-Danveera Raut Dessai

An anesthetic complication may be defined as any

deviation from the normally expected pattern

during or after the securing of regional anesthesia.

These complications may be classified as:

1. Primary or secondary

2. Mild or severe

3. Transient or permanent

A primary complication is the one that is caused and manifested at the time of anesthesia.

A mild complication is the one that exhibits a slight change from the normally accepted pattern and reverses itself without any specific treatment.

A transient complication is one that, although severe at the time of occurrence, leaves no residual effects.

A secondary complication is one that is manifested later, even though it may be caused at the time of insertion of the needle.

A severe complication manifests itself by a pronounced deviation from the normally expected pattern and requires a definite plan of treatment.

A permanent complication would leave a residual effects, even though mild in nature.

Those that result from the

absorption of LA

1. Toxicity

2. Idiosyncrasy

3. Allergy

4. Anaphylactoid reactions

5. Infections caused by

contaminated solutions

6. Local irritations or

tissue reactions

Those complications

attributed to the

insertion

of the needle

1. Syncope

2. Muscle trismus

3. Pain

4. Edema

5. Infections

6. Broken needles

7. Hematoma

8. Bizarre neurological

symptoms

9. Sloughing of tissues

10. Post anesthetic intra

oral lesions

local

systemic

Cause:

Intravascular injection usually coupled with too rapid deposition of solution

Too large a volume

Too great a percentage stregth

Rapid absorption into bloodstream

Symptoms:

Talkativeness, restlessness, apprehension, excitement, convulsions, lethargy, sleepiness, unconsciousness

Increase or decrease in BP, pulse rate and respiration, nausea and vomiting is also seen.

Prevention:

Aspiration must be performed before injecting

Smallest possible volume of drugs should be used

A vasoconstrictor should be employed with the local anesthetic

The term idiosyncrasy is defined as any reaction to a local anesthetic or drug that cannot be classified as toxic or allergic.

Idiosyncrasy have no relation to the pharmacology of the drug and may vary in degree from day, to day even in the same patient.

The treatment for idiosyncrasy type of emergency:

The patients airway must be maintained and adequate oxygenation assured.

Steps should be taken to evaluate the circulation and support it by positional changes, drugs, or parenteral fluids.

Precautions may also be exercised to protect the patient from injury to himself as a result of convulsive seizures, loss of consciousness or similar reactions.

Cause:

The primary cause of allergic reactions is a specific antigen-

antibody reaction in a patient who has previously been

sensitizing to a particular drug or chemical derivative

thereof.

Symptoms:

1.Rashes

2.Urticaria

3.Angioneurotic edema

4.Mucous membrane congestion

a. Rhinitis

b. Asthmatic symptoms

Prevention:

1. Adequate preanesthetic evaluation must be done.

2. No drug or drugs should be used if the patient gives a

history of previous allergic reactions to them.

Infections caused by contaminated solutions are rare at the present

time as high standards of asepsis practiced by the manufacturers of

LA.

The cartridges should be stored as aseptically as possible.

Injections of alcohol contaminated anesthetic may result in prolonged

anesthesia or local irritation.

There should be o burning or irritation caused by the isotonic sterile

solutions used in dentistry.

If the local aesthetic solution is injected too rapidly, particularly In

confined areas such as palate, local tissue damage can occur. To

avoid this, the LA is injected slowly without undue pressure.

Syncope:-

Syncope is the most frequent complication associated with LA in

dental office. This is a form of neurogenic shock and is

caused by cerebral ischemia, with a corresponding drop in BP.

If the patient is conscious, he should be instructed to take a few

deep breaths. This assists venous return while providing

adequate oxygenation.

However if the patient is unconscious, the pulse, respiration,

and color should be checked to determine severity of the

condition.

Such a patient should be placed in a semi reclining position with

legs ad thorax slightly elevated.

Muscle trismus:-

Fairly common complication of regional

anesthesia particularly after blocks to the

inferior alveolar nerve. Any muscle soreness or

limitation of motion is referred as trismus.

The most common cause of trismus is trauma to

muscle during the insertion of needle. irritating

solutions, hemorrhage or low degree infections

within muscle may also cause trismus.

Trismus may be prevented by use of sharp, sterile

needle so that the trauma of insertion ad low

grade infections are prevented. The area of

insertion should be cleaned and painted with

suitable antiseptic.

PainPain during or after the administration of a regional anesthetic

is very common.

Only sharp needles are to be used, and the area of penetration

should be anesthetized with tropical anesthetic.

The insertion if needle should be slow and atraumatic.

Infections, low grade or otherwise, are common cause of pain

after regional anesthesia . Aseptic conditions should be

maintained.

Injected solutions that are too hot seem to cause greater tissue

damage than that of too cold.

EdemaEdema or swelling of tissue, is usually symptom ad rarely

an entity itself.

• Trauma, infection, allergy, hemorrhage, and other

factors ca produce edema.

• Each cause of edema should be considered under its

own classification in regards to prevention and

treatment.

Infection• Dentists should constantly apply all means of their

command to prevent infection.

• All area, instruments, needles, and solutions

should be aseptic as possible.

• The operators hands should be scrupulously

cleaned before working on each patient.

Broken needlesBreakage of needle is one of the most depressing and annoying

complication of regional anesthesia.

Principles to be observed to prevent needle breakage:

1. Do not force the needle against resistance.

2. Do not change the direction of needle while it is embedded

in in the tissue.

3. Do not use too fine needle.

4. Use disposable needles only.

5. Do not insert needle so far as it is out of sight in tissue.

Bizarre neurological symptoms On rare occasions unexplained neurological symptoms may

occur following the insertion of needle.

Patients may exhibit facial paralysis, crossed eyes, muscular

weakness, temporary blindness and many other

complications.

Hematoma(Common complication of

intraoral regional anesthesia.)

Most commonly associated with posterior superior

alveolar and infraorbital nerve block.

o Hematoma is an effusion of blood into the

surrounding tissue and a result of torn blood

vessels.

o The traumatic puncture of vein does not cause

hematoma.

Sloughing of tissues

Due to epithelial desquamation and sterile abscess

Epithelial desquamation

1. Application of topical anesthetic to the gingival tissues for a

prolonged period

2. Heightened sensitivity of the tissues to a local anesthetic

3. Reaction in a area where topical anesthesia has been applied

Sterile abscess

1. Secondary to prolonged ischemia resulting from the use of local

anesthetic with vasoconstrictor

2. Usually develops on the hard palate

Symptoms1. Severe pain & infection

Post anesthetic intraoral lesion

Ulcers are developed in the mouth after 2 days of intraoral LA

CauseTrauma to the tissue by the needle, local aesthetic solutions

cotton swab or ay other instruments may activate the latent

form of the disease like herpes simplex, recurrent apthous

stomatitis that was present in the tissues before injection

ProblemsAcute sensitivity in the ulcerated area

Local Anesthesia- Stanley Malamed.

Monheim’s Local Anesthesia And Pain Control

In Dental Practice.