Patient Evaluation for Local Anesthesia

Question 1

Angina is?

Answer 1

Chest pain

Question 2

Stable Angina?

Answer 2

Character, duration, intensity, resolution, precipitating events all constant over time

caution with: Stress, Epinephrine

Question 3

Unstable Angina?

Answer 3

Change in anything from stable

Angina at rest

Treat in monitored setting

Question 4

Myocardial infarction is?

Answer 4

Destruction of an area of heart muscle as the result of occlusion of a coronary artery

Question 5

Recent MI (caution with?)

Answer 5

Stress

Epinephrine

Question 6

Prolonged MI (more than 6 months ago)

Answer 6

Variable

uncomplicated: relatively low risk
complicated: caution with stress, epinephrine

newer literature reduces this time to 6-8 weeks

Question 7

Coronary artery bypass surgery (CABG)

Answer 7

Recent: caution with stress, epinephrine

More than 3 months ago: variable, similar to MI

Question 8

Arrhythmia is?

Answer 8

any variation from the normal rhythm in the heartbeat

One of the most difficult areas to assess

Need PCP/Caridiologist consultation

Question 9

Controlled arrhythmia

Answer 9

caution with Epinephrine

Question 10

Refractory/uncontrolled arrhythmia

Answer 10

Treat in monitored setting

Question 11

Hypertension (controlled)

Answer 11

consider drug interactions, monitor pressure
(ex. ACE inhibitor, and Beta blocker)

May need to reduce EPI use

Question 12

Hypertension (Severe, untreated, uncontrollable)

Answer 12

limit EPI use

consider monitored setting

Question 13

Congestive Heart Failure (CHF)

Answer 13

controlled: low risk

Uncontrolled, untreated: stress, time in chair are major issues

Question 14

Stroke (Cerebrovascular disease)

Answer 14

low risk, watch BP

Vatiable risk for recurrence:
monitor pressure, may need to reduce EPI

Question 15

Diabetes (controlled)

Answer 15

no problem

Question 16

Diabetes (uncontrolled)

Answer 16

monitor for other problems

Question 17

Thyroid disease

Answer 17

controlled: no problem

Question 18

Uncontrolled Hyperthyroidism

Answer 18

Defer treatment

avoid stress, epinephrine (important because patient is very sensitive to epinephrine)

Question 19

Pheochromocytoma

Answer 19

Rare tumor

defer treatment

avoid EPI, stress

Question 20

Coagulopathy is?

Answer 20

bloods ability to coagulate (form clots) is impaired

Question 21

Coagulopathy

Answer 21

congenital or acquired

alter technique to avoid deep blocks (more chance to poke the blood vessels, so it will keep bleed, patient will have hematoma)

Question 22

Methemoglobinemia

Answer 22

Avoid PRILOCAINE

Lidocaine may be a trigger but is lowest risk anesthetic

Question 23

Methemoglobinemia is?

Answer 23

Dark brown blood: not a lot of oxygenated blood presents

Question 24

Asthma

Answer 24

no problem

Question 25

Chronic obstructive pulmonary disease (COPD)

Answer 25

Time in chair may be the issue

Question 26

Liver disease

Answer 26

Unlikely to be a significant issue (at the end of liver disease: amide is metabolized at the liver, liver is not functional then local anesthesia would not be metabolized and stay in the system)

Question 27

Renal disease

Answer 27

Unlikely to be a significant issue

Question 28

Dialysis patients

Answer 28

treat day after dialysis

Question 29

Malignant Hyperthermia

Answer 29

No problem with AMIDE anesthetics

Question 30

Atypical plasma pseudocholinesterase

Answer 30

delayed metabolism of esters amide anesthetics are NOT a problem

Question 31

Cocaine abuse (IMPORTANT)

Answer 31

avoid EPI, stress defer treatment: 24 hours

Question 32

Preganacy

Answer 32

limit care generally (2nd trimester is OK) Local anesthetics are ok

Question 33

Tricyclic antidepressants

Answer 33

Block neurotransmitter uptake Monitor BP

Question 34

MAO inhibitors

Answer 34

limited clinical significance Monitor BP

Question 35

Beta-blockers

Answer 35

selective: little concern non-selective: monitor pressure with EPI use (can cause severe hypertension)

Question 36

LA with Amide

Answer 36

allergic rxn very rare but POSSIBLE

Question 37

LA with Esters

Answer 37

allergic rxn possible, but we aren't injecting them anymore

Question 38

Parabens?

Answer 38

WE DO NOT USE

Question 39

Sulfites?

Answer 39

allergic rxn possible (in epi containing anesthetics)