1. DEPARTMENT OF
ORAL AND
MAXILLOFACIAL
SURGERY
SEMINAR PRESENTED ON;
COMPLICATIONS OF LOCAL
ANESTHESIA
PRESENTED BY;
NISHTHA SINGHAL
BDS FINAL YEAR

2. LOCAL COMPLICATIONS OF ANAESTHETICS
A)COMPLICATIONS ARISING FROM DRUGS OR CHEMICAL USED
1.SOFT TISSUE INJURY
2.SLOUGHING OF TISSUES
B)COMPLICATIONS ARISING FROM INJECTION TECHNIQUES
1)NEEDLE BREAKAGE
2)HEMATOMA
3)FAILURE TO OBTAIN LOCAL ANESTHESIA
4)POST-INJECTION HERPETIC LESIONS
C)COMPLICATIONS ARISING FROM BOTH
1)PAIN ON INJECTION
2)BURNING ON INJECTION
3)TRISMUS
4)BLANCHING OF SKIN
5)EDEMA
6)PERSISTENT PARATHESIA OR ANESTHESIA
7)INFECTION
8)PERSISTENT PAIN
9)NEUROLOGICAL SYMPTOMS
FACIAL N. PARALYSIS
VISUAL DISTURBANCES

3. 1)SOFT TISSUE
INJURY
CAUSES PREVENTION MANAGEMENT
-SELF INFLICTED -APPROPRIATE -ANALGESICS FOR PAIN
TRAUMA TO LIPS DURATION LA -ANTIBIOTICS
,TONGUE WHILE STILL -COTTON ROLLS -LUKEWARM SALINE
NUMB BETWEEN LIPS AND RINSES TO AID IN
-SEEN IN CHILDREN TEETH DECREASE ANY
AND MENTALLY AND -WARN THE PATIENT SWELLING THAT MAY
PHYSICALLY AND GUARDIAN BE PRESENT
DISABLED AGAINST -PETROLEUM JELLY AS
-SOFT TISSUE EATING,DRINKING HOT LUBRICANT
ANESTHESIA LASTS FLUIDS AND BITING ON
LONGER THEN PULPAL LIPS OR TONGUE TO
TEST FOR ANESTHESIA
2)SLOUGHING
OF TISSUES
i)EPITHELIAL -DO NOT USE HIGH DEPEND ON INJURY
DEQUAMATION CONC. LA WITH -SYMPTOMATIC-
-TOPICAL ANESTHETIC VASOCONSTRICTOR ANALGESICS,ORABASE
FOR PROLONGED (NOREPINEPHRINE -RESOLVES WITHIN 1-2
PERIOD 1:30,000 NOT WEEKS
-HIGHTENED PRESCRIBED) -AN ESTABLISH LESION
SENSTIVITY OF TISSUE MAY REQUIRE
TO LA REACTION IN INCISION AND
AREA OF TOPICAL DRAINAGE
ANESTHETICS
ii)STERILE ABSCESS
-PROLONGED
--ISCHEMIA DUE TO
VASOCONSTRICTOR
-DEVELOPS ON HARD
PALATE

4. B)COMPLICATIONS ARISING FROM
INJECTION TECHNIQUES
1)NEEDLE BREAKAGE
CAUSES
PRIMARY CAUSE-
UNEXPECTED MOVEMENT OF PATIENT
SECONDARY CAUSE-
 INAAPROPRIATE THICKNESS OF NEEDLE
 PREVIOUSLY BENT
 REDIRECTION OF NEEDLES ONCE INSERTED INSIDE TISSUE
 MANUFACTURE DEFECT(RARE)
 FORCING NEEDLE AGAINST RESISTENCE
 NEEDLE ENGAING THE PERIOSTEUM
PREVENTION
 INFORM THE PATIENT
 USE PROPER GAUZE NEEDLE(FOR N. BLOCK-25 GAUZE,FOR
INFILTRATION-27,25,30 GAUZE
 USE PRESTERLIZED DISPOSABLE NEEDLES
 ENTIRE LENGTH SHOULD NOT BE INSERTED(FEW MM AWAY FROM HUB)
 DO NOT REDIRECT IF EMBEDDED
 USE GOOD QUALITY NEEDLE
 GENTLE MANIPULATION-NO EXCESSIVE FORCE
 DO NOT PERMIT THE NEEDLE TO ENGAGE THE PERIOSTEUM
 STABILISATION OF JAW
 NEEDLE SHOULD ALWAYS BE KEPT DURING INSERTION
 AVOID MULTIPLE PENETRATIONS
MANAGEMENT
CALM,DO NOT PANIC
INFORM PATIENT
IF VISIBLE-USE HEMOSTAT OR MAC GILLS TUBE
IF NOT-FLOUROSCOPE,FOLLOW UP,SURGERY

5. 2)HEMATOMA
THE EFFUSION OF BLOOD INTO EXTRAVASCULAR SPACES CAN RESULT
FROM INADVERTENTLY NICKING A BLOOD VESEL(ARTERY OR
VEIN)DURING THE INJECTION OF LA
NICKING OF ARTERY-HEMATOMA INCRESE RAPIDLY IN SIZE
NICKING OF VEIN-MAY OR MAY NOT RESULT IN FORMATION
CAUSE
NICK→BLOOD EFFUSES FROM VESSELS UNTIL EXTRAVASCULAR
PRESURRE EXCEEDS INTRAVASCULAR→CLOTTING OCCURS
PREVENTION
 MODIFY INJECTION TECHNIQUE AS DICTATED BY PATIENT
 USE SHORT NEEDLE(APPROPRIATE LENGTH)
 MINIMIZE NO. OF PENETRATION
 NEVER USE NEEDLE AS A PROBE ON TISSUE
MANAGEMENT
IMMEDIATE-DIRECT PRESSURE AT SITE OF BLEEDING FOR NOT LESS
THAN 2 MINS
BLOCK PRESSURE SITE CLINICAL
MANIFESTATION
IANB MEDIAL ASPECT OF INTRAORAL
MANDIBULAR RAMUS DISCOLORATION AND
PROBABLE TISSUE
SWELLING ON MEDIAL
ASPECT OF
MANDIBULAR RAMUS
INFRAORBITAL INFRAORBITAL DISCOLORATION OF
FORAMEN SKIN BELOW THE
LOWER EYELID
MENTAL N. BLOCK MENTAL FORAMEN DISCOLORATION OF
SKIN OVER THE
MENTAL FORAMEN OR
SWELLING IN THE
MUCOBUCCAL FOLD IN
REGION OF MENTAL

6. FORAMEN
PSA N BLOCK SOFT TISSUE IN COLORLESS SWELLING
MUCOBUCCAL FOLD APPEAR ON SIDE OF
AS FAR AS POSSIBLE AS FACE (USUALLY A FEW
DISTALLY AS CAN BE MINUTES AFTER THE
TOLERATED BY INJEVTION IS
PATIENT COMPLETED)→DAYS
INFERIOR AND
ANTERIOR TOWARD
THE LOWER ANT.
REGION OF CHEEK
IN PSA HEMATOMA EARLIER IN PTERYGOID VENOUS PLEXUS
ACCORDING TO SICHER –PSA ARTERY
OF SORENESS DEVELOPS –ADVISE THE PATIENT TO TAKE ANALGESIC
DO ON APPLY HEAT OVER FOR AT LEAST 4-6 HOUR(VASODILATION-
INCREASES IN SIZE)
HEAT APPLIED ON NEXT DAY-ACTS AS A)ANALGESIC AND B)
VASODILATOR↑RATE AT WHICH BLOOD ELEMENTS ARE RESORBED
IN FORM OF WARM MOIST TOWELS TO THE AFFECTED AREA FOR 20 MIN
EVERY HOUR
RESOLVE S WITHIN 7-14 DAYS.
5)FAILURE TO OBTAIN ANESTHESIA
CAUSES
A)OPERATOR DEPENDENT
i)LA AGENT(TYPE,DOSE)
ii)IMPROPER SURGICAL TECH.
iii)INJ OF WRONG SOLN.
iv)I.V
v_I.M
B)PATIENT DEPENDENT
i)ANATOMICAL-ADDITIONAL INNERVATION
ii)PSYCHOLOGICAL –UNCOOPRATIVE,MOVEMENT
iii)PATHOLOGICAL-INFECTION
ADDITIONAL INNERVATION
‘CUTANEOUS COLLI NERVE’ (CERVICAL CUTANEOUS NERVE)-(A
BRANCH OF 3RD CERVICAL NERVE)-ENTERS A SMALL FORAMEN ON

7. LINGUAL ASPECT OD RAMUS AND SUPPLIES INNERVATION TO
MANDIBULAR TEETH.
IN CASE OF FAILURE IN OBTAINING OPERATIVE ANESTHESIA AFTER A
MANDIBULAR INJ. ,A SUPPLEMENTAL INJ.CAN BE GIVEN TO CERVICAL
CUTANEOUS NERVE.THIS IS DONE BY INSERTING THE NEEDLE LINGUALLY
BETWEEN 2 BICUSPID TEETH,AT THE REFLECTION OF MUCOUS
MEMBRANE AND DIRECTING IT POSTERIORLY,ABOUT HALF OF THE
NEEDLE IS INSERTED AND ABOUT 0.5ML OF SOLN. IS INJECTED.
4)POST INJECTION HERPETIC LESIONS
CAUSE
 REACTIVATION OF DORMANT HERPES VIRUS
 H/O RECUURENT HERPES LABIALIS
 IN TERMINAL BRANCHES OF TRIGERMINAL NERVE
PREVENTION-DELAY SURGICAL INTERVENTION IN THE ACTIVE STAGE
MANAGEMENT-ANTIVIRAL DRUGS
C)COMPLICATIONS ARISING FROM BOTH
CAUSES PREVENTION MANAGEMENT
1)PAIN ON -PROPER TECH. NOT REQUIRED
INSERTION -SHARP NEEDLE-
-CARELESS TECH. INSERT LA SLOWLY
-BLUNT NEEDLE -USE STERILE LA SOLN.
-RAPID INSERTION OF -USE TOPICAL LA B4
LA SOLN. CAN CAUSE -SOLN. AT ROOM TEMP.
TISUE DAMAGE
-HIGH TEMP. OF SOLN.
2)BURNING -SLOW INJ. NOT REQUIRED
SENSATION -SOLN. AT ROOM TEMP.
-RAPID INJ.
-CONTAMINATED
NEEDLE CARTRIDGE
-HIGH TEMP. LA SOLN.
ALTERED PH OF SOLN.
(PH PLAIN-5 APP,WITH

8. VASOCONSTRICTOR-3
APP)
3)INFECTION -PROPER PREP. OF SITE -ANALGESICS
-CONTAMINATION OF PRIOR TO -ANTIBIOTICS
NEEDLE PENETRATION -PHYSIOTHERAPY
-IMPROPER PREP. OF -CAREFUL HANDLING -MUSCLE RELAXANTS
SITE OF NEEDLES (AVOID
-NEEDLE PASSING TOUCHING NON-
THROUGH AN AREA OF STERILE SURFACE)
INFECTION
-LA SOLN DEPOSITED
UNDER PRESSURE ,AS
IN PDL
INJ.→TRANSPORT
BACTERIA
4)EDEMA -PREOP ASSESMENT -FIND OUT CAUSE
-TRUAMA -CAREFUL HANDLING -ALLERGY-(A,B,C,D)
-INFECTION OF LA
-ALLERGY ARMAMENTARIUM
-HEMORRHAGE -ATRAUMATIC TECH.
-INJ OF IRRITATING
SOLN.
5)TISSUE -USE ASPIRATION -TRANSIENT
BLANCHING TECH. PHENOMENON
-TRAUMA TO BLOOD -AVOID -NO T/T REQUIRED
VESSEL BY NEEDLE INTRAARTERIAL
-I.V. ADMINISTRATION ADMINISTRATION
6)TRISMUS
CAUSES
PRIMARY CAUSE-TRAUMA TO MUSCLE ,BLOOD VESSELS IN
INFRATEMPORAL FOSSA
SECONDARY CAUSES-
#INJECTION OF LA CONTAINING IRRITATING SOLN.(ALCOHOL,COLD
STERILISING SOLN.)
#LA HAVE MILD MYOTOXIC PROPERTIES
(AIDS TO PROGRESSIVE NECROSIS OF EXPOSED MUSCLE FIBRES)
# HEMATOMA –(LEADS TO IRITATION OF MUSCLE FIBRES
# LOW GRADE INFECTION

9. # EXCESSIVE DEPOSITION OF LA-DISTENSION OF TISSUES-POST INJ
TRISMUS
#THE BARB OCCURRED WHEN THE NEEDLE COME INTO CONTACT WITH
THE MEDIAL ASPECT OF THR MANDIBULAR RAMUS,WITHDRAWL OF THE
NEEDLE FROM TISSUE INCREASED THE LIKELIHOOD OF INVOLVEMENT OF
THE LINGUAL OR IANB AND DEVELOPMENT OF TRISMUS
PROBLEMS
AVG. INTERINCISAL OPENING IN ACSES OF TRISMUS IS 13.7MM
IN CHRONIC HYPOMOBILTY-
• IF T/T NOT GIVEN
• SECONDARY TO ORGANISATION OF HEMATOMA WITH SUBSEQUENT
FIBROSIS AND SCAR CONTRACTURE
• INFECTION –INCRESED PAIN-INCRASED TISSUE
REACTION(IRRITATION AND SCARRING).
PREVENTION
 USE SHARP,STERILE,DISPOSABLE NEEDLE
 USE ASEPTIC TECH.
 ATRAUMATIC TECH.
 AVOID MULTIPLE PENETRATION
 USE MINM EFFECTIVE VOL. OF LA
MANAGEMENT
1)HEAT THERAPY-HOT MOIST TOWELS TO AFFECTED AREA FOR 20 MINS
EVERY HOUR
2)WARM SALINE RINSE-HELD IN THE MOUTH ON THE INVOLVED SITE AND
SPIT OUT
3)ANALGESICS ASPIRIN(325MG)
4)MUSCLE RELAXANTS-
CHLOROXAZONE (250 mg IN 2 TO 3 DIVIDED DOSE)
OR DIAZEPAM (5-10 mg BID)
OR MEMEPROBAMATE(1.2g IN 3-4 DIVIDED DOSES)
5)PHYSIOTHERAPY-OPENING AND CLOSING THE MOUTH ,AS WELL AS
LATERAL EXCURSIONS OF THE MANDIBLE FOR 5 MINS EVERY 3 TO 4
HOURS.

10. 6)CHEWING GUMS (SUGARLESS)-TO PROVIDE LATERAL MOVEMENT OF
TMJ
7)ANTIBIOTICS
AVOID FURTHER DENTAL T/T IN INVOLVED REGION UNTIL SYMPTOMS
RESOLVE AND PATIENT IS COMFORTABLE.
IF DENTAL CARE HAS TO BE CONTINUED –THAN ALTERNATE METHOD OR
TECH. FOR ACHIEVING LA MAY BE EMPLOYED.
THE AKINSI MANDIBULAR N. BLOCK PROVIDES RELIEF FORM THA MOLAR
DYSFUNCTION AND ALLOWS THE PATIENT TO OPNE THE MOUTH AND
PERMITS ADMINSTARTION OF APPROPRIATE ADDITIONAL INJ. IF
REQUIRED.
COMPELTE RESOLUTION OD POST INJ. TRISMUS TAKES APPROXIMATELT 6
WEKS ,WITH A RANGE OF 4 TO 20 WEEKS.
7)NEUROLOGICAL SYMPTOMS
A)VISUAL DISTURBANCES
i)SQUINT
ii)DIPLOPIA
iii)TRANSIENT AMAUROSIS
iv)PERAMNENT BLINDNESS
i)DIPOPIA OR DOUBLE VISION
 LA SOLN. INFILTRATING INTO THE ORBIT TO ANESTHETIC THE
EXTRINSIC OCULAR MUSLCES OF THE YES.
 INTAARTERIAL INJ.-UNCOMMON VASCULAR PATTERNS-(ORBIT IS
SUPPLIED EITHER WHOLLY OR PARTLY BY MIDDLE MENINGEAL
ARTERY.)
 NO MANAGEMENT REQUIRED (RESOLVES WITHIN 3 HOURS,OR
WHEN EFECT ENDS)
ii)TRANSIENT SQUINT AND DOUBLE VISION
 PARALYSIS OF EXTRINSIC MUSCLES
LA DIFFUSED INTO ORBIT FROM PTERYPALATINE GANGLION AND
INFRATEMPORAL FOSSA VIA INFRAORBTAL FISSURE,EFFECTING
OCCULOMOTOR,TROCHLEAR,ABDUCENS NERVE.
 NO TREATMENT REQUIRED

11. CAUSES PREVENTION MANAGEMENT
FACIAL NERVE FOLLOW STANDARD EXPLAIN, REASSURE
PARALYSIS PROTOCOL PATIENT
-UNILATERAL LOSS OF
MOTOR FUNCTION-
DIRECTLY LA TRANSIENT
DEPOSITION IN -EYE DRESSING GIVEN
VICINITY OF 7TH -CONTACT LENSES SHOULD
CRANIAL NERVE BE REMOVED
1)INFRAORBITAL N.
BLOCK
2)PARAPERIOSTEAL
OF MAXILLARY
CANINE
INDIRECTLY-INTO
DEEP LOBE OF
PAROTID GLAND IN
IANB
8)PERSISTENT -FOLLOW STANDARD -REASSURE THE PATIENT
PARATHESIA OR PROTOCAL - VIT B1,B6,B12
-CAREFUL SURGICAL -IF DOES NOT RESOLVE
ANAESTHESIA TECH. THAN REFER FOR SURGERY
-INJECTING -PROPER HANDLING OF
CONTAMINATED CARTRIDGE
LA SOLUNTION
-TRAUMA TO N.
SHEATH
-HEMORRAHGE
AROUND N.
9)PERSISTENT -GOOD SURGICAL TECH. -SYMPTOMATIC
PROLONGED PAIN -AVOID NEEDLE WITH
-POOR SURGICAL BARBS
TECH.(IN -USE
SUPRAPERIOSTEAL VASOCONSTRICTORS
TEARING VOL.) WITH MAXIMUN
-NEEDLE TIP BARBS DILUTION
-ISCHEMIC -AVOID MULTIPLE
NECROSIS PENETRATION
-MULTIPLE
PENETRATIONS

12. SYSTEMIC COMPLICATIONS OF LA
CAUSES OF ADVERS EDRUG REACTION
TOXICITY CAUSED BY DIRECT EXTENSION OF THE
USUAL PHARMACOLOGICAL EFFECTS OF DRUGS-
1.SIDE EFFECTS
2.OVERDOSE
3.LOCAL TOXIC EFFECTS
TOXICITY CAUSED BY ALTERATION IN RECIPIENT OF
THE DRUG
1.A DISEASE PROCESS(HEPATIC DYSFUNCTION,CHF,RENAL DYSFUNCTION)
2.EMOTIONAL DISTURBANCES
3.GENETIC ABBERATIONS(ATYPICAL PLASMA
CHOLINESTERASE,MALIGNANT HYPERTHERMIA)
TOXICITY CAUSED BY ALLERGIC RESPONSES TO THE
DRUGS

13. OVERDOSE
A DRUG OVERDOSE REACTIONS HAS BEEN DEFINED AS THOSE CLINICAL
SIGNS AND SYMPTOMS THAT RESULT FROM AN OVERLY HIGH BLOOD
LEVEL OF A DRUG IN VARIOUS TARGET ORGANS AND TISSUES
PREDISPOSING FACTOR
PATIENT FACTORS,DRUG FACTORS
PATIENT FACTOR DRUG FACTOR
AGE VASOACTIVITY
WEIGHT CONC.
OTHER DRUGS DOSE
SEX ROUTE OF ADMINISTRATION
PRESENCE OF DISEASE RATE OF INJ.
GENETICS VASCULARITY OF INJ SITE
MENTAL ATTITUDE AND PRESENCE OF VASOCONSTRICTOR
ENVIRONMENT
CLINICAL MANIFESTAIOTNS OF OVERDOSE
MINIMAL TO MODERATE OVERDOSE LEVELS
SIGNS SYMPTOMS
 TALKATIVENESS  LIGHTHEADENESS AND DIZZINESS
 APPREHENSION  RESTLESSNESS
 EXCITABILITY  NERVOUSNESS
 SLURRRED SPEECH  NUMBNESS
 EUPHORIA  SENSATION
 DYSARTHIA  METALLIC TASTE
 NYSTAGMUS  VISUAL DISTURBANCES
 VOMITTING  AUDITORY DISTURBANCES
 DISORIENTATION  LOSS OF CONSCIOUNESS
 LOSS OF RESPONSE TO PAINFUL  DROWSINESS AND
STIMULI DISORIENTATION
 ↑BP
 ↑HR
 ↑RR

14. MODERATE TO HIGH OVERDOSE LEVELS
 SEIZURE
 CNS DEPRESSION
 ↓BP
 ↓HR
 ↓RR
LIDOCAINE LEVEL CVS
1.8-5.0 ug/ML ANTIDYSRRTHMIC ACTIONS
5.0-10.0 MYOCARDIAL DEPRESSION
10.0PLUS MASSIVE PERIPHERAL
VASODILATION,MYOCARDIAL
DEPRESSION
CARDIAC ARREST
CNS
0.5-4 ANTICONVULSANT ACTION
4.5-7 CNS DEPRESSION,EXCITATION
7.5-10.0 CNS DEPRESSION ,SEIZURE
10.0 PLUS GENERALIZED CNS DEPRESSION
CVS EFFECTS
LA (VASODILATOR)
↓
PERIPHERAL RESISTANCE
↓
↓BP(BP=PR*CO)
FURTHER IN LA CONC.
AFFECT N. CONDUCTION OF HEART
↓
MYOCARDIAL CONTRACTILITY
↓
C.O.(CO=HR*SV)
HEART’S NEURONAL CONDUCTION SYS. IS INHIBITED OR COMPLETELY
BLOCKED BY LA.
AT TOXIC LEVELS,DEPRESSION OF INTRACARDIAC N. CONDUCTION CAN
RESULT IN ATRIOVENTRCULAR DISSOCIATION,VENTRICULAR RHYTHM
,VENTRICULAR FIBRILLATION AND ULTIMATELY CARDIAC ARREST.

15. CNS EFFECTS
THE CONDUCTION OF INHIBITORY NEURONS ID USUALLY BLOCKED BY LA
AGENTS AS THEY REACH TOXIC LEVELS-RESULTING IN UNMODIFIED
ACTION OF FACILITATORY NEURONS(IE,CONVULSIVE-LIKE MOVT.)AS THE
DOSE INCREASES,FACILITATORY NEURONS ARE ALSO BLOCKED
RESULTING IN CESSATION OF FUNCTION.
CERTAIN AMIDE TYPE AGENTS(IE LIDOCAINE)-EFFECT PRIMARILY
FACILATORY NEURONS,HENCE DEPRESSION IS SEEN RATHER THAN
EXCITATION.
MANAGEMENT
1)MILD OVERDOSE
RETENTION OF CONCIOUSNESS,TALKATIVENESS,AGITATION,
↑HR,↑BP. ↑RR(5-10 MIN)→←
P→A→B→C→D
DEFINITIVE CARE
i)REASSURE THE PATIENT
ii)ADMINISTER OXYGEN VIA NASAL CANULA TO PREVENT ACIDOSIS
iii)MONITOR AND RECORD VITAL SIGNS
iv)ESTABLISH i.v. INFUSION
v)USE OF ANTICONVULSANTS –NOT USUALLY INDICATED
DIAZEPAM-5mg.MIN i.v.
MIDAZOLAM-1mg/MIN
2)SEVERE OVERDOSE
UNCONSCIOUSNESS WITH OR W/O CONVULSIONS
RAPID ONSET(WITHIN 1 MINUTE)
i)PROTECT PATIENTS ARMS,LEGS AND HEAD
LOOSEN TIGHT CLOTHES
ii)IMMEDIATELY SUMMON EMERGENCY MEDICAL ASSISTENCE.
iii)CONTINUE BLS
iv)ADMINISTER ANTICONVULSANT
DIAZEPAM –i.v -5mg/min
IF VENEPUNCTURE NOT FEASIBLE
MIDAZOLAM-im -1mg
IF HYPOTENSION PERSISTS(30 MINS)-VASOPRESSOR
(PHENYNEPHRINE OR METHAOXAMINE)IM

16. EPINEPHRINE OVERDOSE
CLINICAL MANIFESTATIONS
SIGNS-↑BP. ↑HR,CARDIAC DYSRTHYMIAS
SYMPTOMS-FEAR,ANXIETY,THROBBING
HEADACHE,PERSPIRATION,WEAKNESS,PALLOR,RESP.
DIFFICULTY,PALPITATION
EPINEPHRINE mg/ml Mg/CARTRIDGE MAX NO. OF
CARTRIDGES
1:50,000 0.02 0.036 5(H),1(C)
1:100,000 0.01 0.018 10(H),2©
1:200,000 0.005 0.009 20(H),4©
MANAGEMENT
P→A→B→C→D
P-SEMISITIING OR ERECT POSITION( ↓CEREBRAL BP)
i)REAASURE THE PATIENT
ii)MONITOR VITAL SIGNS
iii)OXYGEN ADMINISTERE IF NECESSARY( C/I IN HYPERVENTILATION)
iv)RECOVERY

17. ALLERGY
ALLERGY IS A HYPERSINSITIVE STATE,ACQUIRED THROUGH EXPOSURE
TO A PARTICULAR ALLERGEN,REEXPOSURE TO WHICH PRODUCE
HEIGHTENED CAPACITY OT REACTION.
PREDISPOSING FACTORS
 METHLYPARABEN
 SODIUM BISULPHITE ALLERGY
 EPINEHRINE
 LATEX ALLERGY
 TOPICAL ANESTHETIC ALLERGY
PREVENTION-PROPER HISTORY
ALLERGY TESTING
0.1ML OF EACH(INTRAVENOUS)
 0.9%NACL
 1% OR 2% LIODCAINE,
 3%MEPIVACAINE
 4%PRILOCAINE(W/O METHYL
PARABEN,BISULPHITE,VASOPRESSORS.
INTRAORAL CHALLENGE TEST
0.9 ML OF LA SOLN. SUPRAPERIOSTEAL INFILTRATION ATRAUMATIC(BUT
W/O TOPICAL LA)ABOVE A MAXILLARY RIGHT OR LEFT PREMOLAR OR
ANT. TOOTH.
DENTAL MANAGEMENT IN CASE OF PRESENCE OF LA ALLERGY:
 NO T/T OF AN INVASIVE NATURE CARRIED OUT
 IF EMERGENCY –THEN UNDER GENERAL ANESTHESIA
 IF GA NOT AVAILABLE –HISTAMINE BLOCKER
DIPPHENHYDRAMINE HCL IN 1 % SOLN. WITH 1:100,000
EPINEPHRINE(30 MIN OF PULPAL ANESTHESIA)
 NITORUS OXIDE
 ALTERNATIVES-ELECRONIC DENTAL ANESTHESIA

18. CLINICAL MANIFESTATIONS OF ALLERGY
DERMATOLOGICAL REACTIONS-
URTICARIA-WHEAL
ANGIOEDEMA-LOCALISED SWELLING INVOLVING
FACE,HANDS,FEET,GENITILIA,LIPS,TONGUE.
RESPIRATORY REACTIONS-
BRONNCHOSPASM
RESP. DISTRESS
DYSPNOEA,WHEEZING,FLUSHING,CYANOSIS,PERSPIRATION,TACHYCARDI
A,INCREASED ANXIETY,LARYNGEAL EDEMA
GENERALISED ANAPHYLAXIS
SKIN REACTION-
PRURITIS,ERYTHEMA,URTICARIA,CONJUCTIVITIS,RHINITIS
GIT DISTURBANCE
RESP STMPTOMS-WHEEZING,DYSPNOEA
CVS-PALLOR,TACHYCARDIA,HYPOTENSION,CARDIAC
DYSARRTHYMIA,UNCONCIOUSNESS,CARDIAC ARREST
MANAGEMENT
P→A→B→C→D
i)ADMINISTER EPINEPHRINE 0.3mg IM/SC OR
HISTAMINE BLOCKER-50mg DIPHENHYDRAMINE OR
10 mg CHLORPHENIRAMINE
ii)MEDICAL CONSULTATION FROM PHYSICIAN
iii)OBSERVE THE PATIENT (60MIN)
iv)PRESCRIBE ORAL HISTAMINE BLOCKER
50 mg CAP-TDS FOR 3-4 DAYS
BRONCHSPASM
P→A→B→C→D
i)TERMINATE T/T
ii)ADMINISTER OXYGEN (5-6 L/MIN)
iii)ADMINISTER EPINEPHRINE 0.3 mg IM/SC
iv)ADMINISTER HISTAMINE BLOCKER TO MINIMIZE RELAPSE
HISTAMINE BLOCKER-50mg DIPHENHYDRAMINE OR
10 mg CHLORPHENIRAMINE

19. v)MEDICAL CONSULTATION
LARYNGEAL ODEMA
P→A→B→C→D
i)ADMINISTER EPINEPHRINE 0.3 mg IM/SC
ii)EMERGENCY MEDICAL SERVICE
iii)MAINTAIN AIRWAY
iv)ADDITIONAL DRUGS
HISTAMINE BLOCKER
-50mg DIPHENHYDRAMINE OR
10 mg CHLORPHENIRAMINE
CORTICOSTEROID-
100mg HYDROCORTICOSONE IM/IV
GENERALIZED ANAPHYLAXIS
P→A→B→C→D
i) EMERGENCY MEDICAL SERVICE
ii) EPINEPHRINE (0.3ML OF 1:1000) IM/IV
iii) OXYGEN AND VITAL SIGNS
iv) IF DOES NOT IMPROVE SECOND DOSE OF EPINEPHRINE IN 10 MIN
v) ADDITIONAL DRUGS
HISTAMINE BLOCKER
-50mg DIPHENHYDRAMINE OR
10 mg CHLORPHENIRAMINE
CORTICOSTEROID-
100mg HYDROCORTICOSONE IM/IV
vi)CPR
THANK YOU
