Local Anesthetics

Toxic doses of lidocaine can cause seizures and respiratory arrest. Furthermore, whenever lidocaine is used, equipment for cardiopulmonary resuscitation must be available for use.

This Anaesthetic case study would describes and discussed the scenario of a patient through the anaesthetic role of their surgical procedure. It will include and discuss the anaesthetic safety procedures equipment and drug interventions used to ensure this particular patients maximum safety and comfort before and during the procedure. The case study will include pre and peri-operative assessment in order to describe the involvement contribution of various specialties in the holistic care of the critical care patient. This assignment will focus only on the anaesthetics side of the procedure but will also highlight the importance of the triad of anaesthesia and discuss the administration, maintenance and reversal of

These medications have evolved and changed due to availability in the past few years. Cost has also had an impact on what medications are available to a dying patient. A patient self-administers an oral liquid suspension or a powdered mixed with a soft food such as applesauce. The mix of medications include barbiturates, chloral hydrate, and morphine which are compounded into a single dose prescription to facilitate death. Premedication is required prior to taking this final dose. The most common barbiturates are phenobarbital, pentobarbital or secobarbital. Phenobarbital is the longest acting and is typically used for seizures. Pentobarbital and secobarbital are used to sedate prior to surgery and are not as long acting as phenobarbital. Barbiturates effect the central nervous system. They are classified by their how long they take to effect and their duration of action. Barbiturates increase GABA (gaba amino-butyric acid) neurotransmissions in the brain. The increase in GABA causes drowsiness. They are highly addictive, and patients may become tolerant. The addiction is not an issue when a patient has reached this stage and does not need to be a concern. More importantly, if they have used them during the disease process as a sleep aid the patient may have built a tolerance and would require a higher dosage to be effective. Barbiturates do not provide pain relief, to provide pain relief a patient would need to reach a dose high enough to cause a comatose state. Chloral hydrate is a sleep aid or tranquilizer prior to surgery. This medication is quick

American physicians begin to use cocaine in medical practices. Cocaine was identified as a drug that depresses the central nervous system; however it had the exact opposite affect. The only general anesthetics available to physicians were chloroform and ether. These anesthetics would induce retching or vomit and did little for pain. Operations that required precision and detail

In 2014, more people died from drug overdoses then in any other year on record. A substantial amount of deaths were due to drug overdose on opioids, according to the CDC. (2015:64). In 1901, surgeon Racoviceanu-Pitesti published his first report on opioids for intrathecal anesthesia. In 1979, a report on the use of morphine as a treatment for pain was made, by Behar and his colleagues. Epidural and spinal opioids are today part of a routine regimen for intra- and postoperative anesthesia, according to Fisher (2003:683). Historically opioids have been used as painkillers, however the potential for misuse is huge; when these are used repeatedly, it increases the risk of developing an addiction. The use of illegal opiate drugs such as heroin

Panizzi L, Pang D, Paterson J. 2011. Successful treatment of hyperkalemic periodic paralysis in a horse during isoflurane anaesthesia. Veterinary Anesthesia and Analgesia. 38. 113-120.

MEDICATIONS: Any use of diuretics, pain medications, antiarrhythmic agents, anti-seizure drugs, sedatives, antibiotics, antihistamines, barbiturates, cephalosporins, salicylates, and sulfonamides?(Ross & Basello, 2003)

For regional anesthesia, a local anesthetic will be injected into a nerve.[1] The anesthetic will then affect a series of nerves. The anesthetic blocks pain by interrupting nerve transmissions, also known as action potentials.[3] Action potentials occur at a constant rate within the body. Action potentials occur between nerve cells and all the body to feel pain.

According to Hah et al. (2017), several studies have shown that nerve blockade of the central nervous system (neuraxial anesthesia) or peripheral nerves (regional anesthesia) reduce the need for opioids in the immediate postoperative phase. There are two mechanisms through which nerve blockade reduces persistent opioid use. First, nerve blockade works by impeding the transmission of pain during the perioperative phase and thereby stopping central sensitization and chronic neuropathic pain. Second, nerve blocks are effective in treating postoperative pain and are good predictor of persistent opioid use. Similarly, studies found that intravenous local anesthetic such as lidocaine reduces perioperative opioid

Discussion: The onset of sensory and motor block was faster and time taken to attain complete sensory and motor block to occur was shorter in the nalbuphine group as compared to bupivacaine group. Postoperative regression of both sensory and motor block was significantly slower in group N than in group B and the first rescue analgesic requirement in group N was significantly late than in group B. 0.8mg intrathecal nalbuphine as an adjunct to spinal bupivacaine prolongs the postoperative analgesia with minimal side effects and with desirable sedation intraoperatively which helps in taking care of psychological impact of operation theatre environment. Rawal et al found that nalbuphine was the least irritating to neural tissue even when used in large doses and was associated with minor behavioral and EEG changes

I have also learnt about the potential complications of epidural e .g Hypotension, Inadvertent high epidural block, inadvertent high epidural block, Local anaesthetic toxicity, Total spinal, Accidental dural puncture (Visser, 2001).

Similar to Isoflurane and Desflurane, Sevoflurane causes slight increases in CBF and intracranial pressure at normocarbia, although some studies show a decrease in cerebral blood flow. High concentrations of Sevoflurane (> 1.5 MAC) may impair autoregulation of CBF, thus allowing a drop in CBF during hemorrhagic hypotension. This effect on CBF autoregulation appears to be less pronounced than with Isoflurane. Cerebral metabolic oxygen requirements decrease, and seizure activity has not been

Mr Cox’s sedation was stopped (Midazolam and Morphine) following the insertion of a tracheostomy. However, due to encephalopathy he never regained consciousness. Despite many attempts he was difficult to wean from the ventilator and eventually there was reduced base entry.

If inadequate spinal anesthesia occurs general anesthesia is used for patients and they will exit from the

In all, when compared to other GABAa agonist such as thiopental, methohexital, and etomidate, propofol has shown to decrease the occurrence of major side effects involved with general anesthesia in use today. This, along with its perfusion proficiency and high positive outcome rate are why propofol is in continued use, even after over 30 years of medical advancement, and bad press due to recreational propofol abuse, leading to the deaths of those without the proper training needed to administer such a