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Complications of local anaesthesia in dentistry and their management

Complications of local anaesthesia in dentistry and their management

2023-04-28

Advanced and preventive


Summary: The anesthesia complications of Zhiya removal are consistent with local anesthesia complications in the maxillofacial area. They are also divided into systemic and local anesthesia complications. The dosage and the total amount of vascular contraction agents will increase, so it should be emphasized that the clinical manifestations of various ectopic complications and their corresponding prevention measures should be emphasized. The article will introduce the symptoms of various complications and prevention methods that may occur in the bureau's hemp, so that dental physicians can better prevent the emergence of such complications and master the emergency methods of various complications.


1. syncope


Si is caused by autonomous nerve reflexes, a temporary cerebral ischemia, acute and short -term consciousness loss caused by acute and hypoxia.


1. The reason

Moisturizing is related to mental and psychological factors. For example, patients with tension, fear, pain, pain, hunger, fatigue, and stuffy weather cause reflected external peripheral vascular expansion and cause cerebral ischemia. Bad visual stimulation caused by surgical equipment, bleeding, etc. can also be induced.


2. Symptoms

Dizziness, dazzling, chest tightness, palpitations, weakness, pale complexion, cold sweaty body, if not dealt with in time, there may be symptoms such as short -term consciousness loss, slow pulse weakness, and blood pressure.


3. Prevention and control principles

① Pay attention to explanation and comfort before injection of hemp medicine to guide patients to relax and reduce their tension and concerns. Avoid surgery in an empty stomach; ② Pay attention to the patient's complexion and expression at any time during surgery. Once the symptoms of syncope occur, the injection should be stopped immediately, and the chair position should be placed. At the same time, give words comfort. If you have low blood pressure, you can inject 0.5 mg of atropine and 15 ~ 30 mg of ephedrine. If necessary, give oxygen absorption.


2. Allergic reaction


A allergic reaction means that there are no adverse reactions after receiving the hemp. When using the drug again, there are adverse reactions.


1. The reason


A variety of ingredients in the patent solution, such as local anesthesia, vascular contraction, and preservatives, can cause allergic reactions. The allergic reactions of the anesthetic bureau's hemp medicine are more common, such as Pulukin, propylene, butadaine, and related composite; the allergic reactions caused by anesthetic drugs of the amide bureau are relatively rare.


2. Symptoms

Can be divided into instant reactions and delayed reactions. Immediate reaction means that after a small amount of medication, severe symptoms similar to poisoning are immediately occurred. Sudden symptoms such as obsession, panic, chills, pale complexion, and blood pressure decreased. The delayed response occurs after a few hours. It is often a local or eye, lip, tongue and other parts of the injection. Generally, the swelling does not exceed 24 hours. Occasionally, urticaria, medicine rashes, or allergic purpura.


3. Prevention and control principles

Before anesthesia, inquire about the history of allergies for hemp drugs. Patients with allergic and allergic constitutions for the ester bureau are used, such as amamiac drugs, such as Lidaine, and a skin sensitive test in advance. For mild allergic reactions, dehydration drugs such as calcium, apposcethia, can be used in pine hormone muscle injection or static injection and oxygen absorption; severe allergic reactions should be injected immediately with adrenaline to give oxygen; convulsions or convulsions; When the convulsions, 2.5%sulfur spray sodium in a static removal, 3 ~ 5ml each time until the septic stops; if an allergic shock occurs, it should be rescued in time in accordance with the principle of resistance shock.


3. Poisoning response


The poisoning response refers to the amount of hemp drug that enters the blood circulation during the unit time that exceeds the decomposition speed of the body's hemp, and the concentration of the blood drug increases, and the poisoning symptoms or excessive reactions occur when reached a certain concentration.


1. The reason

The dose of the hemp medicine in the first injection exceeds the prescribed amount; due to the failure of the anesthesia, the total injection of the anesthesia has exceeded the total amount of the anesthesia in the short time; Patients such as weak patients have poor tolerances.


2. Symptoms

The severity of the poisoning reaction depends on the total dose of the anesthesia or the dose and concentration of the drug in the unit time. Clinical manifestations can be divided into excitement and suppression. The excitement manifestation is irritability, eloquent words, tension, breath, sweat, and rising blood pressure. In severe cases, full -body convulsions, hypoxia, and hair are not obvious. The above symptoms are not obvious. Clear, then breathing and heartbeat stopped.


3. Prevention and control principles

Before the medicinal drugs, the toxicity and maximum dosage of the drug should be understood. The oral and maxillofacial vascular vascular is abundant and the drug absorbs quickly. The amount of hemp drug should be reduced or the blood vessel contraction agent is added to the anesthetic drug to delay the absorption of the anesthetic. After persisting in taking back no blood, then slowly injection of the anesthetic. Those with poor tolerances or children should reduce the amount of bureau's hemp medicine as appropriate. Once the symptoms of poisoning occur, the hemp should be stopped immediately. Poisonous symptoms do not need special treatment. Patients are flat, their heads are low, and the respiratory tract is smooth. The anesthetic of the anesthesia is decomposed in the body and the symptoms are relieved by themselves. Essence


Fourth, complications caused by vascular contraction agents


1. The reason

The concentration of vascular contraction containing vascular contraction in the bureau is too high, excessive dosage in injection, or directly injected blood vessels; patients before anesthesia are highly excited or sensitive to vascular contraction agents.


2. Symptoms

After a few minutes of injection of mochi, the complexion appeared pale with palpitations and shortness of breath. Conscious headache, dizziness, elevated blood pressure, and faster pulse.


3. Prevention and control principles

The vascular contraction agent should be added in the regulations, and a large number of applications should not be applied repeatedly. Do not inject blood vessels, heart disease, hypertension, hyperthyroidism and other patients with contraindications against blood vessels. After the symptoms occur, the patient is lying flat, loosen the collar, keep the respiratory tract open, and the symptoms can be relieved by themselves.


5. Temporary facial paralysis


1. The reason

It is more common in the internal anesthesia of the lower alveolar nerve port. Because the injection needle is biased, the lower jaw is increased to the back edge of the mandible, or the section of the anesthesia of the anesthesia in the parotid glands in the mumps is injected into the mandibular section.


2. Symptoms

The main manifestations are paralysis of different degrees of nerve dominance in the same side, such as the corners of the mouth, the drum leakage, and the shallow nose and lip ditch.


3. Prevention and control principles

Master an anatomical structure and injection signs, and be proficient in technical operations.

Facial paralysis has occurred. After the effect of the anesthetic disappears, the nerve function can be restored without special treatment.


6. Temporary tooth closed tightly


1. The reason


Due to the inaccurate injection, when the lower alveolar neural blockage anesthesia, the anesthetic is injected into the internal muscle or the masseter muscle, causing the muscles to lose normal shrinkage and diastolic functional dysfunction.


2. Symptoms

It is manifested as a limited and closed.


3. Prevention and control principles

Except for the tightness of the teeth caused by infection, it is generally temporary, and most of them can be recovered after the anesthetic failure.


Seven, nerve injury


1. The reason

Most of the occurrence of nerve block and anesthesia. The injection needle is exactly dry in the neurophastin in the stab or a torn nerve fiber due to the pins, or injecting a solution mixed with alcohol. Essence


2. Symptoms

After the anechetic effect disappears, the patient still feels abnormal or the regional neuralgia or numb region dominated by the nerve fiber.


3. Principles of prevention and control

Before the operation, you should check the injection needle. The action should be gently and accurate during operation. The method of pumping while pumping is used to avoid the nerves. Most nerve injuries are temporary and reversible. You can recover after a few days of mild symptoms without treatment; severe nerve recovery is slow, and even those who cannot recover at all. Those who have not recovered after surgery should be actively dealt with early, so as to promote neurological recovery. Hormone therapy is given to reduce edema within 72 hours; physiotherapy can be used, oral vitamin B1 or B12 can be used after 72 hours.


Eight, hematoma


1. The reason

After the injection needle pierces the venous plexus or blood vessels, the blood seeps into the tissue gap or the facial soft tissue. It is more common in the anesthesia and anesthesia of the lower orbital nerve block.


2. Symptoms

Bleeding that occurs in the tissue, purple -red bleeding or mass appears under the mucosa or subcutaneous, causing local swelling and patient discomfort. A few days later, the color of the hematoma gradually became yellow -green, and slowly absorbed and disappeared.


3. Prevention and control principles

It is necessary to ensure that the pointed needle is smooth and sharp, and the injection method should be correct. Do not puncture repeatedly to avoid increasing the chance of piercing blood vessels. Immediately after hematoma occurs, hemostasis should be pressed and applied cold compresses; after 48 hours, hot compresses are applied to promote the absorption of hematoma and dissipate, and antibiotics and hemostatic drugs can be given as appropriate.


Nine, infection


1. The reason

The injection needle is contaminated, the disinfection area is not strictly disinfected, or the injection needle through the infection stove can bring the infection into deep tissue.


2. Symptoms

After the infection is brought into a deep tissue, it can cause infections such as temporal nests, mandibular gaps, and pharynx spaces. Generally, local redness, swelling, heat, and pain are obvious within 1 to 5 days after injection, and there are even limited or difficulty in swallowing. A few cases may also cause systemic infections through blood circulation, causing systemic symptoms.


3. Prevention and control principles

Pay attention to sterile operation, strict disinfection of injection equipment and injection area; avoid injection of injection or directly injection in the inflammatory area; infected those who have occurred should be treated in accordance with the principle of inflammatory treatment.


Ten, injection needle break


1. The reason

The quality of the injection needle is poor, rust, and lack of elasticity. Broken is often located at the connection between the needle and the needle. When anesthesia anesthesia, often moved due to deep pins, and suddenly moved after the injection needle was pierced into the tissue, or the operation was improper to break the needle excessively bent and broken; Or patients can break the needle.


2. Prevention principles


Check the quality of the injection needle before injection. Select an appropriate length injection needle. When injection, at least 1cm length should be retained outside the tissue, and the injection needle should not be pierced completely. Pay attention to the operation technology, do not excessively bend the injection needle when changing the injection direction, and should not be vigorously advanced when there is resistance.


11. Pain in the injection area


1. The reason

The most common reason is that the anesthesia fluid is deteriorated, mixed with impurities, or has not been matched. The injection needle is blunt and bent, or there is an inverted tissue or nerve; the sterile operation is not strictly performed, and the infection is brought into the deep tissue.


2. Symptoms

Patients with different degrees of pain in the injection site, such as inflammation, manifested as local redness and dysfunction.


3. Prevention and control principles

Before the injection, you should carefully check the anesthesia and equipment, strict sterile operation during the injection process, and avoid repeated injection of the same part. If inflammation occurs, it is given hot, physiotherapy, closed, or anti -inflammatory and analgesic drugs.


12. Temporary restoration or blindness


1. The reason

When the lower alveolar nerve blocked anesthesia, the injection needle is mistakenly entered into the lower alveolar arteries and has not been pumped. Temporary viewing or blindness.


2. Symptoms

Patients have symptoms such as temporary visual vague or visual shadowing, and blindness.


3. Prevention and control principles

After this complications disappear, eye movement and vision can be restored. Emphasizing the beta of the betting bureau, insist on returning to the bloodless prescription before injection.


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