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Local Anesthetics Dr. Hala
What are local anesthetics? ,[object Object]
Local anesthetics - Mechanism ,[object Object]
Cocaine Addiction ,[object Object],[object Object],[object Object],[object Object],[object Object]
Procaine replaced  Novocaine  cocaine Problems ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Lidocaine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Differences of Esters and Amides ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Local anesthetics - Classes (Rule of “i’s”) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Structures of Amides and Esters ,[object Object],[object Object],[object Object]
Mechanism ,[object Object],[object Object],[object Object],[object Object],[object Object]
Local anesthetics - Formulation ,[object Object],[object Object],[object Object],[object Object]
Local anesthetics - Formulation ,[object Object],[object Object],[object Object],[object Object]
Factors Affect the Reaction of Local Anesthetics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Factors Affect the Reaction of Local Anesthetics (cont.) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Toxicity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Local Anesthetics - Allergy ,[object Object],[object Object],[object Object]
Local Anesthetics - Toxicity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Factors of circulation levels ,[object Object],[object Object],[object Object],[object Object],[object Object]
Conclusion Anesthetic pKa Onset  Duration (with Epinephrine) in minutes Max Dose (with Epinephrine) Procaine 9.1 Slow 45 - 90 8mg/kg – 10mg/kg Lidocaine 7.9 Rapid 120 - 240 4.5mg/kg – 7mg/kg Bupivacaine 8.1 Slow 4 hours – 8 hours 2.5mg/kg – 3mg/kg Prilocaine 7.9 Medium 90 - 360 5mg/kg – 7.5mg/kg Articaine 7.8 Rapid 140 - 270 4.0mg/kg – 7mg/kg
Local anesthetics - Duration ,[object Object],[object Object],[object Object]
Vasoconstrictors
Local anesthetics - vasoconstrictors Ratios Epinephrine is added to local anesthetics in  extremely  dilute concentrations, best expressed as a ratio of grams of drug:total cc’s of solution. Expressed numerically, a 1:1000 preparation of epinephrine would be 1 gram epi 1000 cc’s solution 1000 mg epi 1000cc’s solution = 1 mg epi 1 cc =
Local anesthetics - vasoconstrictors Therefore, a  1 : 200,000 solution of epinephrine would be = or 5 mcg epi 1 cc solution 1 gram epi 200,000 cc’s solution 1000 mg epi 200,000 cc’s solution
Local anesthetics - vasoconstrictors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
REGIONAL ANESTHESIA
Regional anesthesia - Definition ,[object Object]
Regional anesthesia - Uses ,[object Object],[object Object],[object Object]
Regional anesthesia - types ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Topical Anesthesia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Local/Field Anesthesia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
IV Block - “Bier” block ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Peripheral  nerve block ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Plexus Blockade ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Central neuraxial blockade - “Spinal” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Central Neuraxial Blockade - “epidural” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
 
 
 
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Local Anesthetics

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  • 19. Conclusion Anesthetic pKa Onset Duration (with Epinephrine) in minutes Max Dose (with Epinephrine) Procaine 9.1 Slow 45 - 90 8mg/kg – 10mg/kg Lidocaine 7.9 Rapid 120 - 240 4.5mg/kg – 7mg/kg Bupivacaine 8.1 Slow 4 hours – 8 hours 2.5mg/kg – 3mg/kg Prilocaine 7.9 Medium 90 - 360 5mg/kg – 7.5mg/kg Articaine 7.8 Rapid 140 - 270 4.0mg/kg – 7mg/kg
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  • 22. Local anesthetics - vasoconstrictors Ratios Epinephrine is added to local anesthetics in extremely dilute concentrations, best expressed as a ratio of grams of drug:total cc’s of solution. Expressed numerically, a 1:1000 preparation of epinephrine would be 1 gram epi 1000 cc’s solution 1000 mg epi 1000cc’s solution = 1 mg epi 1 cc =
  • 23. Local anesthetics - vasoconstrictors Therefore, a 1 : 200,000 solution of epinephrine would be = or 5 mcg epi 1 cc solution 1 gram epi 200,000 cc’s solution 1000 mg epi 200,000 cc’s solution
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Editor's Notes

  1. This slide depicts the effect of sodium influx on overall membrane potential. By limiting influx, local anesthetics inhibit the depolarization of the membrane thereby interfering with propagation of the action potential.