CRNA : the clinical forum for nurse anesthetists
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Local anesthetic drugs interrupt nerve transmission by inhibiting the passage of sodium ions (Na+) across neuronal membranes. Signal propagation and transmission along central and peripheral nerve pathways are impeded after the injection of these drugs near or on neuronal tissue. This article briefly reviews the basic pharmacology and toxicology of local anesthetic agents as well as recent studies of regional anesthesia performed with ropivacaine, a versatile new amide local anesthetic with a duration of action similar to bupivacaine, but with less systemic toxicity.
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Pulmonary edema developing after the relief of upper airway obstruction has been reported in association with a variety of factors including laryngospasm, foreign bodies, and tumors. However, as the phrase "negative pressure pulmonary edema" suggests, markedly negative intrapleural pressure is the dominant mechanism for the genesis of pulmonary edema associated with upper airway obstruction. A review for anesthesia providers of this poorly recognized and often perplexing syndrome may help to reduce the occurrence of this potential complication and facilitate its treatment.