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.

1. SYSTEMIC COMPLICATIONS OF
LOCAL ANESTHESIA
DR. SAROSH HUSSAIN
HOUSE OFFICER HUDH

2. LEARNING OBJECTIVES
• There are two most common Systemic Complications:-
1. Overdose
2. Allergy
• Introduction
• Predisposing Factors
• Clinical Manifestations
• Management

3. 1.OVERDOSE
• Overdose reaction is occurring when the drug access to the
circulatory system.
• Normally there is constant absorption of the drug from its
site of admission into the circulatory system and a steady
removal from the blood by the liver.

4. Predisposing Factors
• Patient Factors:-
1. Age.
2. Medications.
3. Gender.
4. Presence of disease.
5. Genetics
6. Mental attitude.

5. Predisposing Factors
• Drug Factors:-
1. Vasoactivity.
2. Concentration of Dose.
3. Route of administration.
4. Rate of injection.
5. Vascularity of the injection site.
6. Presence of vasoconstrictors.

6. Prevention
• Use aspiration syringe.
• Use a needle no smaller than 25 gauge.
• Aspirate in at least two planes before injection.
• Slow inject the anesthetic.

7. Clinical Manifestation
1. Sweating.
2. Vomiting.
3. Failure to follow commands.
4. Elevated blood pressure, heart and
respiratory rate.
5. Tonic-clonic seizure in highly overdose.
6. CNS depression, Myocardial depression
and cardiac arrest.

8. Management
• Mild Overdose:-
1. Slow onset (>5 minutes)
2. Slow onset (>15 minutes)
• Severe Overdose:-
1. Rapid onset (within 1 minute)
2. Slow onset (5 to 15 minutes)

9. Management
• Basic Emergency Management :-
P-C-A-B-D
1. Position.
2. Circulation.
3. Airway.
4. Breathing.
5. Definitive Care.

10. 2.ALLERGY
• Hypersensitive state, acquired through exposure to a
particular allergen.
• Allergic reactions cover a broad spectrum od clinical
manifestations ranging from mild and delayed response
occurring as long as 48 hours after exposure to allergen, to
immediate and threatening reaction develop within
seconds of exposure.

11. Predisposing Factors
1. Sodium Bisulfite:-
• Antioxidant in vasoconstrictor local anesthesia.
2. Epinephrine.
3. Latex.
4. Topical Anesthesia:-
• Preservatives containing such as Methylparaben, Ethylparaben, or
Propylparaben.

12. Clinical Manifestation
1. Dermatological reaction
2. Respiratory reaction
3. Generalized anaphylaxis

13. Clinical Manifestation
1. Dermatological reaction:-
• Urticarial.
• Angioedema.
2. Respiratory reactions:-
• Bronchospasm.
• Laryngeal edema.

14. Clinical Manifestation
3. Generalized anaphylaxis:-
• Skin reactions.
• Smooth muscle spasm of gastrointestinal
and genitourinary tracts and
bronchospasm.
• Respiratory distress.
• Cardiovascular collapse.

15. Management
1. Dermatological reaction :-
• Delayed reaction.
• Immediate reaction.
2. Respiratory reaction:-
• Laryngeal edema.
• Bronchospasm.

16. Management
3. Generalized anaphylaxis:-
• Signs of allergy present.
• No signs of allergy present.

17. Management
1. Dermatological reaction :-
• Delayed reaction:-
a. P-C-A-B.
b. Oral histamine blocker 50 mg diphenhydramine or 10 mg
chlorpheniramine, one q6h for 3-4 days.
c. Observation for 1 hour.
d. Medical consultation.
e. If patient is drowsiness, not allowed to leave the clinic.

18. Management
• Immediate reaction:-
a. P-C-A-B.
b. Epinephrine 0.3 mg IM.
c. IM histamine blocker 50 mg diphenhydramine or 10 mg
chlorpheniramine.
d. Medical consultation.
e. Observation for 1 hour.
f. Prescribe Oral histamine blocker 3 days.

19. Management
2. Respiratory reaction:-
• Laryngeal Edema :- “unconscious patient”
a. P-C-A-B
b. Epinephrine 0.3 IM, dose repeated 10-15 min. if needed.
c. Activate Emergency Medical Services.
d. IM histamine blocker 50 mg diphenhydramine or 10 mg
chlorpheniramine. Corticosteroid IM or IV (100 mg
Hydrocortisone sodium succinate to inhibit and
decrease edema.
e. Perform Cricothyrotomy.

20. Management
• Bronchospasm :-
a. P-C-A-B
b. Administer oxygen at flow 5-6 litersmin.
c. Epinephrine 0.3 IM or Bronchodilator “albuterol” , dose repeated 10-15
min. if needed.
d. Observation for 1 hour.
e. IM histamine blocker 50 mg diphenhydramine or 10 mg
chlorpheniramine.
f. Prescribe Oral histamine blocker 3 days.

21. Management
3. Generalized Anaphylaxis :-
• Signs of allergy present:- “unconscious patient”
a. P-C-A-B.
b. Summon medical assistance.
c. Epinephrine 0.3 IM, dose repeated 10-15 min.
d. Administer oxygen.
e. Monitor vital signs, recorded every 5 min.
f. IM histamine blocker and Corticosteroid IM or IV “ If clinical
improvement noted increased blood pressure, decreased
bronchospasm”.

22. Management
• No signs of allergy present : “unconscious patient”
a. P-C-A-B
b. Summon medical assistance.
c. Administer oxygen.
d. Monitor vital signs, recorded every 5 min.
e. Addition management, on arrival of the emergency medical personnel
depend on the cause of the loss of consciousness.