LOCAL/REGIONAL ANESTHESIA - PowerPoint PPT Presentation

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LOCAL/REGIONAL ANESTHESIA

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SFC Shrader Advantages/Disadvantages of Regional and Local Anesthesia. advantages patient remains conscious maintain his own airway aspiration of gastric contents ... – PowerPoint PPT presentation

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Title: LOCAL/REGIONAL ANESTHESIA


1
LOCAL/REGIONAL ANESTHESIA
  • SFC Shrader

2
Advantages/Disadvantages of Regional and Local
Anesthesia.
3
advantages
  • patient remains conscious
  • maintain his own airway
  • aspiration of gastric contents unlikely
  • smooth recovery requiring less skilled nursing
    care as compared to general anesthesia

4
advantages
  • postoperative analgesia
  • reduction in surgical stress
  • earlier discharge for outpatients
  • less expense

5
Disadvantages
  • patient may prefer to be asleep
  • practice and skill is required for the best
    results
  • some blocks require up to 30 minutes or more to
    be fully effective
  • analgesia may not always be totally
    effective-patient may require additional
    analgesics, IV sedation, or a light general
    anesthetic

6
Disadvantages
  • toxicity may occur if the local anesthetic is
    given intravenously or if an overdose is injected
  • some operations are unsuitable for local
    anesthetics, e.g., thoracotomies

7
Mechanism of Action of Local Anesthetics
  • produce a blockade of nerve impulse by preventing
    increases in permeability of nerve membranes to
    Na ions, slowing the rate of depolarization
  • interact directly with specific receptors on the
    sodium channel, inhibiting sodium influx
  • do not alter the resting membrane resting
    potential or threshold potential

8
Selection of Local/Regional Anesthetics
  • specific nerves to be blocked
  • onset time or latency
  • required duration of effect

9
Systemic Toxicity of Local Anesthetics
  • Drugs-not a great difference in toxicity between
    equally potent local anesthetics-one of low
    toxicity when a large dose is required
  • Site of injection-vascular sites lead to rapid
    absorption
  • accidental I.V. injection is the most common
    cause of toxicity

10
Systemic Toxicity of Local Anesthetics
  • Addition of Epinephrine-causes local
    vasoconstriction and slows absorption
  • Follow recommended dose

11
Signs and Symptoms of Local/Regional Anesthesia
Toxicity
  • CNS
  • CV

12
Signs/symptoms of central nervous system (CNS)
toxicity-- CNS toxicity will be enhanced by
acidosis and hypoxia, both of which can occur
very rapidly if convulsions appear (when
breathing may stop and the excessive muscular
activity consumes oxygen stores)
13
S/S CNS Toxicity
  • Unconsciousness
  • Generalized convulsions
  • Coma
  • Apnea
  • Numbness of the mouth and tongue, metal taste in
    the mouth

14
S/S CNS Toxicity
  • Light-headedness
  • Tinnitus
  • Visual disturbance
  • Muscle twitching
  • Irrational behavior and speech

15
Cardiovascular toxicity
  • slowing of the conduction in the myocardium
  • myocardial depression
  • peripheral vasodilatation
  • usually seen after 2 to 4 times the convulsant
    dose has been injected

16
Prevention and Treatment of Local/Regional
Anesthesia Toxicity
17
prevention
  • Always use the recommended dose
  • Aspirate through the needle or catheter before
    injecting the local anesthetic. Intravascular
    injection can have catastrophic results.
  • If a large quantity of a drug is required, use a
    drug of low toxicity and divide the dose into
    small increments, increasing the total injection
    time
  • always inject slowly (lt10 ml/min) and communicate
    with the pt

18
treatment
  • All necessary equipment to perform resuscitation,
    induction, and intubation should be on hand
    before injection of local/regional anesthetics
  • Manage airway and give oxygen
  • Stop convulsions if they continue for more than
    15 to 20 seconds
  • Thiopental 100 mg to 150 mg IV
  • or Diazepam 5 mg to 20 mg IV
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