Substances which act in the area of afferent nerves endings: Substances which act in the area of afferent nerves endings

Substances which act in the area of afferent nerves endings:

• Substances which act in the area of afferent nerves endings:

• local anesthetics

• astringent

• covering

• adsorbtive

• irritative

• Local anesthetics

Local anesthetics

• Local anesthetics

• Natural compound – aether of benzoilekgonin - cocain

• Synthetic neutrogen compounds

• Aether compounds (derivatives from PABA)

• a) easily dilluted in water : novocain (procain), dicain (tetrakain)

• b) badly dilluted in water: anaesthesin (benzokain), orthokain

• Amide compounds: lidocain (xycain), trimecain, etydocain (duranest), prilocain (citanest), articain (ultracain), piromecain (bumekain), marcain (bupivacain)

Kinds of local anesthesia:

• Kinds of local anesthesia:

• terminal

• conductive

• infiltrative

Terminal (superficial) anesthesia - local anesthetic is spread over mucous membranes, wounds, ulcers, fresh granulations

• Terminal (superficial) anesthesia - local anesthetic is spread over mucous membranes, wounds, ulcers, fresh granulations

• For terminal anesthesia we often use anaesthesin, dicain, xycain, trimecain, very rarely – novocain, because it badly penetrates through mucous membranes

Conductive (regional) anesthesia - is an introduction of anesthetic into area of nervous truncs, ganglia, sensitive roots of spinal cord.

• Conductive (regional) anesthesia - is an introduction of anesthetic into area of nervous truncs, ganglia, sensitive roots of spinal cord.

• Kinds of regional anesthesia: truncal (conductive), plexal (anesthesia of nervous plexuses), paravertebral (anesthesia of nerovus ganglia), spinal-cord, peridural

• For performing of this anesthesia novocain, xycain, trimecain, ultracain are used

Infiltrative anesthesia – is a mixed kind of local anesthesia, in which nervous endings and fibres get turned off because of layer by layer infiltration of tissues with a solution of local anesthetic.

• Infiltrative anesthesia – is a mixed kind of local anesthesia, in which nervous endings and fibres get turned off because of layer by layer infiltration of tissues with a solution of local anesthetic.

• For infiltrative anesthesia novocain, xycain, trimecain, ultracain are used

• Cocain (Cocainum) – alcaloid, which is extracted from leaves of South-American plant Erythroxylon coca. Its local anesthetic action overwhelms local anesthetic activity of novocain in 3 times and toxicity is 3-5 times greater

• It is used very rarely

• only for superficial anesthesia

• in stomatology, otholaryngology, urology in a form of 2-5 % solutions

Novocain (Novocainum) – derivative of PABA (para-aminobenzoic acid)

• Novocain (Novocainum) – derivative of PABA (para-aminobenzoic acid)

• usage

• infiltrative anesthesia - 0,25-0,5 % solutions

• truncal anesthesia - 1-2 % solutions

• treatment blockades (paranephral, vagosympathetic) – 0,25-0,5 % solutions

• spinal cord anesthesia - 2-3 ml of 5 % solution (is introduced into subarachnoid space on the level higher than first lumbal vertebra)

• At recent time novocain was used for depression of reflexes, central nervous system, heart, in patients with gastritis, ulcer disease, hypertonic disease, stenocardia, neurodermitis, spasms of peripheral vessels. In this case this drug was introduced intravenously or intramuscularly

Xycain (Lidocain)

• Xycain (Lidocain)

• it is 2 times stronger (activity regarding) than novocain with the same toxicity

• usage

• for all kinds of local anesthesia:

• infiltrative - 0,25-0,5 % solutions

• conductive – 0,5-2 % solutions

• peridural – 0,5 % solution

• spinal cord – 5 % solution

• terminal – 4-10 % solutions

Xycain eliminates cardiac arrythmias of ventricular origin, i.e. extrasystolia, fibrillation of ventricules in acute miocardial infarction. In this cases xycain is administred intravenously, dropply, slowly, in a form of

• Xycain eliminates cardiac arrythmias of ventricular origin, i.e. extrasystolia, fibrillation of ventricules in acute miocardial infarction. In this cases xycain is administred intravenously, dropply, slowly, in a form of

• 0,2 % solution.

• Xycain (lidocain) can be used in individuals, which are sensybilized towards novocain and other anesthetics of complexed aehters group (dicain, anesthesin)

Trimecain

• Trimecain

• anesthetic avtivity and action duration are 2 times greater, comparatively to novocain, toxicity is a bit higher

• Usage infiltrative - 0,125 %, 0,25 % and 0,5 % solutions

• truncal - 1 % and 2 % solutions peridural - 1 %, 2 % solutions

• spinal cord - 5 % solution

• terminal - 2-5 % solutions

• as an antiarythmic drug in cardial arythmias of ventricular origin - intravenously, at the begging in a form of 2 % solution very slowly after - dropply 0,2 % soluiton

Bupivacain (marcain)

• Bupivacain (marcain)

• one of the most active anesthetics of prolonged action (onset – 2-20 min, duration of action – 7 hours)

• Usage

• infiltrative, truncal, epidural anesthesia

• considerable cardiotoxicity !

Articain (ultracain)

• Articain (ultracain)

• usage

• infiltrative and conductive anesthesia

• Analgetic action develops after 1-2 min. after introduction of the drug, lasts for 1-3,5 hours

• in stomatology - combined drug, which consists of ultracain and adrenalini hydrochloridum (epinephrin)

• - ultracain D-C

Symptoms

• Symptoms

• decreasing of arterial pressure, of heart activity, cardiac arrest, depression of CNS and breathing, seizures

• Treatment

• vasoconstriction drugs (noradrenaline, adrenaline), cardiotonic (strophantin, corglycon), antiseizure drugs (sibazone, tiopental-sodium)

• Prophilaxis

• usage of least possible volume and most possible dillution of the local anesthetics

• Organic, of plant origin

• tannin, infusion of tea, herba Hyperici, flores Chamomillae, cortex Quercus

• Nonorganic

• Bismuthi subnitras, de-nol

Ammonium solution

• Ammonium solution

• Menthol

• Oleum Terpenthini purified

• Mustard plaster

• Camphor

Usage

• Usage

• Unconsciousness (put a cotton ball moistured with ammonium solution to a nose)

• In case of alcohol intoxication (orally 5-10 drops of solution dilluted in half of a glass of water)

• For washing of surgeon’s hands (rarely) (0,5 % solution)

Thanks for your attention!

• Thanks for your attention!

• Good-bye !