action, stages of anesthesia, classifications, and examples. It discusses inhalational anesthetics like nitrous oxide, halothane, sevoflurane and desflurane, outlining their properties such as potency, solubility, and side effects. It also reviews intravenous anesthetics including thiopental, propofol, ketamine and etomidate, noting their mechanisms, onsets, durations and side effect profiles. The document is intended to educate about the different types of general anesthetics used in surgery to induce reversible unconsciousness and muscle relaxation.
Anaphylactic shock is a severe allergic reaction that can occur rapidly after exposure to an allergen like bee venom or peanuts. It causes a drop in blood pressure and airway constriction due to chemicals released by the immune system. Symptoms include a weak pulse, rash, nausea and vomiting. Common triggers are foods, medications, insect venom and latex. Anaphylactic reactions require immediate epinephrine treatment in the emergency room to prevent unconsciousness or death.
This document discusses complications that can occur from regional anesthesia. It classifies complications as primary or secondary, mild or severe, transient or permanent. It also discusses specific complications that can occur from local anesthetic absorption (toxicity, idiosyncrasy, allergy), needle insertion (syncope, trismus, pain, edema, infection), or post-procedure (hematoma, sloughing of tissues, intraoral lesions). For each complication, it describes potential causes and treatments or methods for prevention. The document provides an overview of potential anesthetic complications and strategies to avoid or address issues.
This document discusses complications of local anesthesia. It begins by defining local anesthesia and providing a brief history. It then discusses various local complications that can occur, such as needle breakage, prolonged anesthesia, facial nerve paralysis, and soft tissue injury. Causes of these local complications include needle trauma to nerves, intraneural injection, and hematoma formation around nerves. The document also discusses systemic complications like toxicity and allergic reactions. Prevention strategies aim to avoid nerve trauma during injection and proper use and handling of local anesthetic materials. Most local complications resolve on their own, but persistent cases may require reassurance and follow-up.
GENERAL ANAESTHETIC AGENTS / DRUG WHICH INDUCES GENERAL ANAESTHESIA / DIFFERE...Kameshwaran Sugavanam
This document discusses general anesthetics and the stages of anesthesia. It notes that general anesthetics produce reversible loss of sensation and consciousness by irregularly depressing the central nervous system from higher to lower functions. The four stages of anesthesia are then described: stage I involves analgesia and loss of consciousness; stage II involves excitement and delirium; stage III allows for surgery with regular breathing; and stage IV involves medullary paralysis and failure of vital functions. The document also discusses classifications of anesthetics including inhalational and intravenous agents, as well as pre-anesthetic medications that are used to reduce anxiety, provide amnesia and analgesia, decrease secretions, and reduce gastric acid.
General anesthesia alters the central nervous system and causes pain relief, muscle relaxation, relaxation of reflexes, and deep sleep. It commonly used during surgery and involves five phases: preparation, induction, maintenance, emergence, and recovery.
General anesthesia can be delivered via inhalation of gases like nitrous oxide and liquids like halothane, or intravenously with analgesics, atropine, and anti-emetics. Local anesthetics are also used to block nerve conduction in specific body areas and prevent pain sensation. They come in topical, spinal, epidural, infiltration and nerve block forms.
General anesthesia results in reversible depression of the central nervous system, causing loss of response to external stimuli. It provides benefits like sedation, lack of awareness, muscle relaxation, suppression of reflexes, and analgesia. No single agent provides all benefits, so several drugs are used in combination for optimal anesthesia. Factors like organ function and concurrent medications must be considered when choosing anesthetic drugs to safely induce, maintain, and recover the patient from anesthesia.
Local anesthesia and nerve blocks in large animals.GangaYadav4
Local anesthesia involves the reversible loss of sensation in a limited area of the body using chemical agents without loss of consciousness. It is useful for reducing pain and stress during surgery. The document discusses various local anesthetics used in veterinary practice like lidocaine, bupivacaine and mepivacaine. It also covers the mechanisms of action, classifications, advantages, disadvantages and methods of administering local anesthesia like infiltration, regional and intravenous regional anesthesia. Toxicities can occur if the anesthetic is absorbed systemically. Proper technique and dose are important for safe use of local anesthesia.
This slide comprise the idea of General anesthesia, The intravenous and Inhalation Anesthetics- their mechanism and uses and effects on the organ system. Also the drug distribution and redistribution, MAC and pre-anesthetic medication with proper pictorial demonstration.
Anesthesia affects multiple organ systems and induces a reversible state of unconsciousness. It progresses through stages from induction to maintenance. Common types include intravenous agents like propofol and barbiturates, inhalational gases, and regional techniques. Special populations like diabetics and elderly patients require careful consideration due to altered drug metabolism and responses. The brain remains highly active under anesthesia through synchronized neural firing rather than ceasing activity.
General anesthetics are drugs that induce reversible loss of consciousness and sensations during surgery. They work by depressing the central nervous system in stages, starting with cortical centers and ending with the medulla. There are two main types - inhalational gases administered through masks or intravenous drugs given through injections. A balanced anesthesia approach uses multiple drugs to induce unconsciousness, amnesia, analgesia, and muscle relaxation. Precise drug combinations and dosages are tailored for each patient and procedure type. The goal is to smoothly induce and rapidly recover from anesthesia with minimized risks and side effects.
This document provides information on the treatment of anaphylaxis. It begins by defining anaphylaxis as an acute hypersensitivity reaction and describes the pathophysiology involving the release of histamine. The mainstay treatment is identified as adrenaline (epinephrine) injected intramuscularly. Common causes and signs/symptoms are outlined involving the airways, breathing and circulation. Additional treatment steps are described including IV fluids, antihistamines, steroids, and monitoring. Guidance is provided on discharge instructions and managing pediatric cases.
This document discusses sedation in the intensive care unit (ICU). It outlines the need for sedation to relieve anxiety, pain, and facilitate mechanical ventilation. The goals of sedation are patient comfort while controlling pain and stress responses. An ideal sedative has little respiratory depression, rapid onset/offset, allows for arousal but sedation. Commonly used sedatives include opioids like fentanyl and morphine, benzodiazepines like midazolam, and propofol. Factors like hypoxia or agitation must be addressed and not attributed solely to lack of sedation. Sedation scales standardize treatment and help prevent oversedation. A sedation holiday of stopping sedation may shorten time on
Induction of anaesthesia can be done through inhalational or intravenous routes. Common inhalational inducing agents include sevoflurane, halothane and nitrous oxide. Sevoflurane provides a smooth induction while halothane causes more cardiovascular depression. Intravenous agents like propofol and thiopentone provide rapid onset and recovery but may cause pain on injection. The ideal properties of inducing agents include rapid onset and offset of action, minimal side effects and ease of administration.
This document provides an overview of general anesthetics. It discusses the history of ether and chloroform as the first widely used anesthetics. It then covers the mechanisms of action, sites of action in the body, and cellular/molecular mechanisms of how anesthetics work. The document classifies anesthetics as inhalational agents like nitrous oxide, halothane, and isoflurane or intravenous agents like thiopental and propofol. It also discusses properties of ideal anesthetics, techniques for inhaling agents, adjunct medications, and dissociative anesthetics like ketamine. Depth of anesthesia is assessed using the Guedel classification system.
This document provides an overview of local anaesthesia including:
- A definition and historical background of local anaesthetics such as cocaine and procaine.
- Desirable properties and classifications of local anaesthetics.
- Details on common local anaesthetics like lidocaine including mechanism of action, dosage, and comparisons to other agents.
- Factors to consider in selecting a local anaesthetic for a patient and important information to obtain from the patient.
- Techniques for administering local anaesthesia and managing complications.
General Anesthetics
General anesthesia is a reversible state of central nervous system depression that provides five important benefits during surgery or medical procedures: sedation, lack of awareness and amnesia, muscle relaxation, suppression of reflexes, and analgesia. It is produced through a combination of intravenous and inhaled agents to safely induce, maintain, and recover the patient from anesthesia. The selection of specific anesthetic drugs is based on the procedure, patient characteristics, and status of organ systems. Careful monitoring at each stage ensures optimal anesthesia and recovery.
Charles Robert Richet and Paul Portier coined the term "anaphylaxis" in 1902 to describe a dog's fatal reaction to repeated injections of jellyfish toxin. Anaphylaxis is a type I hypersensitivity reaction mediated by IgE antibodies that causes symptoms such as low blood pressure, rashes, and breathing difficulties upon reexposure to an antigen. Perioperative anaphylaxis is difficult to diagnose due to masking by anesthesia drugs and procedures. Treatment involves epinephrine, oxygen, fluids, steroids, and bronchodilators. Muscle relaxants are a common cause, while antibiotics, latex, and protamine also carry risks. Thorough history screening and allergy testing can help prevent severe anaph
This document provides information on various anesthetic agents used in ophthalmic procedures, including general anesthetics (GA), regional anesthetics (RA), local anesthetics (LA), and topical anesthetics. It describes the types, mechanisms of action, common drugs, dosages, administration routes, indications, and side effects of different anesthetic classes. Key anesthetic agents discussed include nitrous oxide, halothane, ketamine, propofol, lidocaine, bupivacaine, and tetracaine.
General anesthesia involves inducing a state of unconsciousness through medications that provide amnesia, analgesia, muscle relaxation, and sedation. There are two main classes of general anesthetics - inhalational gases and vapors like nitrous oxide and halothane, and intravenous agents like thiopental and propofol. These drugs work by modulating receptors like GABA, NMDA, and nicotinic receptors in the brain to produce reversible loss of consciousness. They are chosen based on properties like rapid onset of action, short duration, and minimal side effects on vital organs like the heart and lungs.
This document provides information about malignant hyperthermia (MH), a rare genetic disorder of skeletal muscle characterized by excessive muscle metabolism in response to certain anesthetic triggers. The key points are:
1) MH is triggered by volatile anesthetics and succinylcholine, causing a hypermetabolic state and muscle rigidity. Left untreated, it can cause death.
2) Diagnosis is based on clinical presentation and muscle biopsy tests detecting abnormal responses to caffeine and halothane.
3) Treatment involves stopping triggers, aggressive cooling, dantrolene to reduce calcium release, and supportive care. Early recognition and treatment have reduced mortality to less than 5%.
4) MH is caused by
Summary notes of Anesthesia. These notes were published in 2020.
You can download them from:
-Mediafire: http://www.mediafire.com/file/wkey81yff7kv3j1/Anesthesia_Q%2526A_2020.pdf/file
Anaphylactic shock is a severe allergic reaction that can occur rapidly after exposure to an allergen like bee venom or peanuts. It causes a drop in blood pressure and airway constriction due to chemicals released by the immune system. Symptoms include a weak pulse, rash, nausea and vomiting. Common triggers are foods, medications, insect venom and latex. Anaphylactic reactions require immediate epinephrine treatment in the emergency room to prevent unconsciousness or death.
This document discusses complications that can occur from regional anesthesia. It classifies complications as primary or secondary, mild or severe, transient or permanent. It also discusses specific complications that can occur from local anesthetic absorption (toxicity, idiosyncrasy, allergy), needle insertion (syncope, trismus, pain, edema, infection), or post-procedure (hematoma, sloughing of tissues, intraoral lesions). For each complication, it describes potential causes and treatments or methods for prevention. The document provides an overview of potential anesthetic complications and strategies to avoid or address issues.
This document discusses complications of local anesthesia. It begins by defining local anesthesia and providing a brief history. It then discusses various local complications that can occur, such as needle breakage, prolonged anesthesia, facial nerve paralysis, and soft tissue injury. Causes of these local complications include needle trauma to nerves, intraneural injection, and hematoma formation around nerves. The document also discusses systemic complications like toxicity and allergic reactions. Prevention strategies aim to avoid nerve trauma during injection and proper use and handling of local anesthetic materials. Most local complications resolve on their own, but persistent cases may require reassurance and follow-up.
GENERAL ANAESTHETIC AGENTS / DRUG WHICH INDUCES GENERAL ANAESTHESIA / DIFFERE...Kameshwaran Sugavanam
This document discusses general anesthetics and the stages of anesthesia. It notes that general anesthetics produce reversible loss of sensation and consciousness by irregularly depressing the central nervous system from higher to lower functions. The four stages of anesthesia are then described: stage I involves analgesia and loss of consciousness; stage II involves excitement and delirium; stage III allows for surgery with regular breathing; and stage IV involves medullary paralysis and failure of vital functions. The document also discusses classifications of anesthetics including inhalational and intravenous agents, as well as pre-anesthetic medications that are used to reduce anxiety, provide amnesia and analgesia, decrease secretions, and reduce gastric acid.
General anesthesia alters the central nervous system and causes pain relief, muscle relaxation, relaxation of reflexes, and deep sleep. It commonly used during surgery and involves five phases: preparation, induction, maintenance, emergence, and recovery.
General anesthesia can be delivered via inhalation of gases like nitrous oxide and liquids like halothane, or intravenously with analgesics, atropine, and anti-emetics. Local anesthetics are also used to block nerve conduction in specific body areas and prevent pain sensation. They come in topical, spinal, epidural, infiltration and nerve block forms.
General anesthesia results in reversible depression of the central nervous system, causing loss of response to external stimuli. It provides benefits like sedation, lack of awareness, muscle relaxation, suppression of reflexes, and analgesia. No single agent provides all benefits, so several drugs are used in combination for optimal anesthesia. Factors like organ function and concurrent medications must be considered when choosing anesthetic drugs to safely induce, maintain, and recover the patient from anesthesia.
Local anesthesia and nerve blocks in large animals.GangaYadav4
Local anesthesia involves the reversible loss of sensation in a limited area of the body using chemical agents without loss of consciousness. It is useful for reducing pain and stress during surgery. The document discusses various local anesthetics used in veterinary practice like lidocaine, bupivacaine and mepivacaine. It also covers the mechanisms of action, classifications, advantages, disadvantages and methods of administering local anesthesia like infiltration, regional and intravenous regional anesthesia. Toxicities can occur if the anesthetic is absorbed systemically. Proper technique and dose are important for safe use of local anesthesia.
This slide comprise the idea of General anesthesia, The intravenous and Inhalation Anesthetics- their mechanism and uses and effects on the organ system. Also the drug distribution and redistribution, MAC and pre-anesthetic medication with proper pictorial demonstration.
Anesthesia affects multiple organ systems and induces a reversible state of unconsciousness. It progresses through stages from induction to maintenance. Common types include intravenous agents like propofol and barbiturates, inhalational gases, and regional techniques. Special populations like diabetics and elderly patients require careful consideration due to altered drug metabolism and responses. The brain remains highly active under anesthesia through synchronized neural firing rather than ceasing activity.
General anesthetics are drugs that induce reversible loss of consciousness and sensations during surgery. They work by depressing the central nervous system in stages, starting with cortical centers and ending with the medulla. There are two main types - inhalational gases administered through masks or intravenous drugs given through injections. A balanced anesthesia approach uses multiple drugs to induce unconsciousness, amnesia, analgesia, and muscle relaxation. Precise drug combinations and dosages are tailored for each patient and procedure type. The goal is to smoothly induce and rapidly recover from anesthesia with minimized risks and side effects.
This document provides information on the treatment of anaphylaxis. It begins by defining anaphylaxis as an acute hypersensitivity reaction and describes the pathophysiology involving the release of histamine. The mainstay treatment is identified as adrenaline (epinephrine) injected intramuscularly. Common causes and signs/symptoms are outlined involving the airways, breathing and circulation. Additional treatment steps are described including IV fluids, antihistamines, steroids, and monitoring. Guidance is provided on discharge instructions and managing pediatric cases.
This document discusses sedation in the intensive care unit (ICU). It outlines the need for sedation to relieve anxiety, pain, and facilitate mechanical ventilation. The goals of sedation are patient comfort while controlling pain and stress responses. An ideal sedative has little respiratory depression, rapid onset/offset, allows for arousal but sedation. Commonly used sedatives include opioids like fentanyl and morphine, benzodiazepines like midazolam, and propofol. Factors like hypoxia or agitation must be addressed and not attributed solely to lack of sedation. Sedation scales standardize treatment and help prevent oversedation. A sedation holiday of stopping sedation may shorten time on
Induction of anaesthesia can be done through inhalational or intravenous routes. Common inhalational inducing agents include sevoflurane, halothane and nitrous oxide. Sevoflurane provides a smooth induction while halothane causes more cardiovascular depression. Intravenous agents like propofol and thiopentone provide rapid onset and recovery but may cause pain on injection. The ideal properties of inducing agents include rapid onset and offset of action, minimal side effects and ease of administration.
This document provides an overview of general anesthetics. It discusses the history of ether and chloroform as the first widely used anesthetics. It then covers the mechanisms of action, sites of action in the body, and cellular/molecular mechanisms of how anesthetics work. The document classifies anesthetics as inhalational agents like nitrous oxide, halothane, and isoflurane or intravenous agents like thiopental and propofol. It also discusses properties of ideal anesthetics, techniques for inhaling agents, adjunct medications, and dissociative anesthetics like ketamine. Depth of anesthesia is assessed using the Guedel classification system.
This document provides an overview of local anaesthesia including:
- A definition and historical background of local anaesthetics such as cocaine and procaine.
- Desirable properties and classifications of local anaesthetics.
- Details on common local anaesthetics like lidocaine including mechanism of action, dosage, and comparisons to other agents.
- Factors to consider in selecting a local anaesthetic for a patient and important information to obtain from the patient.
- Techniques for administering local anaesthesia and managing complications.
General Anesthetics
General anesthesia is a reversible state of central nervous system depression that provides five important benefits during surgery or medical procedures: sedation, lack of awareness and amnesia, muscle relaxation, suppression of reflexes, and analgesia. It is produced through a combination of intravenous and inhaled agents to safely induce, maintain, and recover the patient from anesthesia. The selection of specific anesthetic drugs is based on the procedure, patient characteristics, and status of organ systems. Careful monitoring at each stage ensures optimal anesthesia and recovery.
Charles Robert Richet and Paul Portier coined the term "anaphylaxis" in 1902 to describe a dog's fatal reaction to repeated injections of jellyfish toxin. Anaphylaxis is a type I hypersensitivity reaction mediated by IgE antibodies that causes symptoms such as low blood pressure, rashes, and breathing difficulties upon reexposure to an antigen. Perioperative anaphylaxis is difficult to diagnose due to masking by anesthesia drugs and procedures. Treatment involves epinephrine, oxygen, fluids, steroids, and bronchodilators. Muscle relaxants are a common cause, while antibiotics, latex, and protamine also carry risks. Thorough history screening and allergy testing can help prevent severe anaph
This document provides information on various anesthetic agents used in ophthalmic procedures, including general anesthetics (GA), regional anesthetics (RA), local anesthetics (LA), and topical anesthetics. It describes the types, mechanisms of action, common drugs, dosages, administration routes, indications, and side effects of different anesthetic classes. Key anesthetic agents discussed include nitrous oxide, halothane, ketamine, propofol, lidocaine, bupivacaine, and tetracaine.
General anesthesia involves inducing a state of unconsciousness through medications that provide amnesia, analgesia, muscle relaxation, and sedation. There are two main classes of general anesthetics - inhalational gases and vapors like nitrous oxide and halothane, and intravenous agents like thiopental and propofol. These drugs work by modulating receptors like GABA, NMDA, and nicotinic receptors in the brain to produce reversible loss of consciousness. They are chosen based on properties like rapid onset of action, short duration, and minimal side effects on vital organs like the heart and lungs.
This document provides information about malignant hyperthermia (MH), a rare genetic disorder of skeletal muscle characterized by excessive muscle metabolism in response to certain anesthetic triggers. The key points are:
1) MH is triggered by volatile anesthetics and succinylcholine, causing a hypermetabolic state and muscle rigidity. Left untreated, it can cause death.
2) Diagnosis is based on clinical presentation and muscle biopsy tests detecting abnormal responses to caffeine and halothane.
3) Treatment involves stopping triggers, aggressive cooling, dantrolene to reduce calcium release, and supportive care. Early recognition and treatment have reduced mortality to less than 5%.
4) MH is caused by
Summary notes of Anesthesia. These notes were published in 2020.
You can download them from:
-Mediafire: http://www.mediafire.com/file/wkey81yff7kv3j1/Anesthesia_Q%2526A_2020.pdf/file
General anesthetics are divided into two classes: inhalation anesthetics like nitrous oxide, halothane, isoflurane, sevoflurane, and enflurane which are gases or vapors, and intravenous anesthetics like thiopental sodium, propofol, and ketamine which are injections. Common intravenous induction agents include propofol, thiopental sodium, and ketamine. Induction can be done intravenously for faster onset or inhalationally where IV access is difficult. Maintenance of anesthesia is typically done with an inhaled agent supplemented by intravenous drugs like opioids.
This document discusses contrast reactions and their management. It begins by stating that contrast reactions can range from minor to life-threatening. Proper preparation is needed to treat all potential adverse events. Risk factors for reactions include previous reactions, renal insufficiency, and medications. Reactions are classified as idiosyncratic or non-idiosyncratic. Idiosyncratic reactions are unpredictable and severe. Non-idiosyncratic reactions depend on properties of the contrast agent like osmolality. Management involves stabilizing airway, breathing, and circulation. Specific treatments are outlined for mild, moderate, and severe reactions like urticaria, bronchospasm, and hypotension.
Systemic complications of local anesthesiaSarosh Hussain
This document discusses the systemic complications of local anesthesia, focusing on overdose and allergy. It defines overdose as occurring when the drug accesses the circulatory system. Predisposing factors for overdose include patient characteristics, drug factors, and improper administration technique. Clinical manifestations range from mild symptoms to seizures and cardiac arrest. Management depends on severity and includes positioning, airway support, epinephrine, and activated charcoal. Allergic reactions can involve the skin, respiratory tract, or be generalized. Predisposing factors, clinical presentations, and management strategies are provided for each type of allergic reaction.
This document discusses antipsychotic drugs, including their history, classification, indications, side effects, and nursing implications. It notes that the first antipsychotic drugs were discovered in the 1950s and includes a table classifying examples of first and second generation antipsychotic drugs. The document outlines the mechanisms of action, contraindications, pharmacokinetics, and important considerations for patient education when taking antipsychotic medications.
This document provides an overview of general toxicology. It discusses factors affecting the toxic response, including factors related to the poison and patient. It describes various types of toxins based on origin, site of action, and organ specificity. It also summarizes approaches to managing the poisoned patient, including stabilization, decontamination, and enhanced elimination techniques like activated charcoal, gastric lavage, forced diuresis, and dialysis. Complications and contraindications of different management strategies are also outlined.
This document provides information on premedication. It begins with definitions of premedication and a history of its use from the 1850s when ether and chloroform were commonly used anesthetics. It describes the current practice of selective premedication before anesthesia and the aims of premedication including amnesia, analgesia, and decreasing PONV risk. Common premedication drug classes are discussed including benzodiazepines, opioids, NSAIDs, and paracetamol. Specific agents like midazolam, morphine, fentanyl, diclofenac are explained in terms of pharmacokinetics, effects, side effects and dosing. Factors to consider before premedication are also
1. Delirium is a common clinical syndrome characterized by inattention and acute cognitive dysfunction that is often caused by a medical condition, head injury, intoxication or withdrawal.
2. Predisposing factors for delirium include advanced age, dementia, medical comorbidities, and functional impairment. Precipitating factors are acute medical events, medications, infections, dehydration, and immobilization.
3. Delirium is managed through addressing underlying causes, supportive care including reorientation, a calm environment, and avoiding restraints. Medications like haloperidol may also be used.
This document discusses pain management in palliative care. It defines types of pain including neuropathic and nociceptive pain. It describes approaches to pain control including thorough assessment, investigations if needed, pharmacological and non-pharmacological treatments, and ongoing reassessment. Types of opioids, routes of administration, switching between opioids, and managing breakthrough pain are covered. Adjuvant analgesics and their uses are also summarized.
This document provides an overview of antipsychotic drugs. It discusses the history of antipsychotics beginning in the late 19th century. It describes first and second generation antipsychotics and provides examples of common drugs. The document defines antipsychotics and outlines their classifications. It discusses the indications, pharmacokinetics, mechanisms of action, contraindications, and side effects of antipsychotic drugs. Finally, it provides nursing implications for managing common side effects and patient education guidelines.
The document provides information about upcoming exams covering medication administration, the nervous system, and the respiratory system. It includes a review of topics like medication classifications, drug calculations, respiratory drug classes, and antimicrobial agents. Nursing students are instructed to review learning objectives and prepare for multiple choice and matching questions on topics like medication orders, drug interactions, and specific respiratory conditions and treatments.
This document discusses various causes of vomiting and treatments using antiemetic drugs. It describes how vomiting is coordinated by the vomiting center in the medulla and can be triggered by stimulation of the chemoreceptor trigger zone, peripheral nerves, vestibular system, or higher brain centers. Common causes include motion sickness, pregnancy, drug toxicity, radiation, and chemotherapy. Treatment depends on the cause and may involve 5-HT3 antagonists, dopamine antagonists, muscarinic antagonists, antihistamines, cannabinoids, or glucocorticoids. The most effective drugs for chemotherapy-induced vomiting are 5-HT3 antagonists in combination with neurokinin-1 antagonists and dexamethasone.
Complications of anesthesia
This topic aim to provide information on some common clinical condition that occur to the patients after anesthetized required procedure
Hello friends. In this PPT I am talking about adverse drug effects. If you like it, please do let me know in the comments section. A single word of appreciation from you will encourage me to make more of such videos. Thanks. Enjoy and welcome to the beautiful world of pharmacology where pharmacology comes to life. This video is intended for MBBS, BDS, paramedical and any person who wishes to have a basic understanding of the subject in the simplest way.
The document discusses anaphylaxis and anaphylactic shock during anesthesia. It begins by describing the discovery of anaphylaxis in 1902 and defines anaphylaxis as a severe, systemic allergic reaction involving two or more organ systems that can be life-threatening. Anaphylactic shock is a severe allergic reaction leading to sudden cardiovascular collapse. Common causes of anaphylactic reactions during anesthesia include muscle relaxants, induction drugs, local anesthetics, opioids, and other medications. The mechanism involves IgE antibodies and mast cell degranulation releasing chemical mediators like histamine that cause symptoms. Prompt treatment is critical in an emergency situation.
Management of Pain, Fever, Dyspnea,airway obstruction,incontinence loritacaroline
- Management of pain, fever, incontinence, dyspnea, and airway obstruction involves assessing and treating the underlying causes, as well as providing symptomatic relief.
- For pain, a multidisciplinary approach including medications, psychological therapies, and alternative therapies may be used. Fever is usually managed conservatively with antipyretics, hydration and cooling depending on severity.
- Incontinence has different types that are managed with treatments like behavioral therapy, medications, surgery or electrical stimulation depending on the cause. Airway obstruction can be managed with basic techniques like positioning or advanced techniques like intubation if basic methods are insufficient.
1. General anesthesia blocks the central nervous system by using inhaled anesthetic gases to induce unconsciousness in patients, while regional anesthesia aims to block sensation in a specific part of the body only.
2. The course of general anesthesia involves 3 stages - induction using sedatives and muscle relaxants, maintenance using additional muscle relaxants and gases, and emergence using post-operative medications.
3. There are 4 stages of anesthesia - amnesia, excitement/delirium, surgical anesthesia where intubation can be done, and impending death from overdosage. Common inhaled anesthetic agents include nitrous oxide, isoflurane, sevoflurane and desflurane. Factors like age, drugs and medical conditions can modify
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3. General Principles of Toxicology:
• 1. No drug ever exerts a single action.
2. No clinically useful drug is entirely devoid of toxicity.
3. The potential toxicity of a drug rests in the hand of the user.
Adverse Drug Reactions: Overdose
• absolute or relative over-administration of a drug which
produces elevated levels in the blood; dose related
4. Adverse Drug Reactions: Allergy
• hypersensitive state acquired through exposure to a
particular allergen, re-exposure to which brings about a
heightened capacity to react; not dose related
Adverse Drug Reactions: Idiosyncrasy
• response that cannot be explained by any known
pharmacological or biochemical mechanism
5. Causes of adverse drug reactions:
1.Toxicity caused by direct extension of the usual
pharmacological effects of the drug
• A. Side effects
B. Overdose reactions
C. Local toxic effects
• Causes of adverse drug reactions:
2.Toxicity caused by alteration in the recipient of the drug
• A. A disease process
B. Emotional disturbances
C. Genetic aberrations
D. Idiosyncrasy
3. Toxicity caused by allergic responses to the drug
6. Adverse Drug Reactions
1) Side effects
2) Overdose reactions
3) Local toxic effects (most common)
4) Allergic reactions
7. Signs and Symptoms – Toxic Reaction to Local
Anesthesia
•Talkativeness
•Slurred speech
•Dizziness
•Nausea
•Depression
•Euphoria
•Excitement
•Convulsions
14. Allergic Reactions to Local
Anesthetic Agents
•Hypersensitive state as a result of
exposure to an allergen
•Re-exposure can heighten the initial
reaction
15. Clinical Manifestations of an Allergy
•Fever
•Angioedema
•Urticaria
•Dermatitis
•Depression of blood-forming organs
•Photosensitivity
•Anaphylaxis
17. Angioedema, also known as Quincke's edema, and
angioneurotic edema.
It is the rapid swelling (edema) of the dermis,
subcutaneous tissue, mucosa and submucosal
tissues. It is very similar to urticaria, but urticaria,
commonly known as hives, occurs in the upper
dermis
20. Definition
• Urticaria is a very common problem:
• Classically urticaria is characterised by itchy swollen areas
WHEALS/ ANGIOEDEMA ,or both
• Acute/ chronic
• Acute -<6 weeks; chronic > 6 weeks
21. Classification of urticaria
• The principal antigens capable of producing allergic asthma seasonal
allergens (tree pollen, grass pollen, ragweed and certain seasonal
molds)
• 1) "Allergic" urticarial: urticaria follows less than 30 minutes after
ingestion of contact with the sensitizing agent
Physical urticaria
• Diverse physical stimuli (heat, exercise, the sun, cold, pressure and
vibration) may provoke urticaria.
22. • "Pseudo-allergic" urticaria
Several substance labelled as "non-specific histamine liberators" (foods,
hormones, medications, etc.) can provoke urticaria. Among these agents,
the classics are: codeine, morphine, several antibiotics, radio-contrast
products used in radiology, the curares (general anaesthesia) and dextran.
• "Secondary" urticaria
Urticaria is associated with an auto-immune disease, a
hypocomplementemia, thyroid disease, cancer, or an infection (parasites,
helicobacter pylori, etc.).
23. • "Reflex" urticaria
Several hormones (gastrin, neurohormones) suggest that there is a
link between these substances, mastocytes and the skin. It seems,
therefore, that several "external irritants" (emotional, food, etc.)
could cause urticaria (that is often called "idiopathic").
• Hereditary angioneurotic angioedema and acquired deficiencies
in the inhibitor of C1 esterase . These very rare conditions are
associated with a non-itchy angioedema in particular that may
also manifest internally (within the intestines, etc.)
24. • Treatment of urticaria
• 1) Eliminate the allergic cause (food, medication, contact
allergen, etc.). In the same way for "pseudo-allergic"
urticaria, eliminate the provoking agent.
• 3) Treat, if possible, any disease which may be the cause of
the urticaria (secondary urticaria or angioedema).
• 4) Pharmacotherapy: above-all "symptomatic" (anti-
histamines), with new non-sedating agents with long half-
lives (cetirizine, loratadine, desloratadine, fexofenadine).
25. Latex Allergy
•The cartridge opening into which the needle
is inserted is aluminum with a very thin
diaphragm of latex in the middle
•Though patients with a latex allergy are at an
increased risk, there are no known cases or
reports of an allergic response from the latex
on a local anesthetic cartridge
26. Pregnancy
• Anesthesia crosses the placenta and could be toxic to the fetus, but is not a
known teratogen
• No drug should be administered during pregnancy especially the first trimester
• If treatment is necessary, local anesthetics with epinephrine are considered
relatively safe for use during pregnancy; check with patient’s physician
• Educate patients to the potential risks (document)
27. FDA Category of Prescription Drugs
Drug Category Use During
Pregnancy
Risk
Lidocaine B Yes -
Prilocaine B Yes -
Mepivacaine C Use with caution-
Consult physician
Fetal
bradycardi
a
Bupivacaine C Use with caution-
Consult physician
Fetal
bradycardi
a
28. TOXICITY
• Toxic overdose, due to excessive administration of a drug.
• Depends on a sufficient concentration of the drug in the blood, to
affect the CNS, R.S, CVS.
• When the drug is inadvertently administrated intravascularly
buildup within the bloodstream is so rapid that biotransformation
and elimination can’t keep pace.
29. • In ester type, a high blood level occurs as a result of the absence of
sufficient / effective plasma cholinesterase to catalyze the hydrolysis
of the drug.
• Factors: General physical condition, Rapidity of injection, route
(inadvertant intravascular), Dose, Age of patient.
30. • “A GOOD RULE TO FOLLOW IS TO USE THE LEAST POSSIBLE
VOLUME AND CONCENTRATION NEEDED TO SECURE
SATISFACTORY ANESTHESIA”.
• Should be injected slowly.
• More vascular area, More rapid absorption, and greater is
the possibility of a toxic reaction.
• “ALWAYS ASPIRATE BEFORE INJECTING”
31. C.N.S
• Depression of inhibitory areas excitatory action to occur unopposed
overt manifestation of CNS stimulation.
• Hyperexcitable neurons at cortical centre epilepsy.
• Sub-toxic doses depress these hyperexcitable neurons (anti-
convulsant effect)
33. • Medullary depress fall in H.R / B.P / R.R.
• Development of either excitation / sedation, should alert the
practitioner to the possibility of a rising blood level and subsequent
development of seizure.
• Overt sign of stimulation (depression) lethargy, unresponsiveness,
lack of movement, drowsiness, weakness.
34. • Following a seizures, a period of post-ictal depression occurs (severe
depression of both cortical and medullary centers).
35. C.V.S
• Stimulatory effect noted during the early stages of toxicity (reflex
mediated by CNS).
• The effect on myocardium (quinidine – like) – direct depressant slow
the rate of impulse conduction, prolong refractory period.
36. • Acts as anti-arrythmic in low-doses (1.5 – 5.0 microgram/ml), supress
ectopic pacemaker.
• Cardiac output decreases.
• Peripheral vasodilatation.
• Cardiac standstill (asystole) – irreversible.
• “It’s a mistake to insert a needle, rapidly inject, and immediately
depart for another room, leaving the patient unobserved and
unattended”.
37. MANAGEMENT
• Most instant – immediate, mild, transient – NO SPECIFIC TREATMENT.
• If the patient, is suddenly talkative, apprehension – REASSURANCE.
• In severe – generalized tonic-clonic seizures (sudden and short) stop
dental procedure, padded tongue blade, suction to remove excess saliva,
patency of airway (by extending the neck).
38. • Depression phase is more critical, more time for support and
evaluation, ABC’s of resuscitation, extend the head, airway cleared by
suction, semi-recumbent position (to increase venous return),
ventilation.
• Monitor pulse, B.P.
• Episode becomes self-limiting as the drug undergoes redistribution
and biotransformation.
39. For CNS stimulation:
• If there is progressive development of CNS stimulation – 50-100 mg
phenobarbitol, prevent the development of seizures. The drug must be
given at the earliest signs of toxicity, since these agent will potentiate
the degree of post-stimulatory depression.
• Diazepam – 5-10 mg – doesn’t compound post-stimulatory depression.
• Artificial ventilation – prevents the development of hypoxia,
hypercarbia, and acidosis – factors that tend to extend the duration of
the seizures.
40. • Corrected by positional change + infuse 5% dextrose with R.L.
• Vasopressors.
• For bradycardia – 0.5 mg atropine or 0.2 mg glycopyrrolate
41. For CNS depression
• For MILD – mechanical means are sufficient.
• For severe – mechanical + pharmacological.
• Maintain airway, respiration.
• Dilation of microcirculation results in hypovolemia pooling of blood
fall in venous return decrease in cardiac output / B.P.
• .
42. PREVENTION
• Adequately evaluated before injection.
• Least possible volume.
• Inject slowly.
• ASPIRATION must be done.
• Vasoconstrictor should be used (if not contraindicated).
43. VASOCONSTRICTORS
• Useful adjunct.
• It slows the absorption (reduce toxicity).
• Prolongs the action.
• Permits smaller volume.
• Increases the efficiency of the drug.
• All L.A are vasodilators, are rapidly absorbed into systemic toxic
overdose. Stronger the concentration, the greater the vasodilating
effect.
44. IDIOSYNCRASY
• Bizzare type of reaction that cannot be classified as toxic or allergic.
• Unusual symptoms.
• Unrelated to drug, possibly being psychogenic or having some
underlying pathology.
45. • It has to be differentiated from toxic / allergic reaction.
• Maintain airway, oxygen, fluids, position.
• Psychotherapy, and premedication are useful (by taking preoperative
history).
46. Allergic and Anaphylactoid reaction
• 1% of all reactions.
• Antigen unit with antibody release of histamine. (hypersensitivity)
• Asthma, rhinitis, angioneurotic edema, urticaria, rashes.
47. • Capillaries are more permeable, extravasation of plasma into
surrounding tissues angioedema.
• Spasm of bronchioles and vasodilation of arterioles pool of blood.
• Better to have the patient tested before proceeding.
• Solutions contain methylparaben, germicide / preservative – produce
allergy.
48. • Most common Immediate reactions: urticaria, angioedema.
• Second most common – asthma (R.S distress of expiratory type –
prolonged expiration).
• Angioedema of pharynx, larynx R.S distress.
• In generalized anaphylaxis – sudden CVS collapse, severe R.S distress.
• Pruritis, erythema, urticaria, wheeze, dyspnea, cyanosis,
hypotension, unconscious, cardiac arrest.
50. Asthmatic attacks
• Aerosol inhaler.
• Isoproterenol or epinephrine relaxation of bronchiole smooth
muscles.
• Slow I.V aminophylline 250 to 500mg.
51. Generalized immediate reaction
• Sudden, complete collapse and LOC, with absence of pulse and
respiration, cyanotic.
• Establish airway with ventilation.
• Place the victim in a position to allow gravity to aid venous return, I.V
fluids, vasopressors, steroid.
• DELAYED REACTION:
• Occurs more than 48 hours.
• Localized edema / joint pain, tenderness, malaise.
52. Allergy testing
• Patients who have a history of asthma / hay fever may be allergic
types (atopic) and thus more likely to have an allergic reaction.
• Intradermal and mucous membrane tests may be of little value in
determining the allergic sensitivity.
53. Pharmacogenetic disorder
• Malignant hyperpyrexia excessive calcium ion release release from
the sarcoplasmic reticulum of muscle rapid development of
metabolic and respiratory acidosis.
• Tachycardia, unstable blood pressure, cyanosis, high fever, rigidity.
• Nonester type of L.A – provoking agents.
• Treat – dantrolene.
54.
55.
56.
57. SYNCOPE
• Most frequent complication associated with L.A in dental office.
• Neurogenic shock – due to cerebral ischemia secondary to vasodilation
OR an increase in the peripheral vascular bed, with decrease in B.P.
• When patient in dental chair, the brain is placed in a superior position
and is most susceptible to reduce blood volume.
58. • Discontinue the procedure, lower the chair back, legs are elevated
(semireclining position) aids venous return + weight of viscera is
not thrown onto the diaphragm, which impairs respiration.
• Provide oxygen + deep breaths.
59. Clinical manifestation of syncope can be
divided in to two phases
1. Pre syncope
• Feeling of warmth in face and neck
• Loss of color : Pale
• Heavy perspiration
• Nausea
• Rapid heart rate
• Pupillary dilation
• BP depressed
60. 2. Syncope
• Pupillary dilation
• Hyperpnea
• Hypotension
• Bradycardia
• Visual disturbances
• Dizziness
• Convulsive movement and muscular twitching
• Loss of consciousness
61.
62.
63. AIRWAY:
The instant conscious is lost, pt. also loses the ability to
maintain the patency of airway
Patency of airway is maintained by head tilt chin lift
procedure
Triple airway maneuver –
Maximum head extension
Protrusion of the mandible
Slight opening of the mouth
Oropharyngeal and nasopharyngeal tubes can also be used
64.
65. Clearing the airway of foreign objects :
• Apply four blows with clenched fist to victims back in rapid
succession
• Hamlickes maneuver - Four inward & upward thrusts in the epigastric
area
• cricothyrotomy
66.
67. BREATHING
Various methods
• Mouth to mouth
• Pt. nose is closed
• Mouth to nose
• Ambu bag
• Anesthetic machine
• Lung inflations should be provided once every 5 sec
• In cases of respiratory arrest – 4 full lung inflations without allowing
for full exhalation
68.
69. CIRCULATION
Victim must alwaya be on his back on a firm surface in horizontal
position
The heel of the hand should be placed on the long axis of the
sternum with fingers elevated away from the chest wall
One rescuer –
80 compressions/min
15:2
Two rescuers –
60 compressions/min
Lung inflation on upstroke of fifth compression
73. • An “Anaesthetic complication” may be defined as any deviation from
the normally expected pattern during or after securing of regional
analgesia.
These complications may be classified into:
• Local.
• Systemic.
74. LOCAL COMPLICATIONS
NEEDLE BREAKAGE
PROLONGED ANESTHESIA /
PARESTHESIA
FACIAL NERVE PARALYSIS
TRISMUS
SOFT TISSUE INJURY
HEMATOMA
PAIN ON INJECTION
INFECTION / EDEMA / SLOUGHING OF
TISSUES
POST-ANESTHETIC INTRAORAL
LESIONS
75. NEEDLE BREAKAGE
• Long dental needles most likely have broken during injection, but
some portion of the needle would remain visible in the patients
mouth.
• The fragment of the needle can be removed very easily,
using haemostat.
• Since the introduction of non-reusable, stainless
steel needles, needle breakage has become
an extremely rare complication.
76. • In all situations, needle fracture occurs at the hub (not along the
shaft)
Additional factors include:
• Intentional bending, before injection.
• Sudden movement by the patient while the needle is still.
• Forceful contact with bone.
77. • Ready access to a haemostat, enables to grasp the proximal end and
remove it.
• When the soft tissue has dimpled under pressure from the syringe, the
fragment will not be visible.
78. PREVENTION
• Don’t use short needle for inf. alveolar nerve block.
• Don’t use 30-gauge needle for I.A.N. block.
• Don’t use bent needles.
• Don’t insert a needle into tissue to its hub.
• Caution while inserting in young adults / phobic adult / child.
• Don’t use reusable needles (to ensure sharpness).
• Don’t surprise with a sudden unexpected needle insertion.
79. PROLONGED ANAESTHESIA
• Numbness (frozen)
• Paraesthesia / persistent anaesthesia
• Most frequent cause of dental MALPRACTICE
litigation.
• Associated oral dysfunction – tongue biting, loss of
taste, and speech impediment.
• PARESTHESIA – persistent anesthesia or altered
sensation, beyond the expected duration of anesthesia.
80. CAUSES OF PARAESTHESIA
• L.A contaminated with alcohol / sterilizing solution irritation,
edema, pressure over the nerve. Alcohols are neurolytic (long term
trauma to the nerve).
• Trauma to the nerve sheath can be produced by the needle. C/O
“electric shock” throughout the distribution of nerve.
• Trauma and swelling in proximity to a nerve transient decrease
sensation.
81. • Hemorrhage into or around the neural sheath
Bleeding increases pressure on the nerve paraesthesia (hemorrhage is
resorbed VERY SLOWLY because of poor circulation) degeneration of
nerve fibres.
• Infections – common cause pain after L.A.
82. PROBLEMS OF PARAESTHESIA
• Mostly it is partial, can lead to self-inflicted soft tissue injury.
• Biting / thermal / chemical insult can occur without awareness.
• HYPERESTHESIA - increased sensitivity to noxious stimuli.
• DYSESTHESIA – a painful sensation occurring to usually non
noxious stimuli.
83. PREVENTION OF HYPERESTHESIA
• STRICT adherence to injection PROTOCOL and PROPER
CARE and HANDLING of cartridges help minimize the risk.
• The insertion of needle should be slow / atraumatic.
• Multiple insertion – avoided.
• Sterile solution.
• Should be forced into the tissue – VERY SLOWLY.
84. • Excessive volumes in the constricted areas should be avoided.
• Injected solution should be as close to body temperature.
85. MANAGEMENT OF HYPERESTHESIA
• Most paraesthesia resolve within = 8 weeks without treatment.
Only when damage to the nerve is severe will the paraesthesia
be permanent.
• Assurance (speak personally, it is NOT UNCOMMON, re
examine, record in dental chart)
• Excessive volumes in the constricted areas should be avoided.
• Injected solution should be as close to body temperature.
• Mechanisms for permanent nerve involvement is UNKNOWN
and there is no known prevention / treatment
86. HEMATOMA
• Effusion of blood into the surrounding tissues as a
result of a torn blood vessel, during administration of
L.A.
• COMMON COMPLICATION of intraoral regional
analgesia.
• Most commonly associated with
posterior superior alveolar and infraorbital block /
IANB.
87. • Mainly because of improper technique.
• They all absorb in due time, with little residual effect other than
discolouration.
• No attempt should be made to aspirate.
• COMPLICATIONS: trismus, pain, swelling, discolouration.
88. PREVENTION
• Knowledge of anatomy – important.
• Penetration for a PSA nerve block may be decreased in a patient
with smaller facial characteristics.
• Use of short needle.
• Minimize the number of needle penetration.
• DON’T use needle as a probe in tissues.
89. MANAGEMENT
• IMMEDIATE – direct pressure – 2 minutes.
• IANB – pressure – medial aspect of mandibular ramus.
• INFRAORBITAL – pressure – skin directly over the infraorbital
foramen. Clinically – discolouration of skin below lower eyelid.
• MENTAL NERVE – pressure over mental foramen, externally on the
skin or intra orally. Clinically – discolouration of chin / swelling in
mucobuccal fold in the region of mental foramen.
90. EDEMA
• Usually a symptom and rarely an entity.
• Trauma, infection, allergy, hemorrhage,
other factors can produce edema.
• PREVENTION: proper care / handle, use atraumatic, medical
evaluation.
91. TREATMENT
• After hemorrhage, edema resolves slowly, as extravasated blood
elements are resorbed.
• Angioedema – histamine blocker, supine position, A-B-C-Definitive
treatment-Epinephrine 0.3 ml IM or 3 ml I.V.
• Steroid.
• Prepare for cricothyrotomy.
92. FACIAL NERVE WEAKNESS
• 7th cranial nerve carries motor impulse to facial
expression.
• Paralysis – terminal branches, occurs when an
infraorbital nerve block is administrated /
maxillary canines are infiltrated.
• Muscle droop (L.A into the deep lobe of parotid,
through which terminal portions of nerve extends)
93. CAUSES
• Transient paralysis is common (L.A into capsule of
parotid, located at posterior border of mandibular
ramus, covered by medial pterygoid and masseter.
• Directing the needle posteriorly / inadverently
deflecting, during an IANB, or overinserting during
Vazirani-Akinosi nerve block, may place the tip
within the body of parotid.
94. PROBLEMS ASSOCIATED
• Loss of motor function is transient (last for several hours) – depend
upon formulation / volume / proximity of nerve. NO sensory loss.
• Unilateral paralysis.
• Persons face appear lopsided.
• No treatment.
• Patient is unable to voluntarily close one eye.
• Protective lid reflex – abolished.
• Winking and blinking – impossible.
• Cornea retains its innervation irritated tears lubricate the eye.
95. PREVENTION
• A needle tip that comes in contact with bone (medial
aspect of ramus) before depositing L.A essentially
precludes the possibility that anaesthetic will be
deposited into parotid gland during IANB.
96. MANAGEMENT
• C/O weakness of the muscle on the affected side of
the face.
• Reassure the patient – transient, resolve without
residual effect.
• Remove contact lens.
• Eye patch, manually close the affected eyelid
periodically.
• Record the incident.
97. TRISMUS
• Prolonged tetanic spasm of the jaw muscles
(LOCKED JAW)
• CAUSES – trauma to muscle / blood vessel in
infratemporal fossa – most common.
• L.A with alcohol / cold sterilizing solutions – diffused
irritation of muscle.
• Injection of L.A – intramuscularly or supramuscular
progressive necrosis of muscle.
98. • Hemorrhage – another cause. Large volumes of extravascular blood
irritation muscle dysfunction as the blood is slowly resorbed.
• Low-grade infection – also cause trismus.
• Multiple needle penetration greater incidence of trismus.
• Excessive volumes of L.A deposited into a restricted area produce
distension of tissues post-injection trismus.
99. PROBLEM - TRISMUS
• The average inter incisal opening – male – 44.8 mm
• The average inter incisal – female – 39.2 mm
• The average inter incisal opening in case of trismus – 13.7 mm
• In acute – pain produced by hemorrhage spasm limitation of
movement.
• Chronic phase develops if treatment is not begun, due to organization
of hematoma fibrosis contracture
100. PREVENTION
• Use a sharp, sterile, disposable needle.
• Proper care and cartridges.
• Aseptic technique.
• Atraumatic insertion and injection technique.
• Avoid repeat injections / multiple insertions
into same area, by gaining knowledge of anatomy.
• Use minimum effective volume of L.A.
101. MANAGEMENT - TRISMUS
• Heat therapy – apply hot, moist towel, for 20 mins
• Warm saline rinses
• Analgesics
• If necessary – muscle relaxants
• Physiotherapy – opening / closing, lateral excursions, chewing gum.
• Record the incident, findings, treatment. Avoid further dental treatment in the
involved region.
102. • The Vazirani-Akinosi mandibular nerve block usually provides relief of
motor dysfunction permitting to open his mouth allowing
administration of injection for clinical pain control.
• If pain / dysfunction continue beyond 48 hours, consider the
possibility of infection add antibiotic.
• Complete recovery takes about 6 weeks.
103. SOFT TISSUE INJURY
• Self-inflicted trauma to the lips and tongue – caused
by the patient inadvertently biting / chewing these
tissues while still anesthetized.
• CAUSES: mostly occur in children, mentally /
physically disabled, old age.
104. PREVENTION: L.A of appropriate duration should be selected.
• A cotton roll is placed between teeth and lip, and secured with dental
floss.
• A self-adherent warning sticker may be used on children.
105. MANAGEMENT
• Analgesic.
• Antibiotics
• Lukewarm saline.
• Petroleum jelly to cover the lip.
• Discolouration is due to extravascular blood elements
(resorbed 1-2 weeks).
• Ice is applied immediately (acts as analgesic /
vasoconstrictor).
• DON’T apply heat for 4 to 6 hours (heat produces
vasodilatation increase hematoma). Next day,
apply warm moist heat.
106. PAIN ON INJECTION
• CAUSES: careless injection technique,
• Palatal injection always hurt
• Needle can become dull from multiple injections,
rapid deposition of L.A may cause tissue damage,
• Needles with barb may produce pain as they are
withdrawn.
107. PREVENTION
• Proper techniques,
• Use sharp needles,
• Use topical anesthesia before injection,
• Sterile techniques / solution,
• Inject slowly,
• Correct temperature.
• pH – 7.4, are more comfortable.
108. BURNING ON INJECTION
• CAUSES: depends upon pH of the solution.
• The pH of plain L.A is 6.5, with vasopressor is 3.5
(acidic).
• Rapid injection in the more adherent tissue of palate ,
produces a burning sensation.
• Contamination of cartridges with alcohol / sterilizing
solution.
109. • Transient, due to tissue irritation.
• When a burning sensation occurs as a result of rapid injection, a
contaminated solution, or an overly warm solution, and subsequent
complications such as post-anaesthetic trismus, edema, or possible
paraesthesia are reported.
110. PREVENTION
• By buffering the pH up to 7.4
• Slowing the speed of injection (1 ml/min)
• TREATMENT: it is transient and doesn’t lead to
prolonged tissue involvement
111. INFECTION
• CAUSES: contamination of needle.
• Injecting L.A into infected area.
• L.A are less effective when injected into
infected tissues. If deposited under pressure
(periodontal ligament), it transport the
bacteria into adjacent healthy tissues
spreading infection.
• It may lead to trismus.
112. PREVENTION
• Sterile needle.
• Avoid contamination.
• Avoid multiple injections with same needle.
• Prepare the tissue before penetration.
113. TREATMENT
• Mange trismus: heat, analgesic, muscle relaxant,
physiotherapy
• If signs and symptoms of trismus do not begin to
respond (in 3 days), the possibility of a low-grade
infection start antibiotics.
114. SLOUGHING OF TISSUES
• Prolonged irritation / ischemia of gingival soft tissue epithelial
desquamation
• EPITHELIAL DESQUAMATION: application of topical L.A to
gingiva for long time, sensitivity of tissue, reaction in an area.
• PREVENTION: don’t use overtly concentrated
vasoconstrictor solutions
• TREATMENT: symptomatic, analgesic
115. POST ANESTHETIC INTRAORAL LESION
• C/O ulcerations in the mouth (after 2 days).
• Recurrent aphthous stomatitis
/ herpes simplex
can occur intraorally after a L.A injection
or after any trauma.
• Trauma by a needle, L.A, swab, other instrument activate the latent
form of disease.
• PREVENTION: herpes may be prevented, if treated in its prodromal phase.
• Prodromal – mild burning / itching sensation at the site.
• Acyclovir is applied locally, to minimize the acute phase.
116. TREATMENT
• Symptomatic.
• A mixture of equal amounts of diphenhydramine and milk of magnesia
rinsed in the mouth effectively coats the ulcerations and provide relief.
• Tannic acid preparation.
• Steroid is contraindicated.
• Ulcerations lasts for 7 to 10 days with or without treatment.
117. DIPLOPIA
• Diplopia is one of the very rare complications that follow a posterior
superior alveolar (PSA) nerve block.
• PSA nerve block used for the extraction of
the upper right third molar tooth.
• After the extraction, of double vision and
not being able to gaze laterally with the right eye.
118. • The origins of middle meningeal artery and inferior alveolar artery are closely
situated
The solution may gain access to the middle meningeal artery which may enter the
cranial cavity through the foramen spinosum and gives off many branches.
The ophthalmic branch of the middle meningeal artery may anastomose with the
lacrimal artery.
The blood supply of the lateral rectus muscle derives from the lacrimal artery and
from the lateral muscular trunk of the ophthalmic artery.
Therefore, the intra-arterial injection of the local anaesthetics may reach and
paralyse the lateral rectus muscle and cause diplopia.
119. PRECAUTIONS
• Although it is rare to have ocular complications after local anesthetic
injection, the occurrence is alarming to both the dentist and the
patient.
• For the proper administration of the PSA nerve block, the patient is
positioned such that the maxillary occlusal plane is at a 45-degree
angle to the floor.
• After palpating all the anatomical landmarks, a 1⅝ inch, 25 gauze
needle is inserted to the depth of 14 – 16 mm and the LA is injected.
120. • The following guidelines are to be followed for better management
of the complications.
• a. Reassure the patient regarding the usually transient nature of the
complications.
• b. Cover the affected eye with a gauze dressing to protect the cornea
for the duration of anaesthesia.
• c. The patient should be escorted home by a responsible adult.
• d. If ocular complications last longer than six hours, refer the
patient to an ophthalmologist for evaluation