Management of Local Anesthetic Complications
Local anesthesia is an integral part of any cosmetic surgery in the oral and maxillofacial region. This chapter covers management of local and systemic complications relating to local anesthetic agents that are available in modern practice. Each complicat
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Management of Local Anesthetic Complications Ross Camiel, Samuel Roh, and Christy Lottinger
Introduction Local anesthetics are frequently administered in dentistry and oral surgery, and as a result are expected to be a potential source of drug-related complications. The statistics regarding incidence of complications from administration of local anesthesia are not well documented but may be anywhere from 4% to 26% [27, 36]. In 1997, a study by Daublander et al. of 2731 patients evaluated by questionnaire after receiving local anesthesia reported a 4.5% overall incidence of complication, 0.07% of which were severe adverse events. Although local anesthetics have been widely accepted as safe, effective, and consistent in the fields of dentistry and oral surgery, this chapter will explore the potential complications of their administration and appropriate strategies for management.
Systemic Complications Psychogenic Reactions In the setting of local anesthesia administration, psychogenic reactions occur most commonly. Psychogenic reactions will most likely manifest as syncope, “fight or flight response,” and cutaneous flushing. Cutaneous flushing can be observed as spontaneous onset erythema of the lower face, anterior
R. Camiel Department of Oral and Maxillofacial Surgery, University of Connecticut School of Dental Medicine, Farmington, CT, USA Department of Oral and Maxillofacial Surgery, Boston Medical Center, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA e-mail: [email protected] S. Roh (*) · C. Lottinger Department of Oral and Maxillofacial Surgery, University of Connecticut School of Dental Medicine, Farmington, CT, USA e-mail: [email protected]; [email protected]
neck, and chest, and is thought to result from vasodilation of cutaneous vessels [43]. In the anxious patient, fear concerning the procedure can trigger a sympathetic response, leading to physiological alterations. The provider can expect changes in heart rate, respiratory rate, and blood pressure during a psychogenic episode.
Local Anesthetic Toxicity Local anesthetic toxicity is exceptionally rare; however, the true incidence of overdose is not well documented in the literature. The FDA (Food and Drug Administration)- and ADA (American Dental Association)-guided maximum dosages of local anesthetics are generally weight based and formulated for “average” patient parameters. Suggested manufacturer dosages (Table 6.1) do not include specific patient considerations and special populations; therefore, it is possible for patients to exhibit signs of overdose at less- than-expected maximum dosages. During administration of local anesthesia, overdose may occur even when administered with appropriate dosage and technique. Even when technique was believed to be ideal, intra-arterial injections increase the potential risk for toxicity. Special populations, such as the medically compromised, young, elderly, or pregnant, require additional oversight for signs and symptoms of toxicity. Potential for alteration in absorption, meta
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