3. LA Complications Flashcards Preview

BDS2 CDS LA Symposium > 3. LA Complications > Flashcards

Flashcards in 3. LA Complications Deck (36):
1

Features of lignocaine/lidocaine (4)

Amide
Standard - lidocaine HCl 2%
Vasoconstrictor - none/adrenaline (1:80,000)

2

Features of prilocaine/citanest (3)

Amide
Standard - prilocaine HCl 3%
Vasoconstrictor - plain/felypressin (octapressin - 1.2ug)

3

Features of articaine (4)

Amide
Standard - 4% with varying vasoconstrictor (1:100,000, 1:200,000, 1:400,000)
Uses - infiltration and blocks
Useful if patient has liver disease

4

Length of action of mepivicaine (3)

Infiltration - 20mins
Block - 40mins
Soft tissue - 2hrs

5

Length of action of lignocaine (3)

Infiltration - 60mins
Block - 90mins
Soft tissue - 3-5hrs

6

Length of action of articaine (3)

Infiltration - up to 120mins
Block - 75mins
Soft tissue - 3-5hrs

7

Length of action of prilocaine (3)

Infiltration - 30-45mins
Block - 60mins
Soft tissue - 3-6hrs

8

Systemic complications of LA (6)

Psychogenic/stress
Interactions with other drugs
Cross infection
Allergy
Collapse
Toxicity

9

Psychogenic/stress includes (7)

Fainting
Palpitations
Cold sweat
Restlessness
Excitation
Trembling
Weakness

10

Cause of psychogenic/stress

Lack of oxygenated blood to the brain

11

Clinical features of psychogenic/stress (6)

Light-headedness
Pallor
Beads of sweat (lips/nose/temple)
Bradycardia (slow pulse)
Nausea
Pupil dilation

12

Management of psychogenic/stress (4)

Lay flat and raise legs
Loosen neck clothing
Improve room ventilation
Sweet drink potentially

13

LA interactions with other drugs (5)

MAOI (mono amine oxidase inhibitors)
Tri-cyclics (theoretical risk of HTN)
B-blockers (BP increase_
Non-K sparing diuretics (adrenaline lowers K too)
Cocaine (increased adrenergic activity)

14

Features of LA allergy (2)

True allergy is rare
Most allergies are due to preservatives (methylparaben)

15

Toxicity features (4)

Convulsions
Loss of consciousness
Respiratory depression
Circulatory distress

16

LA and pregnancy (2)

Avoid octapressin (prilocaine)
Has potential to induce labour

17

Max. safe dose of mepivicaine, 3% (3)

Max dose - 3mg/kg
66mg/cartridge
6cartridges/70kg adult

18

Max. safe dose of lignocaine, 2% (3)

Max dose - 5mg/kg
44mg/cartridge
7cartridges/70kg adult

19

Max. safe dose of articaine, 4% (3)

Max dose - 7mg/kg
88mg/cartridge
5cartridges/70kg adult

20

Max. safe dose of prilocaine, 3% (3)

Max dose - 8mg/kg
66mg/cartridge
8cartridges/70kg adult

21

Adrenaline effects on B1-receptors (5)

Increase HR
Increase force of heart contractions
Increase CO
Increase heart muscle excitability
Dilation of coronary BVs

22

Adrenaline effects on B2-receptors (2)

Relaxation of bronchial smooth muscle
Muscle dilation

23

Adrenaline effect on a-receptors

Skin contraction

24

Adrenaline effects on BP (3)

Increases systolic BP
Decreases diastolic BP
Overall little effect on BP

25

Adrenaline contraindications (4)

CVD
Hyperthyroidism (thyroid crisis)
Phaeochromocytoma (HTN)
Drug interactions

26

Adrenaline action (3)

Works by redirecting blood flow (to heart, liver, skeletal muscle from non-essential organs during fight/flight)
Binds to B2 receptors causing vasodilation
Binds to a1 receptors causing vasoconstriction

27

Local complications of LA (12)

Failure to achieve anaesthesia
Prolonged anaesthesia
Pain during/after injection
Trismus (lockjaw)
Haematoma
Intra-vascular injection
Blanching
Facial paresis (weakness)
Broken needle
Infection
Soft tissue damage
Contamination

28

Types of prolonged anaesthesia (3)

Direct trauma from needle
Multiple passes with same needle
Chemical trauma from direct injection

29

Facial palsy presentation

Usually complete, unilateral nerve paralysis within minutes of IDB

30

Facial palsy confirmation

Temporal branch affected (lower MND)

31

Facial palsy cause

LA into parotid gland (injection too far posteriorly)

32

Facial palsy diagnosis

Test branches of CNVII

33

Facial palsy management

Reassurance, cover eye with paid until blink reflex returns

34

Types of intra-vascular injection (2)

Intra-arterial
Intravenous

35

Features of IA injection (5)

Rare
Skin blanching
Visual disturbances
Aural disturbances
Transitionary, but persistence requires rapid specialist referral

36

Features of IV injection (3)

Block injections (IDB)
Avoided by careful technique (aspiration)
Palpitation, anxiousness, restlessness, headache, sweating, pallor