Sedative YS Foanquilizer 5 ¢ t Ntarze ‘ous a_i pees eee a _ pdurrativr F sleep points Sedative _Trenguilizen Defyni tion Ane Pm agers Prakack | Ame the agents that & depressomts and have! ots an depressent 6 ability to achan: omalgesic droug High low Ailey im move Not ed 4o move | ‘May have he ability ane i | te move Exlennal : | Unaacme 6} the “4 entsPhenothi ezime denivatives Pog feat, 1+1— 6.6 Mgikg , 1M , ’ P.romazine hyde chloride. Frenqui ter Dafeat 2 “6 myiK TM ortv Chl erprothixene. deg. 22-44 mglks tv /im- MOA, Ginds with spectfics GABA Receptor on bea vL Evhonce GABA activity wy op eriong e|- channe} - vu Influx sf} et wt Myper planizeion f tHe cel] membrane wb Depre 51 s} ensDissociative Anes taste aii B Ane the class pychedelic, doug Aa? Wrnd usr @ Shyqnce Dike state, denying which a persm feel disso cake fosm theln body am surpounding s- Velewineny Importonce | Essect © Rapid onsek cmd Short duration action. @ muscle pelexatim: * @ Anelgesia- DM mryymeal Tesplpcckony depression - ® Lowen tisk Gf combiovanculan depression. types Bissoctetive. angthe tics TWIGSS or NS O ketene ty cause halfucinalins and ouk 6 bedyJ expemie ces hay both amal gesi ¢ aud omestretic prepevtes -» @ Pheneyclidine (PeP) 1 cause hallucinations, delusions i [ and. psychotic. Sperptems- ) Use ap esthetic oad reerteah'ow v ese Arugs. ® pextro-methr phan =D Produce hallucination and Aissach ative ; Stete Famd- In over counfen cough Suppte ssants.ee dra Ch eambinahin Gf todo ® filetamine -» nl do Ketamine ® 2olarepan— > . provide sedation and. muse tcdaration: Moa. Arply methetics ee , block the NMDA: Keceptor, im bain we prevent twas scien of fan signal. we 1 produce anestheh ¢ & analgesic effeot 4b produce Jeelirng of detachment oom, semracn Bing ard otete of Gis 50 ciatim. Dwwys: 6 Ketamine # 2-1org)kg @ ep hence cldine : tO. Specifre dose @® Tiietomize selaseparr. 1-$rg leg 2/30. Recrag be © Ketemine: os ® Tiletemine tleveeer! 9, 2 S-foy ig IVIEM -: Muscle: Relaxants * * A type “go = hak is wed doecelam-the wmistles dnd. Kaluee tensions Stiffness amd-patn. ba fsorvtetn Types— ~~ 0} Antispash city agents. «pre vents /reduce spasms. Example: © Dachjen © Tizanidine © Diarepon @ Dantwivrr, deuemeus cular blocking agents: TyPY—-2- One apalereig ‘agents: ex: © Traepiun/. Athacunium ® Nov earon/ Ve cumsrinm - © 2emunrm / Recunsniom - O Depolovising r= Suceinglehsire sterenen PUBS . E Dog OS" Zz rg lke 7 © Riazepen se o25-2 mg ls PO Remiermonts 3 5-15 gly TA/tv @ Atracuraem + Deg/cak 5 2-2-6 ng leg TV @ Ve &U fo NUM? Deg! cat 2 eG ry ley rm ® Reeunomium » og: *6-h 2 mpllg tv i eat’ 06-08 m/ke TY| Anesthetics; Gienenal AnestheHcs, Local Anesthetics. Ibalafion Anesthetics Anesthetics: Are the émgs thak “died to neduce en elérninack Jecling duvng medicat procedure « om: ane “he “ogents shat produce a meversille’ loss fb conciousness and emalgesia trperug hort tre, bedy- Use! @® used +o previde — pain relics dering surgery: @ Used to imdece a Stee Se uncenefusness: @ usel gor euthamsia. Dose: “O Ketwmin es cattle: BS vg ley gv/T 04», Lad sins De 2-4rgdKg Dvw/om 5 4-15 wiors @. Meenas eatite: a2 ng ley x ¥/se/ sey Sle nins. Pegi ted mg leg gusts se 1 S-le mens. © poop sfel! Deg: 0-5-2578 Veg, AM/IV 4 10-Se mins Local Anesthe Hest Ave the dug s “that produce < reversible 185 Ef sensatim/edneiovaness im a specitic _ &ren’ | bras. O Used + provide temporary relief Srem pain. , USeA fo mMinop surgical /Riagrsstre procedure @D Used to help minimize the Alsconfert-ey Dregs: = . lo-aome 1 hea, IM/zu/fse 1\O Lido e aine: cattle: ~ doa: 5-10 mg Thy IM/su/se ® Bupiva cine; Cacttte: 2-8 lg Tol se { : 228: 2-3 ng ley oT MISE @® Mepivactne: 4. joj wig heg” 20/5 - | Tnbelahim Anesthe tes Ave dnigs Buak ane mated. +o duce aeveret emeSthesia. indesee Unie tous ne 95, Teeduce pam use; —_@ Used +e Lk Provide: anascle Relexcort- B® Used +o uUthenlde arimals. @_ Used, da penjenm 4-na- Lltpa sounds endosegy: Qwegs: \ o Halothane: Cette: (4279 “HHrer -LO— 30 Wins Blows _ tine: ‘Dog! O-S- 2% -forr Prduchion ? re 1-390 gor -marertenance @ , bas Tseglarene! Cattle: 1-297 5 Time, 20-30 ming. Dog: 2-€9, for induchin 25-10 hr LSD for Mmamfermee—_ jor gormin,Ppe-cpepatve peti Mand-ement medicine OD medicahmr ASAT Ds _ @ NSALDs> Y Dintase oF @ w ‘el f +pauma Doma leg but 2eKg €a GY «= 2 malig veo), i , & dom Mey Wane bm: = Ami kee Pharma cologi cot dose x bint Be ee ah concentration: Dosing a vial | maien toi Ace Mein dose 4 Sema of Lyapiti gation “The process bs which the, viral SUSPENHIO, are cheonged Snare Liquid +o cake Jormatio -Pamagh Pre sgu tle eb. mérntarm 1©7o ma@i supe. ange tren heat :Neat thecara 4$t aos require = goml/ke dag amd Ag equi rs . Lomi lea dey, see ar : = \oml /ieg tbay Zales wdy Weigh - \ex Go 2 Seem loxas + 2d m) Tete 2 Foo mal / 209 196) 3 Avimal marntenmee ASS = Loom - tHagmon, 4 eo > sen. hal dere = (Foy 200). ™! 4 mlz 20 drops - Fen a4 ooomls Wx 20~ (Boda Msps Time = Shoss. Cx BERS 2 24,608. Drsps pep 41sec = eae = OR dvsps. Avene —> gdreps per ISecRole of Fluid thenapy!-DorneeHon of novmal ongoing, ce . #lufd losses - 1) Support of com thiovasevlaw fimeHon: in) Corneetion oF major aefd ~buve jm bel aneg . WW) Counber Vormalizatton of 02 delivery, V) counteri Prevent negative phystolog se effect by anesthetic agent? (hypotension vasodilator » Lenemal prince ips and patient assessment Assess for following tenes types of Huta dis tur banoy, 1) Chamge in volume (detydralion, blood los - W) Chang.2g “In content (hyper karemia) Hii) C bomgez Indi steldutfon (Pleural effusfon , Cleusiticaton of fluid amd elec troly het a) Tsotonie crystals df - Hots mann’s soluHon 2OR ate Oy). Yue)» b) Colloids: Denton Zo, meladin » C) Hypen tontc satin: Estimation of Flufa duwiag a fon curing dehydnahiy, | there ome 3 elements to consider ) Replocemen} h) hain }enom(e & Ongoing leroy HS Saline — Plecheotyte balane-¥ - > Tocnewse Hufd in blood . So, ‘vac tert) ‘Nood ov doxim concentration deom-cesedReeoery of anesthesia: Recovery: of anesthesiats defined af fire OC Of velurnin an animal to anommal phy sfologfea! the Influence -of omestives! fe. s Stake’ af bew fehng un den $1398! 1) Emengence From omestteHas.-id begink hen pre_ anesires(a i$ discontinued and animal stort tor-eg ah, CONSCIOUS NLS |. i) Recovery From anctthertar During om this stage, amiral TS awake but yay SHIl be Avowsy.omd disoriented . m) Post operakye core? Animal pecomen € d from he eo immidvate effeehs of omesthoara and tromsfened FO reeeive post operative cave sve OS parr MANageney , wound come »Phys{cal ther ary » Gx Dyrahon to Pecovienr? General onesthes{ar~ kelaimine, propode? , Hiopente, Cot— to-20 min for 0-02-O.1 my) kg » Cotte 15-35 min- for 2-b mg) ey ~ DOs -1o-30 Min -fow 0.0) ~ 012 my lle y Goad) 12-3G min. for 12-825 minor O1- bk Frolkg Loca) oncsexsa) Lidocaine, Bupi vacatne, Meps Vacaine Cat, 009, cate »goat ~ L28s tham 90 minuby .NSAIDS pe duce pasn )-decneuse Intlomimat, loeme ate even . ’ Sarhentterrti=atert - Trdication? Pre -opemative pain momag-crmner — Int lammmapomy conditton . Poracetamo)® Rumbrat cathe? Gomy ky PO follo wre d by Sa “some leg tut Po 6h: gor godt! Loma lee bur ; contra indica’ cot, dog, {menal snsodffereney ). Mmeloricom ~ Cattle) OGmg [Ney ° goat! O29 Ika . Tol fenasms € Aefd - 2-4 mole gy TG. _ Pages ¢3— Post 0 penaive parnimsnagemeny Te Lekiess — v-Lied Hs relieve PW - ketone 2 Dog! oFs/h- CRI + Ch Bu} 10.5 * Cat toprorofh CRI. Oposds - Ininacpenatve payne am Thomagemeg- > Traveation? Pain perief ) ome shesta, COQ deppresror, Freatmont of dfownecrg “CEB- Peni -procedura) mor phing Pain managen Doses Boe Img lkyFO 5 o.1-1mp/eg zy. Femeapr=b Cat! omg lg Po , Fen tony f - Dog. 0 005-0'0) SC,Amesthosiology Classi ficattons- ee : savers Anesthetic agents ame twotypes: - i A) Agents. for general Anesthesia, ®D Agents for local Anesthasie . 5 | Zeneral onesthetic cgents are “2types:- . 1) Tntravenovs omesthetfe Sern a aie entone Sodium tento bette . ms henirome ws os Tahalotion ag-x6 thetic agent \ sequin ca eee £9! Chlowo form, FH] chloride > EUpens!, Propofol mstomite Dieteyl iter; Holotane, steed Hee Be Fina “ATsoflurane, methory flu fond iat ton a on tah forate Witroas. ox ide ') .g eseus ee alive agent. Dt rae y , Famine hy oh D Local anesthetics s- eeenettonl de . 4. Cocatm bydvoehlorid ¢-— used for eye Sungenry (7 Cocaine byetroe hlert Be) | 2.2% Procaime hydrochloride 3-27. Ligmocaine bydroehlon/ de 05% Gupivacame hydroehlooide BMepvacain 2 6. Cinchocame ‘Anesthesias The tanm anesthesia is derived from the greek work consti, fanalstacsia meaning'in sensi bility’ is used +o, desenibe the loss of Serigation fo the entine om amy-pomt Of Hhebody. Anestresiais induced by drugs that depres the achvity of nenvous pissue locally, reprorally On witin the centra) nervous systems Ressons for Administering anesthesia’ a 1) To alleviate pain Induce muscle reloxction @& costentia) for So! Sungeny, Ww) Restrainina, amtma) WD Safe ‘troms port UD) evthomesfa , Typ of euthen-esia lees on novfe of: -odmni's reqtion [typeof drugs) | 1) Tubalation CD Trjechabl-e ( ovale» recks) oy Flecronay, |) Fras citomeevs 2 lectricalnenve sti mulation vp) Local emd Conduetion vit)Aeupunetvre vei) HypothermseyTewmt vy Anagesia’ - Refers to freedom from ov absence pain, t) “Franquilizatiuny enquihization nefers in behomoral change wherein anxiety is velteved omd the pation} beams betoxed bub remesns awome of itt Surnoundings. w) Sedation: Sedation 1s a state ehcoraetenized by contra] depression aceompanted bydwoassinag - “Tecpatient is generally Op aware of f}s suuerowndings bok nearer to. painfo) monipulaton . ty) Nadesis nesses: Nancosss ‘is acinus induced state of seep deep sleep from whieh: the patient Coon: notbe -croused | v) Hypnosis: “FS "gondition of ombificfalty’ Induced sheep resvl ting, fron Tr feneste depression of the crys from wie ee tepakent, Is readily amoused - vi) Local amesthesiar is a toss of sensation in tietumseribed body asnen - wi) Regionalonasthesia: is insensibllity in allormger frog. Almited , body ave (2:g* Pomulumber nerve bloele ) - vu) General anesthesia: is a. dug induced Uneonse fowsnees Hat ig Chamactenized by controlled ond vevensitie depresn OF He ENS ond omnal g-05fos +Ganena| onestresa, I Defy CIS depragemt, Chanactenized by loss of Conscious ness , loss of sendution Fadequate . muscle relaration « . E «Spb Stages of ene heen ‘ ilee Stoye ls Tndvetion slage or stage of Volumbeny eneitemensor” JB The animal i$ conscious and-mdy imulde foe ible effirds to arora camesthe h7-ed. Brecthingy is entinely Volitiona) and breath held MOY OCEYY. ~MHeneowe IMM pinatw y and ple va te i dilaton of the pupils. Unine and Faecs may be voided » : imvol antexaien-ent or delinum + Stugeds “w stage of Manali Fe nel read > loses Consciousness abovprty on ) Ne als ppd > Resprration is Imre gulom. 9 Phowyrgeal rediex plusent . > cough meflan ht presen, — Limb movement “became Bviokent stage 3° Stage of Sunateal omeshesian _ Plone” pasvation ORF itt potievt oelar Laveyngea} on 1g : P Relexetton a) Regujeer , Ex.aball vioviy |Vowitingsstouig| Limb muses Taora.coablomin palpebra) AbSen1 5 Couphpncens oly 2 foreatuw| PEEPS Peguley | Bye bulls Axel Cough-pensitts | teak (wot Trova. coabdemin| Cmed doun 7 fo middle of iw mie Ampli hul-e Lexy ward) lon & Eyal Fined 4 tovyhabynt | Abdoninat amd eentral in museres All omrmaly Ye loaned , Abdeming), vamntmal aryl’ ‘minimal onl rage ds 2 of medullary pemalysis vv overdue: = “ sane pocnatysis of tke Twerooei & mujelas Ts Complete, and eniy sdfaphnagmate aehvity Vemalns'. The pols (pecom.cg sPapid md pupils dilated wile the eyeball present Figk eyo! appeomenre ducto Cossatun of laerimal seeretion«» ftMeew7 ol i of aluteanede + | befor efrevlation 5 on or va mechanism of action! ther DOABA Ny “A d —t ‘ «“ E Most of the omesthett.es ‘stop vespirehiom While ehlorodorm stops respiration with ‘ai reviotion s ofometthele depends on its Solubility’ “Ja the onset of action blood, thus s | ' © No hoy tow Solubility Brapid onsed owl. : mmethory flare boy golubility & delayed onset » ; Halothome } Dd} von “inPlommable non explosive )) Won- Foritent Produces beoncho dilaton Bee : ‘ Bisodvemtage:-Weale ‘analgesia > Weale¢ Ke beta): muse le. ever Pelagent 3 Comaiibenie a-epato we ‘ oe q BOs Non Anflegnmma ble Smor-aiplosive 21) Non then- ) To0d analgesics im labour av) Good omalgesies in labour. Disodve i) Weal emestelie-n) Weak Sketokal musare Ye lowe 4) Produces affoston hypoxia 1) Maalobleuhie anemic ) Temategenic #0 boln padient & dee for MB te 2a . Enflunane: As halothune byt noi hepatic toxieiby Ses Sensitization of beccr? to Cadfécholoom ines . Metrexy Plunune! Cosrdfotoxte & Waplrotert ¢ - Bedamied ath-esthest, . 10: tr Halotheoreyninimal alvectave anesthetic eoncentmation (MA) Tr ig themininal alveolar .amestiet et scomcen tration ab wwe oy, of patents, donot respond to a syrgiea) shmojys. Tmpovtamces THis a measume of amestuetic potency, iris small for Patent omestehics: suck oS halotrone “8 lange for weak onesitel as tv, 0: : ; . Te Anesthesin OO . 8 pecovery > VO explosive Advomtages : oEasy - > Rapid inde tion | Syo imitation to vespinatony traet'-5 Wo sensitization o ae Cathe tolamines , | Disedvembogyes® Once injected, Cam mot 4s withdrawn Ulirathor} beenbihnate (thiopental, metio, meties® B— Rapidly absemrbed ~ Passes blood bnun teoteiE Pocpaial ‘ ner, (> Fate: Redistnibution & stow ynetabotism > Aceomvlation « as | Aetions : CNNS!. Sedation — hypyrosi = emnestreal eg | ~ Potentiote onalgeses . LMS. Lomge dose > sudden hypotension due to HY ceendine Contractility, Roppiv ution ) ~ Bron Chospasm ~'+Re. stm ~ veloration | Uses Induction of general ames Side effects $ _> Respimatowy comprication > Apnea —. bronchospatm. +> Hypotension 738 owed > Tenritamt*. Phlebitts - Tor om bophle bitis - Palm te A fi i | +> Contratmajeated im aevte Inter wittent Porply nin, Hesion” > Ainhiconvelsonty.” Ketamine “Aretions:” Produces dissociative Sefative emeshasia to of-sen siden Bo motor activity + Promo tAnal gasioy wo! ihnout loss of. Consclous views. Used "TO provide “omalgesia for minoy procedure -espectally inehi laren + ' Side effects! * reson fy in Kalua Mabon duving recovery Vo SBNTOCT ss > Top. . Com tra imadication 1. mental disonders 0 HOF Ter . a ype eater W) flaucoma . : ; Pre_omestnelic medication Benifts. 4.T8, produces Sedation; omnesta, omalgesia ; 1. Te reduce! a) ‘amount of omesthessa » %) Post anesthetic complications . ° Pornasympathe tic supply to lungs ssalivery he es _ lend F heomt » Dewys used t s rtatt L. Womtelies mal gesicht - Monphing gromereine oss a heen Bon bitvwide, Benzodiazepine chiorarhyanate OW. leptie Phenvthiacine Erewp As oe ermpatcljHs Atropine & Byose ne, —_—Local ovrestnesien “Locei) enesthelies ame aoups that eae mevensiore bloe oF Nene, Conduction prodveimg transient Joealized Omestta without Signi fieantHy affecting consciousness. Stovetuve F chemical aspects !> “Mey ame weak bus-e rent of Lipophylie group connected to vonizable hydmophilf¢ gvoup by an intermediate Chain: _Cisssifieation ; A) Bosed on Chemical strvetu re L.A ot Amite Esters —Lidoeaine 1]! _ —_ 2 mepivacaine Bempicraeld ene esters > Bupivocaine L todame eCaINe ~Bemtocaime . b) Recording to thew solubility omd ea application Inte! L.A Pas gaat ee \Solvble L: A, Svitable fem ingeetion b inlet ased 3. Insoluble LA - e A on platy + Bemzotalret * Lidocaine » . Procaine ¥ Cocaine. «Ov the form + Pibveaine + Phenacalne v * Tetrocuime + Bulocalne Used 08 Ses el . om-egstheHes in Bete, Can prodyie. “iain used fo praure forth of fusders Face ames thes x topical cones thes, ond ointments oP excep Peocatne of eye wounds COmyinzection), . Mechemnism -of aetiont They act inside the nemve § inhibit dhe nenve & imbibit Wo vee mem me 9 Fibens ame affected in tals Sequence (sensury, Cold) fever, j Sati Feedon ESS glastly moter) ’§ Uw myelinated before mye linated me — Reevveny oeeurs Inthe wevente direct om: —' mates OP adwmbilitpalion: MSurdce amesthasiq OO TT Ai) Ta filtration omes treat iy) Merve block oes trog A In}. close he | ot S AORSR ©) Sympathetic Boek a) eonvetrfebral blbek Epldumer se Cn “3 a sey 0 oon = HX osround. eee , ORG onout ns of ne storbotnaltres SERRE aC 0 ARERR enn, Spkois \s Batracellulor PH & Foeneasea Pt Dactin dyetp daghnomfanbted thelr absor| tion fo act from ORD AAG : . Tmebe ansenp Aside Ble 2, , Extrocellulom Jongh Deas! anfogonize the action: - MK = @nkamce theaehom it 3. Radrenatine s Prolmngation ofacHon © 18 Ye Hyaluwonidaye enzyme > O Tncacasef onset sdepisof actor . AeKMA roca) anesthetic Aetiim L- “CNS! Stimulation followed bY a depression . 3. Blond vowel: Re: Vosotlilution sexeept cooaine whieh pro Jue, wesocens truth As Smooth musele! Spasmolytic . a Tonicltys Astemierd.Miemgy 2. Cus ! Heweek * Local! Poin ative site ot Ingeelin oedema, Haematoma ., oferty Spiral ames Hatin) as Bowly 7 Hypotension » Respiretony paralysis bs Lopes Menipgstis , Headache .2% “he (me Talelad anf Or 2h 2 amepivacaine b dvochbuade axe onan cme cues heal ane. pBecaune’ of bbws don and hl aa Avenifleria a 10 dohogs Neve took ' ty nee book . Dove Sto lo ml 2% Iidoabive 0% Broreh’ bu ivacal rd ‘in Br bch hedoa wage ama tempura nose P vate pre ed ese Anextrenia ingeed § ord vel between He midfve of. ri confer ond i" of a iat LA ion \ In 6 preven Ing_ingwey , eari| ft se tp ible nut if op al ., Sl none bok - {« (desing, ele a ceduse* OSem on aline appuosi 0'F em repino oP the are bd ah 7° om ea Eh idee. bd een ste Melee canthry and easel re, celles a helocaine cwhieh Hock onl He Jowese pad of te “gy val ae Ve book + fr “ppen fel Appteabin | Ti abril ie “Rebobrlban’ ox 4 port bleok * ah helesied opt 2 Sel at 4 point | wocedune To the bare of’ medial and Indoscal aanthuy ond upper ond, Bowe eyeli in veo bfo ISmlof 2% Idocaine* leading “Yo ents. dhe coienen , seiadin , perl ai4 > Used fore enckalin of he ee aaT % Wek a ale so | preirmase) H wife in vo te - uel . pina, Heo } ee ou woudl i je % ‘vee, 1 Ge ro ane ie Vide bese.) ia in sak “inh Ma Vane muted to. pe aite in an hnvescted | v’ patton f in We 9a bloat n'a The ied pa dube Toe a aulgesuery - Uni e, Oe ‘needle ies Sml of il ode in baiedh i ‘Cue ae muneuel oe costello the i bare ok- ve. cs Trvescled L plea! in a nonapedihie ve gine ek bud Heoky he tinue booredese ad Coes del anpect of the. Hicteensh vib ana “rie / of de eHene 9d Ceny of ern bas vescte bsae_.. upto | Joo wil Deal anehedran mm wht ile te i Aiten inks the tinue baud onloge je Simple +b poks b perchrem =>) Doen vu Inforue atl tion: % mininleer tabi nional edna a mas! inaslvard je >in Ata 4 inenerred @ > pomible draisilyTiel bh ki! Bhele in the ail of une esl: prample ris blook, inveclel ‘i voli ha Eo bloeK , In of .[ocal Ye in non anesG b dhe: ineinisn aite Fox a fne blak OF alo he ubed * onl i2e «ooh prea of she Pascalumbax Forma all SF silent of -lo.ml of focal odd) auton om Px deep murele Henn’ ‘omlaeellanaice y a a I > Reaveckebual pore bheok v 0) Qaim paeay ve Pheal » Bleck Deeniitiee Ty3 ond L; “Ly (2 dal pesacechba) Ta, b-L Ly proceduve > ** : bile! Needle ploed dhecough the skin at the anlerinre edge b the serge proces & L, sty § Le'spinal needle “is, yassed ventrally unlill i} posged though deere process. Dose: 27. lidocaine or bupivacaine inject upto' 2-3 mf Sie: Needle punched, of the ovtertion edge S the verbreal to the Hraraverse proce and coudal to the bis by 8 Ly verlelaa..pees eae ci > Cucdal _opid dual neve look High re dal epidunad neve. bah Loam aopnee (5 - 0, , deneenifiien tb rower (5B, $4, $5 Lewy anudal epideaal rt dak Coal aay olnerast r2e Aae abe (5% 5) * Staind hog ee the osw , de bil shoubl be eed upod wn do healle fwa dehween te laf sacral! acho und at cocey bal Wid fen 0K between G, BRIO. debe. tue onl of 27, hdsesine /ig lady ol potas ehocll be'clowed + shin hoinkebd > needle imadel inels He skin > Phoe the anethhe aoledion inthe heb of : He needle —> Necdle” rer advanced fy ly unl! He aalten ig down ints & e epr dusal apace 7a pe Her alfached ty needle n ane 12. mn «4 Se cnendaca tattle i\ rlexnal pudendal neweve Hoek Ire," Tn female cade ay veheve hating cause ly eae val NNR ) ip >» Brsajieal procedure of penin: > Rpoive (pedbpoer I potent! dan yhemeral of penile popillomay axl > Odpore mnavax ausgecien of penio ond prepuce; ae Done’ “20n) P heal anethele oo Te a rt level ot weint ard trgerny dince leseallt and v ‘ ‘tS idenh He le = adate Pond of when Me Lrcmrer in idol Bed. send idedblthe Neve _ + he pina needle a) held inthe pours y band. and itheodueed hee a canufa in the inchtoneote! bina, 54s Jom me Shen oped pee eee the needle . + 20 ml of “heal anentedia 5 depovifel od, the nexwve , to. L. Then the need /e its widhdraur S ; de ' Redicected, He nee dle Q to Bom mae a and loml, of anendete deposited to desensif; cg a teecenn une aot deadly NUMA 7%heal on ‘Bull : 5 tee nt Horne 4 GA > eee, I Iregl | aie e amine | a any Newhec “Bg (0) mo yl + ys lazing $1’ me ne.) OF Geo) + aphtre- " “ir Reborn 5-1 ng] Kg apesialion Bid lest > 24 lidocaine Hel oh : Ovaseis- byolenechay Lspeyi gor Gl, (cen) (un) gen Neg Ketasnine ‘Aral le sage) et talk ; Aetemine 5 Seale B Coreelin ach a Cw Cuavodebeal neseve Lek) 24. lidocaine 3 (to-te!’) , L. Gm), L Gel » Ewe (oame) - Dore’ to (- Teal) jLilb= fmt) a by 5 £5enl —» Bileh [queen > (va) 7 ae -" = Doe (paverlebral oe Uk) ig, ai oath ted] Medial pubellax destiny > (cHle, —> 27, Trdocaine 25 Bibl oy Tabbed sane in horn foes] (P Ampudion of Ls | > dys) es a "pple Wi Bull Jattle (caudal epidhacal anerdheria_) | sone otal k Cliheal Henin —, Male cal? _y, GeA ! 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