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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
Bupivacaine
Ropivacaine
225 mg
Prilocaine
Levobupivacaine
400 mg
150 mg
Less cardiotoxic
An isomer of bupivacaine, less cardiotoxic
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.
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.
ANAESTHETIC EQUIPMENTS
Components
A. Gas supply and distribution system B. Anesthetic work station C. Airway equipment
Oxygen concentrator
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
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