3. INTRODUCTION
Drugs have 2 types 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 adverse reaction 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 drug overdose 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
8. MODERATE TO HIGH OVERDOSE
LEVELS
SIGNS
Tonic-clonic seizure activity followed by
generalized central nervous system depression
depressed blood pressure, heart rate , respiratory rate
9. SYMPTOMS ( PROGRESSIVE WITH
INCREASING BLOOD LEVELS)
Lightheadedness
Dizziness
Nervousness
Numbness
Metallic taste
Visual disturbances
Auditory disturbances
Drowsiness and disorientation
Loss of consciousness
10. MAXIMUM RECOMMENDED DOSAGE OF 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 BLOOD LEVELS
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)
13.
14. MANAGEMENT
MILD OVERDOSE REACTION
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 overdose reactions
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 is a 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
22. SIGNS AND SYMPTOMS
SKIN REACTIONS
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
Substernal tightness or pain in chest
Cough
Bronchospasm
Dyspnea
Cyanosis
Laryngeal edema
CARDIOVASCULAR SYSTEM
Pallor
Lightheadedness
Tachycardia
Hypotension
Cardiac dysrhythmias
Unconsciousness
Cardiac arrest
24. MANAGEMENT
Delayed skin reaction
Immediate skin reaction
Respiratory reactions
Generalized anaphylaxis
P – A – B - C
25. DEFINITIVE CARE
Administer oral histamine blockers
IM IV
Monitor vital signs
Administer oxygen(bronchospasm)
Cricothyrotomy(laryngeal edema)
Activate EMS(emergency medical service)
administer epinephrine
26. IDIOSYNCRASY
Any reaction to 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 position with legs slightly elevated
Maintainence of airway
Adequate O2 supply
Evaluate circulation
Administer parenteral fluids
28. CONCLUSION
Systemic complication associated with 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)
