DEPARTMENT OF

ORAL AND
MAXILLOFACIAL
SURGERY
SEMINAR PRESENTED ON;
COMPLICATIONS OF LOCAL
ANESTHESIA
PRESENTED BY;
NISHTHA SINGHAL
BDS FINAL YEAR
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
)EDEMA
!)PERSISTENT PARATHESIA OR ANESTHESIA
")INFECTION
#)PERSISTENT PAIN
$)NEUROLOGICAL SYMPTOMS
FACIAL N. PARALYSIS
%ISUAL DISTURBANCES
1)SOFT TISSUE
INJURY
CAUSES PREVENTION MANAGEMENT
-SELF INFLICTED
TRAUMA TO LIPS
&TONGUE 'HILE STILL
NUMB
-SEEN IN CHILDREN
AND MENTALLY AND
PHYSICALLY DISABLED
-SOFT TISSUE
ANESTHESIA LASTS
LONGER THEN PULPAL
-APPROPRIATE
DURATION LA
-COTTON ROLLS
BET'EEN LIPS AND
TEETH
-'ARN THE PATIENT
AND GUARDIAN
AGAINST
EATING&DRINKING HOT
FLUIDS AND BITING ON
LIPS OR TONGUE TO
TEST FOR ANESTHESIA
-ANALGESICS FOR PAIN
-ANTIBIOTICS
-LUKE'ARM SALINE
RINSES TO AID IN
DECREASE ANY
S'ELLING THAT MAY
BE PRESENT
-PETROLEUM JELLY AS
LUBRICANT
2)SLOUGHING
OF TISSUES
()EPITHELIAL
DEQUAMATION
-TOPICAL ANESTHETIC
FOR PROLONGED
PERIOD
-HIGHTENED
SENSTI%ITY OF TISSUE
TO LA REACTION IN
AREA OF TOPICAL
ANESTHETICS
ii )STERILE ABSCESS
-PROLONGED
--ISCHEMIA DUE TO
%ASOCONSTRICTOR
-DE%ELOPS ON HARD
PALATE
-DO NOT USE HIGH
CONC. LA 'ITH
%ASOCONSTRICTOR
)NOREPINEPHRINE
1*3+&+++ NOT
PRESCRIBED)
DEPEND ON INJURY
-SYMPTOMATIC-
ANALGESICS&ORABASE
-RESOL%ES 'ITHIN 1-2
'EEKS
-AN ESTABLISH LESION
MAY RE,UIRE INCISION
AND DRAINAGE
B)COMPLICATIONS ARISING FROM
INJECTION TECHNIQUES
1)NEEDLE BREAKAGE
CAUSES
PRIMARY CAUSE-
UNEXPECTED MO%EMENT OF PATIENT
SECONDARY CAUSE-
1 INAAPROPRIATE THICKNESS OF NEEDLE
1 PRE%IOUSLY BENT
1 REDIRECTION OF NEEDLES ONCE INSERTED INSIDE TISSUE
1 MANUFACTURE DEFECT)RARE)
1 FORCING NEEDLE AGAINST RESISTENCE
1 NEEDLE ENGAING THE PERIOSTEUM
PREVENTION
+ INFORM THE PATIENT
+ USE PROPER GAU-E NEEDLE)FOR N. BLOCK-2 GAU-E&FOR
INFILTRATION-2"&2&3+ GAU-E
+ USE PRESTERLI-ED DISPOSABLE NEEDLES
+ ENTIRE LENGTH SHOULD NOT BE INSERTED)FE' MM A'AY FROM HUB)
+ DO NOT REDIRECT IF EMBEDDED
+ USE GOOD ,UALITY NEEDLE
+ GENTLE MANIPULATION-NO EXCESSI%E FORCE
+ DO NOT PERMIT THE NEEDLE TO ENGAGE THE PERIOSTEUM
+ STABILISATION OF JA'
+ NEEDLE SHOULD AL'AYS BE KEPT DURING INSERTION
+ A%OID MULTIPLE PENETRATIONS
MANAGEMENT
CALM&DO NOT PANIC
INFORM PATIENT
IF %ISIBLE-USE HEMOSTAT OR MAC GILLS TUBE
IF NOT-FLOUROSCOPE,FOLLOW UP,SURGERY
2)HEMATOMA
THE EFFUSION OF BLOOD INTO EXTRA%ASCULAR SPACES CAN RESULT
FROM INAD%ERTENTLY NICKING A BLOOD %ESEL)ARTERY OR
%EIN)DURING THE INJECTION OF LA
NICKING OF ARTERY-HEMATOMA INCRESE RAPIDLY IN SI-E
NICKING OF VEIN-MAY OR MAY NOT RESULT IN FORMATION
CAUSE
NICK.BLOOD EFFUSES FROM %ESSELS UNTIL EXTRA%ASCULAR PRESURRE
EXCEEDS INTRA%ASCULAR.CLOTTING OCCURS
PREVENTION
MODIFY INJECTION TECHNI,UE AS DICTATED BY PATIENT
USE SHORT NEEDLE)APPROPRIATE LENGTH)
MINIMI-E NO. OF PENETRATION
NE%ER 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
S'ELLING ON MEDIAL
ASPECT OF
MANDIBULAR RAMUS
INFRAORBITAL
INFRAORBITAL
FORAMEN
DISCOLORATION OF
SKIN BELO' THE
LO'ER EYELID
MENTAL N. BLOCK
MENTAL FORAMEN DISCOLORATION OF
SKIN O%ER THE
MENTAL FORAMEN OR
S'ELLING 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 S'ELLING
APPEAR ON SIDE OF
FACE )USUALLY A FE'
MINUTES AFTER THE
INJE%TION IS
COMPLETED).DAYS
INFERIOR AND
ANTERIOR TO'ARD
THE LO'ER ANT.
REGION OF CHEEK
IN PSA HEMATOMA EARLIER IN PTERYGOID %ENOUS PLEXUS
ACCORDING TO SICHER /PSA ARTERY
OF SORENESS DE%ELOPS /AD%ISE THE PATIENT TO TAKE ANALGESIC
DO ON APPLY HEAT OVER FOR AT LEAST 4-6 HOUR)%ASODILATION-
INCREASES IN SI-E)
HEAT APPLIED ON NEXT DAY-ACTS AS A)ANALGESIC AND B)
%ASODILATOR0RATE AT 'HICH BLOOD ELEMENTS ARE RESORBED
IN FORM OF 'ARM MOIST TO'ELS TO THE AFFECTED AREA FOR 2+ MIN
E%ERY HOUR
RESOL%E S 'ITHIN "-14 DAYS.
5)FAILURE TO OBTAIN ANESTHESIA
CAUSES
A)OPERATOR DEPENDENT
()LA AGENT)TYPE&DOSE)
(()IMPROPER SURGICAL TECH.
((()INJ OF 'RONG SOLN.
(1)I.%
12I.M
B)PATIENT DEPENDENT
()ANATOMICAL-ADDITIONAL INNER%ATION
(()PSYCHOLOGICAL /UNCOOPRATI%E&MO%EMENT
((()PATHOLOGICAL-INFECTION
ADDITIONAL INNERVATION
3CUTANEOUS COLLI NERVE CERVICAL CUTANEOUS NERVE)-A
BRANCH OF 3
RD
CER%ICAL NER%E)-ENTERS A SMALL FORAMEN ON
LINGUAL ASPECT OD RAMUS AND SUPPLIES INNER%ATION TO
MANDIBULAR TEETH.
IN CASE OF FAILURE IN OBTAINING OPERATI%E ANESTHESIA AFTER A
MANDIBULAR INJ. &A SUPPLEMENTAL INJ.CAN BE GI%EN TO CER%ICAL
CUTANEOUS NER%E.THIS IS DONE BY INSERTING THE NEEDLE LINGUALLY
BET'EEN 2 BICUSPID TEETH&AT THE REFLECTION OF MUCOUS MEMBRANE
AND DIRECTING IT POSTERIORLY&ABOUT HALF OF THE NEEDLE IS
INSERTED AND ABOUT +.ML OF SOLN. IS INJECTED.
4)POST INJECTION HERPETIC LESIONS
CAUSE
REACTI%ATION OF DORMANT HERPES %IRUS
H4O RECUURENT HERPES LABIALIS
IN TERMINAL BRANCHES OF TRIGERMINAL NER%E
PREVENTION-DELAY SURGICAL INTER%ENTION IN THE ACTI%E STAGE
MANAGEMENT-ANTI%IRAL 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 SLO'LY
-USE STERILE LA SOLN.
-USE TOPICAL LA B4
-SOLN. AT ROOM TEMP.
NOT RE,UIRED
2)BURNING
SENSATION
-RAPID INJ.
-CONTAMINATED
NEEDLE CARTRIDGE
-HIGH TEMP. LA SOLN.
ALTERED PH OF SOLN.
PH PLAIN- APP&'ITH
%ASOCONSTRICTOR-3
APP)
-SLO' INJ.
-SOLN. AT ROOM TEMP.
NOT RE,UIRED
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 )A%OID
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)
!)TISSUE
BLANCHING
-TRAUMA TO BLOOD
%ESSEL BY NEEDLE
-I.%. ADMINISTRATION
-USE ASPIRATION TECH.
-A%OID
INTRAARTERIAL
ADMINISTRATION
-TRANSIENT
PHENOMENON
-NO T4T RE,UIRED
6)TRISMUS
CAUSES
PRIMARY CAUSE-TRAUMA TO MUSCLE &BLOOD %ESSELS IN
INFRATEMPORAL FOSSA
SECONDARY CAUSES-
5INJECTION OF LA CONTAINING IRRITATING SOLN.)ALCOHOL&COLD
STERILISING SOLN.)
5LA HA%E MILD MYOTOXIC PROPERTIES
)AIDS TO PROGRESSI%E NECROSIS OF EXPOSED MUSCLE FIBRES)
5 HEMATOMA /)LEADS TO IRITATION OF MUSCLE FIBRES
5 LO' GRADE INFECTION
5 EXCESSI%E DEPOSITION OF LA-DISTENSION OF TISSUES-POST INJ
TRISMUS
5THE BARB OCCURRED 'HEN THE NEEDLE COME INTO CONTACT 'ITH
THE MEDIAL ASPECT OF THR MANDIBULAR RAMUS&'ITHDRA'L OF THE
NEEDLE FROM TISSUE INCREASED THE LIKELIHOOD OF IN%OL%EMENT OF
THE LINGUAL OR IANB AND DE%ELOPMENT OF TRISMUS
PROBLEMS
A%G. INTERINCISAL OPENING IN ACSES OF TRISMUS IS 13."MM
IN CHRONIC HYPOMOBILTY-
IF T4T NOT GI%EN
SECONDARY TO ORGANISATION OF HEMATOMA 'ITH SUBSE,UENT
FIBROSIS AND SCAR CONTRACTURE
INFECTION /INCRESED PAIN-INCRASED TISSUE
REACTION)IRRITATION AND SCARRING).
PREVENTION
USE SHARP&STERILE&DISPOSABLE NEEDLE
USE ASEPTIC TECH.
ATRAUMATIC TECH.
A%OID MULTIPLE PENETRATION
USE MINM EFFECTI%E %OL. OF LA
MANAGEMENT
1 )HEAT THERAPY-HOT MOIST TO'ELS TO AFFECTED AREA FOR 2+ MINS
E%ERY HOUR
2)WARM SALINE RINSE-HELD IN THE MOUTH ON THE IN%OL%ED SITE AND
SPIT OUT
3)ANALGESICS ASPIRIN)32MG)
4)MUSCLE RELAXANTS-
CHLOROXA-ONE )2+ 67 IN 2 TO 3 DI%IDED DOSE)
OR DIA-EPAM )-1+ 67 BID)
OR MEMEPROBAMATE)1.27 IN 3-4 DI%IDED DOSES)
5)PHYSIOTHERAPY-OPENING AND CLOSING THE MOUTH &AS 'ELL AS
LATERAL EXCURSIONS OF THE MANDIBLE FOR MINS E%ERY 3 TO 4
HOURS.
6)CHEWING GUMS (SUGARLESS)-TO PRO%IDE LATERAL MO%EMENT OF
TMJ
7)ANTIBIOTICS
A%OID FURTHER DENTAL T4T IN IN%OL%ED REGION UNTIL SYMPTOMS
RESOL%E AND PATIENT IS COMFORTABLE.
IF DENTAL CARE HAS TO BE CONTINUED /THAN ALTERNATE METHOD OR
TECH. FOR ACHIE%ING LA MAY BE EMPLOYED.
THE AKINSI MANDIBULAR N. BLOCK PRO%IDES RELIEF FORM THA MOLAR
DYSFUNCTION AND ALLO'S THE PATIENT TO OPNE THE MOUTH AND
PERMITS ADMINSTARTION OF APPROPRIATE ADDITIONAL INJ. IF RE,UIRED.
COMPELTE RESOLUTION OD POST INJ. TRISMUS TAKES APPROXIMATELT !
'EKS &'ITH A RANGE OF 4 TO 2+ 'EEKS.
7)NEUROLOGICAL SYMPTOMS
A)VISUAL DISTURBANCES
()S,UINT
(()DIPLOPIA
((()TRANSIENT AMAUROSIS
(1)PERAMNENT BLINDNESS
i)DIPOPIA OR DOUBLE VISION
+ LA SOLN. INFILTRATING INTO THE ORBIT TO ANESTHETIC THE
EXTRINSIC OCULAR MUSLCES OF THE YES.
+ INTAARTERIAL INJ.-UNCOMMON %ASCULAR PATTERNS-)ORBIT IS
SUPPLIED EITHER 'HOLLY OR PARTLY BY MIDDLE MENINGEAL
ARTERY.)
+ NO MANAGEMENT RE,UIRED )RESOL%ES 'ITHIN 3 HOURS&OR 'HEN
EFECT ENDS)
(i)TRANSIENT SQUINT AND DOUBLE VISION
+ PARALYSIS OF EXTRINSIC MUSCLES
LA DIFFUSED INTO ORBIT FROM PTERYPALATINE GANGLION AND
INFRATEMPORAL FOSSA %IA INFRAORBTAL FISSURE&EFFECTING
OCCULOMOTOR&TROCHLEAR&ABDUCENS NER%E.
+ NO TREATMENT RE,UIRED
CAUSES PREVENTION MANAGEMENT
FACIAL NERVE
PARALYSIS
DIRECTLY LA
DEPOSITION IN
%ICINITY OF "
TH

CRANIAL NER%E
1)INFRAORBITAL N.
BLOCK
2)PARAPERIOSTEAL
OF MAXILLARY
CANINE
INDIRECTLY-INTO
DEEP LOBE OF
PAROTID GLAND IN
IANB
FOLLO' STANDARD
PROTOCOL
EXPLAIN& REASSURE
PATIENT
-UNILATERAL LOSS OF
MOTOR FUNCTION-
TRANSIENT
-EYE DRESSING GI%EN
-CONTACT LENSES SHOULD
BE REMO%ED
8)PERSISTENT
PARATHESIA OR
ANAESTHESIA
-INJECTING
CONTAMINATED LA
SOLUNTION
-TRAUMA TO N.
SHEATH
-HEMORRAHGE
AROUND N.
-FOLLO' STANDARD
PROTOCAL
-CAREFUL SURGICAL
TECH.
-PROPER HANDLING OF
CARTRIDGE
-REASSURE THE PATIENT
- %IT B1&B!&B12
-IF DOES NOT RESOL%E
THAN REFER FOR SURGERY
9)PERSISTENT
PROLONGED
PAIN
-POOR SURGICAL
TECH.)IN
SUPRAPERIOSTEAL
TEARING %OL.)
-NEEDLE TIP BARBS
-ISCHEMIC
NECROSIS
-MULTIPLE
PENETRATIONS
-GOOD SURGICAL TECH.
-A%OID NEEDLE 'ITH
BARBS
-USE
%ASOCONSTRICTORS
'ITH MAXIMUN
DILUTION
-A%OID MULTIPLE
PENETRATION
-SYMPTOMATIC
SYSTEMIC COMPLICATIONS OF LA
CAUSES OF AD%ERS EDRUG REACTION
TO"ICITY CAUSED BY DIRECT E"TENSION OF THE
USUAL PHARMACOLOGICAL EFFECTS OF DRUGS-
1.SIDE EFFECTS
2.O%ERDOSE
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 O%ERDOSE REACTIONS HAS BEEN DEFINED AS THOSE CLINICAL
SIGNS AND SYMPTOMS THAT RESULT FROM AN O%ERLY HIGH BLOOD
LE%EL OF A DRUG IN %ARIOUS TARGET ORGANS AND TISSUES
PREDISPOSING FACTOR
PATIENT FACTORS&DRUG FACTORS
PATIENT FACTOR DRUG FACTOR
AGE
'EIGHT
OTHER DRUGS
SEX
PRESENCE OF DISEASE
GENETICS
MENTAL ATTITUDE AND
EN%IRONMENT
%ASOACTI%ITY
CONC.
DOSE
ROUTE OF ADMINISTRATION
RATE OF INJ.
%ASCULARITY OF INJ SITE
PRESENCE OF %ASOCONSTRICTOR
CLINICAL MANIESTAIOTNS O OVERDOSE
MINIMAL TO MODERATE OVERDOSE LEVELS
SIGNS SYMPTOMS
O TALKATI%ENESS
O APPREHENSION
O EXCITABILITY
O SLURRRED SPEECH
O EUPHORIA
O DYSARTHIA
O NYSTAGMUS
O %OMITTING
O DISORIENTATION
O LOSS OF RESPONSE TO PAINFUL
STIMULI
O 0BP
O 0HR
O 0RR
O LIGHTHEADENESS AND
DI--INESS
O RESTLESSNESS
O NER%OUSNESS
O NUMBNESS
O SENSATION
O METALLIC TASTE
O %ISUAL DISTURBANCES
O AUDITORY DISTURBANCES
O LOSS OF CONSCIOUNESS
O DRO'SINESS AND
DISORIENTATION
MODERATE TO HIGH OVERDOSE LEVELS
C SEI-URE
C CNS DEPRESSION
C 8BP
C 8HR
C 8RR
LIDOCAINE LE%EL
CVS
1.#-.+ 974ML ANTIDYSRRTHMIC ACTIONS
.+-1+.+ MYOCARDIAL DEPRESSION
1+.+PLUS MASSI%E PERIPHERAL
%ASODILATION&MYOCARDIAL
DEPRESSION
CARDIAC ARREST
CNS
+.-4 ANTICON%ULSANT ACTION
4.-" CNS DEPRESSION&EXCITATION
".-1+.+ CNS DEPRESSION &SEI-URE
1+.+ PLUS GENERALI-ED CNS DEPRESSION
CVS EFFECTS
LA )%ASODILATOR)
8
PERIPHERAL RESISTANCE
8
8BP)BP:PR;CO)
FURTHER IN LA CONC.
AFFECT N. CONDUCTION OF HEART
8
MYOCARDIAL CONTRACTILITY
8
C.O.)CO:HR;S%)
HEART<S NEURONAL CONDUCTION SYS. IS INHIBITED OR COMPLETELY
BLOCKED BY LA.
AT TOXIC LE%ELS&DEPRESSION OF INTRACARDIAC N. CONDUCTION CAN
RESULT IN ATRIO%ENTRCULAR DISSOCIATION&%ENTRICULAR RHYTHM
&%ENTRICULAR FIBRILLATION AND ULTIMATELY CARDIAC ARREST.
CNS EFFECTS
THE CONDUCTION OF INHIBITORY NEURONS ID USUALLY BLOCKED BY LA
AGENTS AS THEY REACH TOXIC LE%ELS-RESULTING IN UNMODIFIED
ACTION OF FACILITATORY NEURONS)IE&CON%ULSI%E-LIKE MO%T.)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&TALKATI%ENESS&AGITATION&
0HR&0BP. 0RR)-1+ MIN).=
P.A.B.C.D
DEFINITIVE CARE
()REASSURE THE PATIENT
(()ADMINISTER OXYGEN %IA NASAL CANULA TO PRE%ENT ACIDOSIS
((()MONITOR AND RECORD %ITAL SIGNS
(1)ESTABLISH (.1. INFUSION
1)USE OF ANTICON%ULSANTS /NOT USUALLY INDICATED
DIA-EPAM-67.MIN (.1.
MIDA-OLAM-1674MIN
2)SEVERE OVERDOSE
UNCONSCIOUSNESS 'ITH OR '4O CON%ULSIONS
RAPID ONSET)'ITHIN 1 MINUTE)
()PROTECT PATIENTS ARMS&LEGS AND HEAD
LOOSEN TIGHT CLOTHES
(()IMMEDIATELY SUMMON EMERGENCY MEDICAL ASSISTENCE.
((()CONTINUE BLS
(1)ADMINISTER ANTICON%ULSANT
DIA#EPAM $(.1 -6746(>
IF %ENEPUNCTURE NOT FEASIBLE
MIDA-OLAM-(6 -167
IF HYPOTENSION PERSISTS)3+ MINS)-%ASOPRESSOR
)PHENYNEPHRINE OR METHAOXAMINE)IM
EPINEPHRINE OVERDOSE
CLINICAL MANIESTATIONS
SIGNS-0BP. 0HR&CARDIAC DYSRTHYMIAS
SYMPTOMS-FEAR&ANXIETY&THROBBING
HEADACHE&PERSPIRATION&'EAKNESS&PALLOR&RESP.
DIFFICULTY&PALPITATION
EPINEPHRINE 6746? M74CARTRIDGE MAX NO. OF
CARTRIDGES
1*+&+++ +.+2 +.+3! )H)&1)C)
1*1++&+++ +.+1 +.+1# 1+)H)&2@
1*2++&+++ +.++ +.++$ 2+)H)&4@
MANAGEMENT
P.A.B.C.D
P-SEMISITIING OR ERECT POSITION) 8CEREBRAL BP)
()REAASURE THE PATIENT
(()MONITOR %ITAL SIGNS
((()OXYGEN ADMINISTERE IF NECESSARY) C4I IN HYPER%ENTILATION)
(1)RECO%ERY
ALLERGY
ALLERGY IS A HYPERSINSITI%E STATE&AC,UIRED THROUGH EXPOSURE TO
A PARTICULAR ALLERGEN&REEXPOSURE TO 'HICH PRODUCE HEIGHTENED
CAPACITY OT REACTION.
PREDISPOSING FACTORS
1 METHLYPARABEN
1 SODIUM BISULPHITE ALLERGY
1 EPINEHRINE
1 LATEX ALLERGY
1 TOPICAL ANESTHETIC ALLERGY
PREVENTION-PROPER HISTORY
ALLERGY TESTING
+.1ML OF EACH)INTRA%ENOUS)
+.$ANACL
1A OR 2A LIODCAINE&
3AMEPI%ACAINE
4APRILOCAINE)'4O METHYL
PARABEN&BISULPHITE&%ASOPRESSORS.
INTRAORAL CHALLENGE TEST
+.$ ML OF LA SOLN. SUPRAPERIOSTEAL INFILTRATION ATRAUMATIC)BUT
'4O TOPICAL LA)ABO%E A MAXILLARY RIGHT OR LEFT PREMOLAR OR
ANT. TOOTH.
DENTAL MANAGEMENT IN CASE OF PRESENCE OF LA ALLERGY:
g NO T4T OF AN IN%ASI%E NATURE CARRIED OUT
g IF EMERGENCY /THEN UNDER GENERAL ANESTHESIA
g IF GA NOT A%AILABLE /HISTAMINE BLOCKER
DIPPHENHYDRAMINE HCL IN 1 A SOLN. 'ITH 1*1++&+++
EPINEPHRINE)3+ MIN OF PULPAL ANESTHESIA)
g NITORUS OXIDE
g ALTERNATI%ES-ELECRONIC DENTAL ANESTHESIA
CLINICAL MANIESTATIONS O ALLERGY
DERMATOLOGICAL REACTIONS-
URTICARIA-'HEAL
ANGIOEDEMA-LOCALISED S'ELLING IN%OL%ING
FACE&HANDS&FEET&GENITILIA&LIPS&TONGUE.
RESPIRATORY REACTIONS-
BRONNCHOSPASM
RESP. DISTRESS
DYSPNOEA&'HEE-ING&FLUSHING&CYANOSIS&PERSPIRATION&TACHYCARDIA
&INCREASED ANXIETY&LARYNGEAL EDEMA
GENERALISED ANAPHYLA"IS
SKIN REACTION-
PRURITIS&ERYTHEMA&URTICARIA&CONJUCTI%ITIS&RHINITIS
GIT DISTURBANCE
RESP STMPTOMS-'HEE-ING&DYSPNOEA
CVS-PALLOR&TACHYCARDIA&HYPOTENSION&CARDIAC
DYSARRTHYMIA&UNCONCIOUSNESS&CARDIAC ARREST
MANAGEMENT
P.A.B.C.D
()ADMINISTER EPINEPHRINE +.367 IM4SC OR
HISTAMINE BLOCKER-+67 DIPHENHYDRAMINE OR
1+ 67 CHLORPHENIRAMINE
(()MEDICAL CONSULTATION FROM PHYSICIAN
((()OBSER%E THE PATIENT )!+MIN)
(1)PRESCRIBE ORAL HISTAMINE BLOCKER
+ 67 CAP-TDS FOR 3-4 DAYS
BRONCHSPASM
P.A.B.C.D
()TERMINATE T4T
(()ADMINISTER OXYGEN )-! L4MIN)
((()ADMINISTER EPINEPHRINE +.3 67 IM4SC
(1)ADMINISTER HISTAMINE BLOCKER TO MINIMI-E RELAPSE
HISTAMINE BLOCKER-+67 DIPHENHYDRAMINE OR
1+ 67 CHLORPHENIRAMINE
1)MEDICAL CONSULTATION
LARYNGEAL ODEMA
P.A.B.C.D
()ADMINISTER EPINEPHRINE +.3 67 IM4SC
(()EMERGENCY MEDICAL SER%ICE
((()MAINTAIN AIR'AY
(1)ADDITIONAL DRUGS
HISTAMINE BLOCKER
-+67 DIPHENHYDRAMINE OR
1+ 67 CHLORPHENIRAMINE
CORTICOSTEROID-
1++67 HYDROCORTICOSONE IM4I%
GENERALIZED ANAPHYLAXIS
P.A.B.C.D
i) EMERGENCY MEDICAL SER%ICE
ii) EPINEPHRINE )+.3ML OF 1*1+++) IM4I%
iii) OXYGEN AND %ITAL SIGNS
iv) IF DOES NOT IMPRO%E SECOND DOSE OF EPINEPHRINE IN 1+ MIN
1) ADDITIONAL DRUGS
HISTAMINE BLOCKER
-+67 DIPHENHYDRAMINE OR
1+ 67 CHLORPHENIRAMINE
CORTICOSTEROID-
1++67 HYDROCORTICOSONE IM4I%
1()CPR
THANK YOU