Local and Systemic Complications

Question 1

causes of needle breakage

Answer 1

1. smaller needles
2. bent needles
3. defective needles

Question 2

prevention of needle breakage

Answer 2

1. do not bend
2. do not insert the needle to its hub
3. do not redirect the needle once it is inserted into the tissue

Question 3

hub, shaft, bevel?

where are these?

Answer 3

hub - directly after the syringe adapter
then shaft
bevel at the end

Question 4

hematoma example of?

Answer 4

systemic complicaton

Question 5

most needle fractures occur during?

Answer 5

administration of IAN blocks

Question 6

most needle fractures occur when using?

in who?

Answer 6

with a 30-gauge needles and in children who are reported to have moved suddenly and violently as the dentist gave the injection

Question 7

should avoid burrying the needle up to…

Answer 7

the hub - so avoid burying any needle up to the hub

unless it is essential for the block

Question 8

if you can see needle break / if you cant what do you do?

Answer 8

can see it – grasp the most proximal end of the needle fragment and remove it from tissue

cant see it – immediate refer patient to an apporpriate specialist

Question 9

what types of needles should you not use in IAN?

Answer 9

30 - gauge or short needles

Question 10

causes of pain on injection

Answer 10

1. carelessness
2. dull needle
3. rapid deposition
4. needles with barbs

Question 11

prevention to limiting pain on injection

Answer 11

1. proper technique
2. sharp needles
3. topical anesthesia
4. inject slowly
5. temperature of the solution should be at room temperature

Question 12

causes of burning on injection

Answer 12

1. pH of solution
2. rapid injection
3. contamination of the local anesthetic solution
4. temperature of the solution

Question 13

preventing burning on injection

Answer 13

1. it is almost impossible to eliminate the mild burning sensation
2. slowing the injection administration
3. room temperature
4. storage container without alcohol

Question 14

ideal rate of administration

Answer 14

1ml/min

Question 15

ideal rate of administration

Answer 15

1ml/min

Question 16

Onpharma’s Onset

Answer 16

Designed for precisoin buffering of local anesthetic, which provides rapid onset of analgesia and less injection pain

sterile, nonpyrogenic solution of sodium bicarbonate (NaHCO3) in water for injection

Question 17

Onpharma’s Onset added to?

Answer 17

Lidocaine with epinephrine as a neutralizing agent immediately prior to administration

Question 18

causes of persistant anesthesia / paresthesia

Answer 18

1. trauma to the nerve
   - secondary chemical injury (alcohol contaminated cartridge)
   - direct trauma with the needle
   - LA

Question 19

Paresthesia

Answer 19

persistent anesthesia

Question 20

preventing Paresthesia

Answer 20

1. Proper injection protocol

2. proper care and handling of dental cartridges

Question 21

most paresthesia resolves when?

Answer 21

within approx. 8 weeks

Question 22

most paresthesia involves what?

Answer 22

the tongue followed by the lip

• occurs more in tongue than lip

Question 23

keys to patient management with Paresthesia

Answer 23

1. be reassuring – speak to them, arrange appointemnt, record the incident in chart
2. examine the pt.
   - determine extend and degree - map out the affected area, record all findings
3. reschedule the patient
4. consider referring the patient (if necessary)

Question 24

articaine 4% used with lingual nerve block implication

Answer 24

had the most number of nerve injuries reported

Question 25

conclusion from study

Answer 25

suggests that paresthesia occurs more commonly after use of 4% LA formulations

Question 26

94/5% of problems occured with what block?

Answer 26

mandibular block

Question 27

what not to use for IAN block? | why?

Answer 27

articaine or prilocaine Articaine and prilocaine have higher incidence of injury Because has a higher concentration of LA that could damage or be toxic to the nerve

Question 28

trismus

Answer 28

defined as a prolonged, tetanic spasms of the jaw muscle by which normal opening of the mouth is restricted MASSETER, TEMPORALIS, in MEDIAL PTERYGOID

Question 29

most effected muscle in IAN?

Answer 29

medial pterygoid

Question 30

causes of trismus

Answer 30

trauma to the muscles or blood vessels intramuscular injection hemorrhage contaminated cartridges with alcohol

Question 31

preventing trismus

Answer 31

1. use a sharp needle 2. do not store cartridges in alcohol 3. aseptic technique -- no infection 4. atraumatic technique 5. avoid repeated injections 6. use minimum volumes

Question 32

management of trismus

Answer 32

1. arrange an appointment 2. heat therapy 3. warm saline rinses 4. analgesic 5. muscle relaxants 6. physiotherapy 7. record the incidence no improvement after 48 hours - prescribe antibiotics

Question 33

no improvement in trismus after 48 hours?

Answer 33

prescribe antibiotics

Question 34

trismus due to infection or secondary to injection?

Answer 34

hard to tell so give antibiotics to treat

Question 35

hematoma

Answer 35

effusion of blood into extravascular spaces due to a trauma to a blood vessel

Question 36

are there problems w/ hematoma

Answer 36

rarely produced significant problems trismus and pain becomes a problem if they do start bleeding - as airway could be compromised -- so make note to this with patients that have bleeding issues

Question 37

hematoma prevention

Answer 37

1. knowledge of the anatomy 2. minimize the number of needle penetrations 3. never use needle to probe 4. use a short needle for PSA nerve block

Question 38

management of hematoma

Answer 38

1. pressure 2. ice 3. time 4. "do not apply heat"

Question 39

causes of infection

Answer 39

1. contamination of the needle prior to administration of the anesthetic 2. injecting local anesthesia into the effected area

Question 40

infection problem ?

Answer 40

relating to trismus and airway - this could be a problem

Question 41

edema? | causes?

Answer 41

``` swelling of tissues causes 1. trauma 2. infection 3. allergy 4. hemorrhage 5. injection of an irritating solution ```

Question 42

edema from LA results in ...

Answer 42

pain and dysfunction

Question 43

what if airway and breathing are compromised with edema?

Answer 43

1. activate emergency protocol 2. unconscious patient is placed in supine position 3. basic life support 4. active emergency medical service 5. epinephrine -- 0.3 mg adult 0.15 mg child IM or IV q 5 minutes until respiratory distress resolves

Question 44

edema -- airway breathing are compromised ... administer

Answer 44

antihistamine - for inflammation corticosteroids cricothyrotomy

Question 45

cricothyrotomy vs treachostomy

Answer 45

trach- cricothyro-- emergency and needs to be fixed to a trach??

Question 46

causes of facial nerve paralysis

Answer 46

local anesthetic is injected into the capsule of the parotid gland

Question 47

prevention of facial nerve paralysis

Answer 47

correct your technique

Question 48

management of facial paralysis

Answer 48

1. explain | 2. eyepatch

Question 49

managemnt of facial nerve paralysis

Answer 49

1. remove contact lenses 2. record incident 3. reschedule the patient

Question 50

3 principles to systemic complications

Answer 50

1. no drug ever exerts a single action 2. no clinically useful drug is entirely devoid of toxicity 3. the potential toxicity of a drug rests in the hands of the user

Question 51

causes of adverse drug reactions | 3 main ones

Answer 51

1. toxicity caused by direct extension of the usual pharmacological effects of the drug 2. toxicity caused by alteration in the recipient of the drug 3. toxicity caused by allergic responses to the drug

Question 52

1. toxicity caused by direct extension of the usual pharmacological effects of the drug break down

Answer 52

1. side effects 2. overdose reactions 3. local toxic effects

Question 53

2. toxicity caused by alteration in the recipient of the drug break down

Answer 53

1. a disease process (hepatic dysfunction, CHF, renal dysfunction) 2. emotional disturbances 3. genetic aberrations (Atypical plasma cholinesterase, malignant hyperthermia)

Question 54

is allergy dose dependent?

Answer 54

no | but signs symptoms are similar between this and overdoes