LOCAL COMPLICATIONS OF ANAESTHETICS
A)COMPLICATIONS ARISING FROM DRUGS OR
CHEMICAL USED
1.SOFT TISSUE INJURY
2.SLOUGHING OF TISSUES
B)COMPLICATIONS ARISING FROM
INJECTION TECHNIQUES
1)NEEDLE BREAKAGE
2)HEMATOMA
3)FAILURE TO OBTAIN LOCAL ANESTHESIA
4)POST-INJECTION HERPETIC LESIONS
C)COMPLICATIONS ARISING FROM BOTH
1)PAIN ON INJECTION
2)BURNING ON INJECTION
3)TRISMUS
4)BLANCHING OF SKIN
5)EDEMA
6)PERSISTENT PARATHESIA OR ANESTHESIA
7)INFECTION
8)PERSISTENT PAIN
9)NEUROLOGICAL SYMPTOMS
FACIAL
N. PARALYSIS
VISUAL
DISTURBANCES
|
1)SOFT
TISSUE INJURY
|
|
|
|
CAUSES
|
PREVENTION
|
MANAGEMENT
|
|
-SELF INFLICTED TRAUMA TO LIPS ,TONGUE WHILE STILL NUMB
-SEEN IN CHILDREN AND MENTALLY AND PHYSICALLY DISABLED
-SOFT TISSUE ANESTHESIA LASTS LONGER THEN PULPAL
|
-APPROPRIATE DURATION LA
-COTTON ROLLS BETWEEN LIPS AND TEETH
-WARN THE PATIENT AND GUARDIAN AGAINST EATING,DRINKING HOT
FLUIDS AND BITING ON LIPS OR TONGUE TO TEST FOR ANESTHESIA
|
-ANALGESICS FOR PAIN
-ANTIBIOTICS
-LUKEWARM SALINE RINSES TO AID IN DECREASE ANY SWELLING
THAT MAY BE PRESENT
-PETROLEUM JELLY AS LUBRICANT
|
|
2)SLOUGHING
OF TISSUES
|
|
|
|
i)EPITHELIAL DEQUAMATION
-TOPICAL ANESTHETIC FOR PROLONGED PERIOD
-HIGHTENED SENSTIVITY OF TISSUE TO LA REACTION IN AREA OF
TOPICAL ANESTHETICS
ii)STERILE ABSCESS
-PROLONGED
--ISCHEMIA DUE TO VASOCONSTRICTOR
-DEVELOPS ON HARD PALATE
|
-DO NOT USE HIGH CONC. LA WITH VASOCONSTRICTOR
(NOREPINEPHRINE 1:30,000 NOT PRESCRIBED)
|
DEPEND ON INJURY
-SYMPTOMATIC-ANALGESICS,ORABASE
-RESOLVES WITHIN 1-2 WEEKS
-AN ESTABLISH LESION MAY REQUIRE INCISION AND DRAINAGE
|
B)COMPLICATIONS
ARISING FROM INJECTION TECHNIQUES
1)NEEDLE
BREAKAGE
CAUSES
PRIMARY CAUSE-
UNEXPECTED
MOVEMENT OF PATIENT
SECONDARY CAUSE-
¤ INAAPROPRIATE THICKNESS OF NEEDLE
¤ PREVIOUSLY BENT
¤ REDIRECTION OF NEEDLES ONCE INSERTED INSIDE TISSUE
¤ MANUFACTURE DEFECT(RARE)
¤ FORCING NEEDLE AGAINST RESISTENCE
¤ NEEDLE ENGAING THE PERIOSTEUM
PREVENTION
v INFORM THE PATIENT
v USE PROPER GAUZE NEEDLE(FOR N. BLOCK-25 GAUZE,FOR
INFILTRATION-27,25,30 GAUZE
v USE PRESTERLIZED DISPOSABLE NEEDLES
v ENTIRE LENGTH SHOULD NOT BE INSERTED(FEW MM AWAY FROM HUB)
v DO NOT REDIRECT IF EMBEDDED
v USE GOOD QUALITY NEEDLE
v GENTLE MANIPULATION-NO EXCESSIVE FORCE
v DO NOT PERMIT THE NEEDLE TO ENGAGE THE PERIOSTEUM
v STABILISATION OF JAW
v NEEDLE SHOULD ALWAYS BE KEPT DURING INSERTION
v AVOID MULTIPLE PENETRATIONS
MANAGEMENT
CALM,DO NOT PANIC
INFORM PATIENT
IF VISIBLE-USE HEMOSTAT OR MAC GILLS TUBE
IF NOT-FLOUROSCOPE,FOLLOW UP,SURGERY
2)HEMATOMA
THE EFFUSION OF BLOOD INTO EXTRAVASCULAR
SPACES CAN RESULT FROM INADVERTENTLY NICKING A BLOOD VESEL(ARTERY OR
VEIN)DURING THE INJECTION OF LA
NICKING OF ARTERY-HEMATOMA INCRESE RAPIDLY IN SIZE
NICKING OF VEIN-MAY OR MAY NOT RESULT IN FORMATION
CAUSE
NICK→BLOOD EFFUSES FROM VESSELS
UNTIL EXTRAVASCULAR PRESURRE EXCEEDS INTRAVASCULAR→CLOTTING OCCURS
PREVENTION
³
MODIFY INJECTION TECHNIQUE
AS DICTATED BY PATIENT
³
USE SHORT
NEEDLE(APPROPRIATE LENGTH)
³
MINIMIZE NO. OF PENETRATION
³
NEVER USE NEEDLE AS A PROBE
ON TISSUE
MANAGEMENT
IMMEDIATE-DIRECT
PRESSURE AT SITE OF BLEEDING FOR NOT LESS THAN 2 MINS
|
BLOCK
|
PRESSURE SITE
|
CLINICAL
MANIFESTATION
|
|
IANB
|
MEDIAL ASPECT OF MANDIBULAR RAMUS
|
INTRAORAL DISCOLORATION AND PROBABLE TISSUE SWELLING ON
MEDIAL ASPECT OF MANDIBULAR RAMUS
|
|
INFRAORBITAL
|
INFRAORBITAL FORAMEN
|
DISCOLORATION OF SKIN BELOW THE LOWER EYELID
|
|
MENTAL N. BLOCK
|
MENTAL FORAMEN
|
DISCOLORATION OF SKIN OVER THE MENTAL FORAMEN OR SWELLING
IN THE MUCOBUCCAL FOLD IN REGION OF MENTAL FORAMEN
|
|
PSA N BLOCK
|
SOFT TISSUE IN MUCOBUCCAL FOLD AS FAR AS POSSIBLE AS
DISTALLY AS CAN BE TOLERATED BY PATIENT
|
COLORLESS SWELLING APPEAR ON SIDE OF FACE (USUALLY A FEW
MINUTES AFTER THE INJEVTION IS COMPLETED)→DAYS INFERIOR AND ANTERIOR TOWARD
THE
|
IN PSA HEMATOMA EARLIER IN PTERYGOID VENOUS PLEXUS
ACCORDING TO SICHER –PSA
ARTERY
OF SORENESS DEVELOPS –ADVISE THE PATIENT TO TAKE ANALGESIC
DO ON APPLY HEAT OVER
FOR AT LEAST 4-6 HOUR(VASODILATION-INCREASES IN SIZE)
HEAT APPLIED ON NEXT DAY-ACTS AS A)ANALGESIC AND B) VASODILATORè↑RATE AT WHICH BLOOD
ELEMENTS ARE RESORBED
IN FORM OF WARM MOIST TOWELS TO THE AFFECTED AREA FOR 20 MIN
EVERY HOUR
RESOLVE S WITHIN 7-14 DAYS.
5)FAILURE TO OBTAIN
ANESTHESIA
CAUSES
A)OPERATOR
DEPENDENT
i)LA AGENT(TYPE,DOSE)
ii)IMPROPER SURGICAL TECH.
iii)INJ OF WRONG SOLN.
iv)I.V
v_I.M
B)PATIENT
DEPENDENT
i)ANATOMICAL-ADDITIONAL
INNERVATION
ii)PSYCHOLOGICAL
–UNCOOPRATIVE,MOVEMENT
iii)PATHOLOGICAL-INFECTION
ADDITIONAL INNERVATION
‘CUTANEOUS COLLI
NERVE’ (CERVICAL CUTANEOUS NERVE)-(A BRANCH OF 3RD CERVICAL
NERVE)-ENTERS A SMALL FORAMEN ON LINGUAL ASPECT OD RAMUS AND SUPPLIES
INNERVATION TO MANDIBULAR TEETH.
IN CASE OF FAILURE IN OBTAINING OPERATIVE ANESTHESIA AFTER A
MANDIBULAR INJ. ,A SUPPLEMENTAL INJ.CAN BE GIVEN TO CERVICAL CUTANEOUS
NERVE.THIS IS DONE BY INSERTING THE NEEDLE LINGUALLY BETWEEN 2 BICUSPID
TEETH,AT THE REFLECTION OF MUCOUS MEMBRANE AND DIRECTING IT POSTERIORLY,ABOUT
HALF OF THE NEEDLE IS INSERTED AND ABOUT 0.5ML OF SOLN. IS INJECTED.
4)POST INJECTION
HERPETIC LESIONS
CAUSE
- REACTIVATION OF DORMANT HERPES VIRUS
- H/O RECUURENT HERPES LABIALIS
- IN TERMINAL BRANCHES OF TRIGERMINAL NERVE
PREVENTION-DELAY
SURGICAL INTERVENTION IN THE ACTIVE STAGE
MANAGEMENT-ANTIVIRAL
DRUGS
C)COMPLICATIONS
ARISING FROM BOTH
|
CAUSES
|
PREVENTION
|
MANAGEMENT
|
|
1)PAIN ON INSERTION
-CARELESS TECH.
-BLUNT NEEDLE
-RAPID INSERTION OF LA SOLN. CAN CAUSE TISUE DAMAGE
-HIGH TEMP. OF SOLN.
|
-PROPER TECH.
-SHARP NEEDLE-INSERT LA SLOWLY
-USE STERILE LA SOLN.
-USE TOPICAL LA B4
-SOLN. AT ROOM TEMP.
|
NOT REQUIRED
|
|
2)BURNING SENSATION
-RAPID INJ.
-CONTAMINATED NEEDLE CARTRIDGE
-HIGH TEMP. LA SOLN.
ALTERED PH OF SOLN. (PH
PLAIN-5 APP,WITH VASOCONSTRICTOR-3 APP)
|
-SLOW INJ.
-SOLN. AT ROOM TEMP.
|
NOT REQUIRED
|
|
3)INFECTION
-CONTAMINATION OF NEEDLE
-IMPROPER PREP. OF SITE
-NEEDLE PASSING THROUGH AN AREA OF INFECTION
-LA SOLN DEPOSITED UNDER PRESSURE ,AS IN PDL
INJ.→TRANSPORT BACTERIA
|
-PROPER PREP. OF SITE PRIOR TO PENETRATION
-CAREFUL HANDLING OF NEEDLES (AVOID TOUCHING NON-STERILE
SURFACE)
|
-ANALGESICS
-ANTIBIOTICS
-PHYSIOTHERAPY
-MUSCLE RELAXANTS
|
|
4)EDEMA
-TRUAMA
-INFECTION
-ALLERGY
-HEMORRHAGE
-INJ OF IRRITATING SOLN.
|
-PREOP ASSESMENT
-CAREFUL HANDLING OF LA ARMAMENTARIUM
-ATRAUMATIC TECH.
|
-FIND OUT CAUSE
-ALLERGY-(A,B,C,D)
|
|
5)TISSUE BLANCHING
-TRAUMA TO BLOOD VESSEL BY NEEDLE
-I.V. ADMINISTRATION
|
-USE ASPIRATION TECH.
-AVOID INTRAARTERIAL ADMINISTRATION
|
-TRANSIENT PHENOMENON
-NO T/T REQUIRED
|
6)TRISMUS
CAUSES
PRIMARY CAUSE-TRAUMA TO
MUSCLE ,BLOOD VESSELS IN INFRATEMPORAL FOSSA
SECONDARY CAUSES-
#INJECTION OF LA CONTAINING IRRITATING SOLN.(ALCOHOL,COLD
STERILISING SOLN.)
#LA HAVE MILD MYOTOXIC PROPERTIES
(AIDS TO PROGRESSIVE NECROSIS OF EXPOSED MUSCLE FIBRES)
# HEMATOMA –(LEADS TO IRITATION OF MUSCLE FIBRES
# LOW GRADE INFECTION
# EXCESSIVE DEPOSITION OF LA-DISTENSION OF TISSUES-POST INJ
TRISMUS
#THE BARB OCCURRED WHEN THE NEEDLE COME INTO CONTACT WITH
THE MEDIAL ASPECT OF THR MANDIBULAR RAMUS,WITHDRAWL OF THE NEEDLE FROM TISSUE
INCREASED THE LIKELIHOOD OF INVOLVEMENT OF THE LINGUAL OR IANB AND DEVELOPMENT
OF TRISMUS
PROBLEMS
AVG. INTERINCISAL OPENING IN ACSES OF TRISMUS IS 13.7MM
IN CHRONIC HYPOMOBILTY-
- IF T/T NOT GIVEN
- SECONDARY TO ORGANISATION OF HEMATOMA WITH SUBSEQUENT FIBROSIS AND SCAR CONTRACTURE
- INFECTION –INCRESED PAIN-INCRASED TISSUE REACTION(IRRITATION AND SCARRING).
PREVENTION
Ø USE SHARP,STERILE,DISPOSABLE NEEDLE
Ø USE ASEPTIC TECH.
Ø ATRAUMATIC TECH.
Ø AVOID MULTIPLE PENETRATION
Ø USE MINM EFFECTIVE VOL. OF LA
MANAGEMENT
1)HEAT THERAPY-HOT MOIST
TOWELS TO AFFECTED AREA FOR 20 MINS EVERY HOUR
2)WARM SALINE RINSE-HELD
IN THE MOUTH ON THE INVOLVED SITE AND SPIT OUT
3)ANALGESICS
ASPIRIN(325MG)
4)MUSCLE RELAXANTS-
CHLOROXAZONE (250 mg IN 2 TO 3 DIVIDED DOSE)
OR DIAZEPAM (5-10 mg BID)
OR MEMEPROBAMATE(1.2g IN 3-4 DIVIDED DOSES)
5)PHYSIOTHERAPY-OPENING
AND CLOSING THE MOUTH ,AS WELL AS LATERAL EXCURSIONS OF THE MANDIBLE FOR 5 MINS
EVERY 3 TO 4 HOURS.
6)CHEWING GUMS (SUGARLESS)-TO
PROVIDE LATERAL MOVEMENT OF TMJ
7)ANTIBIOTICS
AVOID FURTHER DENTAL T/T IN INVOLVED REGION UNTIL SYMPTOMS
RESOLVE AND PATIENT IS COMFORTABLE.
IF DENTAL CARE HAS TO BE CONTINUED –THAN ALTERNATE METHOD OR
TECH. FOR ACHIEVING LA MAY BE EMPLOYED.
THE AKINSI MANDIBULAR N. BLOCK PROVIDES RELIEF FORM THA
MOLAR DYSFUNCTION AND ALLOWS THE PATIENT TO OPNE THE MOUTH AND PERMITS
ADMINSTARTION OF APPROPRIATE ADDITIONAL INJ. IF REQUIRED.
COMPELTE RESOLUTION OD POST INJ. TRISMUS TAKES APPROXIMATELT
6 WEKS ,WITH A RANGE OF 4 TO 20 WEEKS.
7)NEUROLOGICAL SYMPTOMS
A)VISUAL DISTURBANCES
i)SQUINT
ii)DIPLOPIA
iii)TRANSIENT AMAUROSIS
iv)PERAMNENT BLINDNESS
i)DIPOPIA OR DOUBLE VISION
v LA SOLN. INFILTRATING INTO THE ORBIT TO ANESTHETIC THE EXTRINSIC
OCULAR MUSLCES OF THE YES.
v INTAARTERIAL INJ.-UNCOMMON VASCULAR PATTERNS-(ORBIT IS SUPPLIED
EITHER WHOLLY OR PARTLY BY MIDDLE MENINGEAL ARTERY.)
v NO MANAGEMENT REQUIRED (RESOLVES WITHIN 3 HOURS,OR WHEN EFECT
ENDS)
ii)TRANSIENT SQUINT AND DOUBLE VISION
v PARALYSIS OF EXTRINSIC MUSCLES
LA DIFFUSED INTO ORBIT FROM
PTERYPALATINE GANGLION AND INFRATEMPORAL FOSSA VIA INFRAORBTAL
FISSURE,EFFECTING OCCULOMOTOR,TROCHLEAR,ABDUCENS NERVE.
v NO TREATMENT REQUIRED
|
CAUSES
|
PREVENTION
|
MANAGEMENT
|
|
FACIAL NERVE PARALYSIS
DIRECTLY LA DEPOSITION IN VICINITY OF 7TH
CRANIAL NERVE
1)INFRAORBITAL N. BLOCK
2)PARAPERIOSTEAL OF MAXILLARY CANINE
INDIRECTLY-INTO DEEP LOBE OF PAROTID GLAND IN IANB
|
FOLLOW STANDARD PROTOCOL
|
EXPLAIN, REASSURE PATIENT
-UNILATERAL LOSS OF MOTOR FUNCTION-TRANSIENT
-EYE DRESSING GIVEN
-CONTACT LENSES SHOULD BE REMOVED
|
|
8)PERSISTENT PARATHESIA OR ANAESTHESIA
-INJECTING CONTAMINATED LA SOLUNTION
-TRAUMA TO N. SHEATH
-HEMORRAHGE AROUND N.
|
-FOLLOW STANDARD PROTOCAL
-CAREFUL SURGICAL TECH.
-PROPER HANDLING OF CARTRIDGE
|
-REASSURE THE PATIENT
- VIT B1,B6,B12
-IF DOES NOT RESOLVE THAN REFER FOR SURGERY
|
|
9)PERSISTENT PROLONGED PAIN
-POOR SURGICAL TECH.(IN SUPRAPERIOSTEAL TEARING VOL.)
-NEEDLE TIP BARBS
-ISCHEMIC NECROSIS
-MULTIPLE PENETRATIONS
|
-GOOD SURGICAL TECH.
-AVOID NEEDLE WITH BARBS
-USE VASOCONSTRICTORS WITH MAXIMUN DILUTION
-AVOID MULTIPLE PENETRATION
|
-SYMPTOMATIC
|
SYSTEMIC COMPLICATIONS OF LA
CAUSES OF ADVERS EDRUG REACTION
TOXICITY CAUSED BY DIRECT EXTENSION OF THE USUAL PHARMACOLOGICAL EFFECTS OF DRUGS-
1.SIDE EFFECTS
2.OVERDOSE
3.LOCAL TOXIC EFFECTS
TOXICITY CAUSED BY ALTERATION
IN RECIPIENT OF THE DRUG
1.A DISEASE PROCESS(HEPATIC DYSFUNCTION,CHF,RENAL
DYSFUNCTION)
2.EMOTIONAL DISTURBANCES
3.GENETIC ABBERATIONS(ATYPICAL PLASMA
CHOLINESTERASE,MALIGNANT HYPERTHERMIA)
TOXICITY CAUSED BY ALLERGIC
RESPONSES TO THE DRUGS
OVERDOSE
A DRUG OVERDOSE REACTIONS HAS BEEN DEFINED AS THOSE CLINICAL
SIGNS AND SYMPTOMS THAT RESULT FROM AN OVERLY HIGH BLOOD LEVEL OF A DRUG IN
VARIOUS TARGET ORGANS AND TISSUES
PREDISPOSING FACTOR
PATIENT FACTORS,DRUG FACTORS
|
PATIENT
FACTOR
|
DRUG
FACTOR
|
|
AGE
WEIGHT
OTHER DRUGS
SEX
PRESENCE OF DISEASE
GENETICS
MENTAL ATTITUDE AND ENVIRONMENT
|
VASOACTIVITY
CONC.
DOSE
ROUTE OF ADMINISTRATION
RATE OF INJ.
VASCULARITY OF INJ SITE
PRESENCE OF VASOCONSTRICTOR
|
CLINICAL MANIFESTAIOTNS OF
OVERDOSE
MINIMAL TO MODERATE
OVERDOSE LEVELS
|
SIGNS
|
SYMPTOMS
|
|
q
TALKATIVENESS
q
APPREHENSION
q
EXCITABILITY
q
SLURRRED SPEECH
q
EUPHORIA
q
DYSARTHIA
q
NYSTAGMUS
q
VOMITTING
q
DISORIENTATION
q
LOSS OF RESPONSE TO
PAINFUL STIMULI
q
↑BP
q
↑HR
q
↑RR
|
q
LIGHTHEADENESS AND
DIZZINESS
q
RESTLESSNESS
q
NERVOUSNESS
q
NUMBNESS
q
SENSATION
q
METALLIC TASTE
q
VISUAL DISTURBANCES
q
AUDITORY DISTURBANCES
q
LOSS OF CONSCIOUNESS
q
DROWSINESS AND DISORIENTATION
|
MODERATE TO HIGH OVERDOSE LEVELS
L SEIZURE
L CNS DEPRESSION
L ↓BP
L ↓HR
L ↓RR
|
LIDOCAINE LEVEL
|
CVS
|
|
1.8-5.0 ug/ML
|
ANTIDYSRRTHMIC ACTIONS
|
|
5.0-10.0
|
MYOCARDIAL DEPRESSION
|
|
10.0PLUS
|
MASSIVE PERIPHERAL VASODILATION,MYOCARDIAL DEPRESSION
CARDIAC ARREST
|
|
|
CNS
|
|
0.5-4
|
ANTICONVULSANT ACTION
|
|
4.5-7
|
CNS DEPRESSION,EXCITATION
|
|
7.5-10.0
|
CNS DEPRESSION ,SEIZURE
|
|
10.0 PLUS
|
GENERALIZED CNS DEPRESSION
|
CVS
EFFECTS
LA (VASODILATOR)
↓
PERIPHERAL RESISTANCE
↓
↓BP(BP=PR*CO)
FURTHER IN LA CONC.
AFFECT N. CONDUCTION OF HEART
↓
MYOCARDIAL CONTRACTILITY
↓
C.O.(CO=HR*SV)
HEART’S NEURONAL CONDUCTION SYS.
IS INHIBITED OR COMPLETELY BLOCKED BY LA.
AT TOXIC LEVELS,DEPRESSION OF
INTRACARDIAC N. CONDUCTION CAN RESULT IN ATRIOVENTRCULAR
DISSOCIATION,VENTRICULAR RHYTHM ,VENTRICULAR FIBRILLATION AND ULTIMATELY
CARDIAC ARREST.
CNS
EFFECTS
THE CONDUCTION OF INHIBITORY
NEURONS ID USUALLY BLOCKED BY LA AGENTS AS THEY REACH TOXIC LEVELS-RESULTING IN
UNMODIFIED ACTION OF FACILITATORY NEURONS(IE,CONVULSIVE-LIKE MOVT.)AS THE DOSE
INCREASES,FACILITATORY NEURONS ARE ALSO BLOCKED RESULTING IN CESSATION OF
FUNCTION.
CERTAIN AMIDE TYPE AGENTS(IE
LIDOCAINE)-EFFECT PRIMARILY FACILATORY NEURONS,HENCE DEPRESSION IS SEEN RATHER
THAN EXCITATION.
MANAGEMENT
1)MILD OVERDOSE
RETENTION OF CONCIOUSNESS,TALKATIVENESS,AGITATION,
↑HR,↑BP. ↑RR(5-10 MIN)→←
P→A→B→C→D
DEFINITIVE CARE
i)REASSURE THE PATIENT
ii)ADMINISTER OXYGEN VIA NASAL CANULA TO PREVENT ACIDOSIS
iii)MONITOR AND RECORD VITAL SIGNS
iv)ESTABLISH i.v. INFUSION
v)USE OF ANTICONVULSANTS –NOT USUALLY INDICATED
DIAZEPAM-5mg.MIN
i.v.
MIDAZOLAM-1mg/MIN
2)SEVERE OVERDOSE
UNCONSCIOUSNESS WITH OR W/O CONVULSIONS
RAPID ONSET(WITHIN 1 MINUTE)
i)PROTECT PATIENTS ARMS,LEGS AND HEAD
LOOSEN TIGHT CLOTHES
ii)IMMEDIATELY SUMMON EMERGENCY MEDICAL ASSISTENCE.
iii)CONTINUE BLS
iv)ADMINISTER ANTICONVULSANT
DIAZEPAM –i.v -5mg/min
IF VENEPUNCTURE NOT FEASIBLE
MIDAZOLAM-im -1mg
IF HYPOTENSION PERSISTS(30 MINS)-VASOPRESSOR
(PHENYNEPHRINE OR
METHAOXAMINE)IM
EPINEPHRINE OVERDOSE
CLINICAL
MANIFESTATIONS
SIGNS-↑BP. ↑HR,CARDIAC
DYSRTHYMIAS
SYMPTOMS-FEAR,ANXIETY,THROBBING
HEADACHE,PERSPIRATION,WEAKNESS,PALLOR,RESP. DIFFICULTY,PALPITATION
|
EPINEPHRINE
|
mg/ml
|
Mg/CARTRIDGE
|
MAX NO. OF CARTRIDGES
|
|
1:50,000
|
0.02
|
0.036
|
5(H),1(C)
|
|
1:100,000
|
0.01
|
0.018
|
10(H),2©
|
|
1:200,000
|
0.005
|
0.009
|
20(H),4©
|
MANAGEMENT
P→A→B→C→D
P-SEMISITIING OR ERECT POSITION( ↓CEREBRAL BP)
i)REAASURE THE PATIENT
ii)MONITOR VITAL SIGNS
iii)OXYGEN ADMINISTERE IF NECESSARY( C/I IN
HYPERVENTILATION)
iv)RECOVERY
ALLERGY
ALLERGY IS A HYPERSINSITIVE
STATE
PREDISPOSING
FACTORS
z METHLYPARABEN
z SODIUM BISULPHITE ALLERGY
z EPINEHRINE
z LATEX ALLERGY
z TOPICAL ANESTHETIC ALLERGY
PREVENTION-PROPER
HISTORY
ALLERGY TESTING
0.1ML OF EACH(INTRAVENOUS)
¶ 0.9%NACL
¶ 1% OR 2% LIODCAINE,
¶ 3%MEPIVACAINE
¶ 4%PRILOCAINE(W/O METHYL PARABEN,BISULPHITE,VASOPRESSORS.
INTRAORAL CHALLENGE TEST
0.9 ML OF LA SOLN. SUPRAPERIOSTEAL INFILTRATION ATRAUMATIC(BUT
W/O TOPICAL LA)ABOVE A MAXILLARY RIGHT OR LEFT PREMOLAR OR ANT.
TOOTH.
DENTAL MANAGEMENT IN CASE OF PRESENCE OF LA
ALLERGY:
Í NO T/T OF AN INVASIVE NATURE CARRIED OUT
Í IF EMERGENCY –THEN UNDER GENERAL ANESTHESIA
Í IF GA NOT AVAILABLE –HISTAMINE BLOCKER
DIPPHENHYDRAMINE HCL IN 1 % SOLN.
WITH 1:100,000 EPINEPHRINE(30 MIN OF PULPAL ANESTHESIA)
Í NITORUS OXIDE
Í ALTERNATIVES-ELECRONIC DENTAL ANESTHESIA
CLINICAL
MANIFESTATIONS OF ALLERGY
DERMATOLOGICAL REACTIONS-
URTICARIA-WHEAL
ANGIOEDEMA-LOCALISED
SWELLING INVOLVING FACE,HANDS,FEET,GENITILIA,LIPS,TONGUE.
RESPIRATORY REACTIONS-
BRONNCHOSPASM
RESP. DISTRESS
DYSPNOEA,WHEEZING,FLUSHING ,CYANOSIS,PERSPIRATION,TACHYCARDIA,INCREASED
ANXIETY,LARYNGEAL EDEMA
GENERALISED ANAPHYLAXIS
SKIN REACTION-PRURITIS,ERYTHEMA,URTICARIA,CONJUCTIVITIS,RHINITIS
GIT DISTURBANCE
RESP STMPTOMS-WHEEZING,DYSPNOEA
CVS-PALLOR,TACHYCARDIA,HYPOTENSION,CARDIAC
DYSARRTHYMIA,UNCONCIOUSNESS,CARDIAC ARREST
MANAGEMENT
P→A→B→C→D
i)ADMINISTER EPINEPHRINE 0.3mg IM/SC OR
HISTAMINE
BLOCKER-50mg DIPHENHYDRAMINE OR
10 mg CHLORPHENIRAMINE
ii)MEDICAL CONSULTATION FROM PHYSICIAN
iii)OBSERVE THE PATIENT (60MIN)
iv)PRESCRIBE ORAL HISTAMINE BLOCKER
50 mg CAP-TDS FOR
3-4 DAYS
BRONCHSPASM
P→A→B→C→D
i)TERMINATE T/T
ii)ADMINISTER OXYGEN (5-6 L/MIN)
iii)ADMINISTER EPINEPHRINE 0.3 mg IM/SC
iv)ADMINISTER HISTAMINE BLOCKER TO MINIMIZE RELAPSE
HISTAMINE BLOCKER-50mg DIPHENHYDRAMINE OR
10 mg CHLORPHENIRAMINE
v)MEDICAL
CONSULTATION
LARYNGEAL ODEMA
P→A→B→C→D
i)ADMINISTER EPINEPHRINE 0.3 mg IM/SC
ii)EMERGENCY MEDICAL SERVICE
iii)MAINTAIN AIRWAY
iv)ADDITIONAL DRUGS
HISTAMINE BLOCKER
-50mg DIPHENHYDRAMINE OR
10 mg CHLORPHENIRAMINE
CORTICOSTEROID-
100mg
HYDROCORTICOSONE IM/IV
GENERALIZED ANAPHYLAXIS
P→A→B→C→D
i)
EMERGENCY MEDICAL SERVICE
ii)
EPINEPHRINE (0.3ML OF 1:1000)
IM/IV
iii)
OXYGEN AND VITAL SIGNS
iv)
IF DOES NOT IMPROVE SECOND
DOSE OF EPINEPHRINE IN 10 MIN
v) ADDITIONAL DRUGS
HISTAMINE BLOCKER
-50mg DIPHENHYDRAMINE OR
10 mg CHLORPHENIRAMINE
CORTICOSTEROID-
100mg HYDROCORTICOSONE IM/IV
0 التعليقات:
إرسال تعليق