Anesthetic drugs systemic effects

Inhalation in the form of an aerosol (p. 12), a gas, or a mist permits drugs to be applied to the bronchial mucosa and, to a lesser extent, to the alveolar membranes. This route is chosen for drugs intended to affect bronchial smooth muscle or the consistency of bronchial mucus. Furthermore, gaseous or volatile agents can be administered by inhalation with the goal of alveolar absorption and systemic effects (e.g inhalational anesthetics, p. 218). Aerosols are formed when a drug solution or micron-ized powder is converted into a mist or dust, respectively. 

Combining agonists with some local anesthetics greatly prolongs the duration of infiltration nerve block the total dose of local anesthetic (and the probability of toxicity) can therefore be reduced. Epinephrine, 1 200,000, is the favored agent for this application, but norepinephrine, phenylephrine, and other agonists have also been used. Systemic effects on the heart and peripheral vasculature may occur even with local drug administration but are usually minimal. 

Since local anesthetics have membrane-stabilizing effects, both parenteral (eg, intravenous lidocaine) and oral (eg, mexiletine, tocainide) formulations of local anesthetics have been used to treat patients with neuropathic pain syndromes because these syndromes are thought to involve uncontrolled, rapid, sensory fiber firing. Systemic local anesthetic drugs are commonly used as adjuvants to the combination of a tricyclic antidepressant (eg, amitriptyline) and an anticonvulsant (eg, carbamazepine) in chronic pain patients who fail to respond to the combination of antidepressant and anticonvulsant. 

The two major forms of local anesthetic toxicity are (1) systemic effects following absorption of the local anesthetic from their site of administration and (2) direct neurotoxicity from the local effects of these drugs when high concentrations are administered in close proximity to the spinal cord and other major nerve trunks. When blood levels of local anesthetics rise rapidly, adverse effects on several major organ systems may be observed. 

The method of drug administration or exposure to a poison may impart selectivity to a xenbiotic. For example, atropine can be applied directly to the eye for the dilation of the pupils. Note that eventual absorption into the blood stream from this site will cause systemic effects. Another example would be the topical (skin) application of a local anesthetic such as benzocaine. Monoclonal antibodies, which are specific for chemical functional groups, are tissue and cell-specific natural agents to which drugs can be chemically bonded. 

Systemic effects are more likely to occur with long-acting anesthetics if an excessive dose is used, if absorption into the blood stream is accelerated for some reason, or if the drug is accidentally injected into the systemic circulation rather than into extravascular tissues.17 40 Other factors that can predispose a patient to systemic effects include the type of local anesthetic administered, as well as the route and method of administration.3 Therapists and other health care professionals should always be alert for signs of the systemic effects of local anesthetics in patients. Early symptoms of CNS toxicity include ringing/buzzing... 

Although given locally, the drug may exert a systemic effect because of transport in the blood from the site of administration to other areas, sueh us the heart and central nervous system (CNS). These systemic effect.s. which depend on the concentration of the local anesthetic in the blood, are usually sedation and lighthcudedness. but restlessness, nausea, and anxiety may also occur. High plasma concentrations cun result in convulsions, chiropidy. and coma with rc.spiratory and cardiac depression. 

These may enhance the effects of central nervous system depressants. Therefore, the doses of anesthetics drugs need to be titrated (usually reduced) to the effect required. 

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