Local anesthetics work by blocking sodium channels in nerves, limiting the propagation of action potentials and preventing pain sensation. Lidocaine was the first modern local anesthetic introduced in 1940. Local anesthetics are either esters or amides, with amides like lidocaine causing less allergic reactions. The onset and duration of local anesthetics is influenced by their lipid solubility, pH, presence of vasoconstrictors, and peak circulation levels to avoid toxicity.
Postoperative Thyroid Surgery ComplicationsHossam atef
The document discusses the anatomy and physiology of the trachea. It notes that the trachea lies in the midline of the neck, has 20 C-shaped cartilage rings, and becomes intrathoracic at the 6th ring. During respiration, the trachea and bronchi change in length and diameter due to their elastic structure. The document then discusses various complications that can arise from thyroid surgery, including hemorrhage, infection, recurrent laryngeal nerve injury, respiratory obstruction, and parathyroid issues. It provides details on preventing, diagnosing, and managing each complication.
1) Maxillofacial surgery involves procedures on the head, neck, face and jaws to correct congenital deformities, injuries, tumors, or for cosmetic reasons.
2) Anesthesia for maxillofacial surgery presents several challenges including a shared airway, risk of difficult intubation, significant blood loss, and hemodynamic changes.
3) Careful preoperative evaluation and planning is important to optimize the patient's condition and anticipate any airway issues. Induced hypotension during surgery can help reduce blood loss.
The document discusses local anesthetics, including their definitions, classifications, mechanisms of action, routes of administration, and pharmacokinetics. Local anesthetics work by blocking sodium channels and preventing the generation and conduction of nerve impulses. There are two main classes - amides like lidocaine, which are metabolized in the liver, and esters like procaine, which can cause allergic reactions and are metabolized in plasma. Factors like lipid solubility, pH, and vasodilation influence the onset and duration of action of local anesthetics.
Local anesthetics work by blocking sodium channels in nerves, limiting the propagation of action potentials and producing loss of sensation in a specific area. Early local anesthetics like cocaine and procaine had limitations. Lidocaine, introduced in 1940, was a major improvement as an amide-type local anesthetic with quick onset, duration of hours, and less allergenicity. Factors like lipid solubility, pH, vasoconstrictors, and dosage levels affect the onset and duration of local anesthetics. Regional anesthesia techniques involve anesthetizing broader areas using techniques like topical, field block, and peripheral or central nerve blocks.
Local anesthetics work by blocking sodium channels in nerves, limiting the propagation of action potentials and producing loss of sensation in a specific area. Early local anesthetics like cocaine and procaine had limitations. Lidocaine, introduced in 1940, was a major breakthrough as the first modern local anesthetic due to its quick onset of action, duration of several hours, and minimal allergenicity. The two classes of local anesthetics are esters and amides; amides are preferable due to lower risk of allergic reactions. Factors like lipid solubility, pH, vasoconstrictors, and dosage levels affect the onset and duration of local anesthetics.
1. Local anesthetics work by preventing the generation and conduction of nerve impulses through chemical blockade between the source of impulse and the brain.
2. They act on nerve membranes by decreasing permeability to sodium ions, inhibiting the transmission of action potentials.
3. Doses are presented in milligrams per kilogram of body weight, with a maximum dose between 70-500mg depending on the drug and presence of vasoconstrictors. The dose is reduced for children.
Local anesthetics work by blocking sodium channels in nerves, preventing impulse transmission and sensation. The document traces the history of local anesthetics from ancient use of coca leaves to modern drugs like lidocaine. It discusses the development of cocaine as the first local anesthetic and its replacement by safer amide-based drugs like procaine and lidocaine due to cocaine's high toxicity and potential for addiction. The mechanisms of action, factors affecting onset and duration, and properties of common dental anesthetics are also outlined.
Local anesthetics work by altering the membrane potential of nerve cells and blocking sodium channels, which prevents the propagation of action potentials and results in loss of sensation. Early local anesthetics like cocaine were derived from coca leaves and provided pain relief for surgery. Later developments included procaine, lidocaine, and other synthetic amide and ester local anesthetics. The pharmacokinetics and effects of local anesthetics depend on factors like lipid solubility, pH, vasoconstriction, and metabolism. Toxicity can occur if maximum dosage levels are exceeded.
Postoperative Thyroid Surgery ComplicationsHossam atef
The document discusses the anatomy and physiology of the trachea. It notes that the trachea lies in the midline of the neck, has 20 C-shaped cartilage rings, and becomes intrathoracic at the 6th ring. During respiration, the trachea and bronchi change in length and diameter due to their elastic structure. The document then discusses various complications that can arise from thyroid surgery, including hemorrhage, infection, recurrent laryngeal nerve injury, respiratory obstruction, and parathyroid issues. It provides details on preventing, diagnosing, and managing each complication.
1) Maxillofacial surgery involves procedures on the head, neck, face and jaws to correct congenital deformities, injuries, tumors, or for cosmetic reasons.
2) Anesthesia for maxillofacial surgery presents several challenges including a shared airway, risk of difficult intubation, significant blood loss, and hemodynamic changes.
3) Careful preoperative evaluation and planning is important to optimize the patient's condition and anticipate any airway issues. Induced hypotension during surgery can help reduce blood loss.
The document discusses local anesthetics, including their definitions, classifications, mechanisms of action, routes of administration, and pharmacokinetics. Local anesthetics work by blocking sodium channels and preventing the generation and conduction of nerve impulses. There are two main classes - amides like lidocaine, which are metabolized in the liver, and esters like procaine, which can cause allergic reactions and are metabolized in plasma. Factors like lipid solubility, pH, and vasodilation influence the onset and duration of action of local anesthetics.
Local anesthetics work by blocking sodium channels in nerves, limiting the propagation of action potentials and producing loss of sensation in a specific area. Early local anesthetics like cocaine and procaine had limitations. Lidocaine, introduced in 1940, was a major improvement as an amide-type local anesthetic with quick onset, duration of hours, and less allergenicity. Factors like lipid solubility, pH, vasoconstrictors, and dosage levels affect the onset and duration of local anesthetics. Regional anesthesia techniques involve anesthetizing broader areas using techniques like topical, field block, and peripheral or central nerve blocks.
Local anesthetics work by blocking sodium channels in nerves, limiting the propagation of action potentials and producing loss of sensation in a specific area. Early local anesthetics like cocaine and procaine had limitations. Lidocaine, introduced in 1940, was a major breakthrough as the first modern local anesthetic due to its quick onset of action, duration of several hours, and minimal allergenicity. The two classes of local anesthetics are esters and amides; amides are preferable due to lower risk of allergic reactions. Factors like lipid solubility, pH, vasoconstrictors, and dosage levels affect the onset and duration of local anesthetics.
1. Local anesthetics work by preventing the generation and conduction of nerve impulses through chemical blockade between the source of impulse and the brain.
2. They act on nerve membranes by decreasing permeability to sodium ions, inhibiting the transmission of action potentials.
3. Doses are presented in milligrams per kilogram of body weight, with a maximum dose between 70-500mg depending on the drug and presence of vasoconstrictors. The dose is reduced for children.
Local anesthetics work by blocking sodium channels in nerves, preventing impulse transmission and sensation. The document traces the history of local anesthetics from ancient use of coca leaves to modern drugs like lidocaine. It discusses the development of cocaine as the first local anesthetic and its replacement by safer amide-based drugs like procaine and lidocaine due to cocaine's high toxicity and potential for addiction. The mechanisms of action, factors affecting onset and duration, and properties of common dental anesthetics are also outlined.
Local anesthetics work by altering the membrane potential of nerve cells and blocking sodium channels, which prevents the propagation of action potentials and results in loss of sensation. Early local anesthetics like cocaine were derived from coca leaves and provided pain relief for surgery. Later developments included procaine, lidocaine, and other synthetic amide and ester local anesthetics. The pharmacokinetics and effects of local anesthetics depend on factors like lipid solubility, pH, vasoconstriction, and metabolism. Toxicity can occur if maximum dosage levels are exceeded.
The document discusses the constituents and components of local anesthetic solutions used in dentistry. It describes the various local anesthetic agents, including lignocaine/lidocaine, and how they are classified. It also covers vasoconstrictors like epinephrine/adrenaline and norepinephrine/noradrenaline that are added to local anesthetics to increase their duration and effectiveness. The pharmacokinetics of local anesthetics including distribution, metabolism, excretion are summarized. Factors in selecting local anesthetics and maximum recommended doses are also provided.
Local anesthetics work by blocking sodium channels and include both ester and amide chemical structures. Ester local anesthetics like procaine are metabolized rapidly via plasma esterases while amides like lidocaine undergo hepatic metabolism. Factors like lipid solubility, pH, dose, and route of administration influence a local anesthetic's potency, onset, and duration of action as well as its systemic absorption and toxicity risk profile. The addition of vasoconstrictors can prolong a local anesthetic's effects by decreasing its rate of vascular uptake.
Cocaine was the first local anesthetic discovered and is derived from coca plants. Other synthetic local anesthetics were later developed, including procaine and lidocaine. Local anesthetics work by reversibly binding sodium channels and inhibiting nerve conduction. There are two classes - amino amides like lidocaine and amino esters like cocaine. Proper administration of local anesthetics involves considering the patient, dose, presence of epinephrine, speed of injection, tissue vascularity, and injection technique. Dilution, addition of epinephrine, and slow administration can allow for safer use of local anesthetics.
Dental Courses by Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The document provides information on the history and properties of local anesthesia. It discusses how cocaine was the first local anesthetic isolated in 1860 and procaine was the first widely used synthetic agent in 1905. Key events include the discovery of lidocaine in 1948 and its clinical introduction in 1949. Local anesthesia works by reversibly blocking nerve conduction, producing loss of sensation while maintaining consciousness. The mechanisms of action and properties of various local anesthetic agents are explained.
Local anesthetics work by blocking sodium ion channels in nerve cell membranes, preventing the propagation of action potentials and interrupting pain signals. The first local anesthetic was cocaine, discovered in the 1860s. Local anesthetics are classified as esters like cocaine or amides like lidocaine. They take effect by binding to intracellular sodium channels and slowing nerve conduction. The potency of local anesthetics depends on factors like pH, lipophilicity, and protein binding. Different types of nerve fibers vary in their susceptibility to local anesthetic blockade, with small fibers being more easily blocked. Systemic toxicity from overdose can cause central nervous system or cardiovascular effects. Common techniques for local anesthesia include infiltration, topical blocks, nerve blocks, and
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
General anesthetics cause reversible loss of consciousness and perception during surgery by depressing the central nervous system. They provide analgesia, amnesia, muscle relaxation and unconsciousness. Common inhalational anesthetics include halothane, isoflurane and sevoflurane. Pre-anesthetic medications are often administered to relieve anxiety, provide amnesia and reduce anesthetic requirements. Inhalational anesthetics are delivered via open or closed systems and their effects are determined by factors like potency, solubility and metabolism. Their mechanism of action involves actions on ion channels and receptors in the brain.
LOCAL ANESTHETICS 2024.pdf jdhsjsnsnejsjnsjwnsepicsoundever
Local anesthesia is the reversible loss of sensation in an area without loss of consciousness. Local anesthetics block nerve conduction when applied directly to peripheral nerves, abolishing sensation in the supplied area. They are divided into natural, synthetic, ester, and amide groups. Local anesthetics produce anesthesia by reversibly binding sodium channels, inhibiting nerve excitation. They have different durations of action and are used for various types of local anesthesia including infiltration, nerve block, spinal, and surface anesthesia. Complications can include allergic reactions and systemic toxicity at high doses.
This document provides a review of local anesthetics and anxiolytics used in dental practice. It discusses the history of local anesthetics from early use of whiskey and nitrous oxide to modern drugs like lidocaine and bupivacaine. The pharmacology of local anesthetics is covered, including how they work by blocking sodium ion channels. Factors that influence the effects of local anesthetics like pH, drug properties and injection technique are reviewed. Common local anesthetic drugs, their durations of action, adverse effects and appropriate uses are summarized. Monitoring parameters and special considerations for patient populations are also addressed.
This document discusses the pharmacology of local anesthesia. It describes the constituents of local anesthetic cartridges which include the local anesthetic agent, vasoconstrictor, preservative, and vehicle. It discusses the properties of ideal anesthetic agents and the common properties of injectable local anesthetics. The document outlines the mode of action, pharmacokinetics including uptake, potency, duration, biotransformation, and excretion of local anesthetics. It provides details on ester and amide local anesthetic drugs as well as vasoconstrictor agents.
Local anesthetics reversibly block nerve impulse conduction. They are classified based on chemical structure into amide and ester types, with varying durations of action. Common local anesthetics include lidocaine, bupivacaine, and prilocaine. Local anesthetics work by blocking voltage-gated sodium channels, preventing nerve depolarization. Their effects depend on factors like pH, concentration, and addition of vasoconstrictors. Adverse effects can involve the central nervous system or cardiovascular system in cases of overdose. Proper technique and drug selection are important for safe and effective local anesthesia.
The document discusses local anesthetics (LA), including:
- Their mechanism of action in blocking sodium channels to inhibit nerve conduction and sensation of pain.
- Types include infiltration, nerve block, spinal, epidural, and caudal anesthesia.
- Common LA drugs are procaine, lidocaine, tetracaine, and bupivacaine. Cocaine was the first LA discovered.
- LA chemistry aims to balance lipid solubility for potency versus ionization for reduced toxicity.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Local anesthetics work by blocking sodium channels in nerves, preventing the propagation of action potentials and sensation of pain. There are two classes: esters and amides. Lidocaine is a commonly used amide that has a quick onset and lasts several hours. Regional anesthesia involves administering local anesthetics to specific body areas and can be used for surgery, post-op pain relief, and other procedures. Potential complications include local tissue toxicity, allergy, and overdose. Proper administration and monitoring can help prevent complications.
Local anesthetics work by blocking sodium ion channels, preventing nerve impulse propagation. Early agents included cocaine, while modern ones like lidocaine are further classified as esters or amides. Administration can be via local infiltration, nerve block, or regional techniques like epidural or spinal anesthesia. Toxicities include allergic reactions and central nervous system or cardiovascular issues if too much is absorbed systemically. Proper dosage and addition of vasoconstrictors can maximize efficacy and safety.
Local anesthetics work by blocking sodium ion channels, preventing nerve impulse propagation. Cocaine was the first local anesthetic. Esters like cocaine are hydrolyzed while amides like lidocaine are metabolized in the liver. Small unmyelinated C fibers are most susceptible to blockade. Toxicities include allergic reactions, central nervous system excitation or depression, and cardiovascular effects from systemic absorption of excessive doses.
This document provides an overview of pharmacology topics related to local anesthetics. It begins with a brief history of local anesthetics and discusses the chemistry, including the differences between ester and amide local anesthetics. It covers stereoisomerism, structure-activity relationships, and peripheral nerve anatomy. Mechanisms of action are explained, including the roles of lipophilicity, pKa, and ionized vs. non-ionized forms. Pharmacokinetics, systemic absorption, and toxicity risks are also summarized. The document aims to inform on the essential science underlying local anesthetic use and effects.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
The document discusses the constituents and components of local anesthetic solutions used in dentistry. It describes the various local anesthetic agents, including lignocaine/lidocaine, and how they are classified. It also covers vasoconstrictors like epinephrine/adrenaline and norepinephrine/noradrenaline that are added to local anesthetics to increase their duration and effectiveness. The pharmacokinetics of local anesthetics including distribution, metabolism, excretion are summarized. Factors in selecting local anesthetics and maximum recommended doses are also provided.
Local anesthetics work by blocking sodium channels and include both ester and amide chemical structures. Ester local anesthetics like procaine are metabolized rapidly via plasma esterases while amides like lidocaine undergo hepatic metabolism. Factors like lipid solubility, pH, dose, and route of administration influence a local anesthetic's potency, onset, and duration of action as well as its systemic absorption and toxicity risk profile. The addition of vasoconstrictors can prolong a local anesthetic's effects by decreasing its rate of vascular uptake.
Cocaine was the first local anesthetic discovered and is derived from coca plants. Other synthetic local anesthetics were later developed, including procaine and lidocaine. Local anesthetics work by reversibly binding sodium channels and inhibiting nerve conduction. There are two classes - amino amides like lidocaine and amino esters like cocaine. Proper administration of local anesthetics involves considering the patient, dose, presence of epinephrine, speed of injection, tissue vascularity, and injection technique. Dilution, addition of epinephrine, and slow administration can allow for safer use of local anesthetics.
Dental Courses by Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The document provides information on the history and properties of local anesthesia. It discusses how cocaine was the first local anesthetic isolated in 1860 and procaine was the first widely used synthetic agent in 1905. Key events include the discovery of lidocaine in 1948 and its clinical introduction in 1949. Local anesthesia works by reversibly blocking nerve conduction, producing loss of sensation while maintaining consciousness. The mechanisms of action and properties of various local anesthetic agents are explained.
Local anesthetics work by blocking sodium ion channels in nerve cell membranes, preventing the propagation of action potentials and interrupting pain signals. The first local anesthetic was cocaine, discovered in the 1860s. Local anesthetics are classified as esters like cocaine or amides like lidocaine. They take effect by binding to intracellular sodium channels and slowing nerve conduction. The potency of local anesthetics depends on factors like pH, lipophilicity, and protein binding. Different types of nerve fibers vary in their susceptibility to local anesthetic blockade, with small fibers being more easily blocked. Systemic toxicity from overdose can cause central nervous system or cardiovascular effects. Common techniques for local anesthesia include infiltration, topical blocks, nerve blocks, and
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
General anesthetics cause reversible loss of consciousness and perception during surgery by depressing the central nervous system. They provide analgesia, amnesia, muscle relaxation and unconsciousness. Common inhalational anesthetics include halothane, isoflurane and sevoflurane. Pre-anesthetic medications are often administered to relieve anxiety, provide amnesia and reduce anesthetic requirements. Inhalational anesthetics are delivered via open or closed systems and their effects are determined by factors like potency, solubility and metabolism. Their mechanism of action involves actions on ion channels and receptors in the brain.
LOCAL ANESTHETICS 2024.pdf jdhsjsnsnejsjnsjwnsepicsoundever
Local anesthesia is the reversible loss of sensation in an area without loss of consciousness. Local anesthetics block nerve conduction when applied directly to peripheral nerves, abolishing sensation in the supplied area. They are divided into natural, synthetic, ester, and amide groups. Local anesthetics produce anesthesia by reversibly binding sodium channels, inhibiting nerve excitation. They have different durations of action and are used for various types of local anesthesia including infiltration, nerve block, spinal, and surface anesthesia. Complications can include allergic reactions and systemic toxicity at high doses.
This document provides a review of local anesthetics and anxiolytics used in dental practice. It discusses the history of local anesthetics from early use of whiskey and nitrous oxide to modern drugs like lidocaine and bupivacaine. The pharmacology of local anesthetics is covered, including how they work by blocking sodium ion channels. Factors that influence the effects of local anesthetics like pH, drug properties and injection technique are reviewed. Common local anesthetic drugs, their durations of action, adverse effects and appropriate uses are summarized. Monitoring parameters and special considerations for patient populations are also addressed.
This document discusses the pharmacology of local anesthesia. It describes the constituents of local anesthetic cartridges which include the local anesthetic agent, vasoconstrictor, preservative, and vehicle. It discusses the properties of ideal anesthetic agents and the common properties of injectable local anesthetics. The document outlines the mode of action, pharmacokinetics including uptake, potency, duration, biotransformation, and excretion of local anesthetics. It provides details on ester and amide local anesthetic drugs as well as vasoconstrictor agents.
Local anesthetics reversibly block nerve impulse conduction. They are classified based on chemical structure into amide and ester types, with varying durations of action. Common local anesthetics include lidocaine, bupivacaine, and prilocaine. Local anesthetics work by blocking voltage-gated sodium channels, preventing nerve depolarization. Their effects depend on factors like pH, concentration, and addition of vasoconstrictors. Adverse effects can involve the central nervous system or cardiovascular system in cases of overdose. Proper technique and drug selection are important for safe and effective local anesthesia.
The document discusses local anesthetics (LA), including:
- Their mechanism of action in blocking sodium channels to inhibit nerve conduction and sensation of pain.
- Types include infiltration, nerve block, spinal, epidural, and caudal anesthesia.
- Common LA drugs are procaine, lidocaine, tetracaine, and bupivacaine. Cocaine was the first LA discovered.
- LA chemistry aims to balance lipid solubility for potency versus ionization for reduced toxicity.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Local anesthetics work by blocking sodium channels in nerves, preventing the propagation of action potentials and sensation of pain. There are two classes: esters and amides. Lidocaine is a commonly used amide that has a quick onset and lasts several hours. Regional anesthesia involves administering local anesthetics to specific body areas and can be used for surgery, post-op pain relief, and other procedures. Potential complications include local tissue toxicity, allergy, and overdose. Proper administration and monitoring can help prevent complications.
Local anesthetics work by blocking sodium ion channels, preventing nerve impulse propagation. Early agents included cocaine, while modern ones like lidocaine are further classified as esters or amides. Administration can be via local infiltration, nerve block, or regional techniques like epidural or spinal anesthesia. Toxicities include allergic reactions and central nervous system or cardiovascular issues if too much is absorbed systemically. Proper dosage and addition of vasoconstrictors can maximize efficacy and safety.
Local anesthetics work by blocking sodium ion channels, preventing nerve impulse propagation. Cocaine was the first local anesthetic. Esters like cocaine are hydrolyzed while amides like lidocaine are metabolized in the liver. Small unmyelinated C fibers are most susceptible to blockade. Toxicities include allergic reactions, central nervous system excitation or depression, and cardiovascular effects from systemic absorption of excessive doses.
This document provides an overview of pharmacology topics related to local anesthetics. It begins with a brief history of local anesthetics and discusses the chemistry, including the differences between ester and amide local anesthetics. It covers stereoisomerism, structure-activity relationships, and peripheral nerve anatomy. Mechanisms of action are explained, including the roles of lipophilicity, pKa, and ionized vs. non-ionized forms. Pharmacokinetics, systemic absorption, and toxicity risks are also summarized. The document aims to inform on the essential science underlying local anesthetic use and effects.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
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Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
2. What are local anesthetics?What are local anesthetics?
Local anesthetic: produce loss ofLocal anesthetic: produce loss of
sensation to pain in a specific area of thesensation to pain in a specific area of the
body without the loss of consciousnessbody without the loss of consciousness
3. Local anesthetics -Local anesthetics -
MechanismMechanism
Limit influx of sodium, thereby limitingLimit influx of sodium, thereby limiting
propagation of the action potential.propagation of the action potential.
4. LidocaineLidocaine
In 1940, the first modern localIn 1940, the first modern local
anesthetic agent was lidocaine, tradeanesthetic agent was lidocaine, trade
name Xylocaine®name Xylocaine®
It developed as a derivative of xylidineIt developed as a derivative of xylidine
Belongs to the amide class, cause littleBelongs to the amide class, cause little
allergenic reaction; it’s hypoallergenicallergenic reaction; it’s hypoallergenic
Sets on quickly and produces aSets on quickly and produces a
desired anesthesia effect for severaldesired anesthesia effect for several
hourshours
It’s accepted broadly as the localIt’s accepted broadly as the local
anesthetic in United States todayanesthetic in United States today
5. Differences of Esters and AmidesDifferences of Esters and Amides
All local anesthetics areAll local anesthetics are weak basesweak bases. Chemical structure of local. Chemical structure of local
anesthetics have an amine group on one end and an aromatic ring on theanesthetics have an amine group on one end and an aromatic ring on the
other . The amine end is hydrophilic (soluble in water), and the aromaticother . The amine end is hydrophilic (soluble in water), and the aromatic
end is lipophilic (soluble in lipids)end is lipophilic (soluble in lipids)
Two classes of local anesthetics are amino amides and amino esters.Two classes of local anesthetics are amino amides and amino esters.
Amides:Amides: Esters:Esters:
--Amide link b/t intermediate--Amide link b/t intermediate --Ester link b/t intermediate chain and chain--Ester link b/t intermediate chain and chain
and aromatic ringand aromatic ring aromatic ringaromatic ring
--Metabolized in liver and very--Metabolized in liver and very --Metabolized in plasma through soluble in--Metabolized in plasma through soluble in
the solutionthe solution pseudocholinesterases and notpseudocholinesterases and not
--stable in the solution--stable in the solution
--Cause allergic reactions--Cause allergic reactions
7. Structures of Amides and EstersStructures of Amides and Esters
The amine end is hydrophilic (soluble in water), anesthetic moleculeThe amine end is hydrophilic (soluble in water), anesthetic molecule
dissolve in water in which it is delivered from the dentist’s syringe into thedissolve in water in which it is delivered from the dentist’s syringe into the
patient’s tissue. It’s also responsible for the solution to remain on eitherpatient’s tissue. It’s also responsible for the solution to remain on either
side of the nerve membrane.side of the nerve membrane.
The aromatic end is lipophilic (soluble in lipids). Because nerve cell is madeThe aromatic end is lipophilic (soluble in lipids). Because nerve cell is made
of lipid bilayer it is possible for anesthetic molecule to penetrate through theof lipid bilayer it is possible for anesthetic molecule to penetrate through the
nerve membrane.nerve membrane.
The trick the anesthetic molecule must play is getting from one side of theThe trick the anesthetic molecule must play is getting from one side of the
membrane to the other.membrane to the other.
8. MechanismMechanism
The mechanism of local anesthetics connects withThe mechanism of local anesthetics connects with the ion channels,the ion channels,
nerve, and depolarization.nerve, and depolarization.
Local anesthetics block the conduction in peripheral nerves that inhibitedLocal anesthetics block the conduction in peripheral nerves that inhibited
the nerve to excited and created anesthesia.the nerve to excited and created anesthesia.
The anesthetic is a reversible reaction. It binds and activates the sodiumThe anesthetic is a reversible reaction. It binds and activates the sodium
channels.channels.
The sodium influx through these channels and depolarizes the nerve cellThe sodium influx through these channels and depolarizes the nerve cell
membranes.membranes.
As a result, the nerve loses depolarization and the capacity to create theAs a result, the nerve loses depolarization and the capacity to create the
impulse, the patient loses sensation in the area supplied by the nerve.impulse, the patient loses sensation in the area supplied by the nerve.
9. Local anesthetics - FormulationLocal anesthetics - Formulation
Biologically active substances are frequentlyBiologically active substances are frequently
administered as very dilute solutions whichadministered as very dilute solutions which
can be expressed ascan be expressed as parts of active drug perparts of active drug per
100 parts of solution (grams percent)100 parts of solution (grams percent)
Ex.: 2% solution =Ex.: 2% solution =
__2 grams2 grams__ = ___ = _2000 mg2000 mg_ = ___ = __20 mg20 mg____
100 cc’s 100 cc’s 1 cc100 cc’s 100 cc’s 1 cc
10. Local anesthetics - FormulationLocal anesthetics - Formulation
Biologically active substances are frequentlyBiologically active substances are frequently
administered as very dilute solutions whichadministered as very dilute solutions which
can be expressed ascan be expressed as parts of active drug perparts of active drug per
100 parts of solution (grams percent)100 parts of solution (grams percent)
Ex.: 2% solution =Ex.: 2% solution =
__2 grams2 grams__ = ___ = _2000 mg2000 mg_ = ___ = __20 mg20 mg____
100 cc’s 100 cc’s 1 cc100 cc’s 100 cc’s 1 cc
11. Factors Affect the Reaction of Local AnestheticsFactors Affect the Reaction of Local Anesthetics
Lipid solubilityLipid solubility
All local anesthetics haveAll local anesthetics have weak basesweak bases. Increasing the. Increasing the lipid solubilitylipid solubility
leads to faster nerve penetration, block sodium channels, and speedleads to faster nerve penetration, block sodium channels, and speed
up the onset of action.up the onset of action.
The more tightly local anesthetics bind to the protein, the longer theThe more tightly local anesthetics bind to the protein, the longer the
duration of onset action.duration of onset action.
Local anesthetics have two forms, ionized and nonionized. TheLocal anesthetics have two forms, ionized and nonionized. The
nonionizednonionized form can cross the nerve membranes and block theform can cross the nerve membranes and block the
sodium channels.sodium channels.
So, the more nonionized presented, the faster the onset action.So, the more nonionized presented, the faster the onset action.
pH influencepH influence
Usually at range 7.6 – 8.9Usually at range 7.6 – 8.9
Decrease in pH (acidosis) shifts equilibrium toward the ionized form,Decrease in pH (acidosis) shifts equilibrium toward the ionized form,
delaying the onset action.delaying the onset action.
12. Factors Affect the Reaction of Local AnestheticsFactors Affect the Reaction of Local Anesthetics
(cont.)(cont.)
VasodilationVasodilation
Vasoconstrictor is a substance used to keep the anesthetic solution inVasoconstrictor is a substance used to keep the anesthetic solution in
place atplace at a longer period and prolongs the action of the druga longer period and prolongs the action of the drug
vasoconstrictor delays the absorptionvasoconstrictor delays the absorption
Lower vasodilator activity of a local anesthetic leads to a slowerLower vasodilator activity of a local anesthetic leads to a slower
absorption and longer duration of actionabsorption and longer duration of action
Vasoconstrictor used the naturally hormone called epinephrineVasoconstrictor used the naturally hormone called epinephrine
(adrenaline).(adrenaline).
Side effects of epinephrineSide effects of epinephrine
Epinephrine HR,BP and arrythmiaEpinephrine HR,BP and arrythmia
13. ToxicityToxicity
Toxicity is the peak circulation levels of local anestheticsToxicity is the peak circulation levels of local anesthetics
Levels of local anesthetic concentration administered to patients areLevels of local anesthetic concentration administered to patients are
varied according to age, weight, and health.varied according to age, weight, and health.
Maximum dose for an individual is usually between 70mg to 500mgMaximum dose for an individual is usually between 70mg to 500mg
The amount of dose also varied based on the type of solution usedThe amount of dose also varied based on the type of solution used
and the presence of vasoconstrictorand the presence of vasoconstrictor
Example:Example:
---For adult whose weight is 100kg and up, maximum dose of lidocaine---For adult whose weight is 100kg and up, maximum dose of lidocaine
is about 500mgis about 500mg
---For children, the dosage reduced to about 1/3 to ½ depending on---For children, the dosage reduced to about 1/3 to ½ depending on
their weight.their weight.
The doses are not considered lethal.The doses are not considered lethal.
Some common toxic effects:Some common toxic effects:
--light headedness--light headedness ---shivering or twitching---shivering or twitching --seizures--seizures
--hypotension (low blood pressure)--hypotension (low blood pressure) --numbness--numbness
14. Local Anesthetics - AllergyLocal Anesthetics - Allergy
True allergy is very rareTrue allergy is very rare
Most reactions are from ester class - esterMost reactions are from ester class - ester
hydrolysis (normal metabolism) leads tohydrolysis (normal metabolism) leads to
formation of PABA - like compoundsformation of PABA - like compounds
Patient reports of “allergy” are frequently due toPatient reports of “allergy” are frequently due to
previous intravascular injectionsprevious intravascular injections
15. Local Anesthetics - ToxicityLocal Anesthetics - Toxicity
Tissue toxicity - RareTissue toxicity - Rare
Can occur ifCan occur if
administered in highadministered in high
enough concentrationsenough concentrations
Usually related toUsually related to
preservatives added topreservatives added to
solutionsolution
Systemic toxicity - RareSystemic toxicity - Rare
Related to blood level ofRelated to blood level of
drug secondary todrug secondary to
absorption from site ofabsorption from site of
injection.injection.
Range fromRange from
lightheadedness, tinnituslightheadedness, tinnitus
to seizures andto seizures and
CNS/cardiovascularCNS/cardiovascular
collapsecollapse
16. Factors of circulation levelsFactors of circulation levels
Factors of circulation levels are the rates of absorption,Factors of circulation levels are the rates of absorption,
distribution, and metabolism.distribution, and metabolism.
Absorption depends on the speed of administration andAbsorption depends on the speed of administration and
levels of the doses.levels of the doses.
Distribution allows absorption to occur in three phases.Distribution allows absorption to occur in three phases.
First, the drug occurs at highly vascular tissues in theFirst, the drug occurs at highly vascular tissues in the
lungs and kidneys. Then it appears less in vascularlungs and kidneys. Then it appears less in vascular
muscle and fat. Then the drug is metabolized.muscle and fat. Then the drug is metabolized.
Metabolism involves in the chemical structure based onMetabolism involves in the chemical structure based on
two classes, amide and ester .two classes, amide and ester .
Decreasing the potential toxicity resulted in rapidDecreasing the potential toxicity resulted in rapid
metabolism.metabolism.
18. Local anesthetics - DurationLocal anesthetics - Duration
Determined by rate of elimination ofDetermined by rate of elimination of
agent from site injectedagent from site injected
Factors include lipid solubility, doseFactors include lipid solubility, dose
given, blood flow at site, addition ofgiven, blood flow at site, addition of
vasoconstrictors (does not reliablyvasoconstrictors (does not reliably
prolong all agents)prolong all agents)
Some techniques allowSome techniques allow multiplemultiple
injections over timeinjections over time to increase duration,to increase duration,
e.g. epidural cathetere.g. epidural catheter
19.
20. Local anesthetics - vasoconstrictorsLocal 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
=
21. Local anesthetics - vasoconstrictorsLocal anesthetics - vasoconstrictors
Therefore, a 1 : 200,000 solution of epinephrine
would be
1 gram epi
200,000 cc’s
solution
=
1000 mg epi
200,000 cc’s
solution
or
5 mcg epi
1 cc
solution
22. Local anesthetics - vasoconstrictorsLocal anesthetics - vasoconstrictors
Vasoconstrictors should not be used in theVasoconstrictors should not be used in the
following locationsfollowing locations
FingersFingers
ToesToes
NoseNose
Ear lobesEar lobes
PenisPenis
24. Regional anesthesia - DefinitionRegional anesthesia - Definition
Rendering a specific area of the body,Rendering a specific area of the body,
e.g. foot, arm, lower extremities,e.g. foot, arm, lower extremities,
insensate to stimulus of surgery orinsensate to stimulus of surgery or
other instrumentationother instrumentation
25. Regional anesthesia - UsesRegional anesthesia - Uses
Provide anesthesia for a surgicalProvide anesthesia for a surgical
procedureprocedure
Provide analgesia post-operatively orProvide analgesia post-operatively or
during labor and deliveryduring labor and delivery
Diagnosis or therapy for patients withDiagnosis or therapy for patients with
chronic pain syndromeschronic pain syndromes
27. Topical AnesthesiaTopical Anesthesia
Application of local anesthetic toApplication of local anesthetic to
mucous membrane - cornea, nasal/oralmucous membrane - cornea, nasal/oral
mucosamucosa
Uses :Uses :
awake oral, nasal intubation, superficialawake oral, nasal intubation, superficial
surgical proceduresurgical procedure
Advantages :Advantages :
technically easytechnically easy
minimal equipmentminimal equipment
Disadvantages :Disadvantages :
potential for large doses leading to toxicitypotential for large doses leading to toxicity
28.
29.
30. Local/Field AnesthesiaLocal/Field Anesthesia
Application of local subcutaneously toApplication of local subcutaneously to
anesthetizeanesthetize distal nerve endingsdistal nerve endings
Uses:Uses:
Suturing, minor superficial surgery, lineSuturing, minor superficial surgery, line
placement, more extensive surgery withplacement, more extensive surgery with
sedationsedation
Advantages:Advantages:
minimal equipment, technically easy, rapidminimal equipment, technically easy, rapid
onsetonset
Disadvantages:Disadvantages:
potential for toxicity if large fieldpotential for toxicity if large field
31. IV Block - “Bier” blockIV Block - “Bier” block
Injection of local anesthetic intravenously forInjection of local anesthetic intravenously for
anesthesia of an extremityanesthesia of an extremity
UsesUses
any surgical procedure on an extremityany surgical procedure on an extremity
Advantages:Advantages:
technically simple, minimal equipment, rapid onsettechnically simple, minimal equipment, rapid onset
Disadvantages:Disadvantages:
duration limited by tolerance of tourniquet pain,duration limited by tolerance of tourniquet pain,
toxicitytoxicity
32.
33. PeripheralPeripheral nerve blocknerve block
Injecting local anestheticInjecting local anesthetic near thenear the
course of a named nervecourse of a named nerve
Uses:Uses:
Surgical procedures in the distribution ofSurgical procedures in the distribution of
the blocked nervethe blocked nerve
Advantages:Advantages:
relatively small dose of local anesthetic torelatively small dose of local anesthetic to
cover large area; rapid onsetcover large area; rapid onset
Disadvantages:Disadvantages:
technical complexity, neuropathytechnical complexity, neuropathy
34.
35.
36. Plexus BlockadePlexus Blockade
Injection of local anesthetic adjacent to aInjection of local anesthetic adjacent to a
plexus, e.g cervical, brachial or lumbar plexusplexus, e.g cervical, brachial or lumbar plexus
Uses :Uses :
surgical anesthesia or post-operative analgesia insurgical anesthesia or post-operative analgesia in
the distribution of the plexusthe distribution of the plexus
Advantages:Advantages:
large area of anesthesia with relatively large doselarge area of anesthesia with relatively large dose
of agentof agent
Disadvantages:Disadvantages:
technically complex, potential for toxicity andtechnically complex, potential for toxicity and
neuropathy.neuropathy.
37.
38.
39. Central neuraxial blockade -Central neuraxial blockade -
“Spinal”“Spinal”
Injection of local anesthetic into CSFInjection of local anesthetic into CSF
Uses:Uses:
profound anesthesia of lower abdomen andprofound anesthesia of lower abdomen and
extremitiesextremities
Advantages:Advantages:
technically easy (LP technique), high success rate,technically easy (LP technique), high success rate,
rapid onsetrapid onset
Disadvantages:Disadvantages:
““high spinal”, hypotension due to sympathetic block,high spinal”, hypotension due to sympathetic block,
post dural puncture headache.post dural puncture headache.
40.
41.
42. Central Neuraxial Blockade -Central Neuraxial Blockade -
“epidural”“epidural”
Injection of local anesthetic in to the epiduralInjection of local anesthetic in to the epidural
space at any level of the spinal columnspace at any level of the spinal column
Uses:Uses:
Anesthesia/analgesia of the thorax,Anesthesia/analgesia of the thorax,
abdomen, lower extremitiesabdomen, lower extremities
Advantages:Advantages:
Controlled onset of blockade, long duration whenControlled onset of blockade, long duration when
catheter is placed, post-operative analgesia.catheter is placed, post-operative analgesia.
Disadvantages:Disadvantages:
Technically complex, toxicity, “spinal headache”Technically complex, toxicity, “spinal headache”
Editor's Notes
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.