Local Anesthetic Systemic

Complications and Treatment

Adverse Drug Reactions
1) Side effects
2) Overdose reactions
3) Local toxic effects (most common)
4) Allergic reactions
Toxicity caused by alteration in
the recipient of the drug
1) Disease process
2) Emotional disturbances
3) Genetic aberrations
4) Idiosyncrasy
Signs and Symptoms Toxic Reaction
to Local Anesthesia

Talkativeness
Slurred speech
Dizziness
Nausea
Depression
Euphoria
Excitement
Convulsions
Overdose Reactions
Clinical signs and symptoms that
develop as a result of an
over-administration of a drug
Overdose Contributing Factors
Age
Weight
Other medications
Presence of disease
Genetics
Mental wellbeing
Drug Factors
Vasoactivity
Concentration
Dose
Route of administration
Rate of injection
Vascularity of the injection site
Presence of vasoconstrictors
Mild Overdose Reaction
Slow onset
Reassure patient
Administer oxygen
Monitor vital signs
Allow patient to recover as long as
necessary
Slower Onset of Overdose
Reassure patient
Administer oxygen
Monitor vital signs
Administer anticonvulsant
Call 911
After reaction, have patient examined by a
physician
Do not let patient leave alone
Severe Overdose Reaction
Rapid onset (within one minute)
Remove syringe (if in the process of an injection)
Protect patient for trauma if convulsions are
present
Call 911
Basic life support
Administer anticonvulsant
Allow patient to recover
Do not let patient leave alone

Epinephrine Overdose
Very rare for patient to experience an
epinephrine overdose
Signs and Symptoms of Epinephrine
Overdose
Fear, anxiety
Tenseness
Restlessness
Throbbing headache
Tremor
Perspiration
Weakness
Dizziness
Pallor
Respiratory difficulty
Palpitations
Management of Epinephrine Overdose
Terminate dental procedure
Sit patient upright in the dental chair
Reassure patient
Monitor blood pressure
Administer oxygen
Allergic Reactions to Local
Anesthetic Agents
Hypersensitive state as a result of
exposure to an allergen

Re-exposure can heighten the initial
reaction

Clinical Manifestations of an Allergy
Fever
Angioedema
Urticaria
Dermatitis
Depression of blood-forming organs
Photosensitivity
Anaphylaxis
Angioedema
Urticaria (hives)
Allergy
Incidents of allergy are low

Often allergic reaction is to one of the
ingredients within the cartridge, not the
local anesthesia itself

How to Prevent An Allergic
Reaction
Take a thorough medical history

Dialogue the medical history with the
patient

Common Questions to Ask
the Patient
Allergic to any medications?
Have you ever had a reaction to local
anesthesia?
If yes, describe what happened
Was treatment given? If so, what?
Allergic Responses to local
anesthetic
Dermatitis (hives)
Bronchospasm
Systemic anaphylaxis
Hypersensitivity to esters
(atypical pseudo cholinesterase, PABA)
Latex Allergy
The cartridge opening into which the needle
is inserted is aluminum with a very thin
diaphragm of latex in the middle

Though patients with a latex allergy are at
an increased risk, there are no known cases
or reports of an allergic response from the
latex on a local anesthetic cartridge

Asthma Patient
Thorough medical and dental history
Avoid use of anesthesia that contain
epinephrine or levonordefrin because of
sulfites (may cause wheezing)
Asthma patient that is steroid dependant
may develop brochospasms
Establish rapport and calm environment
Renal Disease
Common diseases associated with renal
failure are diabetes mellitus,
hypertension, or systemic lupus
erythematosus (SLE)

Kidneys are compromised

Drugs Metabolized by the Liver

Lidocaine (Xylocaine)
Prilocaine (Citanest)
Mepivacaine (Carbocaine, Polocaine)
Bupivacaine (Marcaine)

Appear to be safe for use on patients with liver
disease when used in appropriate amounts
Pregnancy
Anesthesia crosses the placenta and could be toxic
to the fetus, but is not a known teratogen
No drug should be administered during pregnancy
especially the first trimester
If treatment is necessary, local anesthetics with
epinephrine are considered relatively safe for use
during pregnancy; check with patients physician
Educate patients to the potential risks (document)
FDA Category of Prescription Drugs
Drug Category Use During
Pregnancy
Risk
Lidocaine B Yes -
Prilocaine B Yes -
Mepivacaine C
Use with caution-
Consult physician
Fetal
bradycardia
Bupivacaine C
Use with caution-
Consult physician
Fetal
bradycardia
Hypertension
Stress and anxiety may raise the patients blood
pressure (>160/100)
Thorough medical, dental and patient history
Norepinephrine and levonordefrin should not be
used because of alpha1 stimulation
(2% Mepivacaine with 1:20,000 levonordefrin)
Up to two cartridges of 2% lidocaine with
1:100,000 epinephrine is safe

Contraindication for Local Anesthetic
with Epinephrine
Uncontrolled hypertension
Myocardial infarction (within 6 months)
Unstable angina
Coronary artery bypass graft (> 3 months)

Quiz
1. Local anesthetics and vasoconstrictors do cross the
placenta in pregnant women; local anesthetics and
vasoconstrictors are known teratogens (cause birth
defects).
a. The first part of the statement is true, the second
part is true.
b. The first part of the statement is true, the
second part is false.
c. The first part of the statement is false, the second
part is false.
d. The first part of the statement is false, the second
part is true.
2. What should you do when using local anesthesia on a patient with
controlled hypertension?
a. Take the BP before the injection and use Mepivacaine only
b. Take the BP before the injection and use an anesthetic without a
vasoconstrictor
c. Take the BP before the injection and use anesthetic with a
vasoconstrictor judiciously
d. Local anesthetics should not be used on patients with hypertension
3. Since local anesthetics are excreted through the
kidneys, what is true concerning giving local
anesthesia to a patient with renal dysfunction?
a. Consult patients physician
b. Potential for overdose
c. Use anesthetics in minimal doses
d. All of the above
4. What is the most common reason for allergies to
local anesthetic solutions?
a. Asthma
b. The anesthetic solution itself
c. The other added ingredients to the solution
d. The vasoconstrictor
5. To prevent an overdose, what should the
maximum safe doses of anesthetic be based on?
a. The patients age
b. The patients weight
c. The patients physical status
d. The patients health
e. All of the above