Anesthetic agents local

The onset of action is fast (within 60 seconds) for the intravenous anesthetic agents and somewhat slower for inhalation and local anesthetics. The induction time for inhalation agents is a function of the equiUbrium estabUshed between the alveolar concentration relative to the inspired concentration of the gas. Onset of anesthesia can be enhanced by increasing the inspired concentration to approximately twice the desired alveolar concentration, then reducing the concentration once induction is achieved (3). The onset of local anesthetic action is influenced by the site, route, dosage (volume and concentration), and pH at the injection site. 

Table 4. In Vitro Conduction Blocking and Physiochemical Properties of Local Anesthetic Agents ...

The rate of removal of the local anesthetic from the site of injection also affects its profile. AH local anesthetic agents possess some vasodilatory activity at clinically useful concentrations. Agents which are more potent in this regard tend to be absorbed more rapidly by the vasculature. They are less potent anesthetics and have shorter durations than those having lower vasodilatory activity. A comparison of potency, onset, and duration as a function of physiochemical properties is presented in Table 4. 

Another clinical consideration is the abiUty of local anesthetic agents to effect differential blockade of sensory and motor fibers. In surgical procedures such as obstetrics or postoperative pain rehef, an agent which produces profound sensory block accompanied by minimal motor block is desirable. On the other hand some procedures such as limb surgery require both deep sensory and motor blockade. In clinical practice, bupivacaine ( 22,... 

Specific Local Anesthetic Agents. Clinically used local anesthetics and the methods of appHcation are summarized in Table 5. Procaine hydrochloride [51-05-8] (Novocain), introduced in 1905, is a relatively weak anesthetic having along onset and short duration of action. Its primary use is in infiltration anesthesia and differential spinal blocks. The low potency and low systemic toxicity result from rapid hydrolysis. The 4-arninobenzoic acid... 

Lidocaine hydrochloride [73-78-9] (Xylocaine), is the most versatile local anesthetic agent because of its moderate potency and duration of action, rapid onset, topical activity, and low toxicity. Its main indications are for infiltration, peripheral nerve blocks, extradural anesthesia, and in spinal anesthesia where a duration of 30 to 60 min is desirable. Because of its vasodilator activity, addition of the vasoconstrictor, epinephrine, increases the duration of action of Hdocaine markedly. It is also available in ointment or aerosol preparations for a variety of topical appHcations. 

The total U.S. market value for the anesthetic agents Hsted was 299.9 million ia 1990 (162). General inhalation agents, valued at 154.5 million, comprised over half (51.5%) of the 1990 market. General iv anesthetics were valued at 111.5 million (37.2%). Local iajectable agents, at 33.9 million, represented the smallest portion of the market (11.3%). U.S. sales for selected anesthesia pharmaceuticals are given ia Table 6. 

ANILINES, BENZYL AMINES, AND ANALOGUES An orally active local anesthetic agent that can be used as an (intiarrhythmic agent is meobenti ne (57). Its patented synthesis starts with -hydroxyphenyl nitrile and proceeds by dimethyl sulfate etherification and Raney nickel reduction to Alkylation of -methyl-dimethylthiourea with completes l.he synthesis of meobenti ne (57). ... 

Dermatological agents-local anesthetics (e.g., salicybc acid)... 

Procainamide (Pwnestyl, Procan SR) is a derivative of the local anesthetic agent procaine. Procainamide has a longer half-life, does not cause CNS toxicity at therapeutic plasma concentrations, and is effective orally. Procainamide is a particularly useful antiarrhythmic drug, effective in the treatment of supraventricular, ventricular, and digitalis-induced arrhythmias. 

The first clinical uses of a local anesthetic agent occurred in 1884, when cocaine was employed as a topical agent for eye surgery and to produce a nerve block. These events inaugurated a new era, that of regional anesthesia. New applications were developed, including spinal, epidural, and caudal anesthesia. The search for a better local anesthetic led to chemical synthesis of a number of other compounds that have more selective local anesthetic properties and few systemic side effects. 

Tetracaine hydrochloride (Pontocaine) is an ester of PABA that is an effective topical local anesthetic agent... 

Tucker CT and Mather LE. Properties, absorption, and disposition of local anesthetic agents. In Cousins MJ and Bridenbaugh PO (eds.). Neural Blockade in Clinical Anesthesia and Management of Pain (2nd ed.). Philadelphia Lippincott, 1988. 

Cryofluorane (CIF2C-CF2CI) (Freon 114) is used as a local anesthetic agent for sport and dental uses. 

Most local anesthetic agents consist of a lipophilic group (eg, an aromatic ring) connected by an intermediate chain via an ester or amide to an ionizable group (eg, a tertiary amine) (Table 26-1). In addition to the general physical properties of the molecules, specific stereochemical configurations are associated with differences in the potency of stereoisomers (eg, levobupivacaine, ropivacaine). Because ester links are more prone to hydrolysis than amide links, esters usually have a shorter duration of action. 

The class lb antiarrhythmic drug mexilitine is structurally related to the local anesthetic agent lidocaine and also shows a voltage- and frequency-dependent block of sodium channels. Mexilitine is not selective for any painrelevant subtype of sodium channel. As an advantage over lidocaine, mexilitine can be given orally. 

Pharmacological Profile. The profile of the ideal local anesthetic agent depends largely on the type and length of the surgical procedure for which it is applied. Procedures could include neuraxial (spinal and epidural) anesthesia, nerve and plexus blocks, or field blocks (local infiltration). In general, tine ideal agent should have a short onset of anesthesia and be useful for multiple indications such as infiltration, nerve blocks. 

TABLE 2. CLINICALLY USED LOCAL ANESTHETIC AGENTS... 

This involves considerable art, which must be learned in the clinic. It falls into two divisions (1) surface application to the mucous membranes, especially of the eye, nose, throat, and urethra and (2) injections about nerves, in different parts of their course and distribution, from their spinal roots to their ultimate fibrils. The advantages and disadvantages in comparison with general anesthesia and the selection of the local anesthetic agent also depend on clinical discrimination. Nervous, fearful, and excitable patients often suffer severely from apprehension, which also disposes toward accidents. They may be at least somewhat quieted by sedatives, morphine (0.015 g hypodermically) half an hour before the operation, or by barbiturates. The latter also tend to prevent convulsions. 

As the anesthetic agent is absorbed and thus removed from the site of application, its local action ceases, and its systemic and toxic effects start. Because most of these drugs, especially cocaine, are rapidly destroyed in the body, the systemic toxicity increases with the rapidity of absorption. It is therefore desirable and often necessary to delay the absorption. This may be done by restricting the local circulation. Cocaine itself tends to do this by producing a local vasoconstriction, an action that is not shared by its substitutes. This vasoconstriction should be reinforced by the addition of epinephrine. More dilute solution may thus be used, and the anesthetic effect is much more prolonged. With intracutaneous infiltration, the pressure and edema also result in ischemia. In suitable situations, the circulation may be slowed by bandages, or arrested by temporarily clamping the arterial blood supply. 

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