Lidocaine local anesthesia

Similar to Voltaren" Emulgel, oily droplets of an eutectic mixture of lidocaine and prilocaine are dispersed in a hydrogel to provide local anesthesia to the skin for injections and siugical treatment (Emla cream). A further possibility is the dermal administration of a liposome dispersion as a spray (Heparin PUR ratiopharm Spriih-gel "). After administration, water and isopropylic alcohol evaporate partially resulting in an increase of concentration and in a transition from the initial liposome dispersion into a lamellar liquid crystal [32]. The therapeutic effect appears to be influenced favorably by the presence of lecithins rather than by the degree of liposome dispersion. 

Answer Bupivacaine use for local anesthesia of this type is very safe and commonly done. However, SOMETIMES inadvertent vascular injection results in a large amount of anesthetic in the systemic circulation. Because the heart is beating, the excitable tissue in the heart is being depolarized repetitively. Local anesthetics bind to rapidly depolarizing tissues more than tissues at rest (frequency-dependent block). Also, bupivacaine has a long duration of action because of its long residence time at receptors (sodium channel). Thus, this combination of factors contributed to the catastrophic outcome of this case. Had the same case involved lidocaine, the resuscitation would have likely been successful. 

Several first-generation Hi antagonists are potent local anesthetics. They block sodium channels in excitable membranes in the same fashion as procaine and lidocaine. Diphenhydramine and promethazine are actually more potent than procaine as local anesthetics. They are occasionally used to produce local anesthesia in patients allergic to conventional local anesthetic drugs. A small number of these agents also block potassium channels this action is discussed below (see Toxicity). 

Topical local anesthesia is often used for eye, ear, nose, and throat procedures. Satisfactory topical local anesthesia requires an agent capable of rapid penetration across the skin or mucosa, and with limited tendency to diffuse away from the site of application. Cocaine, because of its excellent penetration and local vasoconstrictor effects, has been used extensively for ear, nose and throat (ENT) procedures. Cocaine is somewhat irritating and is therefore less popular for ophthalmic procedures. Recent concern about its potential cardiotoxicity when combined with epinephrine has led most otolaryngology surgeons to switch to a combination containing lidocaine and epinephrine. Other drugs used for topical anesthesia include lidocaine-bupivacaine combinations, tetracaine, pramoxine, dibucaine, benzocaine, and dyclonine. 

When tolerability of the compound is sufficient to allow systemic administration, local anesthetic drugs can be employed for relief of neuropathic pain and acute treatment of migraine headache in addition to the broad application for local anesthesia as proven for lidocaine... 

Lidocaine is the most commonly used local anesthetic drug. In addition to its effectiveness for local anesthesia, it provides relief of neuropathic pain and acute migraine headache... 

Iontophoresis has been used to deliver local anesthetics in the field of dentistry. Gangarosa [45] reported the iontophoresis of a 2% solution of lidocaine, with epinephrine (1 100,000) for the local anesthesia for extraction of retained deciduous teeth. Iontophoresis has also been used to desensitize teeth [46]. 

Local anesthesia to the larynx, for example with 4% lidocaine, is generally safe. Laryngeal edema has been reported in a few cases and could be due to the propellant rather than to lidocaine itself (23). 

Kim WY, Pomerance JJ, MUler AA. Lidocaine intoxication in a newborn fohowmg local anesthesia for episiotomy. Pediatrics 1979 64(5) 643-5. 

Precautions must be taken so that lidocaine hydriKhloridc solutions containing epinephrine salts are not used as cardiac depressants. Such solutions are intended only for local anesthesia and are not u.sed intravenously. The aqueous. solutions without epinephrine may be autoclaved several timc.s. if necessary. 

Lidocaine is used for local anesthesia and in the management of ventricular arrhythmias. 

Menendez-Botet, C. J., Collin, C., Osborne, M., Rosen, P., and Schwartz, M. K., Effect of local anesthesia (Lidocaine) and saline on the estrogen and progesterone receptor protein in breast tissue. Clin. Chem. (Winston-Salem, N.C.) 30, 941 (1984). 

Plasma lidocaine concentrations and symptoms of local anesthetic toxicity have been reported in five oriental patients after tumescent local anesthesia [41 ]. The patients received lidocaine in total doses of 20-35 mg/kg. The plasma lidocaine concentration 3 hours later did not exceed the toxic concentration of 5 pg/ml and was significantly lower at 8 hours. 

Local anesthesia refers to injecting anesthetic into the skin to temporarily numb a small area so that a minor procedures can be done painlessly. This type of anesthetic is normally used for stitching small lacerations or for dental procedures. Drugs commonly used as local anesthetics include lidocaine and prilocaine. 

EMLA is a eutectic mbcture of 2.5% lidocaine and 2.5% prilocaine, which, when mbced, form a liquid that is formulated into a water-oil emulsion. EMLA is available as a cream, a gel and an anesthetic disc. Only the cream and gel are available in the USA. The cream is approved for use on intact skin for local anesthesia or genital mucosa for superficial minor surgery and as pretreatment for infiltration anesthesia. The gel is approved for adults who require localized anesthesia in periodontal pockets during scaling and/or root planning [1]. 

The skin is prepared and draped in a sterile fashion, and local anesthesia is injected into the skin and deep soft tissues at the entry site using a 30-gauge needle in the anticipated route. One percent lidocaine mixed with sodium bicarbonate (3 cc 2 cc) minimizes discomfort. Inadequate local anesthesia will result in pain that will awaken the child and make the procedure more difficult and time-consuming. A skin incision is then made with a no. 11 scalpel blade and enlarged with blunt dissection. 

There are many small variations and combinations of electrically assisted transdermal methods, such as alternative current (AC) and switching iontophoresis and jet injection combined with iontophoresis. A variety of drugs can be iontophoretically delivered, such as lidocaine for local anesthesia and acetic acid for tendonitis of the shoulder. The drug reservoir can be formed... 

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. 

Spinal anesthesia Spinal anesthesia is the introduction of local anesthetics directly into the spinal fluid, which causes a sympathetic blockage, or loss of feeling as well as muscle relaxation resulting from the interaction of anesthetic with every spinal nerve tract. This method is used during major surgical interventions. As a rule, lidocaine, mepivacaine, and bupivacaine are used for this purpose. 

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