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LOCAL ANAESTHESIA

anesthesia that is applied locally and block nerve conduction of sensory impulses from the periphery to the CNS. abolish sensation in a limited area of the body without producing unconsciousness

Mechanism of action
At physiologic pH, these compounds are charged; the ionized form interacts with the protein receptor of the Na+ channel to inhibit its function thereby achieving local anesthesia Adrenaline enhances the effect of the local anaesthetic by
Increasing duration of anesthesia Allowing larger dose of the drug to be admenistred without toxic effect

local anesthetic drugs must never be used with adrenaline in areas supplied with end arteries.eg For finger block At the ear lobe For circumcision (on penis) General contraindications to local anesthesia
True allergy to local anesthetic drugs Infection at the intended site of injection Systemic treatment of the patient with anti coagulant drugs

Drugs used for local anesthesia


Name Lidocaine Dose limit 3 mg kg1 7mg kg1 2 mg kg1 Comments Early onset, short acting, good for sensory blocks Longer lasting than lignocaine but more cardiotoxic Less cardiotoxic; greater sensory than motor block

Bupivacaine

Ropivacaine

225 mg

Prilocaine
Levobupivacaine

400 mg
150 mg

Less cardiotoxic
An isomer of bupivacaine, less cardiotoxic

Types and clinical usage


Topical anaesthesia Local infiltration Regional anaesthesia
Spinal anaesthesia Epidural anaesthesia

Field blocks Intravenous regional anaesthesia (Biers block)

Topical anaesthesia
agents are used on the skin, the urethral mucosa, the nasal mucosa and the cornea 4% lidocaine
EMLA cream for venepuncture Urethral catheterization Spray before endoscopy

Local infiltration
is direct injection of drugs into or around a wound ,an area to be incised and between bone ends in fractures. Lidocaine 0.5% is used for this purpose

Regional anaesthesia
Two types 1. Spinal anaesthesia
is a conduction block of nerve roots achieved by injecting a small volume of concentrated local anesthetic solution into the subarachnoidal space Drugs used Heavy or isobaric 0.5% Bupivacaine, duration of anesthesia 2-3 hours Heavy 5% Lidocaine, duration of anesthesia 90 minutes

Used for procedures involving below the level of umbilicus like in the lower extremities, hip, perineum, lower abdomen, lumbar spine.

Complications of spinal anesthesia


Hypotension-due to high spinal block Bradycardia Paralysis of the whole body Post spinal headache

2. Epidural anaesthesia injection of a local anesthetic agent into the epidural or peridural space Used in relief of labor and childbirth pain, including cesarean delivery is slower in onset than spinal anaesthesia advantage of multiple dosing and prolonged use in the postoperative period

Field block
is injection of local anaesthesia so as to create a zone of analgesia around the operative field.
Brachial plexus block for surgery on the upper limb. Field block for inguinal hernia repair Regional block of the ankle for surgery on the toes and the foot.

Intravenous regional anaesthesia (Biers block)


the injection of local anesthetic into the venous system below an occluding tourniquet. only safe in the upper limb prilocaine is best agent used

Intravenous regional anaesthesia (Biers block)


the injection of local anesthetic into the venous system below an occluding tourniquet. only safe in the upper limb prilocaine is best agent used

ANAESTHETIC EQUIPMENTS

Components
A. Gas supply and distribution system B. Anesthetic work station C. Airway equipment

A.Gas supply and distribution system


1) Medical gas cylinder and container are tanks or cylinder made of steel or alloy Used for storing different gases 2) Medical gas pipe line system used to deliver non flamable gases to anesthetic location. 3) Suction Equipment Used to remove or collect solids, gases and liquid from the pt and air way devices. 4) Oxygen concentrator Used to provide oxygen enriched gas for domestic use.

Medical gas cylinder

Oxygen concentrator

B. Anesthetic work station


integrate component necessary for administration of anesthesia. it consist s of 1.Anesthetic machine 2.Vaporizer 3.Ventilater 4.Breathing system 5.Scavenging system

1. Anesthesia Machine
mixes the correct concentrations of gas and drugs to be inhaled and exhaled by the patient

2.Vaporizer
Changes liquid agent to a vapor Used b/c most inhalation anesthesia liquid at room T.

3. Ventilator
a device that assists the passage of gas into and out of the lungs

4.Breathing system 5.Scavanging system.


Protects the breathing circuit or ventilator from excessive positive or negative pressure.

Anesthesia Machine
Flow meter bellow

ventilator

vaporizer

Corrugated tube

APL valve

Soda lime

Scavenging system

Vaporizer

Ventilator

Scavenging system

C.Airway equipments
1. Face mask:
allows gas administration from the breathing system to the patient. It is used to administer anesthesia

2. Mask strap:
used to hold the mask firmly on the face.

3. Airway :
Its purpose is to lift the tongue and epiglottis away from posterior pharyngeal wall . Prevent them from obstructing the space

4 .Bite block
placed b/n the molar teeth and gum prevent teeth from biting on tracheal tube used in electroconvulsive therapy and in un conscious patients to protect tongue and lip

5. Laryngoscope
used to view larynx and adjacent structures to tracheal tube

6. Endotracheal tube
is an instrument inserted through the mouth down to the trachea with the help of laryngoscope done under the sedation Serves as an open passage Provide artificial respiration,

Reference
1. Bailey & Loves short practice of surgery 25th edition 2.Understanding Anesthesia Equipment(5th edi.),Jerry A.Doresh. 3.Sabiston textbook of surgery 18th edition 2007 4. Schwartz Manual Surgery 8th 5. Bailey & Loves short practice of surgery 25th edition

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