 Hello everyone, welcome back to another session in dentistry and more today's topic in local anesthesia We'll be learning about the complications so the local complications and Systemic complications. So this is a part five of our local anesthesia sessions So moving on local Complications of anesthesia that is first one is needle breakage then the oculocomplications paracetia facial nerve paralysis Christmas soft tissue injury hematoma pain on injection infection edema Whereas on systemic complications we have overdose and allergy So we'll start with the local complications the first one is needle breakage So this is quite rare because of using disposable needles but If it happens it is due to mainly because of bending of needles if you are trying to bend the needle for any purpose The chances of breakage then it could be due to sudden unexpected movement of the patient Or sometimes the entire length of their needle inserted into the soft tissue and We Suddenly move or the patient tries to move there are chances of breakage and use of smaller needles that is 40 gauge Needles we are using there are chances of breakage So how do we prevent this? The first thing is always use large gauge needles Especially for IA and B and posterior superior alveolar nerve block and Use always long needles and do not insert the needle into tissues to its hub So completely we should not insert into tissue and do not Redirect a needle once it is inserted into tissue. So the redirecting is always comes with our IA and B So it should be done cautiously because there are chances of breakage So we can manage it because if the needle breakage is visible We need to keep the patient calm and Instruct the patient not to move and keep his mouth open and it can be removed using a hemostat or intubation forceps If it is not visible We can refer the patient to For the surgically removing this and before that we can take an x-ray and confirm it That is needle breakage. The second one is ocular complications So there are chances of temporary blindness pupillary dilation Droopy eyelid or double vision because of this local anesthesia and the causes orbital injunction That is the injection into the orbit through the inferior orbital fissure so it is causing damage and There are chances of ocular complications So prevention how we need to aspirate before the injection and we need to inject very slowly So if any complications either we can treat it by Telling the patient that this is a transient This is a temporary problem and cover the affected eye with gauze dressing and refer the patient to an ophthalmologist and We need to keep a regular follow-up The third one is paracetia Paracetia the main causes trauma to the nerve while giving a block or injection so local anesthesia sometimes contaminated by alcohol or sterilizing solution and and With this contaminated solution we give Anesthesia and it results in edema and increased pressure in the region of the nerve ending which leads to paracetia We should not insert the needle inside a foramen and sometimes hemorrhage With the presence of hemorrhage there will be increased pressure that also create paracetia So prevention is proper care and handling handling to injection control and cartridge So how do we manage paracetia first thing is most paracetia will get resolved within eight weeks without any treatment The first part is always reassuring the patient that it is a transient Problem then we need to follow up the patient for every two months So if sensory deficit is still more than one year consultation with a neurologist or oral surgeon Next we have the facial nerve paralysis. So this is we learned in Our previous session how facial nerve paralysis is happening that is while giving IA and B if the Bond resistance is not obtained and if we are injecting the solution into the parotid gland where the nerve fibers of facial nerve is Present so that time If we are injecting on to the facial nerve, okay branches of facial nerve that will cause Facial nerve paralysis that also temporary or transient problem so It is mostly associated with inferior alveolar nerve block or the wazirani echinocinor block So if we can prevent it by proper care and handling of instruction and give by Doing in a proper way with all the landmarks and other Proper criteria So managing is reassure the patient and if sometimes the patient might be using contact lens that should be removed so and I past should be applied to affected eye or manually close the lower eyelid periodically to keep the Cognia lubricated next we have Trismas Trismas is a pain and difficulty of opening Often after the posterior superior alveolar or inferior alveolar nerve block So it is one to six days after the treatment. It is most commonly seen Courses are the trauma to the muscles or blood vessels in the intra temporal forza so local anesthetic solution Contaminated by alcohol or any other sterilizing solution produce irritation to the muscle and There will be also a low-grade infection So we can prevent it by using sharp sterile or disposable needle and proper care of proper care and handling of this Catridge and always try to do the procedure as a traumatic So management Trismas management how we can with heat therapy warm saline rinse We can give analgesics like aspirin then muscle relaxants if necessary such as diazepam Then 10 milligram twice a day Then physiotherapy for five minutes every three to four hours if there is infection We can give antibiotics for seven days Improvements start within two to three days and recovery will be done In a range of four to 20 weeks So surgical intervention might be required in some cases So next we have the soft tissue injury So that is trauma to lip or the tongue caused by biting or chewing these tissues while still anesthetized especially with children So it is most commonly seen When I am B nerve block where the tongue and lip will be anesthetized and patient won't realize it So always keep a caught-and-roll between the lips and teeth one the patient and Self-hearing and warning sticker should be given for the parents to notice it Soft tissue injury we can manage it by providing analgesics For pain and antibiotics if there is any infection Warm saline rinse to aid in decrease the swelling and petroleum jelly to cover the lesion and minimize the irritation Then we have hematoma So hematoma is a effusion of the blood into extra vascular spaces which can result from damaging of a blood vessel so caused by Peersing to artery or vein when giving the injection. So most commonly occur with I am B and posterior superior alveolar nerve block So this hematoma will be seen 7 to 14 days So prevention is understanding the proper anatomy of nerve and its surrounding structures Use shorter needles for posterior superior alveolar nerve Then minimize the number of needle penetration never use a needle as a probe in the tissue and Management we can Give direct pressure on the site of bleeding apply cold moist towels to affected area each 20 minutes and Advice a patient about soreness and limitation of the mouth opening possibly so we should Educate the patient Regarding the complications and Next we have the pain on injection so pain on injection causes by the careless injection of The palatal injection is always painful and dull Dullness of the needle because of the multiple injection also create pain and rapid deposition also will result in pain So always how we should adhere to proper techniques And always we should use sharp needles. That is nowadays. There is no reuse age of needles. We are using only Disposable syringes and needles We can Use topical anesthetics before giving injection inject slowly Next we have infection Infection the the main causes the contamination of the needle Now it is very rare because as I said it is Disposable needles are being used nowadays. The reuse age of needles is almost not there in any of the dental clinics So before that we had disposable needle and glass cartridge that time this was a common thing infection So if infection is there, we can manage it with antibiotics such as pencil in And last one in local complication the edema the main causes trauma infection allergy hemorrhage injection of Injection of irritating solution that is alcohol or cold solution We can manage it by just giving analgesics for pain and if the large edema is there we can prescribe antibiotics Now let's move on to systemic Complication first one is overdose So overdose reaction is occurring when the drug access to the circulatory system So normally there is constant absorption of the drug from a site of administration Into the circulatory system and a steady removal from the bled by the liver But if overdose is happening, there will be symptoms in the body. So One are the predisposing factors so patient factors and drug factors are there patient factors We have age weight medications gender presence of disease genetics mental attitude So regarding age the function of absorption metabolism and excretion are diminished in older age Okay old age That is a problem So the increasing the half-life of the drug in circulation of bled and weight greater body weight we require larger dose and People who are under medication are also should be Considered before giving injection such as finitoin quinidine such thing has a effect on our local anesthetic Then regarding the gender So renal functions during pregnancy may impaired leading to increased local anesthesia bled level So we need to be careful when giving injection for pregnant women Then presence of any kind of disease such as hepatic renal heart failure. So in this case there are chances of increase in anesthesia bled level and Genetics also is there some of the deficiency of enzymes such as pseudo colonist race and Mental attitude patient who are fearful they need large dose and In such patients we need to Make the patient first relax and then provide the dosage Regarding the drugs so we were talking about the patient factors in our dosage the predisposing factors So in drug factors we have First thing is a vaso activity that is a vasodialyting properties of LA so short duration of clinical anesthesia and Increased blood level of local anesthesia will create vasodilation and Concentration lower concentration should be given and those smallest dose should be given So in the drug factors the first one is vaso activity So vasodialyting properties of LA leads to shorter duration of clinical anesthesia and increased blood level of LA and Concentration lower concentration should be given Dose the smallest dose should be given So root of administration should be careful about the intra vascular injection so rate of injection should be slow and Vasoconstrictors which decrease the absorption of the drug if vasoconstrictor is not there will be rapid uptake So how do we prevent it use of aspiration syringe need use a needle no smaller than 25 gauge Aspirate in at least two planes before injection and always give slow injection so clinical manifestation will be The apprehension There will be slurred speech there will be excitability Sweating vomiting failure to follow commands elevated blood pressure heart rate and respiratory rate There are chances of tonic clonic seizure CNS depression or myocardial depression and cardiac arrest is also there so management for mild onset and Severe onset we can manage it differently So the basic emergency management is first thing is proper positioning This is a Synonym PCAPD that is positioning circulation airway breathing and definite care So for mild overdose For mild overdose we need to give PCAB that is first reassure the patient administer oxygen then Monitor and record the vital signs we can give IV anti convulsions such as diazepam it is an optional and We can go for emergency medical assistance So in cases of mild overdose that is patient is conscious and it is slow onset that is greater than five minutes so in that case we need to reassure the patient and administer oxygen via nasal canal monitor and record vital signs and We can give IV anti convulsions that is a diazepam five milligram per minute, but only if required it is optional and If it is Greater than 15 minutes that is a onset. It's very slow onset Reassure the patient then oxygen the same procedure oxygen via nasal canal monitor the vital signs But the IV anti convulsions as mandatory and before discharging we can Take for medical assistance Severe overdose that is patient is unconscious So in that case that is rapid onset within one minute. We need to first protect the patient then we Need to immediate ask for the emergency medical assistance We need to start the BLS. That is a basic life support and IV anti convulsions should be given immediately Then if the severe overdose where patient is unconscious with slow onset that is five to 15 minutes first of all, we need to give anti convulsions that is through IV diazepam or midas olem and As for medical assistance BLS and also along with we should give vasopressors and IV fluids That is the first one overdose age now. We have the allergy Allergy That is hypersensitive state acquired through exposure to a particular allergen So allergic reactions cover a broad spectrum of clinical manifestation ranging from mild and delayed response Occurring as long as 48 hours after exposure to allergen or to immediate and threatening reaction developed within seconds of exposure So what are the predisposing factors? So predisposing factors could be The first one is sodium bisulfate Sodium bisulfate could be a allergic predisposing factor and epinephrine Epinephrine then latex So these could be predisposing factors. So the clinical manifestation. Basically, there will be articaria and angioedema Articaria and angioedema will be there Then clinical manifestation, there will be bronchospasm such as dyspnea, wheezing, fleshing, synosis perspiration, tachycardia and respiratory distress Sometimes extension of edema to the larynx. It could be a life-threatening emergency For generalized anaphylaxis, there will be skin reactions, smooth muscle spasm of GIT and Bronchospasm will be there, respiratory distress, cardiovascular collapse So management, skin reaction, we can Expect a delayed reaction or immediate reaction for respiratory reaction. There will be bronchospasm and laryngeal edema For skin reaction, if it is a delayed one Our PCAB will be like first oral histamine blocker 50 milligram di phenylhydrene or chlorphenamen should be given and observe the patient for one hour Then medical consultation and if patient is drowsiness not allowed to leave the clinic as the patient to rest for a while So for immediate reaction So we should first administer epinephrine point 3 milligram Intramuscularly then intramuscular histamine blocker then we can ask for medical consultation and observe for one hour And prescribe oral histamine blocker for three days So for respiratory problem We should administer oxygen then epinephrine and similarly the histamine blocker and prescribe oral histamine for three days For laryngeal edema also we should follow this epinephrine histamine blocker and sometimes we need Crico Thyrodomy That is very rare cases and generalized NFL axis if the patient is unconscious We should follow this epinephrine oxygen checking vital signs and intramuscular histamine blocker and corticosteroids That is all about complications of local anesthesia So we learned the complications in two category one is a local complication and second one is systemic complications Local complications we have needle breakage oculocomplications Parasitia facial nerve paralysis, trismas, soft tissue injury, hematoma, pain on injection, infection and edema Whereas in systemic we have just to overdose and allergy, but you need to explain it in detail overdose and allergy How to manage it, how to prevent it, what are the drugs used and should follow this PCAP Code So in overdose there will be predisposing factors that is drug factors and patient factors and also We have clinical manifestations and manage in different category. That is a mild overdose and severe overdose in mild overdose we have slow onset that is More than 5 minutes and more than 15 minutes and rapid onset is also there within 1 minute and 5 to 15 minutes and We need to write about the management and regarding the allergy. We have the clinical manifestations and Also the skin reaction, respiratory and general asthanaphylaxis and also the Management accordingly. So this is very commonly asked question Could be asked a short assay or a long assay. So hope you understood the complications of local anesthesia So I'll come up with a new topic in oral surgery. Thank you