This document discusses complications that can arise from local anesthesia administration including syncope, hypersensitivity reactions, anaphylaxis, and toxicity. Syncope is caused by increased catecholamines and vagal tone leading to decreased blood pressure and cerebral blood flow causing fainting. Hypersensitivity can cause allergic reactions ranging from hives to anaphylaxis. Anaphylaxis is a severe allergic reaction involving multiple organ systems. Toxicity can occur from overdose of local anesthetics and is managed with supportive care and intravenous medications.

2. Complications of Local Anesthesia
Dr. Maged A Omar

4. Anxiety

5. Syncope

6. SYNCOPE
Signs and Symptoms
• Feeling of warmth
• Nausea
• Weakness
• Pale skin
• Sweating over the forehead
• Loss of consciousness

8. SYNCOPE

9. SYNCOPE
Pathophysiology
↑ Catecholamines +
Adrenaline and Nor
Adrenalin
↓ Peripheral vascular
resistance
Peripheral
blood pooling
↓ Arterial
blood flow
Compensatory
mechanism
↑ Heart rate,
Warmth,
Pallor,
Sweating
↑ BR
Decompensation
↑ Vagal Tone
Bradycardia
Hypotension
↓ Cerebral BF
↓
Fainting → Seizure

10. SYNCOPE
Prevention
• Calm and kind patient approach
• Stress reduction protocol
• Working in supine position
Management
•Terminate treatment procedures
• Supine position of the patient
• Monitor vital signs
• Inhale ammonia, give oxygen
• After recovery escort patient to home
• Stress reduction measures in future procedure

12. HypersensitivityHypersensitivity
 AllergyAllergy
 AnaphylaxisAnaphylaxis
 IdiosyncrasyIdiosyncrasy

13. Loss of consciousness
Hives
Tongue swelling
Dysphagia
Rapid swelling of
throat tissues
Anaphylaxis

15. Anaphylaxis
 Acute severe hypersensitivity reaction due toAcute severe hypersensitivity reaction due to
antigen including LAantigen including LA
Signs and symptoms
 Eye : itching, lacrimationEye : itching, lacrimation
 Nose : sneezing, discharge
 Respiration : laryngeal edema, bronchspasm
 CVS : hypotension, tachycardia
 GIT : vomiting
 Skin : erythema, edema
 CNS : convulsions, coma

16. Anaphylaxis
Management
 Supine positionSupine position
 0.5 cc adrenaline 1:1000 in the sublingual0.5 cc adrenaline 1:1000 in the sublingual
area (highly vascular)area (highly vascular)
 IV 50 mg antihistaminicIV 50 mg antihistaminic
 Monitor vital signsMonitor vital signs
 Consider CPRConsider CPR
 Ask for medical assistanceAsk for medical assistance

17. ToxicityToxicity
overdose could be due to:overdose could be due to:
 Too large volumeToo large volume
 Unusual rapid absorption or intravenous injectionUnusual rapid absorption or intravenous injection
 Slow detoxificationSlow detoxification
 Slow eliminationSlow elimination
 Concentration of the drug doseConcentration of the drug dose
 Rapidity of injectionRapidity of injection
 General physical conditionGeneral physical condition
 Emotional statusEmotional status

18. ToxicityToxicity
ManagementManagement
 Intravenous barbiturateIntravenous barbiturate
 Muscle relaxantMuscle relaxant
 OxygenOxygen
 Intravenous fluidsIntravenous fluids
 CoramineCoramine
In the vast majority manifestations are immediate,In the vast majority manifestations are immediate,
mild& transitory but in some cases death follows.mild& transitory but in some cases death follows.