This document provides information about the classification, mechanisms of action, uses, and properties of local anesthesia drugs. It discusses several local anesthetics including lidocaine, ropivacaine, prilocaine, and bupivacaine. It covers their sources and chemistry, pharmacokinetic properties, therapeutic uses, side effects, dosages, and other details. The document contains sections on the individual drugs as well as general topics about local anesthesia.
1. Local anesthesia involves injecting chemical agents near sensory neurons to temporarily disrupt nerve impulses and induce loss of sensation. It has advantages over general anesthesia like low toxicity and excellent pain control.
2. Common local anesthetic agents include lidocaine, bupivacaine, mepivacaine, and procaine. They work by blocking sodium channels and preventing nerve impulse transmission.
3. Local anesthetics can be administered via infiltration, nerve blocks, epidurals, and other regional techniques to induce localized numbness for various surgical procedures. Proper administration and dosage are important to avoid adverse effects.
This document discusses various intravenous anaesthetic agents. It describes the classification of IV induction agents as barbiturates like thiopentone and methohexitone, or non-barbiturates like propofol, etomidate, ketamine and benzodiazepines. It provides details on the properties, uses, advantages and side effects of specific agents like thiopentone, propofol and etomidate. Ketamine is discussed as an agent that produces dissociative anaesthesia and has strong analgesic effects.
The document provides information on various intravenous and inhalational drugs used in anaesthesia.
It discusses IV induction drugs like propofol, sodium thiopentone and etomidate. Propofol causes the most marked fall in blood pressure but is ideal for LMA. Sodium thiopentone directly depresses the heart but airway reflexes are better preserved than propofol. Etomidate causes the least cardiovascular depression but inhibition of adrenal function is a concern.
It also discusses the inhalational agent ketamine which provides dissociative anaesthesia and cardiovascular stability but unpleasant emergence reactions are common. The uptake and release of inhalational agents depends on alveolar gas concentration
Surgery – Anaesthesia -- By Prof.Dr.R.R.Deshpande
• This PPT includes most useful Information of Anaesthesia ,which is syllabus Topic from Shalya tantra syllabus of 4th BAMS . Paper 1 Part A Point 4 --- Local anaesthesia ,Paper 1 Part A Point 4 --- Regional and General anaesthesia .This PPT includes Types of Local Anesthesia ,Drugs used in Local Anaesthesia ,General Anesthesia & drugs for GA ,Muscle Relaxants ,Stages of GA,Spinal Anesthesia ,Comparision of LA & GA
Visit – www.ayurvedicfriend.com
Phone – 9226810630
This document discusses complications that can arise from regional anesthesia. It begins by defining an anesthetic complication and classifying complications as either local or systemic, and mild/severe or transient/permanent. Local complications can be attributed to the anesthetic solution or needle insertion and include issues like infection, tissue reaction, or hematoma. Systemic complications involve toxicity or allergic reaction. Prevention focuses on proper technique, like slow injection rates. Management of specific issues like trismus or nerve injury is also outlined. The conclusion emphasizes the importance of careful technique and minimal necessary doses to avoid complications.
properties, classification and principle of action of intravenous induction agent.
pharmacokinetics
comparison between properties of various agent
summary of ketamine, propofol, thiopenton etomidate , bzd and opioids.
Local anesthetics work by blocking sodium channels and interrupting nerve conduction. They are classified based on their chemical structure as esters or amides. Amides like lidocaine and bupivacaine are metabolized in the liver and have a lower risk of allergic reactions compared to esters. The potency, onset, and duration of local anesthetics depends on factors like lipid solubility, dose, pH, and addition of vasoconstrictors. Toxicity from local anesthetics is related to the dose administered and rate of absorption. Early symptoms of toxicity involve the central nervous system like agitation and seizures. Later, cardiovascular symptoms like arrhythmias and hypotension can occur. Treatment involves stopping administration, managing
Local anesthesia and nerve blocks in large animals.GangaYadav4
Local anesthesia involves the reversible loss of sensation in a limited area of the body using chemical agents without loss of consciousness. It is useful for reducing pain and stress during surgery. The document discusses various local anesthetics used in veterinary practice like lidocaine, bupivacaine and mepivacaine. It also covers the mechanisms of action, classifications, advantages, disadvantages and methods of administering local anesthesia like infiltration, regional and intravenous regional anesthesia. Toxicities can occur if the anesthetic is absorbed systemically. Proper technique and dose are important for safe use of local anesthesia.
1. Local anesthesia involves injecting chemical agents near sensory neurons to temporarily disrupt nerve impulses and induce loss of sensation. It has advantages over general anesthesia like low toxicity and excellent pain control.
2. Common local anesthetic agents include lidocaine, bupivacaine, mepivacaine, and procaine. They work by blocking sodium channels and preventing nerve impulse transmission.
3. Local anesthetics can be administered via infiltration, nerve blocks, epidurals, and other regional techniques to induce localized numbness for various surgical procedures. Proper administration and dosage are important to avoid adverse effects.
This document discusses various intravenous anaesthetic agents. It describes the classification of IV induction agents as barbiturates like thiopentone and methohexitone, or non-barbiturates like propofol, etomidate, ketamine and benzodiazepines. It provides details on the properties, uses, advantages and side effects of specific agents like thiopentone, propofol and etomidate. Ketamine is discussed as an agent that produces dissociative anaesthesia and has strong analgesic effects.
The document provides information on various intravenous and inhalational drugs used in anaesthesia.
It discusses IV induction drugs like propofol, sodium thiopentone and etomidate. Propofol causes the most marked fall in blood pressure but is ideal for LMA. Sodium thiopentone directly depresses the heart but airway reflexes are better preserved than propofol. Etomidate causes the least cardiovascular depression but inhibition of adrenal function is a concern.
It also discusses the inhalational agent ketamine which provides dissociative anaesthesia and cardiovascular stability but unpleasant emergence reactions are common. The uptake and release of inhalational agents depends on alveolar gas concentration
Surgery – Anaesthesia -- By Prof.Dr.R.R.Deshpande
• This PPT includes most useful Information of Anaesthesia ,which is syllabus Topic from Shalya tantra syllabus of 4th BAMS . Paper 1 Part A Point 4 --- Local anaesthesia ,Paper 1 Part A Point 4 --- Regional and General anaesthesia .This PPT includes Types of Local Anesthesia ,Drugs used in Local Anaesthesia ,General Anesthesia & drugs for GA ,Muscle Relaxants ,Stages of GA,Spinal Anesthesia ,Comparision of LA & GA
Visit – www.ayurvedicfriend.com
Phone – 9226810630
This document discusses complications that can arise from regional anesthesia. It begins by defining an anesthetic complication and classifying complications as either local or systemic, and mild/severe or transient/permanent. Local complications can be attributed to the anesthetic solution or needle insertion and include issues like infection, tissue reaction, or hematoma. Systemic complications involve toxicity or allergic reaction. Prevention focuses on proper technique, like slow injection rates. Management of specific issues like trismus or nerve injury is also outlined. The conclusion emphasizes the importance of careful technique and minimal necessary doses to avoid complications.
properties, classification and principle of action of intravenous induction agent.
pharmacokinetics
comparison between properties of various agent
summary of ketamine, propofol, thiopenton etomidate , bzd and opioids.
Local anesthetics work by blocking sodium channels and interrupting nerve conduction. They are classified based on their chemical structure as esters or amides. Amides like lidocaine and bupivacaine are metabolized in the liver and have a lower risk of allergic reactions compared to esters. The potency, onset, and duration of local anesthetics depends on factors like lipid solubility, dose, pH, and addition of vasoconstrictors. Toxicity from local anesthetics is related to the dose administered and rate of absorption. Early symptoms of toxicity involve the central nervous system like agitation and seizures. Later, cardiovascular symptoms like arrhythmias and hypotension can occur. Treatment involves stopping administration, managing
Local anesthesia and nerve blocks in large animals.GangaYadav4
Local anesthesia involves the reversible loss of sensation in a limited area of the body using chemical agents without loss of consciousness. It is useful for reducing pain and stress during surgery. The document discusses various local anesthetics used in veterinary practice like lidocaine, bupivacaine and mepivacaine. It also covers the mechanisms of action, classifications, advantages, disadvantages and methods of administering local anesthesia like infiltration, regional and intravenous regional anesthesia. Toxicities can occur if the anesthetic is absorbed systemically. Proper technique and dose are important for safe use of local anesthesia.
Thiopental is an ultra short-acting barbiturate that is commonly used for induction of anesthesia. It works by facilitating the inhibitory neurotransmitter GABA at GABAA receptors in the brain, causing sedation, hypnosis and general anesthesia. Thiopental has a rapid onset within 10-20 seconds after intravenous injection and its effects wear off within 5-15 minutes. It is highly soluble in water and stable in solution. Common uses include induction of anesthesia, treatment of increased intracranial pressure, and cerebral protection during certain surgeries. Side effects include respiratory depression, emergence delirium and prolonged recovery.
This document summarizes information about local anesthetics used in central neuraxial blocks and their toxicity. It discusses how local anesthetics work, the drugs and doses used in epidural and spinal anesthesia, risks of local anesthetic systemic toxicity, prevention methods, and treatment of toxicity. Signs and symptoms of toxicity are outlined for the central nervous and cardiovascular systems. Risk factors, complications like methemoglobinemia, and neural toxicity are also reviewed.
This document provides guidelines for managing severe local anesthetic toxicity:
1. Signs of toxicity include sudden changes in mental status, seizures, and cardiovascular collapse. Immediate steps are to secure the airway, provide oxygen, treat seizures, and assess the cardiovascular system.
2. For circulatory arrest, start CPR and treat arrhythmias. Consider lipid emulsion and continue CPR during treatment. For stable patients, consider lipid emulsion and treat hypotension, bradycardia, or tachyarrhythmias.
3. Follow up includes monitoring for pancreatitis, reporting cases, and safe transfer until recovery is achieved.
Consensus guidelines for the management of PONVDr Krunal Bhatt
The document provides guidelines for managing postoperative nausea and vomiting (PONV) based on a review of recent literature. It describes the incidence and causes of PONV, risk factors, and the effectiveness of various pharmacologic and nonpharmacologic therapies both alone and in combination, including 5-HT3 receptor antagonists, neurokinin 1 receptor antagonists, corticosteroids, butyrophenones, antihistamines, scopolamine patches, and acupuncture/acustimulation. Optimal dosing and timing of antiemetic administration is discussed.
Lidocaine is a rapid-acting local anesthetic first synthesized in 1943 that was approved by the FDA in 1948. It is widely used for local anesthesia and pain management. Lidocaine works by blocking sodium channels in neurons, preventing action potentials and nerve conduction. It has a short half-life of 1.6 hours and is metabolized in the liver. Lidocaine is commonly administered via local injection but is also available in topical forms and as an intravenous antiarrhythmic. When combined with a vasoconstrictor like epinephrine, lidocaine has an increased duration of anesthesia. Lidocaine remains the gold standard for local anesthesia due to its fast onset and short duration of action.
Local anesthesia complications can be divided into those associated with absorption of the anesthetic solution and those associated with needle insertion. Complications from solution absorption include toxicity from overdose, idiosyncrasy from abnormal reactions, allergy, and anaphylaxis. Toxicity symptoms involve early CNS stimulation and late CNS depression that can lead to respiratory depression and death if not treated. Prevention focuses on careful patient evaluation, using minimum effective doses, and monitoring after injection. Needle insertion complications involve issues like fainting, infection, and nerve injury.
General anesthesia is used in ruminants and camels for surgical procedures. It provides effective pain control and immobilization. Ruminants face risks like regurgitation and aspiration during anesthesia due to their physiology. Care must be taken to position them laterally and pass a stomach tube. Various sedative combinations can be used for induction and maintenance, with inhalant gases being preferred for longer procedures. Close monitoring of vitals is important to avoid cardiovascular and respiratory depression. Post-operative pain management is also important due to the stoic nature of these animals.
Intravenous induction agents are drugs that cause rapid loss of consciousness when given intravenously in an appropriate dose. The ideal IV induction drug has rapid onset and offset, minimal cardiorespiratory depression, no excitatory effects, and is safe to use across patient populations. Common IV induction agents discussed include barbiturates, propofol, ketamine, etomidate, and benzodiazepines. Each drug has unique effects on organ systems and potential complications that must be considered when selecting an agent for induction of anesthesia.
This document provides information on principles of anesthesia use in cattle. Some key points include:
1) Cattle are not ideal subjects for heavy sedation or general anesthesia due to risks of regurgitation and aspiration.
2) Common sedative drugs used in cattle include xylazine, detomidine, medetomidine, acepromazine, chloral hydrate, and pentobarbital.
3) Local anesthesia techniques described include nerve blocks and intravenous regional anesthesia.
A powerpoint explaining in detail about all the intravenous induction agents and their clinical uses, pharmacokinetics & pharmacodynamics, adverse effects and complications.
This document discusses complications of local anesthesia. It begins by defining complications as any deviation from the normal expected pattern during or after local analgesia. Complications are then classified and discussed in two main categories: those associated with absorption of the anesthetic solution and those associated with needle insertion. Systemic complications from solution absorption include toxicity, idiosyncrasy, allergy, and anaphylaxis. Toxicity occurs due to overdosage and is manifested by early CNS stimulation and late CNS depression symptoms. Prevention focuses on careful patient evaluation, use of weak concentrations, vasoconstrictors, and minimal volumes. Treatment ranges from observation to IV barbiturates and oxygen depending on severity of symptoms.
This document provides information on various local anaesthetics, including their classification, mechanisms of action, durations of effect, concentrations used, metabolism and side effects. It discusses aminoester and aminoamide local anaesthetics such as procaine, lignocaine, mepivacaine, prilocaine, bupivacaine, levobupivacaine, ropivacaine and etidocaine. It also briefly mentions dibucaine as having the longest duration of action of any local anaesthetic.
This document provides an overview of local anaesthesia including:
- A definition and historical background of local anaesthetics such as cocaine and procaine.
- Desirable properties and classifications of local anaesthetics.
- Details on common local anaesthetics like lidocaine including mechanism of action, dosage, and comparisons to other agents.
- Factors to consider in selecting a local anaesthetic for a patient and important information to obtain from the patient.
- Techniques for administering local anaesthesia and managing complications.
Intravenous induction agents are drugs that cause rapid loss of consciousness when given intravenously. Some of the most commonly used agents are thiopental, propofol, etomidate, and ketamine. Thiopental was the first agent introduced in the 1930s and provided rapid induction but was unsuitable for maintenance. Propofol provides pleasant sedation and recovery but causes hypotension. Etomidate offers hemodynamic stability but can cause excitation. Ketamine produces dissociative anesthesia and analgesia with cardiorespiratory stability but may cause emergence reactions. Each agent has advantages and disadvantages depending on the surgical situation and patient characteristics.
This document provides information on general anesthesia, local anesthesia, and conscious sedation including:
- The key differences between general anesthesia, local anesthesia, and conscious sedation.
- The American Society of Anesthesiologists patient physical status classification system.
- The stages of general anesthesia according to Guedel and Gillespie.
- Common routes of administration for anesthesia including intravenous, inhalation, intramuscular, and oral.
- Common drugs used for intravenous and inhalation anesthesia like propofol, sevoflurane, and ketamine.
- Guidelines for preoperative, intraoperative, and postoperative care when providing general anesthesia.
This document defines local anesthetics and describes their properties and mechanisms of action. It discusses various local anesthetics including lidocaine, prilocaine, bupivacaine, ropivacaine, dibucaine, benzocaine, butamben, and oxethazaine. It covers their uses for surface anesthesia, infiltration, nerve blocks, epidurals, and other techniques. Complications are also summarized.
This document provides information on post-chemotherapy care and management of side effects. It discusses extravasation, which is when chemotherapy leaks from the vein into surrounding tissue. It classifies extravasation reactions and describes how to recognize and manage it. It also covers chemotherapy-induced nausea and vomiting (CINV), discussing pathophysiology and providing recommendations for preventing nausea based on emesis risk. The document further addresses febrile neutropenia, defining it and outlining management strategies. It then discusses anemia as a side effect of chemotherapy and radiation, describing treatment goals and options. Finally, the document defines mucositis as inflammation of mucosal surfaces throughout the body.
This document provides an introduction to general anaesthesia. It discusses the stages of anaesthesia according to the Guedel classification system and describes various drugs used in anaesthesia including intravenous agents like thiopentone, propofol, and benzodiazepines. It also discusses inhalational agents such as nitrous oxide, ether, halothane, isoflurane, and sevoflurane. Finally, it covers muscle relaxants, distinguishing between depolarizing agents like suxamethonium and non-depolarizing agents. The document provides an overview of the pharmacodynamics and uses of these different drug classes for anaesthesia.
Ropivacane: A new break through in regional and neuraxial BlockadeProf. Mridul Panditrao
No significant changes in vitals. Minimal bradycardia and fall in BP observed in a few patients.
No significant events like Nausea, Vomiting, Shivering,
Pruritus, Sedation, Respiratory distress etc.
No need for rescue analgesia in 30 patients (75%)
Rescue analgesia given in 10 patients (25%)
Systemic complications can arise from either the absorption of local anesthetic solutions or from needle insertion. Complications from absorption include toxicity, allergy, anaphylaxis, and idiosyncratic reactions due to the local anesthetic agent. Complications from needle insertion are local effects like pain, edema, and hematoma formation. Prevention focuses on using the minimum effective dose and concentration of local anesthetic and vasoconstrictor. Treatment depends on the specific complication but may include oxygen, IV fluids, antihistamines, epinephrine, or barbiturates.
Emergency situations during hair transplant and how to avoid them.DrAnilKumarGargRejuv
Hair Transplant surgery is a safe outpatient day surgery.
Emergencies are uncommon but can appear suddenly.
Many of the emergencies, but not all, are preventable through attentive pre-operative and intraoperative care.
Clinic doctors and support staff must be prepared to manage emergencies.
Potential medical conditions which may convert into life-threatening emergencies during Hair transplant are-
Medication- Lidocaine toxicity, drug interactions( beta-blockers with adrenaline, lidocaine with Dilantin ), over sedation.
Allergy/ Anaphylactic shock
Hypotension- due to hypovolemia, cardiovascular shock, vasovagal syndrome.
Cardiovascular- Angina, myocardial infarction, arrhythmias (cardiac arrest).
Pulmonary- Dyspnea, Asthma, respiratory arrest.
Neurologic- seizures, stroke
Coagulation- bleeding diathesis
Trauma- accidental injury/fall
Thiopental is an ultra short-acting barbiturate that is commonly used for induction of anesthesia. It works by facilitating the inhibitory neurotransmitter GABA at GABAA receptors in the brain, causing sedation, hypnosis and general anesthesia. Thiopental has a rapid onset within 10-20 seconds after intravenous injection and its effects wear off within 5-15 minutes. It is highly soluble in water and stable in solution. Common uses include induction of anesthesia, treatment of increased intracranial pressure, and cerebral protection during certain surgeries. Side effects include respiratory depression, emergence delirium and prolonged recovery.
This document summarizes information about local anesthetics used in central neuraxial blocks and their toxicity. It discusses how local anesthetics work, the drugs and doses used in epidural and spinal anesthesia, risks of local anesthetic systemic toxicity, prevention methods, and treatment of toxicity. Signs and symptoms of toxicity are outlined for the central nervous and cardiovascular systems. Risk factors, complications like methemoglobinemia, and neural toxicity are also reviewed.
This document provides guidelines for managing severe local anesthetic toxicity:
1. Signs of toxicity include sudden changes in mental status, seizures, and cardiovascular collapse. Immediate steps are to secure the airway, provide oxygen, treat seizures, and assess the cardiovascular system.
2. For circulatory arrest, start CPR and treat arrhythmias. Consider lipid emulsion and continue CPR during treatment. For stable patients, consider lipid emulsion and treat hypotension, bradycardia, or tachyarrhythmias.
3. Follow up includes monitoring for pancreatitis, reporting cases, and safe transfer until recovery is achieved.
Consensus guidelines for the management of PONVDr Krunal Bhatt
The document provides guidelines for managing postoperative nausea and vomiting (PONV) based on a review of recent literature. It describes the incidence and causes of PONV, risk factors, and the effectiveness of various pharmacologic and nonpharmacologic therapies both alone and in combination, including 5-HT3 receptor antagonists, neurokinin 1 receptor antagonists, corticosteroids, butyrophenones, antihistamines, scopolamine patches, and acupuncture/acustimulation. Optimal dosing and timing of antiemetic administration is discussed.
Lidocaine is a rapid-acting local anesthetic first synthesized in 1943 that was approved by the FDA in 1948. It is widely used for local anesthesia and pain management. Lidocaine works by blocking sodium channels in neurons, preventing action potentials and nerve conduction. It has a short half-life of 1.6 hours and is metabolized in the liver. Lidocaine is commonly administered via local injection but is also available in topical forms and as an intravenous antiarrhythmic. When combined with a vasoconstrictor like epinephrine, lidocaine has an increased duration of anesthesia. Lidocaine remains the gold standard for local anesthesia due to its fast onset and short duration of action.
Local anesthesia complications can be divided into those associated with absorption of the anesthetic solution and those associated with needle insertion. Complications from solution absorption include toxicity from overdose, idiosyncrasy from abnormal reactions, allergy, and anaphylaxis. Toxicity symptoms involve early CNS stimulation and late CNS depression that can lead to respiratory depression and death if not treated. Prevention focuses on careful patient evaluation, using minimum effective doses, and monitoring after injection. Needle insertion complications involve issues like fainting, infection, and nerve injury.
General anesthesia is used in ruminants and camels for surgical procedures. It provides effective pain control and immobilization. Ruminants face risks like regurgitation and aspiration during anesthesia due to their physiology. Care must be taken to position them laterally and pass a stomach tube. Various sedative combinations can be used for induction and maintenance, with inhalant gases being preferred for longer procedures. Close monitoring of vitals is important to avoid cardiovascular and respiratory depression. Post-operative pain management is also important due to the stoic nature of these animals.
Intravenous induction agents are drugs that cause rapid loss of consciousness when given intravenously in an appropriate dose. The ideal IV induction drug has rapid onset and offset, minimal cardiorespiratory depression, no excitatory effects, and is safe to use across patient populations. Common IV induction agents discussed include barbiturates, propofol, ketamine, etomidate, and benzodiazepines. Each drug has unique effects on organ systems and potential complications that must be considered when selecting an agent for induction of anesthesia.
This document provides information on principles of anesthesia use in cattle. Some key points include:
1) Cattle are not ideal subjects for heavy sedation or general anesthesia due to risks of regurgitation and aspiration.
2) Common sedative drugs used in cattle include xylazine, detomidine, medetomidine, acepromazine, chloral hydrate, and pentobarbital.
3) Local anesthesia techniques described include nerve blocks and intravenous regional anesthesia.
A powerpoint explaining in detail about all the intravenous induction agents and their clinical uses, pharmacokinetics & pharmacodynamics, adverse effects and complications.
This document discusses complications of local anesthesia. It begins by defining complications as any deviation from the normal expected pattern during or after local analgesia. Complications are then classified and discussed in two main categories: those associated with absorption of the anesthetic solution and those associated with needle insertion. Systemic complications from solution absorption include toxicity, idiosyncrasy, allergy, and anaphylaxis. Toxicity occurs due to overdosage and is manifested by early CNS stimulation and late CNS depression symptoms. Prevention focuses on careful patient evaluation, use of weak concentrations, vasoconstrictors, and minimal volumes. Treatment ranges from observation to IV barbiturates and oxygen depending on severity of symptoms.
This document provides information on various local anaesthetics, including their classification, mechanisms of action, durations of effect, concentrations used, metabolism and side effects. It discusses aminoester and aminoamide local anaesthetics such as procaine, lignocaine, mepivacaine, prilocaine, bupivacaine, levobupivacaine, ropivacaine and etidocaine. It also briefly mentions dibucaine as having the longest duration of action of any local anaesthetic.
This document provides an overview of local anaesthesia including:
- A definition and historical background of local anaesthetics such as cocaine and procaine.
- Desirable properties and classifications of local anaesthetics.
- Details on common local anaesthetics like lidocaine including mechanism of action, dosage, and comparisons to other agents.
- Factors to consider in selecting a local anaesthetic for a patient and important information to obtain from the patient.
- Techniques for administering local anaesthesia and managing complications.
Intravenous induction agents are drugs that cause rapid loss of consciousness when given intravenously. Some of the most commonly used agents are thiopental, propofol, etomidate, and ketamine. Thiopental was the first agent introduced in the 1930s and provided rapid induction but was unsuitable for maintenance. Propofol provides pleasant sedation and recovery but causes hypotension. Etomidate offers hemodynamic stability but can cause excitation. Ketamine produces dissociative anesthesia and analgesia with cardiorespiratory stability but may cause emergence reactions. Each agent has advantages and disadvantages depending on the surgical situation and patient characteristics.
This document provides information on general anesthesia, local anesthesia, and conscious sedation including:
- The key differences between general anesthesia, local anesthesia, and conscious sedation.
- The American Society of Anesthesiologists patient physical status classification system.
- The stages of general anesthesia according to Guedel and Gillespie.
- Common routes of administration for anesthesia including intravenous, inhalation, intramuscular, and oral.
- Common drugs used for intravenous and inhalation anesthesia like propofol, sevoflurane, and ketamine.
- Guidelines for preoperative, intraoperative, and postoperative care when providing general anesthesia.
This document defines local anesthetics and describes their properties and mechanisms of action. It discusses various local anesthetics including lidocaine, prilocaine, bupivacaine, ropivacaine, dibucaine, benzocaine, butamben, and oxethazaine. It covers their uses for surface anesthesia, infiltration, nerve blocks, epidurals, and other techniques. Complications are also summarized.
This document provides information on post-chemotherapy care and management of side effects. It discusses extravasation, which is when chemotherapy leaks from the vein into surrounding tissue. It classifies extravasation reactions and describes how to recognize and manage it. It also covers chemotherapy-induced nausea and vomiting (CINV), discussing pathophysiology and providing recommendations for preventing nausea based on emesis risk. The document further addresses febrile neutropenia, defining it and outlining management strategies. It then discusses anemia as a side effect of chemotherapy and radiation, describing treatment goals and options. Finally, the document defines mucositis as inflammation of mucosal surfaces throughout the body.
This document provides an introduction to general anaesthesia. It discusses the stages of anaesthesia according to the Guedel classification system and describes various drugs used in anaesthesia including intravenous agents like thiopentone, propofol, and benzodiazepines. It also discusses inhalational agents such as nitrous oxide, ether, halothane, isoflurane, and sevoflurane. Finally, it covers muscle relaxants, distinguishing between depolarizing agents like suxamethonium and non-depolarizing agents. The document provides an overview of the pharmacodynamics and uses of these different drug classes for anaesthesia.
Ropivacane: A new break through in regional and neuraxial BlockadeProf. Mridul Panditrao
No significant changes in vitals. Minimal bradycardia and fall in BP observed in a few patients.
No significant events like Nausea, Vomiting, Shivering,
Pruritus, Sedation, Respiratory distress etc.
No need for rescue analgesia in 30 patients (75%)
Rescue analgesia given in 10 patients (25%)
Systemic complications can arise from either the absorption of local anesthetic solutions or from needle insertion. Complications from absorption include toxicity, allergy, anaphylaxis, and idiosyncratic reactions due to the local anesthetic agent. Complications from needle insertion are local effects like pain, edema, and hematoma formation. Prevention focuses on using the minimum effective dose and concentration of local anesthetic and vasoconstrictor. Treatment depends on the specific complication but may include oxygen, IV fluids, antihistamines, epinephrine, or barbiturates.
Emergency situations during hair transplant and how to avoid them.DrAnilKumarGargRejuv
Hair Transplant surgery is a safe outpatient day surgery.
Emergencies are uncommon but can appear suddenly.
Many of the emergencies, but not all, are preventable through attentive pre-operative and intraoperative care.
Clinic doctors and support staff must be prepared to manage emergencies.
Potential medical conditions which may convert into life-threatening emergencies during Hair transplant are-
Medication- Lidocaine toxicity, drug interactions( beta-blockers with adrenaline, lidocaine with Dilantin ), over sedation.
Allergy/ Anaphylactic shock
Hypotension- due to hypovolemia, cardiovascular shock, vasovagal syndrome.
Cardiovascular- Angina, myocardial infarction, arrhythmias (cardiac arrest).
Pulmonary- Dyspnea, Asthma, respiratory arrest.
Neurologic- seizures, stroke
Coagulation- bleeding diathesis
Trauma- accidental injury/fall
This document discusses obstetric analgesia and anesthesia techniques. It covers:
1) Characteristics of drugs used including local anesthetics, their mechanisms of action, and placental transfer.
2) Techniques for regional analgesia including local infiltration, epidural, spinal and their combinations. Systemic analgesics are also discussed.
3) Considerations for analgesia and anesthesia in abnormal obstetrics like fetal distress, preeclampsia, hemorrhage. Safety of mother and fetus is the primary concern.
This document discusses contrast-induced nephropathy (CIN), an important cause of hospital-acquired acute kidney injury. It defines CIN and outlines its risk factors such as pre-existing kidney disease, diabetes, procedures using high volumes of contrast, and certain medications. The mechanisms of CIN and its natural history are described. Prevention strategies like adequate hydration and use of low-osmolar contrast agents are recommended. The role of N-acetylcysteine in prevention is controversial based on conflicting trial results. The overall incidence of CIN in one study was reported as 12.6%.
This document discusses contrast reactions and their management. It begins by stating that contrast reactions can range from minor to life-threatening. Proper preparation is needed to treat all potential adverse events. Risk factors for reactions include previous reactions, renal insufficiency, and medications. Reactions are classified as idiosyncratic or non-idiosyncratic. Idiosyncratic reactions are unpredictable and severe. Non-idiosyncratic reactions depend on properties of the contrast agent like osmolality. Management involves stabilizing airway, breathing, and circulation. Specific treatments are outlined for mild, moderate, and severe reactions like urticaria, bronchospasm, and hypotension.
Fentanyl is a synthetic opioid analgesic that is 100 times more potent than morphine. It is commonly used in surgical settings for its short duration of action and analgesic effects. It works by binding to mu opioid receptors in the brain, spinal cord, and other tissues. Some applications of fentanyl include use as an anesthetic adjunct, for acute postoperative pain, and for chronic pain or cancer pain management. It has several routes of administration but carries risk of respiratory depression so must be carefully monitored.
A 30-year-old female presented to the emergency department with vomiting, sweating and shortness of breath for 45 minutes after ingesting an unknown substance one hour prior. On examination, she had bradycardia, hypotension, constricted pupils, hyper salivation, diaphoresis and crepitations in both lungs. Based on the history and examination findings, OPC (organophosphorus compound) poisoning was suspected. Treatment for OPC poisoning includes atropine to reverse muscarinic effects, pralidoxime as a specific antidote to reactivate cholinesterase, supportive care and monitoring for complications like intermediate syndrome.
Various forms of contrast media have been used to improve medical imaging.
• Their value has long been recognized, as attested to by their common daily use
in imaging departments worldwide.
• Like all other pharmaceuticals, however, these agents are not completely devoid
of risk.
• Adverse side effects from the administration of contrast media vary from minor
physiological disturbances to rare severe life-threatening situations.
• Preparation for prompt treatment of contrast media reactions must include
preparation for the entire spectrum of potential adverse events and include
prearranged response planning with availability of appropriately trained
personnel, equipment, and medications.
• Thorough familiarity with the presentation and emergency treatment of
contrast media reactions must be part of the environment in which all
intravascular contrast media are administered.
1. Neonatal seizures are commonly caused by hypoxic ischemic encephalopathy, intracranial hemorrhage, or metabolic disorders. Phenobarbital and levetiracetam are the main anticonvulsant drugs used for treatment.
2. It is important to provide supportive care during seizures to ensure proper airway, breathing, and circulation. Seizures become more difficult to treat the longer they last.
3. Anticonvulsants can be stopped if the neonate has been seizure-free for over 72 hours and has normal neurological examination and EEG results.
1. The document discusses various complications that can arise from local anesthesia (L.A.) administration including toxic overdose reactions, allergic reactions, and idiosyncratic responses.
2. Toxic overdose occurs when too high of a concentration of the drug reaches the bloodstream, potentially causing central nervous system or cardiovascular system effects like seizures, changes in heart rate and blood pressure, or cardiac arrest.
3. Allergic reactions involve a histamine response and can range from mild reactions like hives or swelling to life-threatening anaphylaxis. Proper allergy testing of patients is recommended.
This document discusses anticoagulation and neuraxial anesthesia. It begins by introducing some risks of anticoagulation like bleeding. It then focuses on the risks of spinal and epidural hematoma formation during regional anesthesia when patients are anticoagulated. It provides recommendations from ASRA on the timing of regional blocks for various anticoagulants like heparin, LMWH, warfarin, antiplatelets, and newer anticoagulants. It also briefly discusses peripheral nerve blocks and herbal therapies. The recommendations aim to balance thrombosis prevention with bleeding risks from regional anesthesia.
Complications of anesthesia
This topic aim to provide information on some common clinical condition that occur to the patients after anesthetized required procedure
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3. Classification of Local anesthesia
according to :
Onest
Rapid
Lidocaine
Medium
Ropivacaine & Prilocaine
Slow
Bupivacaine & Tetracaine
4. Mechanism of Action
• Alerts depolarization in neurons by blocking the fast voltage gated
sodium (NA+) channels in all cell membrane
• With sufficient blockade , the membrane of the presynaptic
neuron will not depolarize and so fail to transmit the action
potential , leading to its anaethetic effects
5. Action on CNS
1):blocks conduction
around the nerve "
anaesthesia"
2):initially causes
drowsiness &
lethargy
3):higher doses cause
excitation followed
by depression
Action on CVS
1):On Heart: -
Abbreviates effective
refractory period
2):On Blood Vessels :-
Vasodilatation in the
injected area
6. I ):Source & chemistry
Lidocaine, the first amino amid type local anesthetic,
was first synthesized under the name Xylocaine by Swedish
Chemist Nils Lofgren in 1943
Lidocaine
7. • Ph of plain solution : 6.5
• Ph of vasoconstrictor containing solution : 5_5.5
• Onset of action : rapid
• Pregnancy classification : B
• Effective dental concentration : 2 %
• Protein binding : 60_80 %
• Distribution : Lipo-philic , widely distributed into body
8. • Absorption : absorbed rapidly after parental administration & from GIT
& Respiratory Tract
• Metabolism : metabolized in liver
• Excretion : metabolites & unchanged drug are excreted by the kidneys
in the urine
II ):Pharmacokinetics
12. VI): Precautions
1):If you are using this medicine in the mouth or throat, do not eat or drink
anything for one hour after using it.
2):Do not use cosmetics or other skin care products on the treated skin
areas
3):If you are using the viscous topical solution medicine in the mouth or
throat, be aware of signs of toxicity. If you or your child experience
lethargy, shallow breathing, or seizures after use of this medication,
seek immediate medical attention and do not give any more doses
13. VII): Effect on Pregnancy & lactation
• 1):Effect on pregnancy :
Does not show evidence of harm to the fetus .
• 2):Effect on lactation :
No adverse effect on breastfeeding
15. IX):Doses
• 1):Usual Adult Dose for Local Anesthesia
• Local Injectable Anesthesia:
-Maximum individual dose: 4 mg/kg (IV regional anesthesia); 4.5
mg/kg (infiltration)
-Maximum total dose: 300 mg .
• 2):Usual Adult Dose for (Ventricular-
Tachycardia/Fibrillation)&Cardiac Arrhythmia
• Initial dose: 50 to 100 mg IV bolus once over 2 to 3 minutes; may
repeat after 5 minutes if necessary not to exceed up to 300 mg in a 1-
hour period
Following bolus administration: 1 to 4 mg/min continuous IV infusion .
16. X):Routes of Administration
1):Intravenous injections ( sometimes combined with "Epinephrine" )
2):Dermal patch ( sometimes combined with
Prilocaine )
3):Topical gel
4):Nasal instillationspray ( combined with
“Phenylephrine” )
5):Epidural
6):Spinal anesthesia
20. I):Chemical structure
• A local anaesthetic drug belonging to the amino amide group. The
name ropivacaine refers to both the racemate and the marketed S-
enantiomer .Ropivacaine hydrochloride is commonly marketed by
AstraZeneca under the trade name Naropin.
21. II):Pharmacokinetic properties
• The plasma concentration of ropivacaine depends on the total dose
administered and the route of administration, as well as the
haemodynamic and circulatory condition of the patient and vascularity
of the administration site
• When ropivacaine was administered intravenously in subjects, its
pharmacokinetics were linear and dose proportional up to 80 mg
• The absorption of ropivacaine 150 mg from the epidural space is
complete and biphasic. The mean half-life of the initial phase is
approximately 14 minutes, followed by a slower phase
22. • with a mean absorption t1/2 of approximately 4.2 hours.
• Ropivacaine is bound to plasma proteins to an extent of 94%, mainly to
α1-acid glycoprotein. The total plasma concentration increase during
continuous epidural infusion of ropivacaine is caused by an increase in
the degree of protein binding and subsequent decrease in clearance of
ropivacaine .
• Ropivacaine rapidly crosses the placenta during epidural administration
for caesarean section, resulting in near complete equilibrium of the
free fraction of ropivacaine
23. • ropivacaine in the maternal and foetal circulation However, the total
plasma concentration of ropivacaine was lower in the foetal circulation
than in the maternal circulation, reflecting the binding of ropivacaine to
α1-acid glycoprotein, which is more concentrated in maternal than in
foetal plasma
24. III):Therapeutic uses
Ropivacaine is used as a local (in only one area) anesthesia for a
spinal block, also called an epidural. The medication is used to
provide anesthesia during a surgery or C-section, or to ease
labor pains.
Ropivacaine may also be used for purposes not listed in this
medication guide.
26. V):Contraindications / Cautions
Intra-articular continuous infusion
Caution if hepatic impairment
Caution if renal impairment
Caution if impaired cardiac
Caution if heart block
Caution if hypovolemia
•
27. VI):Precautions
• Ropivacaine should only be used by clinicians well versed in the
potential toxicities that may occur with local anesthetics and the
management of those toxicities. Adequate oxygen, resuscitative
equipment and personnel resources should be immediately
available prior to the administration of any local anesthetic.
• The general condition of the patient should be optimized and an
intravenous line inserted prior to receiving major
28. • blocks. All necessary precautions should be taken to prevent
intravascular injection.
• Ropivacaine is contraindicated in any patient with a known
hypersensitivity to ropivacaine or any amide-type local
anesthetic.
• As with all local anesthetics, ropivacaine should be dosed in
increments. Avoid rapid injection in emergency situations where a
fast onset of surgical anesthesia is needed. Aspiration for blood
or cerebrospinal fluid should be performed
• prior to epidural injection of the local anesthetic.
29. VII):Pregnancy & Lactation
• Pregnancy Category: C
• Lactation: not known if excreted in breast milk
• in LIFE-THREATENING emergencies when no safer drug
available. Positive evidence of human fetal risk.
• Do not use in pregnancy. Risks involved outweigh potential
benefits. Safer alternatives exist.
30. VIII ):Interactions
• Ropivacaine can cause numbness over a large portion of your
body. Take care to avoid injury before the feeling has returned
completely.
• Tell your doctor about all your current medicines and any you
start or stop using, especially
fluvoxamine
ketoconazole
an antibiotic--ciprofloxacin, enoxacin, norfloxacin, ofloxacin
31. a heart rhythm medication--amiodarone (Cordarone, Pacerone),
dronedarone (Multaq), dofetilide (Tikosyn), ibutilide (Corvert), or
sotalol (Betapace).
• This list is not complete. Other drugs may interact with
ropivacaine, including prescription and over-the-counter
medicines, vitamins, and herbal products. Not all possible
interactions are listed in this medication guide.
32. IX):Dosage & Route of Adminsteration
• Ropivacaine is given as an injection through a needle placed into an
area of your middle or lower back near your spine. You will receive this
injection in a hospital or surgical setting.
• Your breathing, blood pressure, oxygen levels, and other vital signs will
be watched closely while you are receiving ropivacaine.
• Some numbing medications can have long-lasting or delayed effects.
Talk to your doctor if you have concerns about this risk. Call your
doctor if you have joint pain or stiffness, or weakness in any part of
your body that occurs after your surgery, even months later.
• Tell your caregivers right away if you think you have received too much
of this medicine.
35. prilocaine
is a local anesthetic of the amino amide type first prepared by Claes
Tegner and Nils L. In its injectable form (trade name Citanest), it is
often used in dentistry. It is also often combined with lidocaine as a
topical preparation for dermal anesthesia (lidocaine/prilocaine or
EMLA), for treatment of conditions like paresthesia. As it has low
cardiac toxicity, it is commonly used for intravenous regional
anaesthesia
36. I):Source and chemistry
Chemical and physical data
Formula C13H20N2O
Molar mass 220.311 g/mol
Structure
Melting point 37 to 38 °C (99 to 100 °F)
Chemical and physical data
C13H20N2O
220.311 g/mol
37 to 38 °C (99 to 100 °F)
37. II):Pharmacokinetic properties
• Protein binding 55%
• Metabolism Hepatic and renal
• Biological half-life 10-150 minutes, longer with impaired hepatic or
renal function
38. III):Contraindication
• In some patients, ortho-toluidine, a metabolite of prilocaine, may
cause methemoglobinemia, which may be treated with
methylene blue. Prilocaine may also be contraindicated in people
with sickle cell anemia, anemia, or symptomatic hypoxia.
• People with pseudocholinesterase deficiency may have difficulty
metabolizing this anesthetic
40. V):Side effect and adverse reaction
• Adverse CNS and cardiovascular effects, swelling and
persistent paresthesia of the lips and oral tissues, persistent
neurologic deficit. (See CNS Effects and also Cardiovascular
Effects, under Cautions.)
• Some side effects of prilocaine may not be reported. Always
consult your doctor or healthcare specialist for medical
advice. You may also report side effects to the FDA.
42. VII):Precautions
• Keep a list of all your drugs (prescription, natural products, vitamins,
OTC) with you. Give this list to your doctor.
• Check all drugs you are taking with your doctor. This drug may not mix
well with some other drugs.
• Do not eat while your mouth feels numb. You may bite your tongue.
• If you have a weak heart, talk with your doctor.
• Tell your doctor if you are pregnant or plan on getting pregnant.
• Tell your doctor if you are breast-feeding.
43. VIII):Effect on pregnancy and lactation
• Pregnancy
• In a study, the effect of prilocaine on pre- and postnatal development
was examined in rats treated with up to 2.8 times the maximum
recommended human dose of prilocaine in lidocaine-prilocaine gel
from day 6 of gestation to weaning. There was no evidence of altered
postnatal development, viability, or reproductive capacity in any
offspring.
• Lidocaine-prilocaine topical cream has been assigned to pregnancy
category B by the FDA. Animal studies have failed to reveal evidence
of impaired fertility or fetal harm. There are no controlled data in
human pregnancy. prilocaine topical cream is only recommended for
use during pregnancy when benefit outweighs risk
44. • lactation
• probably prilocaine, are excreted into human milk. Following
application of the cream to a nursing mother, the milk:plasma ratio of
lidocaine is 0.4 and is not determined for prilocaine. The manufacturer
recommends that caution be used when administering lidocaine-
prilocaine topical cream to nursing women.
45. IX):Dosages and Routes
• prilocaine periodontal (gingival) gel is used on the gums to cause
numbness or loss of feeling during dental procedures. This medicine
contains a mixture of two topical local anesthetics (numbing
medicines). It deadens the nerve endings in the gum.
• This medicine is available only with your dentist's prescription.
46. X):Storage
• This drug will be given to you in a hospital or doctor's office. You will
not store it at home.
• Store the medicine in a closed container at room temperature, away
from heat, moisture, and direct light. Keep from freezing.
• Keep out of the reach of children.
• Do not keep outdated medicine or medicine no longer needed.
• Ask your healthcare professional how you should dispose of any
medicine you do not use.
48. I):Source & chemistry
• Like lidocaine, bupivacaine is an amino-amide anesthetic; the
aromatic head and the hydrocarbon chain are linked by an amide
bond rather than an ester as in earlier local anesthetics
• As a result, the amino-amide anesthetics are more stable and
less likely to cause allergic reactions. Unlike lidocaine, the
terminal amino portion of bupivacaine (as well as mepivacaine,
ropivacaine, and levobupivacaine) is contained within
a piperidine ring; these agents are known as pipecholyl xylidines
49. II):Pharmacokinetic properties
• The rate of systemic absorption of bupivacaine and other local
anesthetics is dependent upon the dose and concentration of
drug administered, the route of administration, the vascularity of
the administration site, and the presence or absence of
epinephrine in the preparation.
• Onset of action (route and dose-dependent): 1-17 min
• Time to peak plasma concentration (for peripheral, epidural, or
caudal block): 30-45 min
• Protein binding: about 95%
• Metabolism: hepatic
• Excretion: renal (6% unchanged)
50. III):Therapeutic uses
• Bupivacaine is indicated for local infiltration, peripheral nerve
block, sympathetic nerve block, and epidural and caudal blocks.
It is sometimes used in combination with epinephrine to prevent
systemic absorption and extend the duration of action. The
0.75% (most concentrated) formulation is used in retrobulbar
block.[7] It is the most commonly used local anesthetic in epidural
anesthesia during labor, as well as in postoperative pain
management.
• NB;
• It can be used in infiltration anaesthesia, conduction anaethesia
&epidural anaesthesia
52. V):Contraindications
• Known or suspected hypersensitivity to bupivacaine.
• Skin infection adjacent to the intended site of injection, concomitant
anticoagulant therapy or an abnormal bleeding tendency.
• Severe anaemia or heart disease.
• Spinal and epidural anaesthetics should never be administered to
dehydrated or hypovolaemic patients.
53. VI):Precautions
• Facilities and equipment for resuscitation should be readily available at
all times.
• Assurance must be obtained that the patient is psychologically
prepared to accept the proposed procedure.
• High blood levels of bupivacaine must be avoided in patients with
hepatic impairment.
• Care must always be taken to avoid inadvertent intravascular injection.
54. VII):Pregnancy and lactation
• Use bupivacaine with caution during pregnancy if benefits outweigh
risks. Animal studies show risk and human studies are not available or
neither animal nor human studies were done.
• Bupivacaine excretion in breast milk is unknown. It is not
recommended if breastfeeding.
55. VIII):Inter action
• Co-administration of oxytocic drugs post-partum may cause severe and
prolonged hypertension. The use of bupivacaine preparations
containing epinephrine during or following the administration of
halothane or trichloroethylene creates a risk of cardiac dysrhythmias
56. IX):Dosage
• The aim is to administer the smallest effective dose. This varies with
the procedure adopted, the degree of anaesthesia required, the rate of
absorption from the injection site and the size and responsive-ness of
the patient. Higher initial blood levels are attained with more
concentrated solutions.
•
• The maximum cumulative safe dose for adults and children of a 0.25%
solution of bupivacaine is 1.5 mg/kg. The table provides a general
guide to dosage in adults. Smaller dosages should be administered to
debilitated, elderly, epileptic and acutely ill patients.
57. • Bupivacaine is generally not recommended for children aged less
than 12 years since there is insufficient information on the
effects of its use in this age group.
•
• Solutions containing preservatives should not be used for spinal,
epidural or caudal anaesthesia.
59. XI):Storage
• Bupivacaine injection should be kept protected from light and should
not be allowed to freeze. Ampoules should not be used if the solution
is discoloured.
62. I):Source and Chemistry
-Tetracaine was patented in 1930 and come into medical Use
in 1941 . --It's on the world health organization list of essential
medicines in a health system .
63. II):Pharmacokinetic properties
Tetracaine also know as amethocaine is local anesthetic used to numb
the eyes, nose and the foot . It may also be used before starting an
intravenous to decrease pain .
64. III):Therapeutic Uses
It's used to prevent pain and to induce anesthesia.
Topical : used during short surgical procedures and examination of the
eye.
Injectable : it's available in an to be given directly into the spinal cord by
health care professional.
65. IV):Contraindications
In the case of
-Sever burning, sting and swelling
-Redness and warmth
-Nervousness and dizziness
-Breathing problems
-Eye irritation, watering and increase sensitivity to the light
66. V):Precautions
1-Ophthalmic Route
*Protect you eyes from injury while they’re still numb.
*Do not use additional eye drops in the eye until your doctor tells you.
*protect your eyes from anything that may cause irritation like dust or
sand.
2-Topical Application Route
*If you have skin rash, burning, swelling or irritation; stop using the
drug.
*Don’t use cosmetics or other skin care products on the treated skin
areas.
67. VI):Effect On Pregnancy and Lactation
On pregnancy:-
No well controlled studies have been done in pregnant women.
So Tetracaine can be given to pregnant women if clearly needed.
On Lactation:
It’s not known if Tetracaine crossed into human milk. So the doctor and
the mother will decide if the benfits overweigh the risk of using the
drug.
68. VII):Drug Interactions
The drug has over 350 interactions like sulfonamides, sulfasalazine,
sumatriptan, zonisamaide, acetazolamide and celecoxib.
69. VIII):Dosages and Routes
1- Dosage of Tetracaine may be based on the following:
*The condition being treated
*Other medical conditions you have
*Other medications you’re taking
*How you respond to this medication
70. *Area to be anesthetized
*Technique of anesthesia
*Individual Tolerance.
The lowest dosage needed to provide effective anesthesia should be
administrated.
2- Routes
*Topical
*Parenteral
71. IX):Storage
-Store below 40 degree C (104 degree F)
Preferably between 15 and 30 degree C (59 ad 86 degree F)
-Store in a tight, light resistant container
-Protect from Freezing.
*Do not use the solution if it contains crystals or is cloudy or discolored.