Articles: anesthetics.
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Acta Anaesthesiol Belg · Jan 1988
ReviewIs there a need for chloroprocaine 3% and bupivacaine 0.75%?
Bupivacaine and chloroprocaine have proven to be valuable local anesthetics for a variety of surgical and obstetrical situations. Bupivacaine is particularly useful as a long acting agent which provides excellent sensory analgesia particularly during labor with minimal blockade of motor fibers. The 0.75% solution is useful for epidural surgical anesthesia since it does result in a decrease in onset time and a more marked motor blockade. ⋯ The local neural toxicity of chloroprocaine solutions is referably to the low pH and the inclusion of sodium bisulfite in these particular solutions. The toxicity of chloroprocaine solutions is related to total dosage rather than the concentration of solution employed. Careful administration of chloroprocaine epidurally in order to avoid accidental subarachnoid injection should preclude the possibility of local neural toxicity.
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Int J Clin Monit Comput · Jan 1988
'Anestheticography': on-line monitoring and documentation of inhalational anesthesia.
The safe practice of inhalational anesthesia requires control over the amount of volatile anesthetic delivered to the patient. With minimal fresh gas flow this is facilitated by continuous monitoring and recording of the agent's concentration ('Anestheticography'). Alterations brought about by routine clinical maneuvers become visible. ⋯ Initiating emergence by closing the vaporizer during minimal flow led to a slow decrease in concentration whilst at a flow of 61/min the inspiratory isoflurane concentration rapidly decreased to subanesthetic levels. Insertion of a charcoal filter into the inspiratory limb of the breathing circuit immediately dropped the inspiratory concentration to undetectable levels. 'Anestheticography' is a useful means of monitoring and documentation of inhalational anesthetic. With the use of a charcoal filter all advantages of minimal flow anesthesia can be realized throughout the entire anesthetic, including emergence.
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Ann Fr Anesth Reanim · Jan 1988
[Systemic toxicity of local anesthetics. Pharmacokinetic and pharmacodynamic factors].
Local anaesthetics can have systemic adverse effects, mostly affecting the central nervous system and the heart. The physicochemical characteristics of the different local anaesthetics are recalled, for they determine the relationship between structure, activity and toxicity. The pharmacokinetic factors involved in the toxic effects of local anaesthetics, whether the drug is given in a single extravascular dose or, accidentally, within a blood vessel, are discussed. ⋯ Systemic maternal effects and transplacental passage probably explain their foetal toxicity. Specific toxic effects are seen with some drugs, such as methaemoglobinaemia and allergic reactions (rarely for amide agents). Overall, local anaesthetic accidents are rare, but they must be prevented.
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J. Pharm. Pharmacol. · Jan 1988
Myoclonic seizures in the mouse induced by alphaxalone and related steroid anaesthetics.
The anaesthetic steroids alphaxalone. 5 beta-alphaxalone and pregnanolone each caused myoclonic jerks in mice in a dose-related manner between 4 and 16 mg kg-1 i.v. There was no loss of righting reflex at these doses. The veterinary product Saffan, which contains alphaxalone and alphadalone, also caused myoclonic jerks at 2 mg kg-1 i.v., and a loss of righting reflex at doses of 4 mg kg-1 and above. These effects appear to be unrelated to the wide spectrum of potencies at the GABAA receptor complex of the three individual steroids as potentiators of muscimol, or as attenuators of picrotoxin.
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The prevention of toxic accidents due to local anesthetics is simple. The doses used must be carefully selected according to the drug chosen, the areas to be anaesthetized, and whether or not the local anaesthetic solution contains adrenaline. Continuous infusions of local anaesthetics should be used with great care. ⋯ Using a test dose of adrenaline to detect accidental vascular puncture is simple, but not foolproof (patients treated with beta-blockers, obstetrical cases). The slow injection of local anaesthetics is the best way of preventing this type of accident. Finally, the technique for intravenous regional anaesthesia must be very strict.