DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY

SEMINAR PRESENTED ON;COMPLICATIONS OF LOCAL ANESTHESIA

PRESENTED BY;NISHTHA SINGHALBDS FINAL YEAR

LOCAL COMPLICATIONS OF ANAESTHETICS

A)COMPLICATIONS ARISING FROM DRUGS OR CHEMICAL USED1.SOFT TISSUE INJURY2.SLOUGHING OF TISSUES

B)COMPLICATIONS ARISING FROM INJECTION TECHNIQUES1)NEEDLE BREAKAGE2)HEMATOMA3)FAILURE TO OBTAIN LOCAL ANESTHESIA4)POST-INJECTION HERPETIC LESIONS

C)COMPLICATIONS ARISING FROM BOTH1)PAIN ON INJECTION2)BURNING ON INJECTION3)TRISMUS4)BLANCHING OF SKIN5)EDEMA6)PERSISTENT PARATHESIA OR ANESTHESIA7)INFECTION8)PERSISTENT PAIN9)NEUROLOGICAL SYMPTOMS FACIAL N. PARALYSIS VISUAL DISTURBANCES

1)SOFT TISSUE INJURYCAUSES 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 TISSUESi)EPITHELIAL DEQUAMATION-TOPICAL ANESTHETIC FOR PROLONGED PERIOD-HIGHTENED SENSTIVITY OF TISSUE TO LA REACTION IN AREA OF TOPICAL ANESTHETICSii )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 PATIENTSECONDARY 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 INFORM THE PATIENT USE PROPER GAUZE NEEDLE(FOR N. BLOCK-25 GAUZE,FOR

INFILTRATION-27,25,30 GAUZE USE PRESTERLIZED DISPOSABLE NEEDLES ENTIRE LENGTH SHOULD NOT BE INSERTED(FEW MM AWAY FROM HUB) DO NOT REDIRECT IF EMBEDDED USE GOOD QUALITY NEEDLE GENTLE MANIPULATION-NO EXCESSIVE FORCE DO NOT PERMIT THE NEEDLE TO ENGAGE THE PERIOSTEUM STABILISATION OF JAW NEEDLE SHOULD ALWAYS BE KEPT DURING INSERTION AVOID MULTIPLE PENETRATIONS

MANAGEMENTCALM,DO NOT PANICINFORM PATIENTIF VISIBLE-USE HEMOSTAT OR MAC GILLS TUBEIF 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 SIZENICKING OF VEIN-MAY OR MAY NOT RESULT IN FORMATION

CAUSENICK→BLOOD EFFUSES FROM VESSELS UNTIL EXTRAVASCULAR PRESURRE EXCEEDS INTRAVASCULAR→CLOTTING OCCURS

PREVENTION MODIFY INJECTION TECHNIQUE AS DICTATED BY PATIENT USE SHORT NEEDLE(APPROPRIATE LENGTH) MINIMIZE NO. OF PENETRATION NEVER USE NEEDLE AS A PROBE ON TISSUE

MANAGEMENT

IMMEDIATE-DIRECT PRESSURE AT SITE OF BLEEDING FOR NOT LESS THAN 2 MINSBLOCK PRESSURE SITE CLINICAL

MANIFESTATIONIANB MEDIAL ASPECT OF

MANDIBULAR RAMUSINTRAORAL 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 LOWER ANT. REGION OF CHEEK

IN PSA HEMATOMA EARLIER IN PTERYGOID VENOUS PLEXUSACCORDING TO SICHER –PSA ARTERY

OF SORENESS DEVELOPS –ADVISE THE PATIENT TO TAKE ANALGESICDO 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) VASODILATOR↑RATE AT WHICH BLOOD ELEMENTS ARE RESORBEDIN FORM OF WARM MOIST TOWELS TO THE AFFECTED AREA FOR 20 MIN EVERY HOURRESOLVE S WITHIN 7-14 DAYS.

5)FAILURE TO OBTAIN ANESTHESIA

CAUSESA)OPERATOR DEPENDENTi)LA AGENT(TYPE,DOSE)ii)IMPROPER SURGICAL TECH.iii)INJ OF WRONG SOLN.iv)I.Vv_I.M

B)PATIENT DEPENDENTi)ANATOMICAL-ADDITIONAL INNERVATIONii)PSYCHOLOGICAL –UNCOOPRATIVE,MOVEMENTiii)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

PROBLEMSAVG. 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

USE SHARP,STERILE,DISPOSABLE NEEDLE USE ASEPTIC TECH. ATRAUMATIC TECH. AVOID MULTIPLE PENETRATION 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 TMJ7)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 DISTURBANCESi)SQUINTii)DIPLOPIAiii)TRANSIENT AMAUROSISiv)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 VASCULAR PATTERNS-(ORBIT IS

SUPPLIED EITHER WHOLLY OR PARTLY BY MIDDLE MENINGEAL ARTERY.)

NO MANAGEMENT REQUIRED (RESOLVES WITHIN 3 HOURS,OR WHEN EFECT ENDS)

ii)TRANSIENT SQUINT AND DOUBLE VISION PARALYSIS OF EXTRINSIC MUSCLESLA DIFFUSED INTO ORBIT FROM PTERYPALATINE GANGLION AND INFRATEMPORAL FOSSA VIA INFRAORBTAL FISSURE,EFFECTING OCCULOMOTOR,TROCHLEAR,ABDUCENS NERVE.

NO TREATMENT REQUIRED

CAUSES PREVENTION MANAGEMENT

FACIAL NERVE PARALYSIS

DIRECTLY LA DEPOSITION IN VICINITY OF 7TH CRANIAL NERVE1)INFRAORBITAL N. BLOCK2)PARAPERIOSTEAL OF MAXILLARY CANINEINDIRECTLY-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 EFFECTS2.OVERDOSE3.LOCAL TOXIC EFFECTS

TOXICITY CAUSED BY ALTERATION IN RECIPIENT OF THE DRUG1.A DISEASE PROCESS(HEPATIC DYSFUNCTION,CHF,RENAL DYSFUNCTION)2.EMOTIONAL DISTURBANCES3.GENETIC ABBERATIONS(ATYPICAL PLASMA CHOLINESTERASE,MALIGNANT HYPERTHERMIA)

TOXICITY CAUSED BY ALLERGIC RESPONSES TO THE DRUGS

OVERDOSEA 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 FACTORPATIENT FACTORS,DRUG FACTORS

PATIENT FACTOR DRUG FACTORAGEWEIGHTOTHER DRUGSSEXPRESENCE OF DISEASEGENETICSMENTAL ATTITUDE AND ENVIRONMENT

VASOACTIVITYCONC.DOSEROUTE OF ADMINISTRATIONRATE OF INJ.VASCULARITY OF INJ SITEPRESENCE OF VASOCONSTRICTOR

CLINICAL MANIFESTAIOTNS OF OVERDOSE

MINIMAL TO MODERATE OVERDOSE LEVELSSIGNS SYMPTOMS

TALKATIVENESS APPREHENSION EXCITABILITY SLURRRED SPEECH EUPHORIA DYSARTHIA NYSTAGMUS VOMITTING DISORIENTATION LOSS OF RESPONSE TO PAINFUL

STIMULI ↑BP ↑HR ↑RR

LIGHTHEADENESS AND DIZZINESS

RESTLESSNESS NERVOUSNESS NUMBNESS SENSATION METALLIC TASTE VISUAL DISTURBANCES AUDITORY DISTURBANCES LOSS OF CONSCIOUNESS DROWSINESS AND

DISORIENTATION

MODERATE TO HIGH OVERDOSE LEVELS SEIZURE CNS DEPRESSION ↓BP ↓HR ↓RR

LIDOCAINE LEVEL CVS

1.8-5.0 ug/ML ANTIDYSRRTHMIC ACTIONS5.0-10.0 MYOCARDIAL DEPRESSION10.0PLUS MASSIVE PERIPHERAL

VASODILATION,MYOCARDIAL DEPRESSIONCARDIAC ARREST

CNS0.5-4 ANTICONVULSANT ACTION4.5-7 CNS DEPRESSION,EXCITATION7.5-10.0 CNS DEPRESSION ,SEIZURE10.0 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 OVERDOSERETENTION OF CONCIOUSNESS,TALKATIVENESS,AGITATION,↑HR,↑BP. ↑RR(5-10 MIN)→←

P→A→B→C→D

DEFINITIVE CAREi)REASSURE THE PATIENTii)ADMINISTER OXYGEN VIA NASAL CANULA TO PREVENT ACIDOSISiii)MONITOR AND RECORD VITAL SIGNSiv)ESTABLISH i.v. INFUSIONv)USE OF ANTICONVULSANTS –NOT USUALLY INDICATED DIAZEPAM-5mg.MIN i.v. MIDAZOLAM-1mg/MIN

2)SEVERE OVERDOSEUNCONSCIOUSNESS WITH OR W/O CONVULSIONSRAPID ONSET(WITHIN 1 MINUTE)

i)PROTECT PATIENTS ARMS,LEGS AND HEADLOOSEN TIGHT CLOTHESii)IMMEDIATELY SUMMON EMERGENCY MEDICAL ASSISTENCE.iii)CONTINUE BLSiv)ADMINISTER ANTICONVULSANT DIAZEPAM –i.v -5mg/minIF VENEPUNCTURE NOT FEASIBLE MIDAZOLAM-im -1mg

IF HYPOTENSION PERSISTS(30 MINS)-VASOPRESSOR (PHENYNEPHRINE OR METHAOXAMINE)IM

EPINEPHRINE OVERDOSE

CLINICAL MANIFESTATIONSSIGNS-↑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©

MANAGEMENTP→A→B→C→DP-SEMISITIING OR ERECT POSITION( ↓CEREBRAL BP)

i)REAASURE THE PATIENTii)MONITOR VITAL SIGNSiii)OXYGEN ADMINISTERE IF NECESSARY( C/I IN HYPERVENTILATION)iv)RECOVERY

ALLERGY

ALLERGY IS A HYPERSINSITIVE STATE,ACQUIRED THROUGH EXPOSURE TO A PARTICULAR ALLERGEN,REEXPOSURE TO WHICH PRODUCE HEIGHTENED CAPACITY OT REACTION.

PREDISPOSING FACTORS METHLYPARABEN SODIUM BISULPHITE ALLERGY EPINEHRINE LATEX ALLERGY TOPICAL ANESTHETIC ALLERGY

PREVENTION-PROPER HISTORY

ALLERGY TESTING0.1ML OF EACH(INTRAVENOUS) 0.9%NACL

1% OR 2% LIODCAINE, 3%MEPIVACAINE 4%PRILOCAINE(W/O METHYL

PARABEN,BISULPHITE,VASOPRESSORS.

INTRAORAL CHALLENGE TEST0.9 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: NO T/T OF AN INVASIVE NATURE CARRIED OUT IF EMERGENCY –THEN UNDER GENERAL ANESTHESIA IF GA NOT AVAILABLE –HISTAMINE BLOCKER

DIPPHENHYDRAMINE HCL IN 1 % SOLN. WITH 1:100,000 EPINEPHRINE(30 MIN OF PULPAL ANESTHESIA)

NITORUS OXIDE ALTERNATIVES-ELECRONIC DENTAL ANESTHESIA

CLINICAL MANIFESTATIONS OF ALLERGY

DERMATOLOGICAL REACTIONS-URTICARIA-WHEALANGIOEDEMA-LOCALISED SWELLING INVOLVING FACE,HANDS,FEET,GENITILIA,LIPS,TONGUE.

RESPIRATORY REACTIONS-BRONNCHOSPASMRESP. DISTRESSDYSPNOEA,WHEEZING,FLUSHING,CYANOSIS,PERSPIRATION,TACHYCARDIA,INCREASED ANXIETY,LARYNGEAL EDEMA

GENERALISED ANAPHYLAXISSKIN REACTION-PRURITIS,ERYTHEMA,URTICARIA,CONJUCTIVITIS,RHINITISGIT DISTURBANCERESP STMPTOMS-WHEEZING,DYSPNOEACVS-PALLOR,TACHYCARDIA,HYPOTENSION,CARDIAC DYSARRTHYMIA,UNCONCIOUSNESS,CARDIAC ARREST

MANAGEMENT

P→A→B→C→Di)ADMINISTER EPINEPHRINE 0.3mg IM/SC OR HISTAMINE BLOCKER-50mg DIPHENHYDRAMINE OR10 mg CHLORPHENIRAMINEii)MEDICAL CONSULTATION FROM PHYSICIANiii)OBSERVE THE PATIENT (60MIN)iv)PRESCRIBE ORAL HISTAMINE BLOCKER 50 mg CAP-TDS FOR 3-4 DAYS

BRONCHSPASMP→A→B→C→D

i)TERMINATE T/Tii)ADMINISTER OXYGEN (5-6 L/MIN)iii)ADMINISTER EPINEPHRINE 0.3 mg IM/SCiv)ADMINISTER HISTAMINE BLOCKER TO MINIMIZE RELAPSEHISTAMINE BLOCKER-50mg DIPHENHYDRAMINE OR10 mg CHLORPHENIRAMINE v)MEDICAL CONSULTATION

LARYNGEAL ODEMAP→A→B→C→Di)ADMINISTER EPINEPHRINE 0.3 mg IM/SCii)EMERGENCY MEDICAL SERVICEiii)MAINTAIN AIRWAYiv)ADDITIONAL DRUGSHISTAMINE BLOCKER-50mg DIPHENHYDRAMINE OR10 mg CHLORPHENIRAMINECORTICOSTEROID- 100mg HYDROCORTICOSONE IM/IV

GENERALIZED ANAPHYLAXISP→A→B→C→D

i) EMERGENCY MEDICAL SERVICEii) EPINEPHRINE (0.3ML OF 1:1000) IM/IViii) OXYGEN AND VITAL SIGNSiv) 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/IVvi)CPR

THANK YOU