Lipid Emulsion Therapy as Treatment for Local Anesthetic Systemic Toxicity

Local anesthetic systemic toxicity, due to misapplication of local anesthetic in an otherwise routine procedure, can result in deleterious effects. Although improved regional anesthesia techniques, effective test-dosing, and availability of less toxic local anesthetics have resulted in a decline in local anesthetic toxicity rates, adverse events do occur. A comprehensive review of literature was conducted and current research findings and documented case studies were systematically reviewed. The “lipid sink” phenomenon is the most widely accepted theoretical framework surrounding intravenous lipid emulsion treatment for local anesthetic induced cardiovascular collapse (Rothschild, Bern, Oswald, & Weinberg, 2010). Current evidence suggests that immediate infusion of lipid emulsion should be considered when clinical signs of local anesthetic toxicity manifest. By relaying information surrounding practice guidelines on local anesthetic systemic toxicity, anesthesia practitioners will have an improved understanding of local anesthetic systemic toxicity clinical diagnosis and lipid emulsion infusion as a treatment modality

Effects of Preoxygenation and Positioning of Obese Patients During Intubation

Local anesthetic systemic toxicity, due to misapplication of local anesthetic in an otherwise routine procedure, can result in deleterious effects. Although improved regional anesthesia techniques, effective test-dosing, and availability of less toxic local anesthetics have resulted in a decline in local anesthetic toxicity rates, adverse events do occur. A comprehensive review of literature was conducted and current research findings and documented case studies were systematically reviewed. The lipid sink phenomenon is the most widely accepted theoretical framework surrounding intravenous lipid emulsion treatment for local anesthetic induced cardiovascular collapse (Rothschild, Bern, Oswald, & Weinberg, 2010). Current evidence suggests that immediate infusion of lipid emulsion should be considered when clinical signs of local anesthetic toxicity manifest. By relaying information surrounding practice guidelines on local anesthetic systemic toxicity, anesthesia practitioners will have an improved understanding of local anesthetic systemic toxicity clinical diagnosis and lipid emulsion infusion as a treatment modality. Implications: When anesthesia providers pre-oxygenate their obese patients for three minutes in • • a head up position, this extends the amount of time, to safely secure the airway. !!\u27(It Keywords: Obesity, Anesthesia, pre-oxygenation, patient positioning, head-up, supin

Clinical pain evaluation with intraoral vibration device during local anesthetic injections

Objectives: To evaluate the clinical pain during local anesthetic injection using such intra-oral device. Study Design: A comparative split-mouth clinical study to evaluate clinical pain was conducted among the subjects who required bilateral local anesthetic intra-oral injections. Results: A total of 99 subjects participated in the study out of which 39 were female. A total of 256 local anesthetic injections were administered to all the subjects with at least one pair of similar local anesthetic injections. Comparison of mean VAS score for anticipated pain in without vibration group was significantly higher in all types of nerve blocks when compared to that of with vibration. Similarly, the comparison of mean VAS score for actual pain in without vibration group was significantly higher in all types of nerve blocks when compared to that of with vibration. No significant difference in the mean VAS score was seen between anticipated and actual pain in without vibration group with respect to inferior alveolar ( p =0.673), infra-orbital ( p =0.175) and palatal ( p =0.343) local anesthetic injections. The mean VAS score was significantly lower for actual pain when compared to anticipated pain in vibration group with respect to inferior alveolar ( p <0.001) and infra-orbital ( p =0.002) local anesthetic injections. Conclusions: There was significant reduction in the pain encountered during local anesthetic injection with the use of intra-oral vibration device

The thermodynamics of general and local anesthesia

General anesthetics are known to cause depression of the freezing point of transitions in biomembranes. This is a consequence of ideal mixing of the anesthetic drugs in the membrane fluid phase and exclusion from the solid phase. Such a generic law provides physical justification of the famous Meyer-Overton rule. We show here that general anesthetics, barbiturates and local anesthetics all display the same effect on melting transitions. Their effect is reversed by hydrostatic pressure. Thus, the thermodynamic behavior of local anesthetics is very similar to that of general anesthetics. We present a detailed thermodynamic analysis of heat capacity profiles of membranes in the presence of anesthetics. This analysis is able to describe experimentally observed calorimetric profiles and permits prediction of the anesthetic features of arbitrary molecules. In addition, we discuss the thermodynamic origin of the cutoff-effect of long-chain alcohols and the additivity of the effect of general and local anesthetics.Comment: 12 pages, 9 figures, 1 tabl

Effect of Local Anesthesia on Postoperative Pain with General Anesthesia

Purpose: The aim of this study was to determine if the use of local anesthesia with general anesthesia results in less postoperative pain. The alternative hypothesis is that children will experience less postoperative discomfort when utilizing intraligamental local anesthetic during the intra-operative time period. Methods: Patients were recruited for this single blind, randomized, prospective cohort study with the following inclusion criteria: English speaking children age 3-6 years, ASA I/II requiring general anesthesia for dental treatment. Randomization was done to place patients in groups of no local anesthetic vs. local anesthetic administration. A Wong-Baker Faces Pain Scale was utilized to evaluate pre-operative and postoperative pain. Data were compared using a two way mixed model ANCOVA controlling for sex, ethnicity, pre-op pain, and intra-op meds given. Results: Data was collected and evaluated on 90 patients. There was a statistically significant difference in postoperative pain for patients who received extractions without local anesthesia vs. those with local anesthetic. There was no statistically significant difference in pain outcomes based solely on whether local anesthetic was administered regardless of treatment type. Conclusions: The outcome of this study shows evidence for provision of local anesthetic during general anesthesia in patients receiving extractions to reduce postoperative pain

New patents on topical anesthetics.

Anesthesia is defined as a total or partial loss of sensation and it may be general, local or topical, depending on the method of drug administration and area of the body affected. General anesthesia is a reversible state of unconsciousness produced by anesthetic agents, characterized by amnesia, muscle relaxation and loss of sensitivity to pain of the whole body. General anesthetic drugs can be classified into two main groups according to their predominant molecular pharmacological effects: volatile and intravenous agents. Local anesthesia produce a reversible loss of sensation in a portion of the body and it reversibly block impulse conduction along nerve axons and other excitable membrane. All local anesthetics (LA) are membrane stabilizing drugs; they reversibly decrease the rate of depolarization and repolarization of excitable membranes. They act mainly by inhibiting sodium influx through sodium-specific ion channels in the neuronal cell membrane, in particular the voltage-gated sodium channels. When the influx of sodium is interrupted, an action potential cannot arise and signal conduction is inhibited. The main local anesthetic (LA) agents for skin anesthesia are benzocaine (aminoester), prilocaine and lidocaine (aminoamides) which are commercially available as gels, ointments and creams (benzocaine and eutectic mixture of lidocaine and prilocaine) or as a bioadhesive (lidocaine) with different compositions (vehicles and excipients) for adults or pediatric use. Topical anesthetics decrease anxiety, pain and discomfort during cutaneous procedures and provide effective analgesia with rapid onset, prolonged duration and minimal side effects. This article outlines the different classes of topical anesthetics available and gives an overview of the mechanism of action, metabolism of each different class, of the possible complications that can occur because of their use and their possible treatment options and new patents. © 2014 Bentham Science Publishers

Evaluation of local anesthetic and antipyretic activities of Cinchona alkaloids in some animal models

Purpose: To evaluate the local anesthetic and antipyretic activities of an aqueous extract of Cinchona officinalis (C. officinalis) in experimental animal models.Methods: Various doses of the aqueous extract was tested for its local anesthetic activity in guinea pigs and frogs using intracutaneous and plexus anesthesia, respectively. For comparison, 2 % xylocaine was used as a reference drug. The anti-pyretic activity of the aqueous extract was determined by Brewer’s yeast-induced pyrexia in rats, using aspirin (300 mg/kg) as reference.Results: C. officinalis extract, at concentrations of 10 and 20 %, produced significant anesthetic effects, of 72.12 and 88.08 %, respectively, compared with 96.86 % anesthetic effect of 2 % standard xylocaine (p &lt; 0.001). In the plexus model, the mean onset of anesthetic effect was recorded at 6.44 ± 0.68 min versus 3.86 ± 0.42 min (p &lt; 0.001) for the standard drug. Single administration of the extract (100, 200 and 400 mg/kg) showed significant dose-dependent anti-pyretic activity throughout the observation period, which was comparable to the standard aspirin group.Conclusions: The findings suggest that the aqueous extract of C. officinalis has significant local anesthetic and anti-pyretic activities in rats.Keywords: Cinchona officinalis, Antipyretic, Aspirin, Local anesthesia, Cinchona alkaloids, Xylocain

Alkylaminoalkyl esters of 2-thiophene carboxylic and furoic acids

The association of local anesthetic activity with alkaninoalkyl ester of aromatic carbonyl acids has been well susbstantietes. Compounds obtained as varieties of the anesthesiophoric group are usually capable of some degree of local anesthetic activity

Current Local Anesthetic Applications in Regional Anesthesia

Complete anesthesia is often described using terminology that pertains to the pharmacodynamic effects of the medications administered. This vocabulary often includes akinesia, analgesia, amnesia and hypnosis. Local anesthesia is more specific and represents the administration of an amide or ester local anesthetic, to affect analgesia, at or around the site of administration. Anesthesiologists employ a breadth of different clinical techniques that utilize local anesthetic medications. These techniques include topical, mucosal, endotracheal, intravenous, peripheral nerve block, epidural, and intrathecal (spinal) administration. Unique to the fields of anesthesiology and pain medicine, however, is the administration of epidural and intrathecal local anesthetic. Together, these routes are jointly referred to as neuraxial anesthesia and are often utilized to facilitate surgical intervention, labor analgesia, or pain therapy. The history of neuraxial local anesthetic administration is rich and intriguing. The anatomy of the spinal cord and surrounding structures is complex and pertinent to the pharmacologic discussion of neuraxial local anesthetic administration. The pharmacodynamic and pharmacokinetic interactions of local anesthetics, when administered via the neuraxial route, are unique and worthy of continued investigation. Much has been studied, but there is still more to be discovered. These topics will be the focus of our discussion