Meeting abstract
Systematic Side-Effects of Local Anaesthetics in Dental Medicine
Darin Žagar
Stojanka Gašparović
Abstract
Systematic side effects are the consequences of non-selective pharmacodynamic interactions of local anaesthetic with tissues and organs outside the oral cavity.
The aim of the study was to give a short review of systematic side effects, their pathophysiology, clinical appearance and therapy, which the dentist should apply in the dental surgery until the arrival of urgent medical help.
We classified systematic side-effects into: psychogenic reactions, toxic reactions, reactions to vasoconstrictors and reactions of hypersensitivity.
The most frequent clinical presentation of psychogenic reaction is syncope, a consequence of vasovagal reactions or hyperventilation. The condition requires the cessation of the dental operation and placing the patient in Trendelenburg's position.
Toxic reactions occur when the concentration of anaesthetic in the blood exceeds the minimal toxic concentration. They can occur in the case of overdosing and intravascular application of the anaesthetic. Toxicity can be interpreted in the central nervous and cardiovascular system. Involvement of the cardiovascular system can be seen in AV block of different degrees or asystolia, which requires resuscitation.
Toxic reactions in CNS are interpreted as excitation or depression. The most serious presentations of excitation are clonic-tonic cramps, which are halted by intravenous application of diazepam. Respiratory depression requires mechanical ventilation of the patient.
Reaction to vasoconstrictors is the result of the stimulation of adrenergic receptors in the cardiovascular system, and symptoms are transient raised frequency of cardiac and blood pressure, and also arrhythmia. In the case of mild symptoms the patient should be sedated and kept under observation, and in the case of significantly raised blood pressure medication therapy applied.
Reactions of hypersensitivity may be local or systematic. Local reactions involve changes on the skin and mucous membrane such as erythema and urticaria, and they require intramuscular application of an antihistaminic. Systematic hypersensitivity includes laryngo broncho spasm with a fall in blood pressure. The therapy choice is intravenous application of adrenaline, antihistaminic and corticosteroids and ventilation of the patient with 100% oxygen.
Algorithm of clinical procedure is proposed for easier differential diagnosis and therapy.
Keywords
Hrčak ID:
2295
URI
Publication date:
15.12.2004.
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