Complications and Contraindications

Question 1

where is LA metabolised

Answer 1

liver

Question 2

where is LA excreted

Answer 2

kidney

Question 3

what are the systemic complications

Answer 3

psychogenic, drug interactions, cross infections, allergy, collapse, toxicity

Question 4

what is psychogenic stress?

Answer 4

fainting, palpitations, cold sweat, restlessness, excitation, trembling, weakness

Question 5

what is the cause of psychogenic stress

Answer 5

lack of oxygenated blood to brain

Question 6

what are the clinical features of psychogenic stress

Answer 6

light headedness, pallor, beads of sweat, bradycardia, nausea, pupil dilation

Question 7

how do you manage psychogenic stress

Answer 7

lay flat with legs raised, loose clothing, ventilate room, glucose in a sweet drink

Question 8

what drugs can adrenaline interact with?

Answer 8

tri-cyclics, B blockers, diuretics without K, cocaine

Question 9

what are most allergies for?

Answer 9

latex bung/preservatives/antioxidants

Question 10

what is included with toxicity

Answer 10

convulsions, loss of consciousness, respiratory depression, circulatory collapse

Question 11

what happens to pregnant women if give felypressin

Answer 11

induces labour

Question 12

what is the effect of adrenaline on the heart

Answer 12

increase rate, force, output and excitability

Question 13

what is the effect of adrenaline on blood vessels

Answer 13

coronary dilation, skin contraction, muscle dilation

Question 14

what is the effect of adrenaline on blood pressure

Answer 14

systolic up and diastolic down but not much effect really

Question 15

what is the effect of adrenaline on the lungs

Answer 15

bronchial muscle relaxation

Question 16

what are the dangers of adrenaline?

Answer 16

cardiovascular disease, hyperthyroidism, phaeochromocytoma, drug interactions

Question 17

what are the local complications of LA?

Answer 17

failure to achieve LA, prolonged LA, pain during or after injection, trismus, haematoma, intravascular injection, blanching, facial paresis, broken needle, infection, soft tissue damage, contamination

Question 18

how does prolonged anaesthesia occur?

Answer 18

direct trauma from needle, multiple passes with same needle, chemical trauma from direct injection

Question 19

how would a patient have pain during or after injecton?

Answer 19

giving injection too fast or patient has muscular spasm during injection

Question 20

when does trismus present

Answer 20

within a few hours of IDB and may restrict opening of mouth lasting weeks or months

Question 21

what is the cause of trismus

Answer 21

injection to medial pterygoid

Question 22

how do you manage trismus?

Answer 22

reassurance, muscle relaxant, anti-inflammatory

Question 23

how do you tell if facial palsy is stroke or due to LA?

Answer 23

upper spares upper for stroke (can wrinkle forehead) whereas LA you can’t do anything

Question 24

when does facial palsy present?

Answer 24

unilateral motor nerve paralysis within minutes of IDB

Question 25

what is the cause of facial palsy

Answer 25

local into parotid gland (facial nerve is here), injection too posteriorly

Question 26

how do you manage facial palsy

Answer 26

reassurance cover with eye patch

Question 27

what does intra-vascular injection cause

Answer 27

skin blanching, visual disturbance, aural disturbances

Question 28

how do you avoid intravascular injection

Answer 28

careful technique, aspiration, slow drug introduction

Question 29

what are the features noticed with intravascular injection

Answer 29

most noted is adrenaline effect (most likely palpitation)