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83 Cards in this Set
- Front
- Back
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Describe Adverse Events |
Undesired effects which occur in response to the pharmacologic actions of a drug |
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What are two different types of adverse events |
Local Systemic |
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Describe Local |
More frequent Mild reactions Short term management |
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Describe Systemic |
Less Frequent More serious reactions |
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Name some local complications (8) |
Hematoma Trismus Pain on Injection Broken Needles Self Injury Paresthesia Facial Nerve Paralysis Post anesthetic mucosal lesions |
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How is a Hematoma formed? |
from blood leaking from vessels into surrounding tissues |
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Describe Hematoma and vessels (3) |
Not as noticeable in minor vessels Larger vessels result in rapid dramatic develop Can also occur following a negative aspiration caused by going through a vessel |
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What are the most common injections that can cause a hematoma |
PSA Inferior Alveolar/ Lingual Mental/Incisive |
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What are further complications that can occur with a hematoma (3) |
Infection (secondary infection let it spread) Trismus Failure to achieve adequate anesthesia |
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How can a hematoma be prevented (3) |
Minimize the number of needle pentrations Avoid Trauma Avoid PSA injections if a patient is taking blood thinners |
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How should you respond to a hematoma (4) |
Be alert to hematoma formation Respond to initial signs of swelling by discontinueing tx for the day and apply pressure and ice Instruct the patient to apply ice intermittently for the next 6 hours and avoid aspirin Advice the patient regarding development of bruising and discolorations to notify you immediately of any changes such as signs and symptoms of infection and limited jaw opening |
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Define Trismus |
A motor disturbance of the trigeminal nerve Inability to open the mouth |
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What muscle is most frequently affected by trismus |
Medial Pterygoid |
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How can Trismus be prevented |
Minimize number of needle penetrations Change needles frequently Assure needle contamination does not occur |
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How do you manage Trismus (5) |
Apply hot moist towels approx 20 minutes every hour (5 minutes on 10 minutes off) Use analgesic as needed (Particulary ibuprofen) Open and Close the mouth gradually/repeatedly (Maintain mobility of the TMJ) Monitor for signs of infection (may require antibiotics) Refer to an oral surgeion or physcian ( if signs and symtoms fail to improve or worsen) |
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PAIN ON INJECTION |
............. |
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How can pain on injection be prevented (5) |
Provide adequate pre-anesthesia Maintain a slow rate of deposition Verify temperature is similiar to temperture of oral envirmonent Administer plain local anestetic solutions first If a drug causes a burning sensation substitute another appropriate drug |
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Describe Broken Needls |
Needle breakage is uncommon today however litagation is possible should it occur |
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What are risk facors increasing risk of broken needles (4) |
Unexpected movements Smaller diameter needles in deeper penetrations Bending needles at the hub Needle penetrations to the hub |
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How can needle breakage be prevented (7) |
Inspect needles before use Avoid inserting needles to the hub Use larger diameter needles Avoid excessive force on needles Avoid excessive numbers of penetrations with the same needle Avoid bending at the hub |
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How would you manage a broken needle (4) |
Keep a sterile hemostat or forceps nearby Do not allow the patient to close if there is breakage If the needle is visible remove with hemostat Keep accurate recors |
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If the needle is not visible how should it be managed |
Immediately refer to an oral/maxillofacial surgeon Send remaining unembedded fragments to the surgeon Surgical removal may be indicated due to potential for extensive tissue damage Keep accurate records |
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What should be kept in the records for a needle breakage (4) |
Location Needle size Any unforeseen events precipitating events Patient communication |
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Describe Self Injury |
It is important to advice the patient, parent, care giver of the risk of self-injury while tissues are anesthetized |
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What are examples of self-injury |
Biting Burning |
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Biting is seen more in who Burnng is seen more in who |
Kids Adults |
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How can self injury be prevented |
Communication Anesthesia reversal Oraverse |
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How should self injury be managed |
OTC preparations for oral sores and pain relief |
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What does Paresthesia mean |
Broad term for a number of neurological effects that result in nerve injury Altered sensation and or persistent partial or complete numbness |
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What are some possible etiologies of Paresthesia (6) |
Direct trauma Drug induced Detergent effect of drugs Pressure from localized edema Higher local anesthetic drug concentrations Vasoconstrictors and their perservatives |
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What drug concentrations has the most reporated incidence of paresthesia |
4% |
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What injection technique is most to cause parethesia |
IA nerve block Lingual nerve |
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Describe Facial nerve paralysis |
Occurs when facial nerve travels through the parotid gland is anesthetized |
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How can facial nerve paralysis be prevented |
Avoid depositing IA blocks withouth confiming bony resistance Use smaller gauged needles Avoid needle over insertion and use alternative techniques |
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How can facial paralysis be managed (3) |
Discontinue tx and reassure patient remove contact lens and place eye patch Document the incidence |
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Describe post anesthetic mucosal lesions |
Result from either infectious or suspected autoimmune processes or from direct injury to the mucosa |
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How can post anesthetic mucosal lesions be prevented (4) |
Avoid epinephrine at 1:50 000 Avoid excessive durations of topical Avoid excessive blanching Avoid extensive distention of tissue |
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How can post anesthetic mucosal lesions be managed (4) |
Recommend OTC medication (apply coat prior to each meal) Avoid hot and acidic foods Take care not to spread injection if herpetic Recommed OTC pain relievers as needed |
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SYSTEMIC COMPLICATIONS |
///////////////// |
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What are some systemic complications (4) |
Overdose Localized Allergic Events Systemic Allergic Events Idiosyncratic Events |
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What are initial signs and symtoms of overdose (5) |
Manifestation of CNS (Excitation) Ringing in the ears (tinnitus) Metallic taste in the mouth Increased anxiety Circumoral tingling or numbness |
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What are laster signs and symtoms (5) |
CNS depression prevails Twitching and tremors Slurred speech Fatigue and or unconsciousness Seizures Coma respiratory arrest and cardiac arrest are possible |
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How can overdose be prevented (4) |
Assess MRD based on weight and health Administer slowly Aspirate to avoid intravascular deposition re-aspirate through out injections |
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How can mild overdose be managed (2) |
Activate emergency protocals as indicated Reassure observe monitor |
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How can moderate to severe overdose occur |
Activate emergency protocols (monitor vital signs) Administer O2 and perform CPR Patient should be dismissed with escort or emergency transport |
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What is Localized allergic Events |
Most frequent after topical anestetic contact Usually limited responds well to antihistamines |
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How can localized allergic events be manged |
Rapid recognition and response Removal of remaining traces of topical drugs |
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How can localized allergic events be prevented (4) |
Avoid medications and same class topicals that previously has a reaction cosult with previous providers when patient report past experiences Refer for allergy testing Document in the chart |
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Describe systemic allergic reactions |
Less frequent than local allergic reactions but more serious |
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What can cause systemic allergic reactions |
Local anesthetic drugs Sulfite preservatives with vasoconstrictors If and ester to the by product of hydrolysis (PABA) |
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What are signs and symtoms of systemic allergic reactions (4) |
sking reactions (itching flushing and hives) Gastrointestinal reactions (Cramps, Vomiting, Diarrhea, and nausea) Respiratory ( coughing wheezing dyspnea) CVS( palpitation lighheadedness hypotenstion and tachycardia, unconsciousness, and arrest ) |
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How can systemic allergic reactions be managed (5) |
Terminte procedure Activate emergency protocols Administer epinephrine Administer diphenhydramine Obtain medical consult before subsequent therapy including allergy testing |
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What are Idiosyncratic events |
Averse events may occur that have no known etiolgy |
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What s Atypical cholinesterase |
Impairs patients ability to effectively metabolize ester-type local anestetics in any form injectable or topical Genetic |
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What is Methemoglobinemia |
Genetic or acquired condition that reduces oxygen carrying capacity of blood (BENZOCAINE AND PRILOCAINE) |
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The IA/L nerve block is indicated for anesthesia of what |
Mandibular anterior teeth in one quadrant |
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The IA/L will anesthetize structures innervated by what |
IA nerve Lingual nerve on injected side |
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What are anatomical factors (3) |
Ptyergomandibular raphe Coronoid notch Internal oblique ridge |
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What is the penetration site of the IA/LS |
Slightly lateral to pterygomandibular raphe Height 2 to 3 mm superior to greatest concavity of coronoid notch Well medial of the internal oblique ridge |
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What needle should be used |
25 or 27 gauge LONG NEEDLE |
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What is the needle pathway of the IA/L |
Along the lateral aspect of the pterygomandibular raphe Through thin mucosal tissue and fibers of buccinator muscle into pterygomandibular space Passes lateral to medial pterygoid muscle lingual nerve and spenomandibular ligament Superior to lingula and mandibular foramen |
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Where is the deposition site |
1mm lateral to medial aspect of ramus Above the mandibular foramen |
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Give step by step technique how to do the IA/L |
Retract cheek laterally and hold mucosa taut by keeping index finger or thumb on the anterior border of the ramus Position syringe at the labial commisure over the premolars on the contra lateral side of the mouth Barrel should remain parallel to and above the occlusal plane of the mandibular molars Penetrate and progress needle along the correct needle pathway adjust pathway if needed After contacting bone withdraw 1mm aspirate and deposit Withdraw needle half way reaspirate and deposit |
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How should the barrel be moved is there is no bony contact How should the barrel be moved if bony contact is met to soon |
Posterior Anterior |
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How much of the cartridge is deposited first |
3/4 |
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How much of the cartridge is deposited the second time |
1/9 |
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How do you confirm anesthesia for the IA/L |
Sense of numbness of soft tissues of inferior portion of ramus and body of mandible lower lip Buccal periosteum of premolar and incisors |
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Anesthesia failure |
failure rates are high (10 to 31%) |
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What are common causes for failure |
Variations in anatomy Technique factor (depositing too far away from foramen) DOESNT MAKE BONY CONTACT |
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BUCCAL INJECTION |
........................... |
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Buccal nerve block is indicated for anesthesia during procedures that involve What |
Buccal soft tissues along the molar teeth of the mandible |
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The Buccal nerve block with anesthetize structures innervated by what |
The buccal nerve |
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Buccal nerve block will anesthetize what
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Buccal soft tissues Buccal periosteum |
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What is the penetration site for the buccal nerve block |
Buccal fold just distal and buccal to the most posterior molar |
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What is the needle pathway for the buccal nerve block |
Advance slowly until bevel is fully inserted Thin mucosa in the area limits depths of penetration |
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What is the deposition site |
At the buccal aspect of ramus Lateral to external oblique ridge as nerve passes over anteiror border of the ramus |
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What type of needle should be used |
25 to 27 gauge long needles are common due to following the IA/L |
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If administered along what needle should be used |
27 gauge short needle |
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Injection Procedure |
Retract lip and cheek fully pulling tissue taut because the tissue is very thin Penetrate tissue and progress at an angle parallel to the occlusal plan Insert to a depth of 3-4 mm Aspirate, and deposit |
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How much of the cartridge should be deposited |
0.2 to 0.3 ml (1/9 to 1/6th) |
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How do you confirm anesthesia for the buccal nerve block |
Sense of numbness of buccal soft tissues of the mandibular molars |
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Anesthesia failure |
Rarely fails |
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What can cause the buccal nerve block to fail (3) |
Inadequate volumes Insufficient volumes folloqing IA/L Inadequate depth to fully insert bevel |
