| Abstract | Nuspojave na lokalne anestetike su rijetka neželjena djelovanja u organizmu. U kliničkoj praksi češće su lokalne komplikacije kao posljedica pogreške u samom postupku injiciranja ili oštećenja anatomskih struktura. Posebnu skupinu nuspojava čine vazovagalne reakcije koje nemaju direktnu vezu s anesteticima, već injiciranjem se uzrokuje jaka emocionalna podraženost, kratkotrajni gubitak svijesti tzv. vazovagalna sinkopa. Stanje se normalizira u ležećem položaju s blago podignutim nogama u položaju autotransfuzije. Sistemski učinci anestetika mogu uzrokovati toksične, alergijske i reakcije na vazokonstriktore. Toksične reakcije imaju glavni uzrok u previsokoj koncentraciji anestetika u krvnoj plazmi. Češće se javljaju pri sistemskim bolestima koje mijenjaju biotransformaciju i mogu povisiti razinu anestetika u krvnom optoku. Najviše utječu na SŽS i kardiovaskularni sustav. Zbog poremećaja funkcije provodnog sustava mogu uzrokovati atrioventrikularni blok, a kod SŽS u fazi stimulacije kloničkotoničke grčeve, a u fazi depresije gubitak svijesti. Alergijske reakcije su rijetke i češće su kod esterskih anestetika. Lakše manifestacije su eritem, urtikarija, bronhospazam. Teži oblik je anafilaktički šok koji vitalno ugrožava bolesnika. Nagla hipotenzija, bronhokonstrikcija i dispneja su osnovni simptomi. Oni zahtijevaju hitan terapijski postupak.Vazokonstriktori imaju strukturu kateholamina pa utječu na KVsustav i uzrokuju tahikardiju i hipertenziju. S jačom intoksikacijom moguća je aritmija, infarkt miokarda i smrt. Prevencija neželjenih reakcija na lokalne anestetike može postići adekvatnom dozom, dobrom tehnikom, aspiracijom te prije operacijskom anamnezom. |
| Abstract (english) | Adverse drug reactions to local anesthetics are rare, undesired effects in organism. Local complications occure more offten in dental treatment in consequence of mistake made in the process of injecting or demaging anatomic structures. Vasovagal
reactions are a separate group of advers reactions that are not directly connected to anesthetics, but to injecting, wich causes strong emotional stimulation. As a consequence the so-called vasovagal syncope occurs, i.e. short loss of conscionsness. The condition is normalized in autotransfusion. Toxicity, allergic reactions, as well as reactions to vasoconstrictors can develop as systemic effects of local anesthetics. The main cause of toxicity is anesthetics overdose in the blood plasma. Patients, who suffer from systemic disorders which alter biotransformation of anesthetics and can elevate their concetration in the blood stream, are more susceptible to toxicity. Overdose affects the central nervous system
(CNS) and cardiovascular system the most. It disrupts the function of the conducting system and it can cause AV-block. In the CNS, in the stimulation phase it gives rise to tonic-clonic convulsions, and in the depression causes loss of consionsness due to hypotension. Although extremely rare, allergic reactions may occure, especially in the case of ester local anesthetic. Mild manifestations are urticaria, erythema and bronchospasm. More severe reaction is anaphylactic shock, life-threatening situation. Hypotension, bronchoconstriction and dyspnea are the main symptoms. Emediate treatment is required. Vasoconstrictors have catecholamine structures which stimulate KV-system, increase heart rate and elevate blood pressure. With sever overdose arrhythmia; myocardial infarction and death are possible. Adverse reactions to local anesthetics can be prevented with adequate dose, orderd technique,aspiration and pri-operational case history. |
