LA complications

Question 1

___________ anesthesia involves the deposition of local anesthetic solution into the cancellous bone that supports the teeth

Answer 1

intraosseous anesthesia

Question 2

T/F a PDL injection will utilize the traditional syringe with a long needle

Answer 2

false. special syringe and a 27g short needle

Question 3

what injection is useful for perio curettage and flap procedures

Answer 3

intraseptal

Question 4

what angle is the needle inserted for an intraseptal

Answer 4

90 degrees to tissue

Question 5

T/F you can make a small hole in the cortical bone and give local anesthetic to a given area

Answer 5

true

Question 6

where will you inject for an intrapulpal injection?

Answer 6

inject into tooth (pulp chamber/canal)

Question 7

if a mandibular infiltration is given; who will it work better in: children or adults? why?

Answer 7

children, cortical bone is less thick and more porous

Question 8

what injection can you use for a troublesome mand. 1st molar

Answer 8

mylohyoid injection (~100% effective)

Question 9

what are some complications with intraosseous anesthesia?

Answer 9

Needle breakage
Facial nerve paralysis (CN VII)
Soft tissue injury
Hematoma
Nerve injury (CN V)

Question 10

what do you run the risk of if you bend the needle?

Answer 10

breaking the needle

Question 11

if a needle will break where will it break?

Answer 11

at the hub

Question 12

if a needle breaks in the hard tissues or it’s hard to locate, what should you do?

Answer 12

refer
precedent to leave if retrieval appears difficult

Question 13

which nerve will be affected if local anesthetic is injected into parotid capsule?

Answer 13

hemifacial paralysis (VII)
V3 normal sensation
inability to voluntarily close eye

Question 14

what can happen if you give repeated palatal injections with vasoconstrictors?

Answer 14

prolonged ischemia to tissues/ tissue sloughing

Question 15

what are the post-anesthetic lesions that are usually secondary to trauma?

Answer 15

-Recurrent aphthous ulcer
-Herpes simplex
-Duration: 7-10 days regardless of treatment

Question 16

what should you remind the pt to avoid while numb?

Answer 16

not to bite lip/tongue

Question 17

how does a hematoma occur?

Answer 17

nicking vessel during injection

Question 18

what are the most common hematoma sites?

Answer 18

PSA – visible extra-orally
IAN – visible intra-orally
Bleeding into surrounding tissue

Question 19

what doe you do for management of a hematoma

Answer 19

Direct pressure
Tissue pressure (hematoma) on vessel
Ice to face

Question 20

with an IAN hematoma where should you put pressure

Answer 20

pressure to medial aspect of ramus

Question 21

with an ASA hematoma where should you put pressure

Answer 21

pressure over infra-orbital foramen

Question 22

with an mental hematoma where should you put pressure

Answer 22

pressure over mental foramen

Question 23

with an Long buccal or palatal hematoma where should you put pressure

Answer 23

direct pressure over inject site

Question 24

with an PSA hematoma where should you put pressure

Answer 24

more difficult management due to location of pterygoid plexus, posterior superior alveolar artery
-Located posterior, superior and medial to tuberosity
-Pressure – mucobuccal fold as far distally as possible
-Ice to face (heat causes vasodilation = bleeding)

Question 25

what is the most common cause of a lawsuit with anesthesia?

Answer 25

persistent paresthesia or anesthesia

Question 26

how can a local anesthesia solution become contaminated?

Answer 26

-Carpule sitting in alcohol – diaphram semi-permeable -Alcohol -> neurolytic

Question 27

what happens if a pt feels an "electric shock"?

Answer 27

needle grazes sheath could cause injury to nerve

Question 28

can local anesthesia itself cause persistent paresthesia or anesthesia?

Answer 28

yes

Question 29

can parasthesia or dysthesia go away?

Answer 29

it can

Question 30

what systemic complications can happen with anesthetic?

Answer 30

local anesthetic overdose allergic reaction

Question 31

what are the predisposing factors for a local anesthetic overdose?

Answer 31

Age Weight Comorbid diseases Other medications Genetics - biotransformation

Question 32

what are the most common ages for anesthetic overdose?

Answer 32

extremes of age: youngest/oldest

Question 33

what is the rule of thumb of ~70kg refer to?

Answer 33

refer to how a susceptible a pt is to overdose on anesthetic

Question 34

what comorbid diseases make the pt more likely to overdose

Answer 34

Cardiac: Congestive heart failure: decreased liver perfusion Hepatic: biotransformation to inactive form Renal: ESRD can lead to inadequate clearance

Question 35

what drug factors affect overdosing?

Answer 35

Vasoactivity/presence of vasoconstrictors Concentration Dose Route of administration Rate of injection Vascularity of injection site

Question 36

if vasodiliators are present what will happen with anesthetic?

Answer 36

shorter duration

Question 37

how will the route of administration affect predisposing factors for overdose

Answer 37

-Intravascular injection -High levels reached in short period of time = potential overdose -Aspirate, aspirate, aspirate (ex)aspirating redundency

Question 38

what happens if too much benzocaine (hurricane) is used?

Answer 38

risk of methemoglobinemia: suspect if pulse oximeter is ~85% and not responsive to 100% oxygen

Question 39

T/F with methemaglobinemia the blood will go from Fe 3+ to Fe 2+

Answer 39

false 2 is us (ferrus), 3 is a crowd from 2+ to 3+

Question 40

what is the tx of methemaglobinemia

Answer 40

Slow IV infusion of 1% Methylene Blue (1.5mg/kg) q4h if cyanosis is persistent or returns

Question 41

T/F local anesthetics exert a depressant effect on all excitable membranes

Answer 41

true

Question 42

what's the first CNS step of someone who's going into an overdose?

Answer 42

Excitability: talkative, irritable, agitated Inhibitory impulse is depressed more than the excitatory impulse

Question 43

what's the second CNS step of someone who's going into an overdose?

Answer 43

seizure activity

Question 44

what's the last CNS step of someone who's going into an overdose?

Answer 44

generalized depression Respiratory center in medulla oblongata - brainstem Respiratory depression and resp arrest

Question 45

what happens to the cardiovascular system during an overdose?

Answer 45

-myocardium depression (shutdown of electrical activity) -peripheral vasculature (hypotension)

Question 46

what's the different levels of cardiovascular overdoses?

Answer 46

Overdose levels Profound hypotension caused by decreased: Contractility, cardiac output and peripheral vascular resistance Lethal levels = cardiovascular collapse Massive vasodilation, decreased contractility and heart rate (profound bradycardia) In addition, Marcaine overdose may precipitate Ventricular Fibrillation (fatal V. fib)

Question 47

Overdose to the cardio-respiratory centers in the __________ will cause _____________ and (secondarily) ______________.

Answer 47

medulla oblongata, respiratory arrest, cardiac arrest

Question 48

what is present in anesthetic solutions that a pt can be allergic to?

Answer 48

ester, amides

Question 49

what is used as an antioxidant for vasopressors that pt's can be allergic to?

Answer 49

sodium bisulfite

Question 50

what was removed form dental carpules, but is in multidose vials that pt's may be allergic to?

Answer 50

methylparaben

Question 51

what is an allergy that can't occur in humans

Answer 51

epinephrine (like being allergic to air)