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LA Complications Flashcards

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1
Q

List features of the LA lidocaine (3)

A
  1. Amide type
  2. Lidocaine HCL 2%
  3. Vasoconstrictor:
    With adrenaline 1: 80,000
    Plain (none)
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2
Q

List features of the LA Citanest (3)

A
  1. Amide type
  2. Prilocaine HCL 3%
  3. Vasoconstrictor:
    With Octapressin
    Plain
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3
Q

List features of the LA Articaine

A
  1. Amide type
  2. 4% with adrenaline
  3. Comes in a variety adrenaline concentrations
    1: 100,000
    1: 200,000
    1: 400,000
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4
Q

Uses of:
Lidocaine
Citanest
Articaine

A

Infiltrations

Blocks

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5
Q

Does Mepivicaine 3% plain contain a vasoconstrictor?

A

No

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6
Q

Mepivicaine working time for infiltration?

A

20 mins

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7
Q

Mepivicaine working time for a block?

A

40 mins

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8
Q

Mepivicaine working time for soft tissue anaesthesia

A

2 hours

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9
Q

Does lignocaine 2% HCl contain a vasoconstrictor?

A

1:80,000

Adrenaline

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10
Q

Lignocaine working time for infiltration?

A

60 mins

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11
Q

Lignocaine working time for a block?

A

90 mins

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12
Q

Lignocaine working time for a soft tissue anaesthesia

A

3-5 hours

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13
Q

Does articaine 4% HCl contain a vasoconstrictor?

A

Adrenaline
1:100,000
1:200,000
1;400,000

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14
Q

Articaine working time for infiltration?

A

Up to 120 mins

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15
Q

Articaine working time for a block?

A

75 mins

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16
Q

Articaine working time for soft tissue anaesthesia

A

3-5 hours

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17
Q

Does Prilocaine HCl 3% contain a vasoconstrictor?

A

Octapressin

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18
Q

Prilocaine working time for infiltration?

A

30-45 mins

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19
Q

Prilocaine working time for a block?

A

60 mins

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20
Q

Prilocaine working time for a soft tissue anaesthesia?

A

3-6 hours

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21
Q

List systemic complications of LA (6)

A
  1. Psychogenic
  2. Interaction with other drugs
  3. Cross infection
  4. Allergy
  5. Collapse
  6. Toxicity
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22
Q

List the main psychogenic/stress complications of LA (7)

A
  1. Fainting
  2. Palpitations
  3. Cold sweat
  4. Restlessness
  5. Excitation
  6. Trembling
  7. Weakness
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23
Q

Whats the reason for psychogenic/stress complications?

A

Lack of oxygenated blood to the brain

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24
Q

What clinical features can present with psychogenic complications (6)

A
  1. Lightheadedness
  2. Pallor
  3. Beads of sweat
  4. Bradycardia (slow pulse)
  5. Nausea
  6. Pupil dilation
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25
How are these psychogenic complications managed? (4)
1. Lay flat and raise legs 2. Loosen neck clothing 3. Improve room ventilation 4. Sweet drinks
26
List some examples of other drugs LA may interact with (3)
1. B blockers 2. Cocaine - increased adrenergic activity 3. Tricyclics - risk of hypertension
27
What are most allergic reactions to LA due to?
Mostly due to preservatives
28
List some toxicity complications with LA (4)
1. Convulsions 2. Loss of consciousness 3. Respiratory depression 4. Circulatory collapse
29
How can toxic effects of LA be reduced? (2)
1. By use of an aspirating technique | 2. Rate of introduction (injection) should be slow, thereby decreasing the chance of overload
30
Max dose of Mepivicaine 3%
3 mg/kg
31
Mgs within a Mepivicaine 3% cartridge
66 mgs
32
Max number of Mepivicaine cartridges (70kg adult)
6
33
Max dose of Lignocaine 2%
5 mg/kg
34
Mgs within a Lignocaine 2% cartridge
44 mgs
35
Max number of Lignocaine cartridges (70kg adult)
7
36
Max dose of Articaine 4%
7 mg/kg
37
Mgs within Articaine 4% cartridge
88 mgs
38
Max number of Articaine cartridges (70kg adult)
5
39
Max dose of Prilocaine 3%
8 mg/kg
40
Mgs within Prilocaine 3% cartridge
66 mgs
41
Max number of Prilocaine cartridges (70kg adult)
8
42
List the effects of adrenaline on the heart (4)
Via B1 1. Rate increases 2. Force increases 3. Output increases 4. Excitability increases
43
List the effects of adrenaline on the vessels (3)
Via B2 1. Coronary dilation 2. Skin contraction 3. Muscle dilation
44
Give the effects of adrenaline on the blood pressure (2)
1. Systolic pressure increases 2. Diastolic pressure decreases Overall - little effect
45
Give the effects of adrenaline on the lungs
Via B2 | Bronchial muscle - relaxation
46
List some dangers of adrenaline in LA (4)
1. CVD 2. Hyperthyroidism 3. Hypertension 4. Drug interactions
47
List some local complications of LA (7)
1. Failure to achieve anaesthesia 2. Prolonged anaesthesia 3. Pain during/after injection 4. Trismus 5. Haematoma 6. Blanching 7. Soft tissue damage
48
Give some causes of prolonged anaesthesia with LA (3)
1. Direct trauma from needle 2. Multiple passes with same needle 3. Chemical trauma for direct injection Different depending on LA used
49
How does trismus affect the patient
Muscular spasm so can't open mouth very wide and this can be very frightening for the patient
50
Describe the presentation of trismus
Within a few hours of IAN block it may severely restrict opening and it may last for weeks or months
51
List the causes of trismus (3)
1. Damage to medial pterygoid 2. Injection too low 3. Injection too rapid
52
Describe the management used for trismus (3)
1. Reassurance (after diagnosis) 2. Muscle relaxant 3. Anti inflammatories
53
Describe the presentation of facial palsy from LA
Usually complete unilateral motor nerve paralysis within minutes of inferior dental blocks
54
How does LA induced palsy present?
LA has been deposited in an area that affects all facial nerves so they can't move that side of their face at all
55
How does a stroke present?
During a stroke they may not be able to use muscles in lower half of the face but can wrinkle forehead and close eye Upper spares upper (If patient has an upper motor neurone defect - stroke it spares the upper branches of the facial nerve)
56
How does LA injection lead to facial palsy?
LA into parotid gland as | injection was too far posteriorly instead of touching the bone
57
How is LA facial palsy diagnosed?
Testing the 5 branches of the facial nerve
58
How is a case of LA facial palsy confirmed?
Temporal branch affected | Lower motor neurone distribution
59
What is the management for LA facial palsy
Reassurance _ cover eye with pad until blink reflex returns
60
List the effects of intravascular infection due to LA (3)
1. Skin blanching 2. Visual disturbance 3. Aural disturbances
61
What LA technique could result in an intra-vascular injection
IAN dental block
62
How is intra-vascular injection with LA avoided? (4)
1. By careful technique 2. Aspirating system 3. Slow drug introduction 4. Safe quantity
63
Symptoms of intravascular LA injections (6)
1. Palpitations 2. Anxiousness 3. Restlessness 4. Sweating 5. Headache 6. Pallor

LA Symposium (3 decks)

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