4.12.07

CTBMF - Anestesia local


Anestesia Local em Odontologia

Definição
Perda de sensibilidade causada por uma depressão da excitação nas terminações nervosas ou uma inibição do processo de condução nos nervos periféricos numa área circunscrita do corpo. Na anestesia local ocorre perda de sensibilidade sem indução da perda de consciência.

Métodos de induzir anestesia local
- Trauma mecânico
- Baixa temperatura
- Anóxia
- Irritantes químicos
- Agentes neurolíticos como o álcool e fenol
- Agentes químicos como os anestésicos locais

Dor: experiência emocional desagradável geralmente iniciada por um estímulo nocivo e transmitida por uma trama neural especializada para o S.N.C., onde é interpretada como tal.

Condução nervosa - Potencial elétrico - Membrana da célula nervosa
Estado de repouso:
K+ Aniontes (-) interna
Na+, Cl- Cationtes (+) externa
Potencial de repouso = -70 à -90 mv.

Despolarização (inversão de polarização)
A qualquer momento apenas uma pequena porção da fibra nervosa encontra-se despolarizada

Repolarização
Retorno ao estado de repouso em 3 a 4 mseg

Estímulo fraco >Afeta apenas algumas fibras nervosas>Estímulo + nocivo, + potente> Afeta um maior número de fibras nervosas

Receptores da dor:
São terminações nervosas sensitivas que mediam a dor, são quimioreceptores e mecanoreceptores.
Existem substâncias que produzem dor após injeção (algésicas), acetilcolina, histamina, bradicinina.

Natureza dualística da dor
Percepção da dor:
Processo fisioanatômico através do qual é gerado um impulso, após aplicação de um estímulo adequado que é transmitido ao S.N.C.
Reação à dor:
Processo psicofisiológico que representa uma manifestação evidente da pessoa do processo perceptível indesejável que acabou de ocorrer. Determina como a pessoa reagirá à experiência desagradável da dor.
Limiar de reação à dor:
É inversamente proporcional à reação à dor, ou seja, paciente com baixo limiar de reação à dor apresenta uma reação exacerbada ao estímulo nocivo.

Fatores relacionados a reação à dor (Responsáveis pelas variações do limiar de reação à dor)
- Estados emocionais
- Fadiga
- Idade
- Caráter racial e de nacionalidade
- Sexo
- Temor e apreensão (Captar a confiança do paciente)

Métodos de Controle da Dor
- Remoção da causa
- Bloqueio das vias de condução dos impulsos dolorosos
- Elevação do limiar da dor. (Reação à dor reduzido)
- Impedimento da Reação à dor por meio de depressão cortical (Anestesia geral)
- Métodos psicossomáticos (honestidade, sinceridade). O sistema nervoso não aprecia surpresas.

Dor Psicogênica
Sensação desagradável sem fundamento orgânico.

Anestésicos locais
São substâncias que em contato com a fibra nervosa possuem a propriedade de inibir todas as modalidades de influxo nervoso de maneira reversível.
As alterações estruturais nos anestésicos locais alteram a toxicidade, potência, capacidade de difusão e profundidade do anestésico, bem como a duração da ação.
Todos os anestésicos locais apresentam algum grau de vasoatividade, a maioria deles dilatando o leito vascular
A cocaína é o único anestésico local que produz vasoconstrição

Qualidades de um anestésico local ideal
- Não ser irritante para os tecidos ao qual é aplicado
- Não deve causar qualquer alteração permanente da estrutura nervosa
- Sua toxicidade sistêmica deve ser baixa
- Deve ser eficaz, independentemente de ser infiltrado no tecido ou aplicado localmente às mucosas
- O tempo de início da anestesia deve ser o mais breve possível
- A duração de ação deve ser longa o suficiente para permitir que se complete o procedimento, embora não tão longa que exija uma recuperação prolongada
- Deve ter potência suficiente para induzir anestesia completa sem o uso de soluções em concentrações prejudiciais
- Deve ser relativamente isento de produzir reações alérgicas
- Deve ser estável em solução e prontamente passar por biotransformação no corpo
- Deve ser estéril ou capaz de ser esterilizado pelo calor sem deterioração


Anestésico local : Anfipáticos 3 porções
- Porção hidrofílica - permite sua injeção nos tecidos
- Porção lipofílica - responsável pela difusão do anestésico através da bainha nervosa
- Cadeia intermediária – que une as 2 porções e de acordo com a estrutura química permite classificar os A.L. em ésteres e amida

Como funcionam os A.L.(teoria do receptor específico)
- Deslocamento dos íons cálcio do sítio receptor dos canais de sódio o que permite
- Ligação da molécula de A.L. a este sítio receptor o que então produz
- Bloqueio do canal de sódio e uma
- Diminuição de condutância de sódio que leva a
- Depressão da taxa de despolarização elétrica e a uma
- Falha em obter o nível do potencial de limiar, juntamente com uma
- Falta de desenvolvimento dos potenciais de ação o que é chamado

Bloqueio de condução
O bloqueio adequado do nervo é mais difícil de obter-se em tecidos inflamados ou infectados devido ao número relativamente pequeno de moléculas capazes de atravessar a bainha nervosa(RN) e ao aumento da absorção das moléculas restantes de anestésico nos vasos dilatados desta região

Anestésicos locais
*Grupo Éster:
R2
R - - COOR1 - N
R3
*Grupo Amida:

R - - NHCO - R2 N

Anestésicos locais são bases fracas
*grupo éster:
- Procaína (Novocaína)
- Tetracaína (Pantocaína)
- Propoxicaína (Ravocaína)
- Benzocaína (Somente tópico)
- Cloroprocaína

*grupo amida
- Bupivacaína (Marcaína, Sensorcaína)
- Etiodocaína (Duranest)
- Lidocaína (Xilocaína)
- Mepivacaína (Carbocaína)
- Prilocaína (Citanest)
- Articaína e Ropivacaína

A lidocaína é o anestésico mais utilizado, na concentração de 2% , é plenamente eficaz não se justifica o emprego de solução mais concentrada (3%) que só aumenta o risco de toxicidade.
Vasoconstritores:
São drogas que contraem os vasos sangüineos e portanto controlam a perfusão tecidual. São adicionados às soluções anestésicas locais para equilibrar as ações vasodilatadoras dos A.Ls.

Importância dos vasoconstritores
- Através da constrição dos vasos sangüineos, os vasoconstritores diminuem o fluxo sangüineo(perfusão) para o local de administração
- A absorção do A.L. para o sistema cárdio-vascular torna-se mais lenta, resultando em níveis sangüineos menores do anestésico
- Os níveis sangüineos do A.L. são reduzidos, minimizando assim, o risco de toxicidade anestésica local
- Maiores quantidades de A.L. permanecem no nervo e ao seu redor por períodos mais longos,aumentando assim a duração de ação da maioria dos A.Ls.
- Diminuem o sangramento no local

Aminas Simpaticomiméticas
- Epinefrina
- Norepinefrina
- Fenilefrina(ñ catec.)
- Levonordefrina(corbadrina)

Análogo sintético da vasopressina
- Felipressina (Estimula diretamente o músculo liso da parede dos vasos sangüineos)
-Epinefrina
É o vasocostritor mais utilizado nos E.U.A., associado a vários sais anestésicos.No Brasil a associação de adrenalina à lidocaína somente começou em1997,nas concentrações de 1:50000 e 1:100000
Atua nos receptores α e β adrenérgicos sendo que os efeitos β predominam
Norepinefrina
Não apresenta vantagens sobre a adrenalina,a maioria dos relatos de reações adversas ao uso de vasoconstritor, parece ter ocorrido com este. Apresenta maior toxicidade , ¼ da potência da adrenalina 90% de ação nos receptores α , ocorrência de cefaléia necrose e descamação tecidual , efeitos colaterais 9x maiores que a adrenalina (a levonordefrina é semelhante)
Fenilefrina
Exerce pequena ou nenhuma ação nos receptores β apresenta 5% da potência vasoconstritora da adrenalina
Felipressina
Atua sobre os receptores V1 da vasopressina presente na parede dos vasos sangüineos, mínimo valor no controle da hemostasia, não agem em receptores α e β com menores efeitos no sistema cárdio vascular

Biotransformação(Metabolismo) dos anestésicos locais
- Método pelo qual o organismo transforma biologicamente a droga ativa em uma farmacologicamente inativa
- O metabolismo é importante , pois a toxicidade da droga depende do equilíbrio entre a velocidade de absorção para a corrente sangüinea no local da injeção e a velocidade em que ela é removida do sangue
- Os anestésicos locais do tipo éster são hidrolizados no plasma pela enzima pseudocolinesterase – a velocidade de hidrólise dos diferentes ésteres varia consideravelmente
- As reacões alérgicas que ocorrem em resposta aos A.Ls. do tipo éster, são relacionadas com o PABA que é o produto metabólico principal destes anestésicos
- O local primário de biotransf. das drogas do tipo amida é o fígado ( lidocaína, mepivacaína, articaína, etidocaína, bupivacaína). A prilocaína sofre metabolismo primário no fígado e possivelmente a seguir no pulmão
- A articaína apresenta uma meia vida mais curta do que as outras amidas porque uma parte de sua biotransformação ocorre no sangue
- Os produtos da biotransformação de alguns anestésicos podem apresentar atividade clínica significativa se for permitido seu acúmulo no sangue Ex: metemoglobinemia em pacientes que recebem grandes doses de prilocaína, a ortotoluidina um metabólito primário induz a metemoglobinemia

Ação do A.L. no S.N.C.
- Atravessam facilmente a barreira hemato-encefálica , sua ação farmacológica no S.N.C. é a depressão, em níveis sangüineos baixos não ocorrem efeitos clinicamente significativos.
- Em níveis mais altos a manifestação clínica primária é a convulsão tônico-clônica generalizada
- Em níveis sangüineos maiores que o nível terapêutico promovem redução da contratibilidade do miocárdio e diminuição do débito cardíaco ambos levando a um colapso circulatório

Pacientes que requerem cuidados especiais
O C.D. deverá sempre ter um ótimo conhecimento da farmacologia dos A.Ls. e vasoconstritores que emprega na prática cotidiana pois a responsabilidade pelo ato é de quem procede e não de quem recomenda

O uso de vasoconstritores deve ser evitado nas seguintes condições
- Hipertensão severa não tratada ou não controlada (P.S. >200mmHg P.D. >115mmHg
- Doença cardiovascular grave.
Menos de 6 meses após o infarto do miocárdio
Menos de 6 meses após A.V. C.
Cirurgia recente de ponte de artéria coronária
Angina de peito instável
Arritmias cardíacas refratárias, apesar do tratamento adequado e insuficiência cardíaca congestiva não tratada ou não controlada
Diabetes mellitus não controlado
Hipertireoidismo
Feocromocitoma
Sensibilidade aos sulfitos
Usuários de cocaína ou crack

Paciente Idoso
Paciente com atividade hepática ou filtração glomerular reduzida a dose máxima de lidocaína = 3 tubetes
Adrenalina = Taquicardia

Noradrenalina
Fenilefrina Bradicardia = parada cardíaca
Obs. Em idosos com insuf.card. ou arritmia optar por soluções que contenham adrenalina

3 Regras Básicas
- Conhecimento sobre estado de saúde do paciente
- Seleção correta da anestesia
- Domínio da técnica anestésica escolhida

Crianças
- As maiores complicações com anest. locais estão ligadas as crianças
- Crianças de 3,5 anos aprox. 1,5l de sangue adulto = 6 litros
- Não realizar bloqueio pela possibilidade de acontecer injeção intramuscular
Opções anest. para criança
- 1a - lidocaína 2% c/ adrenalina 1:100.000
- 2a - mepivacaína 2% c/adrenalina 1:100.000
- 3a - prilocaína 3% c/ felipressina
Obs. A prilocaína a 3% deve ser evitada em crianças portadoras de anemia pelo risco de metemoglobinemia

Gestantes
Os fatores que determinam a quantidade e a velocidade de transferência placentária são:
- Tamanho da molécula
- Grau de ligação do a.l. às proteínas plasmáticas na circulação materna
Obs. 1a escolha lidocaína c/ adrenalina 1 :100.000

Diabéticos
- Adrenalina em grandes doses provoca glicogenólise hepática
- Em condições estáveis todos os vasocostritores podem ser empregados
- Ideal prilocaína com felipressina

Equipamento (manuseio)
- Agulhas
- Cartuchos
- Seringas
- Material Auxiliar

Agulhas (5 partes)
- Bisel (curto de preferência)
- Haste
- Canhão
- Adaptador da seringa
- Extremidade do cartucho
Calibre 20 = 0,81 mm de diâmetro ...
Calibre 25 = 0,45 mm de diâmetro ...
Comprimento (vantagens do compr. ideal)


Cartuchos (1,8 ml) Composição
- Sal Anestésico
- Vasoconstritor
- Bissulfito de Sódio - preserv. do vasoconstr.
- Cloreto de Sódio - p/ tornar sol. isotônica
- Agua Destilada
- Metil Parabeno (germicida / preservativo) retirado.
obs: validade 18 à 12 meses
lavar diafr. borracha c/ álcool etílico 70 %

Anestesia Cirúrgica
Local
Geral
Na anestesia cirúrgica geral o paciente perde completamente a consciência, ocorrendo também, completo relaxamento muscular
Na Anestesia cirúrgica local ocorre a perda da sensação e do sentido em apenas uma área do corpo, na seguinte ordem: dor, temperatura, tato, propriocepção e tonus muscular esquelético

Anestesia local
Terminal



Bloqueio
Superficial

Infiltrativa



Regional

Troncular
Anestesias terminais são aquelas em que o agente anestésico atua nas terminações nervosas, sejam elas superficiais ou profundas
Nas Anestesias Terminais Superficiais a ação do agente anestésico dar-se-á através do contato superficial com a pele ou a mucosa

Anestesia Terminal Superficial
- compressão
- refrigeração
- pulverização
- fricção
Anestesias Terminais Infiltrativas à ação do agente anestésico dar-se-á pela sua infiltração nos tecidos através de injeções


Anestesias Terminais Infiltrativas
- supraperiostal }paraperiostal
- subperiostal }
- submucosa
- intraseptal
- intra-óssea
- peridental
- intrapulpar
- circular
Anestesias por bloqueios são aquelas em que o agente anestésico age sobre um ramo ou um tronco nervoso bloqueando os estímulos nervosos de determinada área
Anestesia por bloqueio regional, quando um ramo nervoso é insensibilizado, promovendo anestesia da região por ele inervada
Anestesia por bloqueio troncular é aquela em que o agente anestésico é depositado ao nível do tronco nervoso, insensibilizando várias áreas por ele inervado

Anestesia por bloqueio regional dos nervos mentoniano e incisivo

Nervo mentoniano – 3 ramos
• Para pele e mento
• Pele , mucosa labial e mucosa da região anterior da mandíbula.

Nervo incisivo
• Pré-molares
• Dentes anteriores inferiores
• Alvéolos correspondentes

Segundo COOK
• Em 91% dos crânios examinados o forame mentoniano localiza-se entre 13 à 15mm da base da mandíbula.
• Eqüidistante entre bordo inf. e a crista do processo alveolar.
• Localiza-se mais comumente abaixo do ápice do 2ºpré molar ou entre os ápices dos prés molares.
Indicações
• Intervenções cirúrgicas nos tecidos moles inervados pelo nervo mentoniano.
• Intervenções nos dentes anteriores inf. e primeiros pré-molares.
• Quando esta contra-indicada na. term.inf. ou quando se intervirá em 2 ou mais dentes inervados pelo nervo incisivo.

Anestesia por Bloqueio Regional dos nervos alveolar inferior lingual e bucal
No nervo trigêmio dos três ramos terminais provenientes do gânglio de Gasser, o terceiro ou ramo mandibular constitui o mais volumoso e externo dos três

Nervo mandibular
- Emerge do crânio através do forame oval em direção vertical para baixo e para fora, atravessando a região zigomática, na qual verifica-se sua divisão terminal.Têm interesse em anestesia odontológica os ramos
-Bucal
-Lingual
-Alveolar inferior
Nervo Bucal
- Emite filetes cutâneos ou externos para pele da bochecha, comissura labial e parte externa dos lábios. O ramo mucoso ou interno perfura o músculo bucinador ao nível da borda alveolar inferior inervando a mucosa vestibular compreendendo a região dos molares.

Nervo lingual
- Terminal do nervo mandibular , inerva 2/3 anteriores da língua , emite no seu trajeto ramos para face interna da gengiva inferior e região sublingual.
Nervo alveolar inferior
- Inerva molares e pré-molares inferiores e seus alvéolos correspondentes

Indicações deste bloqueio
- Intervenções nos dentes inferiores
- No tecido ósseo e mucoso da mandíbula
- No lábio inferior

Técnicas
- Indireta ou das três posições
- Direta
- Da boca fechada (Vazirani-Akinosi)

Técnica indireta (Braun)
- Várias posições impostas a seringa para se alcançar os nervos alveolar inferior lingual e bucal

Técnica direta
- Inserção da agulha na depressão formada entre a prega do ligamento ptérigo mandibular por dentro e a linha oblíqüa externa por fora. Necessita de complementação anestésica no nervo bucal ( vértice do triângulo retromolar ou nas faces bucal e distal ao último molar)
- Pode-se considerar o ponto de introdução da agulha a ¾ da distância ântero-posterior da incisura coronóide até a parte mais profunda da rafe pterigomandibular.

Técnica da boca fechada
- Seringa na altura das papilas gengivais dos dentes superiores
- Deve-se injetar a solução de A.L. à 1mm do nervo alvo
- Aguardar 3 à 5 minutos antes de iniciar o procedimento

Anestesia por Bloqueio Regional do Nervo Alveolar Superior Posterior
Inervam
- 3º e 2º Molar superior
- Raízes lingual e disto vestibular do 1º molar superior
- Filetes para mucosa vestibular, periósteo e alvéolos correspondentes
- 1º Molar sup. raiz mésio vest. 72% dos casos

Indicações
- Intervenções no 2ºe 3º molar superior ou quando processo patológico contra – indique anestesia terminal infiltrativa

- Agulha curta para todos os pacientes exceto os maiores

Pontos de Reparo
- Apófise zigomática do maxilar
- Plano oclusal dos molares superiores
- Plano sagital mediano do paciente
- Raiz disto - vestibular do 2º molar superior
- Àrea de introdução na altura da prega mucovestibular acima do 2º molar sup.

Erros de inserção
- Músculo pterigoideu lateral
- Plexo venoso pterigoídeo

Anestesia por Bloqueio Regional dos Nervo Nasopalatino
Insensibiliza-se a mucosa que atapeta a zona palatina dos incisivos e caninos superiores
O forame incisivo dista 4 à 10mm do rebordo alveolar, sua forma é triangular ou ovalada e encontra-se coberto pela papila incisiva

Técnica- Pontos de reparo
- Incisivos centrais superiores
- Papila palatina incisiva

Indicações
- Intervenções na fibromucosa palatina no seu terço anterior
- Anestesia de complementação quando se intervêm em dentes anteriores superiores

Anestesia por Bloqueio Regional do nervo Palatino Maior
Indicações
- Intervenções na fibromucosa palatina na região de molares e pré molares
- Anestesia de complementação para outros tipos de cirurgia

Técnica – Pontos de Reparo
- Limite palato duro x Palato mole
- Rafe mediana
- Terceiros molares superiores

Anestesia por Bloqueio Regional para os Maxilares
O nervo Maxilar emerge do endocrânio pelo forame redondo e atravessa a fossa ptérigo-palatina
- Colaterais de interesse
- Nervos esfeno-palatinos e alveolares superiores

Terminais
Palpebral, nasal e labial

Anestesia por Bloqueio Regional dos Nervos Alveolar Superior Anterior e Médio
Inervam
- Alveolar Superior anterior – Incisivos e Caninos
- Alveolar Sup. Médio – Pré-molares e raiz mésio vestibular do 1ºmolar superior
Inervam ainda mucosa labial, periósteo e alvéolos correspondentes
Para esta anestesia deve-se penetrar com a agulha através do forame infra - orbital
Indicações
- Intervenções nos incisivos, caninos e pré-molares numa única etapa.
- Quando processo infeccioso contra-indique anestesia terminal infiltrativa
- Para intervenções nos tecidos moles da hemiface superior , através de anestesia do nervo infra-orbital

Pontos de Reparo
- Borda infra-orbital
- Forame infra-orbital
- Centro pupilar
- 2º Pré-molar
- Àpice da raiz do canino superior
- Ângulo mesial do incisivo central superior
- Canto interno do olho
- Fundo do vestíbulo

Técnicas
- Técnica da linha centro pupilar/eixo do 2ºpré-molar
- Técnica das linhas canto interno do olho / fundo do sulco vestibular
- Técnica da linha incisivo / ápice do canino

Erros de inserção
- Cuidados com os músculos da região : Músculo canino e Quadrado do lábio superior

Sinais e Sintomas
- Parestesia da asa do nariz, lábio superior e pálpebra inferior
- Insensibilização dos dentes superiores
- Pode ocorrer queda do lábio superior (não sendo este sinal de insensibilização dos nervos alveolares sup. ant. e médio)

Acidentes e Complicações da Anestesia local em Odontologia
Acidentes e complicações com origem nas drogas ou substâncias químicas utilizadas
1. Emprego de soluções contaminadas
- Tempo de validade
- Tubetes mal vedados

2. Idiossincrasia

Susceptibilidade individual onde pequena dose de uma droga pode causar resposta compatível a superdosagem
No transcurso o paciente poderá ter:

Oxigenoterapia
Massagem cardíaca externaColapso
Depressão respiratória
Parada cardíaca

Convulsões: Proteção da cabeça e língua , internação para sedação e cuidados médicos

3. Reações alérgicas ou Hipersensibilidade
- Reações antígeno-anticorpo, reações tipo urticária, prurido, febre, artralgia e enfartamento ganglionar

Possibilidades
- Reações alérgicas imediatas
- Edema angioneurótico
- Choque anafilático – com edema generalizado, perda do tônus vasomotor, queda do pulso, cianose. Tratamento colocar paciente em decúbito dorsal, oxigenoterapia e corticóide ou anti-histamínico intra-muscular
- Reações alérgicas tardias
- Dermatite alérgica ou de contato

4. Intoxicação - Superdosagem
- Parada respiratória
- Colapso circulatório
Medida – Eliminar corpos estranhos na boca, respiração boca a boca (ocluindo fossas nasais) , massagem cardíaca ( para pacientes com pulso imperceptível)

Acidentes e Complicações Associados as Técnicas Anestésicas
1. Dor - Causas
- Paciente sensível
- Temperatura da solução anestésica
- Anestesia de fibromucosa espessa e aderida – Técnica anestésica sub periostal
Dor pós anestesia – infecção, trauma, inj. de sol. não isotônica, inj. no interior do músculo, etc.,

2.Edema
- Injeção de solução anestésica no interior do músculo
Tratamento – Drogas anti – inflamatórias, compressas quentes e úmidas e antbioticoterapia quando na presença de infecções

Falhas anestésicas
- Erro de técnica
- Alterações anatômicas

4.Fratura de agulhas - Causas
- Agulhas oxidadas
- Agulhas torcidas
- Movimentos bruscos do paciente
- Emprego de agulhas com calibres não apropriados para a técnica

5. Hematoma - Acúmulo de sangue no interior dos tecidos
- Áreas mais comuns
Tuberosidade
Região ptérigo-mandibular
Região infra-orbital e mentoniana

Tratamento
- Calor úmido, luz infravermelha (redução espontânea)
- Aplicação de pomadas anticoagulantes e fibrinolíticas
- No risco de infecção prescreve-se antibióticos
As áreas passam por variações de cor do arroxeado ao violáceo e amarelo

6. Infecção - Causas
- Inserção da agulha em locais inflamados e com supuração
- Falta de assepsia prévia
- Uso de instrumental não esterelizado
- Solução contaminada
- Excesso de anestésico

7. Náuseas e Vômitos
- No bloqueio do palatino maior atinge-se os palatinos menores e consequentemente a úvula, palato mole e amígdalas são anestesiados.

8. Isquemia da pele da face
9.Paralisia
- Atinge-se terminações nervosas motoras
- Agulha longa atinge a parótida ( nervo facial)
- Paciente não consegue sorrir , piscar e mostrar os dentes, deve-se proteger o olho do paciente.

10.Parestesia
- Lesão dos nervos sensitivos , toca-se no nervo
Queixa principal dor repentina tipo agulhada, choque elétrico
Tratamento – infra-vermelho
complexo vit. B
Sinaxial (neuroreabilitador) 10 ou 20mg uma ampola por dia 10 à 20 dias

11.Xerostomia
- Na anestesia do nervo lingual o nervo corda do tímpano poderá ser anestesiado, bloqueando secreções glandulares

12.Transtornos oculares e visuais
- Anestesia-se músculos do olho durante anestesia dos nervos alveolares superiores anterior e médio

Resultados – visão dupla , diplopia e estrabismo
13. Traumas dos lábios e bochechas

14.Trismo – perda da função normal do músculo(anestesia de fibras motoras do masseter e pterigodeu medial )

15.Troca de tubos e soluções

16.Lipotímia = Ocorre devido ao medo, emotividade ou injeção de anestésico num vaso sangüineo
- Manifestações da lipotímia:
Diminuição da circulação cerebral
Vazio gástrico
Náuseas e suores frios
Palidez facial
Obnubilação mental s/ perda da consciência
Escurecimento da visão
Relaxamento muscular
Discreta depressão respiratória
Importante Prevenção

Tratamento
- Posição de Trendelemburg
- Afrouxar as vestes
- Inalar sais de amônia
- Palmadas na face
- Coramina ou Cardiazol

17.Síncope
- Perda da consciência
- Face cadavérica
- Hipotermia
- Pulso quase imperceptível
- Dilatação pupilar
- Ausência de movimentos
- Parada cardíaca
- Parada respiratória

Tratamento
Mesmo da lipotímia, se houver parada cardíaca e respiratória, haverá necessidade do emprego de métodos de ressuscitação com massagem cardíaca externa e respiração boca à boca

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Blogger monicaematheusmartins said...

Tomei 3 tubetes de anestesia para fazer um curativo no dente e minha bochecha ficou dolorida e inchada por 3 dias e após 5 dias, minha pele está amarelada (aquela cor de final de hematoma...)
A dentista que ia tratar o canal 2 dias depois não quis tratá-lo porque disse que poderia ser uma alergia à anestesia...
...já tomei anestesia várias vezes e nunca aconteceu nada assim, nem quando eu tive que extrair os sisos...
Eu acho que foi a 1ª dentista que aplicou a injeção no lugar errado. O que você acha?

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