EVERYTHING RELATED TO LOCAL ANESTHETICS LIKE DEFINITION, HISTORY INTRODUCTION PHYSIOLOGY MECHANISM OF ACTION ANATOMY OF NERVES CLASSIFICATIONS INDIVIDUAL DRUGS AND ITS USES LOCAL ANESTHETICS TOXICITY LOCAL ANESTHETIC SYSTEMIC TOXICITY (LAST) MANAGEMENT OF LAST ETC...
EVERYTHING RELATED TO LOCAL ANESTHETICS LIKE DEFINITION, HISTORY INTRODUCTION PHYSIOLOGY MECHANISM OF ACTION ANATOMY OF NERVES CLASSIFICATIONS INDIVIDUAL DRUGS AND ITS USES LOCAL ANESTHETICS TOXICITY LOCAL ANESTHETIC SYSTEMIC TOXICITY (LAST) MANAGEMENT OF LAST ETC...
A teaching slide set describing the mechanisms of action and clinical use of local anaesthetics. This session is a basic introduction to the pharmacodynamics and pharmacokinetics of local anaesthetics. It is aimed at preclinical medical or dental students, or students in the early years of a pharmacology degree.
The presentation gives a detailed overview of local anesthetics. This presentation made very effectively, covering mostly all the important sub topics. It will be definitely useful for all the students Comment your response regarding the presentation.
Classification
Mechanism of action
Duration of action
Absorption and distribution
Mode of action
Theories of action of L.A
Pharmacokinetics of local anaesthetics
Routes of administration
Metabolism or biotransformation
Individual agents
Vasoconstrictors
Systemic effects
Toxicity
Advantages
Disadvantages
Maximum allowable dose
Local anaesthetics in community trust services
Local anesthesia has been defined as loss of sensation in a circumscribed area of the body caused by depression of excitation in nerve endings or inhibition of the conduction process in peripheral nerves.
A teaching slide set describing the mechanisms of action and clinical use of local anaesthetics. This session is a basic introduction to the pharmacodynamics and pharmacokinetics of local anaesthetics. It is aimed at preclinical medical or dental students, or students in the early years of a pharmacology degree.
The presentation gives a detailed overview of local anesthetics. This presentation made very effectively, covering mostly all the important sub topics. It will be definitely useful for all the students Comment your response regarding the presentation.
Classification
Mechanism of action
Duration of action
Absorption and distribution
Mode of action
Theories of action of L.A
Pharmacokinetics of local anaesthetics
Routes of administration
Metabolism or biotransformation
Individual agents
Vasoconstrictors
Systemic effects
Toxicity
Advantages
Disadvantages
Maximum allowable dose
Local anaesthetics in community trust services
Local anesthesia has been defined as loss of sensation in a circumscribed area of the body caused by depression of excitation in nerve endings or inhibition of the conduction process in peripheral nerves.
Sedatives and Hypnotics
Pharmacology
Clinical uses
Sedation
Coping with stress and anxiety
Smoothing effects of stimulants
Potentiation of narcotics
Treatment of serious mental disorders
Pleasurable sensations, including intoxication
Classifications
Benzodiazepines
Diazepam, Clonazepam, Oxazepam, Clobazam, Clordiazepoxide, Midazolam
Barbiturates
Phenobarbitone, Amobarbital, Thiopental-Na
Newer drugs
Zolpidem, Zaleplon, Buspirone
Chloral hydrate
Paraldehyde
Diphenhydramine
Benzodiazepines
Properties
High therapeutic index (high LD50)
Relatively safe in overdose
Develop tolerance slowly
Less addiction liability
Benzodiazepines
Benzodiazepines
Most commonly prescribed Benzodiazepines
All Benzodiazepines are classified as Controlled Drugs in some countries.
Most are CD Schedule 4
Diazepam (Valium,Anxicalm)
Alprazolam (Xanax)
Bromazepam (Lexotan)
Clobazam (Frisium)
Lormetazepam (Noctamid)
Nitrazepam (Mogadon)
Clonazepam
Two are CD Schedule 3
Flurazepam (Rohypnol)
Temazepam (Nortem)
Structure Activity Relationship
In ring A an electron – withdrawing group such as Cl, Br, NO2 or CN at position 7.
A methyl Group is attached to the nitrogen atom in position 1 in ring B. However, substituents at position 1 that are metabolically are still clinically useful e.g. Flurazepam.
Replacement of the carbonyl function with two hydrogens in position 2 gives medazepam, less potent than diazepam.
Replacement of one of the hydrogen with a OH group on position 3 lower the activity on the one hand and aids elimination on the other.
Introduction of a carbonyl function in the 3 position increases the duration of action and also favours formation of water soluble salts.
e) α-pyridyl derivative and cycloalkyl substituent at 5 position give potent compounds.
f) Electronegative substituents such as Cl or F at the ortho and disubstituted in both ortho positions in ring C.
g) Derivatives with additional rings joining the diazepine nucleus at the 1 and 2 positions are generally more active than the corresponding 1-methylbenzodiazepines.
h) Replacement of the benzene ring by heteroaromatic (e.g. pyrazole) resulted in compounds with interesting anxiolytic properties ( e.g. ripazepam).
i) Saturation of the 4,5- double bond reduces potency, as does a shift of the unsaturation into the 3,4-position.
Barbiturates
Barbiturates
Barbiturates
Barbiturate poisoning
Treatment of Barbiturate poisoning
Buspirone
"Barbiturate poisoning" : By rxvichu-alwz4uh!RxVichuZ
Hello buddies!!!
Its Vishnu..back again , with my 17th ppt...
This time, its regarding BARBITURATE POISONING....which is of relevance in the subject CLINICAL TOXICOLOGY, studied in 4th year............
It includes all the required details for BARBITURATE POISONING....Along with fatal doses, and management strategies.............
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Local anesthesia in dentistry /certified fixed orthodontic courses by Indian...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.
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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.
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This presentation gives you a detail information about the Local Anesthetics and its history, mechanism of action, Pharmacological action along with its indication and adverse effect. It also contains the information about techniques used for Injecting Local Anesthesia.
Summary notes of Anesthesia. These notes were published in 2020.
You can download them from:
-Mediafire: http://www.mediafire.com/file/wkey81yff7kv3j1/Anesthesia_Q%2526A_2020.pdf/file
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
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The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Local anaesthetics
1. L0CAL ANAESTHETICS AND LOCAL ANAESTHESIA
BY :DR. RAJESH CHOUDHURI
PGT, DEPARTMENT OF ANAESTHESIOLOGY
MODERATOR: Dr. V. MAJUMDER, Asst. Prof
AGMC & GBP HOSPITAL, AGARTALA
2. OBJECTIVES
• Introduction.
• History.
• Uses of local anaesthetics.
• Structure and classification.
• Mechanism of effect.
• Clinical pharmacology ( Pharmacokinetics and pharmacodynamics)
• Factors influencing the action of LAs.
• Effects on organ system and toxicity.
• Management of severe local anaesthetic toxicity .
• Measures to prevent local anaesthetic toxicity.
3. INTRODUCTION
• Local anesthetics—that produces transient loss of sensory, motor, and autonomic
function in a specific part of the body when the drugs are injected or applied in
proximity to neural tissue- without loss of conciousness.
• Prosperities of ideal LA
Reversible action.
Non-irritant.
No allergic reaction.
No systemic toxicity.
Rapid onset of action.
Sufficient duration of action.
Potent.
Stable in solutions.
Not interfere with healing of tissue.
Have a vasoconstrictor action or compatible withVC.
Not expensive
4. HISTORY
• The first LA, cocaine, was isolated in 1860.
• Cocaine introduced into practice in 1884 as a topical
ophthalmic anesthetic.
• Despite its addictive property, cocaine was used for 30
years.
• In 1905 procaine was synthesized, which became the
dominant LA for the next 50 years.
• Lidocaine, which is still a widely used LA, was
synthesized in 1943
5. USE OF LOCAL ANAESTHETICS
• Local anesthesia. Six Placement Sites are:
1.Surface/topical anesthesia,
2.Local infiltration,
3.peripheral nerve block,
4. Bier block (IV regional anesthesia),
5.Epidural anesthesia,
6. Spinal anesthesia
• Ventricular arrhythmia.
• Decrease haemodynamic response to tracheal intubation also decrease
cough.
• Treatment of epileptic fits.
6. STRUCTURE AND CLASSIFICATION
Ester-linked
Short acting, less stable in solution
Metabolized in the plasma and tissue fluids
by cholineestarase to produce PABA.
May cuase allergic reaction.
Excreted in urine
Amide-linked
Longer acting, heat stable
Metabolized by liver microsomal P450 enzymes
Rarely cause allergic reaction
Excreted in urine
ALL LOCAL ANAESTHETICS ARE WEAK BASES
9. MECHANISM OF ACTION OF LAs
• Primary target of action: voltage gated sodium channels in the phospholipid bilayers
encapsulating neurons.
• Lipid soluble non-ionised LAs diffuse across the neural sheath to gain access to the
cytoplasm changed to cation form gain access to the open channel from
inside of the cell bind a specific region of the α subunit ofVASC
Prevent channel activation inhibit Na+ influx prevent generation of
action potential.
• As the conc. of LAs increases, the height of the AP reduced, the firing threshold
elevated, the spread of impulse conduction slowed and the refractory period
lengthened. Finally nerve conduction is completely blocked.
• Las are “use-dependant” blockers.
11. PHARMACOKINETICS
• More important determinants of elimination and toxicity than desired clinical effect.
• ABSORPTION
Most mucous membranes provide a weak barrier to local anesthetic penetration.
Intact skin requires a high water concentration for its penetration and a high
concentration of lipid-soluble local anesthetic base to ensure analgesia.
Systemic absorption of injected local anesthetics depends on :
1) Site of Injection: vascularity of the site of injection: intravenous > tracheal >
intercostal > caudal > paracervical > epidural > brachial plexus > sciatic >
subcutaneous.
2) Presence ofVasoconstrictors : The effects of vasoconstrictors are more
pronounced with shorter-acting agents.
3) Local Anesthetic Agent: highly tissue bound are more slowly absorbed.
12. PHARMACOKINETICS
• DISTRIBUTION
• Depends on the following factors:
1) Tissue Perfusion: The highly perfused organs (brain, lung, liver, kidney, and heart) are
responsible for the initial rapid uptake ( α phase), which is followed by a slower redistribution ( β phase) to
moderately perfused tissues (muscle and gut).
2)Tissue/Blood Partition Coefficient: Strong plasma protein binding tends to retain anesthetic
in the blood, whereas high lipid solubility facilitates tissue uptake.
3) Tissue Mass: Muscle provides the greatest reservoir for local anesthetic agents
• METABOLISM AND EXCRETION
1)Esters: metabolized by pseudocholinesterase , metabolites are excreted in the urine. ( except
Cocaine).
Procaine and benzocaine are metabolized to p-aminobenzoic acid (PABA).
2) Amides: metabolized (N-dealkylation and hydroxylation) by microsomal P-450 enzymes in the
liver. Much slower than ester hydrolysis. Depends on the specific agent.
Metabolites of prilocaine (o-toluidine derivatives), which accumulate after large doses of
drug (> 10 mg/kg), convert hemoglobin to methemoglobin.
13. FACTORS INFLUENCING THE ACTION OF LA
1. Lipid solubility: more lipid solubility-more potency.
2. Aromatic ring and alkyl group: larger the alkyl group-more lipid solubility-more potency. ( eg.
Tetracaine vs. procaine, Bupivacaine vs. Mepivacaine)
3. Size, type and myelination of nerve fibre: order of blocking nerve fibres-(i) Autonomic
preganglionic B fibres ; (ii) temperature fibres-cold before warm; (iii) pin prick fibres; (iv) fibres coveying pain
greater than pin prick; (v) touch fibres; ( vi) deep pressure; (vii) somatic motor fibres; (viii) vibratory sense
and propioception.
4. PH : acidic PH antagonizes block. ( eg. Infectected tissue).
5. Frequency of nerve stimulation.
6. Electrolyte concentration: hypokalaemia and hypercalcaemia antagonizes block.
7. pKa : Local anesthetics with a pKa closest to physiological pH generally have a more rapid onset.
14. FACTORS INFLUENCING THE ACTION OF LA
8. Onset of action : depends on lipid solubility and pKa. Less potent , less lipid soluble agents
generally have a faster onset than more potent, more lipid soluble agents.
9. Duration of action: correlates with potency and lipid solubility. Highly lipid-soluble local
anesthetics have a longer duration of action.
10. Commercial formulation with epinephrine: they have slower onset of action comparing
to to the ‘plain’ solution.
11. Tachyphylaxis: decereased efficacy of repeated doses.
12. Alkalinization of the LA solution: speeds the onset and improves the quality of block. Also
decreases pain during subcutaneous infiltration. Done by adding 1 ml 8.4% sodium
bicarbonate per 10 ml local anaesthetic.
15. EFFECTS ON ORGAN SYSTEM AND TOXICITY
1. Central nervous system: central stimulation followed by depression.
Early symptom-circumoral numbness,tongue paresthesia, dizziness,tinnitus and blurred vision. Excitatory signs-
restlessness, agitation,nervousness, garrulousness and a feeling of impending dome, seizure. At higher doses-coma
and respiratory failure.
Neurological deficit, cauda equina syndrome, transient neurological symptoms.
2. Respiratory toxicity: may cause respiratory depression progressing to apnoea.—delayed onset.
Lidocaine depresses hypoxic drive.
3. Cardiovascular system: depresses myocardial autimaticity. At higher concentration-depresses myocardial
contractility and conduction velocity. All except cocain cause arteriolar vasodilatation.
At still increased concentration arrhythmia, heart block, depressed ventricular contractility and
hypotension may lead to cardiac arrest.
4. Immunological: esters may induce a true allergic reaction. Amides due to presence of Methylparaben may cause
allergic reaction.
5. Musculoskeletal: mildly myotoxic.
6. Hematological:lidocaine mildly depresses normal blood coagulation and enhnace fibrinolysis of whole blood.
16. Management of severe local anaesthetic toxicity: AAGBI safety guideline
1. RECOGNITION:
-Sudden alteration of mental status, severe agitation or loss of consciousness, with or without
tonic-clonic convulsions.
-Cardiovascular collapse: sinus bradycardia, conduction blocks, asystole and ventricular
tachyarrhythmias.
2. IMMEDIATE MANAGEMENT:
-Stop injecting the LA.
-Call for help.
-Maintain the airway and, if necessary, secure it with a tracheal tube.
-Give 100% O2 and ensure adequate lung ventilation.
-Confirm or establish IV access.
-Control seizures: give a benzodiazepine, thiopental or propofol in small increamental doses.
-Assess cardiovascular status throughout.
-Consider drawing blood for analysis, but do not delay definitive treatment to do this.
17. Management of severe local anaesthetic toxicity: AAGBI safety guideline
3.TREATMENT:
IN CIRCULATORYARREST WITHOUT CIRCULATORYARREST
Start CPR using standard protocol.
Manage arrhythmia using the same protocols ,
recognizing that arhrythmia may be very
refractory.
Consider the use of CPB if available.
Consider lipid emulsion
ContinueCPR with lipid emulsion.
Recovery may be > 1 hr.
Use conventional therapies to treat:
Hypotension, bradycardia, tachyarrhythmia.
Consider lipid emulsion
Propofol is not a suitable substitute for lipid
emulsion.
18. Management of severe local anesthetic toxicity: AAGBI safety guideline
• FOLLOW UP :safe transfer to a clinical area with appropriate equipment and suitable
staff until sustained recovery is achieved.
Exclude pancreatitis by regular clinical review, including daily amylase or lipase
assays for two days.
• INTRALIPID DOSES:
Immediately: an initial IV bolus inj. of lipid emulsion @ 1.5 mi/kg over 1min and
start an IV infusion of 20% lipid emulsion @ 1.5 ml/kg/ hr.
After 5 min: a max. of two repeat boluses at 5 min interval ( same dose) if
cardiovascular stability has not been restored .
A maximum of 3 boluses can be given( including initial bolus)
AND continue infusion at same rate, but double the rate at any time
after 5 min, if cardiovascular stability has not been restored .
Continue infusion until stable or maximum dose of lipid emulsion
given.
19. MEASURES TO PREVENT SEVERE LA TOXICITY
1. Perform RA in an area equipped to deal with cardiorespiratory collapse.
2. The age, weight and infirmity of the patient should be taken into account,
and doses adjusted accordingly.
3. Clear labeling of syringes.
4. Gentle aspiration of the syringes before every injection.
5. Keep talking to the patient– both during and after drug administration.
6. Appropriate test dosing depending on the situation.
7. USG guided nerve block– if available.