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20 Cards in this Set
- Front
- Back
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4 contents of local anesthetic carpule
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1. local anesthetic agent: neural blockade
2. vasoconstrictor - vasoconstriction leads to less absorption, less toxicity, longer duration, improved hemostasis 3. sodium bisulfite- preservative of vasoconstrictor 4. sodium chloride - isotonicity of sodium |
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Describe 3 principles of systemic complications
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1. No drug ever exerts a single action
2. No clinically useful drug is entirely devoid of toxicity 3. The potential toxicity of the drug rests in the hands of the user |
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When do systemic complications actually occur? Where are these effects most encountered?
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-Occurs when blood concentrations of the local anesthetic increase to toxic levels.
This manifests in: -unintentional intravenous injection -excessive dose of anesthetic -allergic reactions -methemoglobinemia |
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In local anesthetic reactions, which type are dose related and which reactions are not?
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Overdose rxns are dose related + allergic reactions aren't.
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Name 4 situations where the toxicity is caused by alteration in the recipient of the drug
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1. disease process: hepatic dysfunction, CHF, renal dysfunction
2. emotional disturbances 3. genetic aberrations - plasma cholinesterase, malignant hypertermia 4. toxicity caused by allergic responses to drug |
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What causes toxicity leading to systemic complications?
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Biotransformation of the drug is unusually slow
The unbiotransformed drug is too slowly eliminated from the body through the kidneys Too large of a total dose is administered Absorption from the injection site is unusually rapid Inadvertent intravasular administration occurs |
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Patient and drug predisposing factors for local anesthetic overdose
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Patient Factors:
Age Weight Other drugs Sex Presence of disease Genetics Mental attitude and environment Drug Factors: Vasoactivity Concentration Dose Route of administration Rate of injection Vascularity of the injection site Presence of vasoconstrictors |
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What are 4 manifestations of local anethstic overdose?
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Initial excitement followed by CNS depression
Apprehension/restlessness Tremors Seizures |
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What is involved in the basic management of a local anesthetic overdose? What if seizure activatey is noted?
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Basic management:
Oxygen, and airway management Vital signs monitoring If seizure activity is noted: Administer IV valium push 5-10mg Activate EMS if unsure or vital signs remain unstable |
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What are the signs and symptoms of epinephrine overdose?
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Signs:
Sharp elevation of blood pressure Elevated heart rate Possible cardiac dysrhythmias Symptoms: Fear, anxiety and restlessness Throbbing headache Palpitations Tachycardia Tremors Respiratory difficulty |
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Management of epinephrine overdose
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No formal management if overdose is minimal and of short duration
If prolonged, terminate the procedure P – A – B – C – D Monitor vital signs and administer oxygen An apprehensive patient may be hyperventilated, avoid administrating oxygen Do not discharge patient if any doubt remains about ability for self care |
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systemic complications of local anesthetics
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Extremely rare with amides (many topical anesthetics are ester-benzocaine)
Must determine what anesthetic was actually used Epinephrine containing solutions also contain sulfites as preservative (may use plain mepivicaine) Consider referral to allergist Consider general anesthesia (hospital setting) |
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Management of allergic reactions
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Place patient in supine position
Administer oxygen and support airway Monitor vital signs and compare to baseline Albuterol 2-4 puffs if stridor is present to assist breathing Epinephrine 0.3-0.5 mg (1:1000) SC/IM Hydrocortisone 100mg IV push IV fluids – D5W or LR Airway MUST be considered a priority – Activate EMS |
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What is idiosyncrasy?
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The third category of true adverse drug reaction
Used to describe a qualitatively abnormal, unexpected response to a drug, differing from its pharmacological actions and thus resembling hypersensitivity Virtually all instances of idiosyncratic reaction have an underlying genetic mechanism |
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Describe syncope and the manifestation
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Psychogenic reaction leading to parasympathetic
response with sudden vasodilation producing bradycardia and cerebral ischemia Manifestation: Dizziness Pallor, sweating, nausea Hypotension Loss of consciousness, possible seizure |
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What is the treatment for syncope?
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Trendelenberg position
ABC – Airway, Breathing, Circulation Oxygen Spirits of ammonia Apply a cool wet towel to forehead Ephedrine IV if bradycardia and hypotension persists It will take 24 hours for the patient’s body to fully recover |
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Hyperventilations cause and manifestations
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Often caused by severe anxiety/panic attack
Manifestation: Palpitations Chest pain Tachycardia Dizziness Numbness and tingling on extremities Muscle pain and cramp (carpopedal tetany) |
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Treatment for hyperventilations
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Stop treatment
Position patient comfortable Calm patient Breathe CO2 enriched air through face mask of paper bag Consider IV sedation |
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HOw are its with suspected LA complications stabilized ?
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Treatment of impending airway compromise
Treatment of local anesthetic-induced seizures Treatment of allergic reaction CNS toxicity-hypoxia and acidosis Lidocaine-induced cardiac toxicity – cardiopulmonary resuscitation (CPR). I V Ephedrine 5.mL in incremental doses of total 15-30mg until blood pressure response is noted |
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What are some ways to avoid complications related to the use of local anesthesia legally?
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To avoid complications related to use of LA:
Obtain and document informed consent for use of LA prior to the procedure Document type and amount used during the procedure Always obtain an adequate history and physical examination to identify the risk factors and allergies Do not use class IB antidysrhythmics (including phenytoin/dilantin for seizures or dysrhythmias believed to be due to cocaine toxicity Look for any changes in signs or symptoms as possible manifestations of anesthetic toxicity Admit patients with serious or unresolved symptoms |
