complications

Question 1

what type of LA is lidocaine?

Answer 1

amide

Question 2

what vasoconstrictors are used in lidocaine?

Answer 2

none

1:80,000 adrenaline

Question 3

what is lidocaine used for?

Answer 3

infiltration, blocks, others

Question 4

where is lidocaine metabolised and excreted?

Answer 4

liver, kidney

Question 5

describe the onset of lidocaine

Answer 5

rapid, 2-3 mins

Question 6

what % lidocaine is used?

Answer 6

2%

Question 7

what type of LA is priloccaine?

Answer 7

amide

Question 8

what vasoconstrictors are used in prilocaine?

Answer 8

none
felypressin (octapressin) 1.2 micogms

Question 9

what are the uses of prilocaine?

Answer 9

infiltrations, blocks, others

Question 10

what % pilocaine is used?

Answer 10

3%

Question 11

what is the brand name of prilocaine?

Answer 11

citanest

Question 12

what type is articaine?

Answer 12

amide

Question 13

what % articaine is used?

Answer 13

4%

Question 14

what vasoconstrictor is used in articaine?

Answer 14

adrenaline

1: 100,000
1: 200,000
1: 400,000

Question 15

what is articaine most commonly used for?

Answer 15

infiltrations

Question 16

where is articaine metabolised & excreted?

Answer 16

liver and plasma

kidney

Question 17

describe the onset of articaine?

Answer 17

rapid

2-3 mins

Question 18

what is 1.5x more potent than lidocaine?

Answer 18

articaine

Question 19

what are the possible systemic complications of LA?

Answer 19

psychogenic
interactions with other drugs
cross infection
allergy
collapse
toxicity

Question 20

describe the psychogenic complication

Answer 20

lack of oxygenated blood to brain
fainting, palpitations, cold sweat, restlessness, excitation, trembling, weakness
lightheaded, pallor, sweat
bradycardia, nausea, pupil dilation
management: lay flat, raise legs, loosen neck clothing sweet drink

Question 21

what drugs interact with LA?

Answer 21

cocaine- increased adrenergic activity
B blockers
non potassium sparing diuretics- lowers K
tri-cyclics - hypertension risk- limit 2 cartridge
M.A.O.I - anti-depressants

Question 22

what are most allergic reactions caused by?

Answer 22

preservatives/antioxidant

-methylparaben/sodium bisulphite

Question 23

what allergic reactions can occur?

Answer 23

skin reactions, respiratory reactions, anaphylaxis

-not treated in general practice

Question 24

what are the symptoms of toxicity?

Answer 24

convulsions
loss of consciousness
respiratory depression
circulatory collapse

Question 25

what can induce labour?

Answer 25

octapressin

Question 26

what technique reduces toxic effects?

Answer 26

aspirating | slow injection

Question 27

what is the max dose of lignocaine?

Answer 27

5mg/kg

Question 28

how many mgs in a lignocaine cartridge?

Answer 28

44

Question 29

what effect does adrenaline have on the heart?

Answer 29

rate, force, output, excitability increase

Question 30

what effect does adrenaline have on bv?

Answer 30

coronary dilation skin contraction muscle dilation

Question 31

what effect does adrenaline have on bp?

Answer 31

increase systolic | decrease diastolic

Question 32

what effect does adrenaline have on lungs?

Answer 32

bronchial muscle relaxation

Question 33

what conditions should adrenaline be limited/avoided?

Answer 33

hyperthyroidism | phaechromocytoma (hypertension)

Question 34

what local complications can happen?

Answer 34

``` failure prolonged pain trismus haematoma intra-vascular injection blanching facial paresis broken needle infection soft tissue damage contamination ```

Question 35

what can cause prolonged anaesthesia?

Answer 35

direct trauma from needle multiple passes with same needle chemical trauma for direct injection different depending on LA used

Question 36

how do you know if you are too close to a nerve?

Answer 36

jump/electric shock

Question 37

what is the 1st drug of choice in LA blocks?

Answer 37

lidocaine 2% w/ adr

Question 38

describe the presentation of trismus

Answer 38

w/i a few hours of IDB may severely restrict opening | can be weeks/months

Question 39

what is the cause of trismus?

Answer 39

damage to medial pterygoid injection too low too forcefeul/rapid

Question 40

what is the management of trismus?

Answer 40

reassurance after diagnosis muscle relaxant anti-inflammatory

Question 41

how to differentiate between palsy and stroke?

Answer 41

stroke can use upper half of face muscles | LA palsy- all facial nerves cant move muscles on one side

Question 42

what is the presentation of facial palsy?

Answer 42

unilateral motor nerve paralysis w/i mins of inferior dental blocks

Question 43

how to confirm facial palsy?

Answer 43

temporal branch affected

Question 44

what is the cause of facial palsy?

Answer 44

local into parotid gland | -injected too far posteriorly

Question 45

what is the management of facial palsy?

Answer 45

reassurance | cover eye with pad until blink reflex returns

Question 46

describe intra-arterial injection

Answer 46

skin blancing visual disturbance aural distrubance

Question 47

when do intra-venous injections usually occur?

Answer 47

inferior dental block

Question 48

what are the features of intra-venous injection?

Answer 48

adrenaline effect palpitation also can be anxious, restless, headache, sweating, pallor

Question 49

what is the max dose of mepivicaine 3%?

Answer 49

3mg/kg

Question 50

how many mgs in a cartridge of mepivicaine 3%?

Answer 50

66

Question 51

what is the max dose of articaine 4%?

Answer 51

7mg/kg

Question 52

how many mgs in a cartridge of atricaine?

Answer 52

88

Question 53

what is the max dose of prilocaine 3%?

Answer 53

8mg/kg

Question 54

how many mgs in a cartridge of prilocaine?

Answer 54

66