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Anestezie Curs 1
Anestezie Curs 1
• Tripod on a platform
Analgesia
Muscular relaxetion
Hypnosis and amnesia
• Dupa mecanisme
• Anestezie generala
• Anestezie, locala, loco-regionala
• Tehnici combinate (generala si loco-regionala)
• Not metabolized
• Synthesized in 1956 by
Suckling
• Halogen substituted
ethane
• MAC of 0.75%
• Prolonged emergence
Halothane Systemic Effects
• Enflurane, Isoflurane…
• Low solubility in blood-- produces rapid
induction and emergence
• Minimal systemic effects-- mild respiratory
and cardiac suppression
• Few side effects
• Expensive
• Differences
Intravenous Anesthetic Agents
Amino-ester Amino-amine
“Esters” “Amines”
Physiochemical Properties
• Amino-esters (“Esters”)
– Older class of drugs
– Derivatives of PABA (p-aminobenzoic acid)
– Hydrolyzed by serum cholinesterase
• Examples
– Procaine (Novocaine)
– Cocaine
– Tetracaine
– Benzocaine
• Amino-amines (“Amines”)
– Newer class of drugs
– Derivatives of aniline
– Hepatic degradation
• Examples
– Lidocaine
– Bupivocaine (Marcaine, Sensoricaine, Polocaine)
– Mepivocaine (Carbocaine)
– Etidocaine
– Prilocaine
Mechanism of action
Protein binding Lipid solubility
Vasodilatation Vasodilatation
Mode of administration Tissue pH
ion
Pot
Presence of vasoconstrictor Concentration of drug
ra t
enc
Du
y
Onset
Inherent pKa
Myelination
Interspersed tissue
Dosage of drug
Ideal Anesthetic
• Immediate onset
• Reversible
• Appropriate duration
• No permanent damage
• No tissue irritation / pain
• Wide therapeutic range
• Effective regardless of application
Topical anesthesia
• Epidermis
– Avascular layer measuring 0.12 to 0.7 mm
– Barrier to diffusion of topicals
• Dermis
– Support structure
– Contains blood vessels and nerve endings
– Anesthetic’s targeted site of action
Uses
• Intact skin procedures
– Venopuncture
– Punch biopsies
– Lumbar puncture
Lidocaine Cream
• 30% lidocaine cream
• Saturated on gauze pad adherent to an elastic
patch
• 45 minutes minimum application time
• ½ hour anesthetic duration = 2 hour
application
• Effective and safe, but not practical
EMLA
(Eutectic Mixture of Local Anesthetics)
• 2.5% lidocaine and 2.5% prilocaine
• 1-hour application time
• Maximum dose at 2-3 hours
• Depth of anesthesia correlated to duration of
application
• Duration of 1-2 hours after removal
• Hypersensitivity and systemic toxicity rare
Ethyl Chloride (C2H5CL)
• Not an anesthetic, but a vapocoolant
• Immediate anesthesia, but limited duration
• Spray for 3 to 7 seconds
• Used for injections and lancing small
abscesses or boils
• Not used for punch biopsies
Mucous Membranes
• Nose, mouth, throat, tracheobronchial tree,
esophagus, and genitourinary tract
• Tetracaine
• Lidocaine
• Cocaine
• Benzocaine
Infiltration Anesthesia
• Injection of anesthetic agent directly into
tissue
• Excision of skin lesions
• Incision of abscess
• Suturing of wounds
Advantages & Disadvantages
• Advantages
– Quick and safe
– Provides hemostasis
• Disadvantages
– Large dose for small area
– Distorts wounds
Choice of Agent
Maximum Dose
Concentration Pediatric Onset
Agent (%) Adult (mg) (mg/kg) (min) Duration
Procaine 0.5-1.0 500 (600) 7.0 (9) 2-5 15-45 min
Lidocaine 0.5-1.0 300 (500) 4.5 (7) 2-5 1-2 hr