LOCAL ANESTHETICS, COMPLICATIONS AND MANAGEMENT.ppt

7/18/2019 LOCAL ANESTHETICS, COMPLICATIONS AND MANAGEMENT.ppt

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Marwoto

Department of Anesthesiology

School of MedicineUniversity of Diponegoro

S e m a r a n g



Local Anesthesia : developed in using

many advantages

complications are unpredictable pharmacology

complications &

management

prevention &

preparation

Should be understood



History

!!" #arl $oller : eye cocaine

%illiam Halsted : nerve bloc

!!' (aedice : ben)oic acid ester

!*+ Albert ,eiman : e-tract

!.! August /ier : spinal

.+! August /ier : i0v0 regional

.+" Alfred 1inhorn : procaine

Heinrich /raun : clinical practice 2 epinephrine

.+ 3erdinand #athelin & 4ean Sicard : epidcaudal

.5 3ridel 6ages : epid lumbal

.7 Achille Doblioti : epid lumbal



.+' 1inhorn : procaine

.7+ : dibucaine

.75 : tetracaine

."7 Lofgren : lidocaine

."8 : clinical practice

.'' : chloroprocaine.'8 : mepivacaine

.*+ : prilocaine

.*7 : bupivacaine

.85 : etidocaine

#urrently : ropivacaine

levobupivacaine



Group Potention Duration

1ster9amide :•6rocaine•#ocaine• etracaine

5*

ShortMedium

Long

Amide9amide :•Mepivacaine•6rilocaine•Lidocaine•1tidocaine•/upivacaine•;opivacaine•Levobupivacaine

57"****

MediumMediumMedium

LongLongLongLong



1ster : < unstable in solubility< disrupted more easy

< half9life minute

< degradation product : p9amino ben)oic

acidAmide : < minimally metaboli)ed

< plasma accumulation

< disrupted by hydrolisis in liver

,9dealylation

< half9life 5 = 7 hrs

< more stable



Mechanism of action

>n?ltr

#a22

out of receptor

inhibitsreceptor ,a2 channel blocade inhibits

ion ,a2 conduction speed conduction

depress can@t reach potential value no

potential action conduction blocade

Dissociation constants

most of all are base

pH value where ioni)ed and unioni)ed formavailable in balanced condition





>nuenced by : Site of inB and dose

Using epinephrine

6harm characteristic

Amide groups are more e-tensivedistributed in tissue than ester

6lasma conc decided by distribution andclirens



Distribution Lungs e-traction : lidoC bupiC prilo 6lacenta transfer : 6/ bupi .'

6/ lido 8+

1ster : hidrolysis

#lirens Amide : liver & idneys 1ster : plasma

o-icity #ardiovascular #entral nervous system



Metabolism

Depends on liver & ydneys en)ymes 6roducts eliminated by idneys

1ster disrupted by plasma cholinesterase

1ster@s half9life minute

Degradation product is p9aminoben)oicacid

Amide ,9dealylation hydrolisis

EliverF Amide@s half9life 5 = 7 hrs







1. Any procedure for which local anaesthesiawill

provide satisfactory operating conditions

2. Pulmonary disease provide that the patientwill

be able to tolerate the position reguired fortheoperation.

3. Previous adverse reaction to general

anaesthetic agents

4. Anticipated problems with maintaining theair way or intubation

. !rgent operation without ade"uatestarvation

>ndication



A. Absolute

1. #efusal by the patient

2. Allergy to local anaesthetic drugs

3. $nfections at the site of in%ection

4. Anticoagulant therapy

. &leeding diathesis

'. !se of adrenaline ( containing silutionfor

patients on tricyclic antidepressants

#ontra >ndications



&. #elative

1. )ac* of patiens co ( operation

2. +eurological desease, an e-acerbation

maybe blamed on the anaesthetic

techni"ue



1. Local

Incision Absces

Hematom

Infiltrate

Necrosis

Nerve Injury

compress

Necrotomy

Neurotonic /

Tropic

omplications



2. Systemic Over ose

Hyper absorbtion

Hyper sensitivity

Intravasasion

!ause by "

A. !NS

Cortex

Stim

#ep

!onv$ a%it

&O2 ' anti conv(

)ea*$ unconcious

&O2 ' fluis(



Medulla

+ St Hyperventilation

+ #ep Hypoventilation

& ass vent(

& ,esp. #ep. -etiine / orpine (

!irc St Hypertension ' tacycaria

& O2 ' bloc*er (

#ep Hypotension ' braycaria

& L -os ' flui ' O2 ' 0asopr(

,esp



. yocarium #epress

-erip vessels #ilat

Hypot ' ray

& !irc #ep(

!. Aller%y / urticaria & Hyrocortisone ' antiystamine (

#. Anapylactic soc*

Air3ay &O2($ breatin% L -os ' 4luis Arenaline 5$6 7 5$8 m% i.m

& reapete 8 7 15 min(

Arenaline rips 1 7 9 / gr0 *g 0 min etyl -renisolone Succ 155 m% i.v / : rs

Aminopylline bolus an rips #ipenyramine 1 m% / *% / : rs

;. iscellanous - Siverin%- nausea / vomitus- ysartria



6repared as general anesthesia

Avoid over9dose

(ood Guestioning Monitoring

um adrenaline : 5++0+++

Stop inBectionC when reaction



(roupsC potentionC duration Dissociation constants Absorption & distribution #lirensC to-icityC metabolism MD of topical I in?ltration

#omplication & management 6revention & preparation

hould be understoodhould be understood

!ne-pected incident!ne-pected incident



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LOCAL ANESTHETICS, COMPLICATIONS AND MANAGEMENT.ppt