SYNCOPE AND TRISMUS

                                                      SYNCOPE      

 Syncope or fainting is perhaps the most frequent complication associated with local anesthesia in the dental office. It is a form of neurogenic shock. 

When the patient is sitting on dental chair, the brain is placed in superior position and is most susceptible to reduced cerebral blood flow result in cerebral ischemia   and  increase in peripheral vascular bed (pooling of blood in the lower extremities), with a corresponding drop in blood pressure.
loss of consciousness is an extreme manifestation of cerebral ischemia.

TREATMENT;

1)  the time of treat this complication is in its early phases before patient has lost consciousness.

2) Operator should discontinue any procedure in progress

3)  lower the chair back while the patient’s legs are slightly elevated , thus placing the patient in a semireclining position.

4) This position aids venous return from the lower portions of the body while preventing venous congestion in upper body.

5) If the patient is conscious , he should be instructed to take a few deep breaths.

6) Ammonia or ammonia spirit inhalation (in limit) is indicated to treat or prevent syncope (fainting).

 Adverse effect ;  ammonia comes in contact with eye or skin causes burning sensation/ irritation of eye and skin, inhalation in high concentration of ammonia can cause lung damage.

7) Electrolyte solution, fruit juice or salt tablet are given to raise B.P. which is  very usefull in treat sycope.

                                                                             

                                             MUSCLE TRISMUS

 Muscle trismus is a fairly common complication of regional analgesia or anesthesia, particularly after blocks of the inferior alveolar nerve.

The most common cause of trismus is trauma to muscle during  the insertion of needle.

Irritating solution, hemorrhage , or low grade in fection within the muscle may also cause varying degrees of trismus.

Treatment should depend on the cause of the trismus;

TRISMUS due to trauma ;- slightly excercises and drug therapy  necessary to relieve pain.

·        Muscle relaxants (MR) such as diazepam (valium) 2.5-5.0 mg three time per day or  meprobamate ;- 1200-1600 mg / day with application of warm water

            Example; FLEXON MR , ACECLOFENAC + MR given TDS.

·        Physiotherapy; consisting of opening and closing the mouth as wll as from side to side for 5 to 10 minutes every 3 or 4 hours will also assist recovery.