1. ARJUN SHENOYPOSTGRADUATE STUDENTDEPT OF MAXILLOFACIAL SURGERYKVGDCH

2. Definition Requirements composition Mechanism of action Classification Biotransformation Indications and contraindications 3. The word was coined by Dr Oliver Holmes 1846Greek word.An means without and aisthetos means pain. Anesthesia means loss of sensation includingpain, touch, temperature and pressure perceptionand may be accompanied by impairment of motorfunction 4. Nonirritant. Should not produce any local reaction. Should not cause any permanent change in thenerve structure. Should cause minimal systemic toxicity. Should be effective and enough penetratingproperties when used topically. Should have short time of onset. 5. Duration should enough to allow thecompletion of procedure. Should have enough potency. Should be free from allergy producingsubstances. Should be sterilized of capable of beingsterilized by heat without deterioration. Should be stable and readily undergobiotransformation in the body. 6. AGENT FUNCTIONLIGNOCAINE HYDROCHLORIDE 2% LOCAL ANAESTHETIC AGENTADRENALINE 1:80000 VASOCONSTRICTORSODIUM METABISULFATE REDUCING AGENTMETHYLPARABEN PRESERVATIVE 7. DISTILLED WATER DILUTING AGENTRINGERS SOLUTION VEHICLESODIUM HYDROXIDE TO ADJUST PHNITROGEN BUBBLES PREVENTS DESTRUCTION OFVASOPRESSOR BY OXYGEN 8. Acetylcholine theory. Calcium displacement theory. Surface charge theory. Membrane expansion theory. Specific theory. 9. Local anaesthetics are membrane stabilizingdrugs. Acts by inhibiting sodium influx throughvoltage gated sodium specific ion channels inthe nueronal cells. Hence action potential cannot arise due tothis inhibition and blockade of conduction isestablished. 10. PAIN TEMPERATURE TOUCH PROPRIOCEPTION SKELETAL MUSCLE TONEINITIALLY GRADE CFIBRES ARE BLOCKEDFOLLOWED BY GRADE A 11. ON THE BASIS OFDURATION OF ACTIONBASED ONORGINON BASIS OFCHEMICALNATURE 12. ON BASIS OF OCCURANCE 13. On the basis if OCCURRENCE in nature: NATURALLY OCCURING: e.g. cocaine.SYSTEMIC COMPOUNDS Derivatives of acentanillide: e.g. lignocaine(lidocaine, xylocaine)l Miscellaneous drugs with local anestheticaction like phenol, chlorpromazine 14. ESTERSThese can be further classified as:Esters of benzoic acide.g. cocaine butacaine.Esters of para-aminobenzoic acide.g. procaine, propoxycaine. AMIDESe.g. articaine, bupivacine, lidocaine. 15. short actingarticaine, lidocaine, mepivacaine, prilocaine. Long acting:bupivacaine, etidocaine, bucricaine 16. Incision and drainage of incised abscess. Removal of cysts, residual infection areas,hydrophilic groups and neoplastic growths,ranula and salivary calculi. In the treatment of tic douloreux byproducing prolonged anesthesia with thecombination of a local anesthetic agent andalcohol injection. 17. Extraction of teeth and fractured roots. Odontectomy. Treatment of alveolagia. Alveolectomy. Apicoectomy. 18. Esters are rapidly metabolised in the plasmaby cholinestrase Amides are slowly destroyed in the liver bymicrosomal P450 enzymes 19. LIPIDSOLUBILITYPH of theinflamedtissuesvasoconstrictors 20. Premonitory signs Ringing in ears Metallic taste Numbness around lipsMORE SERIOUS COMPLICATIONS- First apparent convulsions followed by CNSdepression (death). CVS arryhythmias and hypotension. 21. MODES OF APPLICATIONTOPICAL OR SURFACE APPLICATIONINFILTRATIONSNERVE BLOCKSFIELD BLOCKSCENTRALLY ACTING (SPINAL) 22. Methhaemoglobinemia neurotoxicity hypersensitivity 23. ABSOLUTECONTRAINDICATION.RELATIVECONTRAINDICATION 24. History of allergy to local anesthetic agent, orhistory of allergy to any of the constituents ofthe local anesthetic solution. 25. Fear and apprehension. Presence of acute inflammation or suppurativeinfection at the site of insertion of needle. Infants or small children. Mentally retarded patients. 26. Major surgical procedures withhaemodynamic unstabilityepilepsy Presence of methhaemoglobinemia. Twodrugs are to be avoided. They arebenzocaine and articaine. Presence of atypical plasma cholinesterase 27. 1)patient remains awake and cooperative. 2)little disturbance of normal physiology. 3)low incidence of morbidity. 4)patient can leave the hospital unescorted. 5)additional personnel not required. 28. 6)percentage of failure is small. 7)technique not difficult master. 8)no additional expense to the patient. 9)Patient need not miss the previous meal. 29. No true disadvantages to the use of regionalanesthesia, when the patient is mentallyprepared and when there are nocontraindications. 30. Potency: depends solely on the chemicalnature. Duration of anesthesia: depends onmolecular weight and presence ofvasoconstrictor If lipophillic group predominates then theability to diffuse into the lipid rich nervediminishes. 31. NORMALHEART FAILURE1.8 hr1.9 hrHEPATIC DISEASERENAL DISEASE4.9 hr1.3 hr