Complications of Local Anesthesia

Dr. Maged A Omar

Anxiety

Syncope

SYNCOPESigns and Symptoms

• Feeling of warmth• Nausea• Weakness• Pale skin• Sweating over the forehead• Loss of consciousness

SYNCOPE

SYNCOPEPathophysiology Catecholamines + Adrenaline and Nor

Adrenalin

Peripheral vascular resistance

Peripheral blood pooling

Arterial blood flow

Compensatory mechanism

Heart rate, Warmth,

Pallor, Sweating

BR

Decompensation

Vagal Tone

Bradycardia Hypotension

Cerebral BF

Fainting Seizure

SYNCOPEPrevention• Calm and kind patient approach• Stress reduction protocol• Working in supine position

Management•Terminate treatment procedures• Supine position of the patient• Monitor vital signs• Inhale ammonia, give oxygen• After recovery escort patient to home• Stress reduction measures in future procedure

HypersensitivityHypersensitivity

AllergyAllergy

AnaphylaxisAnaphylaxis

IdiosyncrasyIdiosyncrasy

Loss of consciousness

Hives

Tongue swelling Dysphagia

Rapid swelling of throat tissues

Anaphylaxis

Anaphylaxis

Acute severe hypersensitivity reaction due to Acute severe hypersensitivity reaction due to antigen including LAantigen including LA

Signs and symptoms Eye : itching, lacrimationEye : itching, lacrimation Nose : sneezing, discharge Respiration : laryngeal edema, bronchspasm CVS : hypotension, tachycardia GIT : vomiting Skin : erythema, edema CNS : convulsions, coma

Anaphylaxis

Management Supine positionSupine position 0.5 cc adrenaline 1:1000 in the sublingual 0.5 cc adrenaline 1:1000 in the sublingual

area (highly vascular)area (highly vascular) IV 50 mg antihistaminicIV 50 mg antihistaminic Monitor vital signsMonitor vital signs Consider CPRConsider CPR Ask for medical assistanceAsk for medical assistance

ToxicityToxicityoverdose could be due to:overdose could be due to:

Too large volumeToo large volume Unusual rapid absorption or intravenous injectionUnusual rapid absorption or intravenous injection Slow detoxificationSlow detoxification Slow eliminationSlow elimination Concentration of the drug doseConcentration of the drug dose Rapidity of injectionRapidity of injection General physical conditionGeneral physical condition Emotional statusEmotional status

ToxicityToxicity

ManagementManagement

Intravenous barbiturateIntravenous barbiturate Muscle relaxantMuscle relaxant OxygenOxygen Intravenous fluidsIntravenous fluids CoramineCoramine

In the vast majority manifestations are immediate, In the vast majority manifestations are immediate, mild& transitory but in some cases death follows. mild& transitory but in some cases death follows.