Articles: anesthetics.
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Local anesthetics are in general not suitable for the treatment of patients with severe cancer pain. Local blocks are useful for diagnostic and prognostic purposes. ⋯ The use of local anesthetics may yield long-lasting relief in some specific pain syndromes, such as tumor-related reflex dystrophies, in painful muscle spasms, and trigger points due to tumor-affected vertebrae. In addition, local anesthetics may have a generally beneficial effect in the restless, cachectic, and aged patient.
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The problem of waste anesthetic gases must be addressed because of potential health hazards. However, solutions must be considered within a larger context than that of the operating room or dental suite. The impact of shifting wastes from the hospital into the atmosphere must be examined for both ecologic and ethical implications. ⋯ Are waste anesthetic gases an atmospheric pollutant with impact sufficient to cause concern? If not, do the economic considerations of recycling exhausted anesthetic and respiratory gases warrant implementation? Anesthesiologists need to consider these issues within the constraints of the environments in which they practice. The problem will exist as long as inhalation anesthesia is in use. Solution should not create new problems.
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The methods of providing postoperative analgesia by regional anaesthetic techniques with local anaesthetics are outlined. For the use of epidural analgesia, the techniques of inserting an epidural catheter at any level of the spine must be familiar. The block should be regional, restricted to the area of pain and effective at all times after its institution with a minimum of side effects. ⋯ A dose regimen for thoracic, abdominal, perineal and lower extremity pain is presented. Side effects of the epidural technique and ways to treat and avoid them are discussed. The intercostal nerve block for post-thoracotomy and upper abdominal pain is described with special reference to the recent development of the continuous technique with bupivacaine and the cryoanalgesia technique.
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The clinically useful local anesthetic agents can be divided chemically into the amino-esters, e.g., procaine, chloroprocaine and tetracaine, and the amino-amides, e.g., lidocaine, mepivacaine, prilocaine, bupivacaine and etidocaine. Pharmacologically, these agents can be categorized as agents of low potency and short duration of action, e.g., procaine and chloroprocaine; agents of intermediate potency and duration of action, e.g., lidocaine, mepivacaine and prilocaine; and agents of high potency and long duration, e.g., tetracaine, bupivacaine and etidocaine. The blood level of local anesthetics is determined by the rate of uptake, tissue redistribution, metabolism and excretion. ⋯ Among the ester agents chloroprocaine is cleared most rapidly due to its fast rate of hydrolysis. Within the amide series, prilocaine is cleared most rapidly due to its fast rate of tissue redistribution and its rapid hepatic metabolism. Bupivacaine is cleared most slowly due primarily to its decreased rate of hepatic degradation.
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Biol Res Pregnancy Perinatol · Jan 1984
ReviewObstetric analgesia: pharmacokinetics and its relation to neonatal behavioral and adaptive functions.
The neonatal pharmacokinetic and neurobehavioral properties of certain agents used in obstetric analgesia are reviewed (local anesthetics, opiates, inhalation agents, benzodiazepines). Fetal and neonatal pharmacokinetic alterations partly explain the neurobehavioral differences observed between different drug groups and ways of drug administration. The most effective and safest method with fewest neonatal neurobehavioral effects appears to be regional epidural analgesia performed with plain bupivacaine. ⋯ Inhalation agents and parenteral pethidine (meperidine) are still clinically useful alternative compounds in circumstances where epidural analgesia is not possible. Pharmacokinetically and according to neurobehavioral assessments, inhalation agents appear to be more attractive than pethidine. Benzodiazepines, especially after high or repeated doses, may cause the so-called floppy-infant syndrome, at least partly, due to a slow neonatal drug elimination.