Pain Management U1M4
ASA Classifications - ANS
Types Contraindications to Local Anesthetic - ANS - Absolute Contraindication: may NOT
administer / NOT safe
- Relative Contraindication: administer with caution
Absolute Contraindications - ANS - Heart attack within 6 months (uncontrolled
angina/arrhythmias)
-Stroke (CVA, TIA, RIND) within 6 months
-sulfite allergy
-uncontrolled hyperthyroidism
-cocaine or meth use within 24 hours
Relative Contraindications - Medical - ANS -Atypical plasma cholinesterase (*avoid articaine*)
-Significant liver or kidney disease (*articaine only*)
-Diabetes
-HBP & CV disease
-Sickle cell anemia
-Methemoglobinemia
- Pregnancy
- Allergies to LA
Relative Contraindications - Drugs - ANS -Nonselective Beta-Blockers - vasoconstrictors
-Phenothiazines - vasoconstrictors
-Tricyclic antidepressants - vasoconstrictors
-Anticonvulsants - LA
-Antipsychotics - LA
-Anxiolytics - LA
CV Disease & Hypertension - ANS -undiagnosed/not under care = elective dental treatment is
deferred
- MI = no tx within 6 months after
- NO dental care for 6 months with any strokes
LA Hypertension Guidelines - ANS 180+/120+ = defer treatment & immediate medical referral
Hyperthyroidism - ANS -absolute
-epinephrine increases risk of crisis in poorly controlled pts
-may have hyper-response to "usual" dose of epi
, Hypothyroidism - ANS -relative
-dosage kept to minimum
-use caution
Sickle Cell Anemia - ANS -relative
-consult on cardiac condition
-use plain LA when possible
Pregnancy - ANS -relative
-ASA II
-small doses of LA with or without vaso
-when in doubt = consult OB
Malignant Hyperthermia - ANS -relative
-physician consult recommended
-okay to use all LA
Allergies to Sulfate - ANS -absolute
-all vaso contain bisulfite
-more common allergy in asthma patients
Beta-Blockers - ANS NO vasoconstrictors or limit to cardiac dose
-risk for hypertensive episode
Medication Cautions - ANS -Anticonvulsants - (Klonopin, Dilantin, Topamax) - avoid higher
doses of LA drugs
-Antipsychotics (Zyprexa, Risperdal) - avoid higher doses of LA drugs
-Anxiolytics (Valium) - limit doses
-Phenothiazines (Thorazine, Mellaril) - use cardiac dose of vasoconstrictor
-Tricyclic antidepressants (Elavil, Tofranil) - avoid levonordefrin, use epi with caution - low dose
as possible
-Digitalis glycosides (Digoxin, Digitoxin) - physician consult before vasoconstrictor use or use
plain
Hematoma - ANS - blood leaking into tissues from inadvertent nicking of vessel
-most frequent PSA injection then IA
-Prevent: minimizing penetrations, avoiding trauma, review MH for anticoagulants
-apply ice intermittently for next 6 hours, AVOID anticoagulants
Trismus - ANS -motor disturbance of trigeminal nerve (CN V)
-hemorrhage & muscle trauma
-Prevent: minimize penetrations, change needles and avoid contamination
ASA Classifications - ANS
Types Contraindications to Local Anesthetic - ANS - Absolute Contraindication: may NOT
administer / NOT safe
- Relative Contraindication: administer with caution
Absolute Contraindications - ANS - Heart attack within 6 months (uncontrolled
angina/arrhythmias)
-Stroke (CVA, TIA, RIND) within 6 months
-sulfite allergy
-uncontrolled hyperthyroidism
-cocaine or meth use within 24 hours
Relative Contraindications - Medical - ANS -Atypical plasma cholinesterase (*avoid articaine*)
-Significant liver or kidney disease (*articaine only*)
-Diabetes
-HBP & CV disease
-Sickle cell anemia
-Methemoglobinemia
- Pregnancy
- Allergies to LA
Relative Contraindications - Drugs - ANS -Nonselective Beta-Blockers - vasoconstrictors
-Phenothiazines - vasoconstrictors
-Tricyclic antidepressants - vasoconstrictors
-Anticonvulsants - LA
-Antipsychotics - LA
-Anxiolytics - LA
CV Disease & Hypertension - ANS -undiagnosed/not under care = elective dental treatment is
deferred
- MI = no tx within 6 months after
- NO dental care for 6 months with any strokes
LA Hypertension Guidelines - ANS 180+/120+ = defer treatment & immediate medical referral
Hyperthyroidism - ANS -absolute
-epinephrine increases risk of crisis in poorly controlled pts
-may have hyper-response to "usual" dose of epi
, Hypothyroidism - ANS -relative
-dosage kept to minimum
-use caution
Sickle Cell Anemia - ANS -relative
-consult on cardiac condition
-use plain LA when possible
Pregnancy - ANS -relative
-ASA II
-small doses of LA with or without vaso
-when in doubt = consult OB
Malignant Hyperthermia - ANS -relative
-physician consult recommended
-okay to use all LA
Allergies to Sulfate - ANS -absolute
-all vaso contain bisulfite
-more common allergy in asthma patients
Beta-Blockers - ANS NO vasoconstrictors or limit to cardiac dose
-risk for hypertensive episode
Medication Cautions - ANS -Anticonvulsants - (Klonopin, Dilantin, Topamax) - avoid higher
doses of LA drugs
-Antipsychotics (Zyprexa, Risperdal) - avoid higher doses of LA drugs
-Anxiolytics (Valium) - limit doses
-Phenothiazines (Thorazine, Mellaril) - use cardiac dose of vasoconstrictor
-Tricyclic antidepressants (Elavil, Tofranil) - avoid levonordefrin, use epi with caution - low dose
as possible
-Digitalis glycosides (Digoxin, Digitoxin) - physician consult before vasoconstrictor use or use
plain
Hematoma - ANS - blood leaking into tissues from inadvertent nicking of vessel
-most frequent PSA injection then IA
-Prevent: minimizing penetrations, avoiding trauma, review MH for anticoagulants
-apply ice intermittently for next 6 hours, AVOID anticoagulants
Trismus - ANS -motor disturbance of trigeminal nerve (CN V)
-hemorrhage & muscle trauma
-Prevent: minimize penetrations, change needles and avoid contamination
