Day 3 - Local Anesthesia Complications

Question 1

What is usually the cause of Facial Nerve (VII) paralysis? How can it be avoided?

Answer 1

introduction of LA into parotid gland posterior of ramus….CONTACT bone to prevent!

Question 2

What is the duration of VII paralysis?

Answer 2

the duration of the soft tissue anesthesia

Question 3

What are the 4 injection types at greatest risk for a hematoma?

Answer 3

1.IANB 2.Mental NB 3.IO NB 4.PSA NB

Question 4

What is the best and IMMEDIATE mgmt of a hematoma?

Answer 4

pressure at the site for 2 min with ice

Question 5

What do you avoid in the Tx of a hematoma? How long will it probably last?

Answer 5

avoid using HEAT on the area for 4-6 hrs…It should resolve in 7-14 days

Question 6

What is PROLONGED anesthesia and a tingling/itching sensation?

Answer 6

PAR-esthesia

Question 7

What is Painful sensation to non-noxious stimuli?

Answer 7

DYS-esthesia

Question 8

What is Increased sensitivity to noxious stimuli?

Answer 8

HYPER-esthesia

Question 9

What is a main concern of paresthesia (esp in kids)?

Answer 9

self-inflicted injury (biting)

Question 10

Which nerve paresthesia would cause impaired taste via the lingual nerve?

Answer 10

CHORDA TYMPANI

Question 11

Paresthesia: ______ gauge needles almost never totally sever a nerve….only damage a small portion of fibers

Answer 11

SMALL

Question 12

Paresthesia: Pressure or chemically induced injury to nerve may develop from injection within the neural ______

Answer 12

sheath

Question 13

Paresthesia: __% LA solutions have an increased incidence of paresthesia. Two examples are: ________ and ______

Answer 13

4%….prilocaine and articaine

Question 14

MOST paresthesia develops in the ________

Answer 14

mandible (IA, lingual nerves) (so avoid using 4% prilocaine or articaine in the mandible)

Question 15

“Electric shock” impingement on nerve by needle

􏰀 felt along peripheral distribution of nerve…_______ slightly before depositing solution

Answer 15

withdraw

Question 16

Paresthesia: Explain that paresthesia normally persists for at least _______

Answer 16

2 months

Question 17

Paresthesia: If present after _______ with little/no improvement, consider referral to oral maxillofacial surgeon, neurologist

Answer 17

3 months

Question 18

_________: Motor disturbance of the trigeminal nerve, especially spasm of the muscles of mastication

Answer 18

Trismus

Question 19

A possible cause of Truisms is Trauma to blood vessels of the ____________

Answer 19

infratemporal fossa

Question 20

_______: Limitation of mandibular opening, usually mild but may become chronic and severe

Answer 20

Trismus

Question 21

Trismus mgmt: Management: See patient and Prescribe:
􏰀 _____ therapy, analgesics, muscle _______ as needed,􏰀 exercise (open/close + lateral excursions) chewing ____, tongue depressors, Record in chart

Answer 21

heat….relaxants…GUM

Question 22

How long does Truisms usually last?

Answer 22

resolves in 48 hrs.

Question 23

What do you do if Truisms symptoms last longer than 48 hrs?

Answer 23

Consider an infection in the area and Rx antibiotics

Question 24

What do you do if all of your Truisms tx fail with in 1 week?

Answer 24

Refer to OMFS

Question 25

What is the key instrument to manage a needle break?

Answer 25

Hemostats or cotton pliers

Question 26

When would a Tonic clonic seizure typically occur after direct intravenous injection? When should it resolve?

Answer 26

5 seconds to get to brain...resolve in 30sec

Question 27

__________ should ALWAYS be included in local anesthetics unless there is a compelling reason to exclude them

Answer 27

Vasopressors

Question 28

To obtain full mouth anesthesia in the primary dentition, fewer than ___ cartridges of LA need be administered

Answer 28

2

Question 29

What is the safest anesthetic in pediatric dentistry? What is the maximum dose?

Answer 29

2% lidocaine with 1:100,000 epinephrine...Max dose: 1 cartridge/ 20 lbs body weight

Question 30

What is the acronym for managing a dental emergency/LA overdose? What does each letter mean?

Answer 30

P A B C D.....Position, Airway, Breathing, Circulation, Definitive care

Question 31

Without proper airway space, the pt cannot breathe and therefore becomes _______ (acidotic/alkalytic). What does this do to the amount of LA needed in blood to cause a seizure?

Answer 31

acidotic...DECREASES amount of blood needed to cause a seizure, so the next one is more intense

Question 32

There is NO _____, _____, or _______ justification for a dental doctor not being able to manage emergency situations which might arise during a patients treatment

Answer 32

moral, ethical or legal

Question 33

The most common cause of cardiac arrest in healthy children is ___________ or ______

Answer 33

AIRWAY OBSTRUCTION or apnea

Question 34

Irreversible CNS damage develops with anoxia in ___ minutes*

Answer 34

3 minutes

Question 35

IN GENERAL: are the signs of a MILD LA overdose typically more of a SNS response or PNS response?

Answer 35

More of a Sympathetic NS response: increased BP, HR,Resp, sweating, excitability

Question 36

IN GENERAL: are the signs of a MODERATE to HIGH overdose typically more of a SNS or a PNS response?

Answer 36

More of a Parasympathetic NS response: decrease BP, HR, Resp...general CNS depression

Question 37

Which has a greater risk for OD: Esters or Amides?

Answer 37

AMIDES (metabolized in Liver instead of blood, and therefore is in body longer)

Question 38

How much ug/mL of LA in blood is needed for Tonic-clonic seizure?

Answer 38

7.5-10ug/mL

Question 39

How do we prevent PAIN/Burning on injection?

Answer 39

Technique dawg! (pH of solution-go slower)

Question 40

What are two ways we can help prevent cheek/lip biting in kiddos after LA?

Answer 40

Anchor cotton rolls to their shirt and put them in their mouth..or OraVerse!

Question 41

What are the TWO LA's that are category B in Pregnancy and are therefore safer to use? (the rest are C)

Answer 41

1.Lidocaine 2.Prilocaine

Question 42

What are the two LA's with UNKNOWN crossing into mothers milk? What is the ONLY LA drug that is NOT SAFE during breast feeding?

Answer 42

Unknown: 1.Articaine 2.Prilocaine...NOT SAFE: Epinephrine-definitely travels to milk

Question 43

What is a NORMAL ASA status for a pregnant woman? What are risk factors for the higher ASA status woman?

Answer 43

ASA II is standard, no risks....ASA III for pregnant women with diabetes, previous miscarriages, spontaneous abortions

Question 44

How long does a methodoglobinemic take to have BROWN BLOOD post injection?

Answer 44

about 90 minutes

Question 45

In methemoglobinemia you inject a _____ drug into a _____ patient to make them turn ______..... What is the name of the drug, what does it do?

Answer 45

blue....blue....pink....methylene blue IV (1.0 to 1.5 mg/kg).....converts methemoglobin to oxyhemoglobin