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47 Cards in this Set

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first local anesthetic
cocaine in 1855
first used as nerve block
1884
Dr. William Halsted/Hall
cocaine for nerve block
1891 lumbar puncture for?
hydrocephalus

Dr. Quinke
first synthesized local
procaine(novacaine)
introduced caudal epidural anes
Ferdinand Cathelin and Jean Sicard circ.1901
introduced lumbar epidural anes
Fidel Pages circ 1921
most recent local anes developed
ropivacaine-deriv of bupivacaine, but less cardiotoxic
char. of locals
poorly H20 sol
weak base
benzoic acid joined by ester linkage to tert amine
3 parts of local makeup
hydrophilic chain(tert amine)
lipophilic (aromatic ring)
ester or amide linkage
ester locals
cocaine
procaine
chloroprocaine
tetracaine
4 of them
amide locals
mepivacaine, ropivacaine, Bupivacaine, lidocaine, etidocaine, prilocaine
Mr. Blep
char of locals
less stable-shorter shelf life
met by pseudocholinesterase
most likely to cause allerg rx
char of amides
more stable
met by liver
rare allergies
importance of acid preparation
highly ionized-portion is h20 soluble.
epi(if added) needs acidic environment. not stable in alk
mech of locals
Na channel blockers
blocks Na from?
inside the channel
nonionized vs ionized portion of local structure
non crosses axonal membrane..

ionized cation is resp for blockade
base form of locals keeps the Na gate in what state?
closed inactive
locals (do/do not) alter resting membrane potential?
do NOT. it slows the rate of depolarization so threshold potential is not reached
Cm=
minimum concentration. minimum amount needed to produce block
Cm influenced by-
potency of local
nerve diameter
myelenated or not
"frequency dependant block principle"
position of nerve in bundle
frequency dependant blockade
the more a nerve fires, the more sensitive to local block
myelinated vs nonmyelinated
non is quicker unless rapid firing
nerve fibers classified by
nerve fiber diameter and conduction velocity
Largest diameter nerves are?
A fibers
A-alpha
innervate skeletal muscle for motor and proprioception
A-beta
sensation of touch and pressure
A-gamma
skeletal muscle of muscle tone
A-delta
pain, temp, touch
B-fibers
preganglionic autonomic.
blocked first
A-delta and C fibers
blocked at same time and then the rest of the A fibers
Potency of local rel to ?
lipid solubility
onset of local rel to
pKa
absorp of locals in order...
IV, intercostal, tracheal, caudal/cervix, epidural, brachial plexus, spinal, subQ
active metabolite of lido
mono ethyl glycine xylodide
metabolite of prilocaine
ortho toluidine. causes metHgb
reduces Fe2+ to Fe3+
s/s of local toxicity-in order of severity
numbness of lips/tongue, lightheaded, visual/hearing disturbances, muscle twitches, unconsciousness, convulsions, coma, resp collapse, CV collpase
tx of local tox
O2
benzo's
barbs
all increase the seizure threshold, and airway managemnt
CV s/s of local tox
initial tachy and hypertension
then brady and hypo with dec. CO
tx of CV s/s of local
epi, ephedrine, atropine, bretylium, extend the CPR time
PABA
para aminobenzoic acid
from the esters
dibucaine 80
normal. dibucaine is 80% depressed. # is the % inhibition of pschase
dibucaine 40
heterozygous (1 of each gene)
20-30 block
dibucaine 20
homozygous (two genes) profound extended block. up to 8 hours
atypical pseudocholinesterase
incapable of hydrolyzing ester locals
tx for metHb
methyline blue at 1-2 mg/kg over 5 minutes
agent in diluents that causes rxns
parabens-cytotoxic. use preservative free or MPF