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systemic complications.pptx
- 1. SYSTEMIC COMPLICATIONS OF LOCALANESTHESIA
- 2. CONTENTS Introduction Systemiccomplication Overdosage Allergy Idiosyncrasy Conclusion
- 3. INTRODUCTION Drugs have 2types of effect when administered Desirable=actions may be sought beneficial Undesirable =actions may not be beneficial not sought THREE PRINCIPLES OF DRUG 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 user
- 4. SYSTEMIC COMPLICATIONS The adversereaction which occurs in the body as a side effect of adverse experiences , drug induced disease , disease of medical progress , secondary effects of a drug and intolerance Three major methods by which drug produce adverse reactions 1. Overdosage 2. Allergy 3. Idiosyncrasy
- 5. OVERDOSE A drugoverdose reaction is defined as those clinical signs and symptoms that results from an overly high blood level of a drug in various target organs and tissues For an overdose reaction to occur the drug first must gain access to the circulatory system in quantities sufficient to produce adverse effects on various tissues of the body
- 6. PREDISPOSING FACTORS Patient factors Age Weight Other drugs Sex Presence of disease Genetics Mental attitude and environment Drug factors Vasoactivity Concentration Dose Route of administration Rate of injection Vascularity of injection site Presence of vasoconstrictors
- 7. MILD TO MODERATEOVERDOSE LEVELS SIGNS Talkativeness Apprehension Elevated blood pressure , heart rate , respiratory rate Excitability Slurred speech Twitching and tremor Euphoria Dysarthria Nystagmus Sweating Vomiting Disorientation
- 8. MODERATE TO HIGHOVERDOSE LEVELS SIGNS Tonic-clonic seizure activity followed by generalized central nervous system depression depressed blood pressure, heart rate , respiratory rate
- 9. SYMPTOMS ( PROGRESSIVEWITH INCREASING BLOOD LEVELS) Lightheadedness Dizziness Nervousness Numbness Metallic taste Visual disturbances Auditory disturbances Drowsiness and disorientation Loss of consciousness
- 10. MAXIMUM RECOMMENDED DOSAGEOF LA ARTICAINE 7.0 LIDOCAINE PLAIN 4.4 MEPIVACAINE 4.4 PRILOCAINE 6.0 BUPIVACAINE 1.3 LIDOCAINE WITH EPINEPHRINE 7.0 DRUG RECOMMEN DED mg/kg
- 11. LOCAL ANESTHETIC BLOODLEVELS CARDIOVASCULAR SYSTEM normal blood level after intraoral injection No cardiovascular actions 1.8-5.0 antidysrhythmic actions , tachycardia 5.0-10.0 ECG alterations , myocardial depression , peripheral vasodilation 10.0+ massive peripheral vasodilation Intensive myocardial depression cardiac arrest CENTRAL NERVOUS SYSTEM Normal blood level after intraoral injection 0.5-4.0 ( Anticonvulsant actions) 4.5-7.0 CNS depression manifest as excitation , agitation, irritability 7.5-10.0 CNS depression manifest as tonic clonic seizures 10.0+ generalized CNS depression
- 12. BASIC EMERGENCY MANAGEMENT P… POSITION unconscious - supine with feet elevated conscious - based on patient comfort A…. AIRWAY unconscious -assess and maintain airway conscious – assess airway B…..BREATHING unconscious - assess and ventilate if necessary conscious - asses breathing C….CIRCULATION unconsciouss -external cardiac compression if necessary conscious -asses circulation D…..DEFINITE CARE – diagnosis , management (emergency medicines)
- 14. MANAGEMENT MILD OVERDOSEREACTION Slow onset (>5minutes after administration) - slow absorption and rapid absorption Slower onset (>15minutes after administration) - abnormal biotranformation & renal dysfunction P – A – B – C – D for all medical emergency Definitive care 1. Reassure the patient 2. Administer oxygen 3. Monitor vital signs 4. Administer anticonvulsant(midazolam)
- 15. Severe overdosereactions Rapid onset(within 1 minute)-loss of consciousness with or without convulsion severe onset( 5 to 15 minutes)-rapid absorption , biotransformation , renal dysfunction P – A – B – C Definitive care 1. Protect the patient arms , legs, head 2. Immediately call emergency medical assistance 3. BLS 4. Maintain airway ventilation 5. Administer anticonvulsant 6. IM OR IV administration
- 16. ALLERGY Allergy isa hypersensitive state acquired through a exposure of a particular allergen it long lasts for 48 hours from immediate to life threatening reactions developing within seconds of exposure
- 17. PREDISPOSING FACTORS Estertype local anesthetics(procaine , benzocaine ,tetracaine) Sodium bisulfite allergy Epinephrine allergy Latex allergy Topical anesthetic allergy( benzocaine, tetracaine)
- 18. Type 1 anaphylactic(IgE) ANAPHYLAXIS(DRUGS ) BRONCHIAL ASTHMA ALLERGIC RHINITIS URTICARIA ANGIOEDEMA HAY FEVER
- 19. Type 2 cytotoxic(IgG,IgM) TRANSFUSIONREACTION AUTOIMMUNE HAEMOLYSIS HEMOLYTIC ANAEMIA CERTAIN DRUG REACTIONS GLOMERULONEPHRITIS GOODPASTURES SYNDROME
- 20. Type 3 immunecomplex(IgG) SERUM SICKNES LUPUS NEPHRITIS ALLERGIC ALVEOLITIS VIRAL HEPATITIS
- 21. Type 4 cellmediated ALLERGIC CONTACT DERMATITIS INFECTIOUS GRANULOMA TISSUE GRAFT REJECTION CHRONIC HEPATITIS
- 22. SIGNS AND SYMPTOMS SKINREACTIONS Itching (pruritis) Flushing (erythema) Urticaria Nausea and vomiting Conjunctivitis rhinitis SKIN RESPONSE TO SMOOTH MUSCLE SPASM Abdominal cramps Diarrhoea Urinary incontinence Nausea and vomiting
- 23. RESPIRATORY SYSTEM Substernaltightness or pain in chest Cough Bronchospasm Dyspnea Cyanosis Laryngeal edema CARDIOVASCULAR SYSTEM Pallor Lightheadedness Tachycardia Hypotension Cardiac dysrhythmias Unconsciousness Cardiac arrest
- 24. MANAGEMENT Delayed skinreaction Immediate skin reaction Respiratory reactions Generalized anaphylaxis P – A – B - C
- 25. DEFINITIVE CARE Administeroral histamine blockers IM IV Monitor vital signs Administer oxygen(bronchospasm) Cricothyrotomy(laryngeal edema) Activate EMS(emergency medical service) administer epinephrine
- 26. IDIOSYNCRASY Any reactionto a LA agent or any other drug that cannot be classified as allergic or toxic reaction is often called as idiosyncrasy Also used to describe a qualitatively abnormal unexpected response to a drug differing from its pharmacological actions and thus resembling hypersensitivity PREVENTION Pre anesthetic evaluation Precautions to the patients from injury Psychotherapy Pre medication
- 27. MANAGEMENT Supine positionwith legs slightly elevated Maintainence of airway Adequate O2 supply Evaluate circulation Administer parenteral fluids
- 28. CONCLUSION Systemic complication associatedwith LA drug administration can be prevented by Medical evaluation should be done before administering LA All dental injections should be administered in patients supine position Topical anesthetic should be applied before injections for a minimum of 1minute Vasoconstrictors should be included in all local anesthetics Observe the patient during and after anesthetic administration for signs and symptoms of undesirable reaction The anesthetic solution selected should be appropriate for particular dental treatment(duration of action)