Friday, September 13, 2013

ANESTHESIA 8 Regional anesthesia



REGIONAL ANESTHESIA
Definition
Regional (local) anesthesia is the reversible blockade of conduction by regionally injected agents, for the purpose of sensory ablation. The examples are spinal and epidural caudal and major nerve blocks.
Local Anesthetic Agents
Local anesthetic agents act by inducing a blockade of nerve transmission in peripheral nerve impulses. This occurs as a result of obstruction to sodium channels in the axon membrane.
     Local anesthetic agents belong to one of two chemical classes according to their structure.
Ester Class
The only ester still in frequent use is cocaine, which is an ester of benzoic acid. It is used generally only for topical anesthesia of mucous membranes in the nose and sinuses.
Amide Class
The first amide to be synthesized was lignocaine others are listed in Table 4.3.

Anesthetics
Drugs
Local anesthetics
•   Lignocaine 5%, heavy (hyperbaric)*
•   Bupivacaine (Marcaine) 0. 5% heavy, (hyperbaric)*
•   Cinchocaine (Nupercaine, Dibucaine, Sovacaine)0.5%, heavy (hyperbaric)
•   Amethocaine (Tetracaine, Pantocaine, Pontocaine, Decicain, Decicain Butethane, Anethaine) 1% solution prepared in saline, water or dextrose
•   Mepivacaine (Scandicaine, Carbocaine, Meaverin)-4% heavy (hyperbaric).
Other drugs* available in India
•   Vasopressors
•   Metaraminol (Aramine)
•   Ephedrine
•   Methoxamine (Vasoxine)
•   Phenylephrine
•   Noradrenaline/adrenaline
•   Mephentermine.
Sterile cutting file
Sterile drapes—Four separate towels or a simple sheet with center eye hole.
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