Medical local anesthesia mind map

Surgery - Anesthesia: Local anesthesia, using local anesthetics to temporarily block the impulse conduction of certain peripheral nerves, causing anesthesia in the areas innervated by these nerves.

Edited at 2024-02-27 10:26:10

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Medical local anesthesia mind map

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Outline

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Neural Anesthesia--Spinal Anesthesia
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Pre-anesthetic medication
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Preparation before anesthesia and medication before anesthesia (2) Physical and mental preparation of the patient
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surgical anesthesia
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Pediatric anesthesia
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anesthesia for cardiovascular surgery
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Local anesthesia

Use local anesthetics to temporarily block the impulse conduction of certain peripheral nerves, causing anesthesia to the areas innervated by these nerves.

include

local anesthesia

topical anesthesia

local infiltration anesthesia

regional anesthesia

nerve block anesthesia

neuraxial anesthesia

Subarachnoid space anesthesia

epidural anesthesia

Combined neuraxial epidural anesthesia

local anesthetic

Classification

Esters: Procaine Tetracaine

Amides: lidocaine Bupivacaine Ropivacaine

Physical and chemical properties

dissociation constant

Ka=[hydrogen ion]·[B]/[BH ]

The larger the pKa, the more ions there are, making it difficult to pass through the nerve sheath and membrane, and the longer the onset of action takes.

The larger the pKa, the worse the dispersion performance

fat soluble

The higher the value, the stronger the anesthetic effect.

Protein binding rate

The higher the value, the longer the action time

absorb

drug dosage

injection site

Local anesthetic properties

vasoconstrictor

It can constrict blood vessels, delay the absorption of medicinal solution, prolong the action time, and reduce the occurrence of toxic reactions.

Adverse reactions

toxic reactions

reason

Dosage exceeds tolerance at one time

Inject into blood vessel

The injection site has rich blood supply and faster absorption.

Reduced patient tolerance - hypersensitivity reaction

clinical manifestations

center

Excite first and then inhibit

Mild: Dizziness, hyperphagia, drowsiness, chills, panic, disorientation

serious: Loss of consciousness, tremors of facial muscles and limbs, convulsions or convulsions

cardiovascular

Reduced myocardial contractility, reduced cardiac output, slowed heart rate, dilation of peripheral blood vessels, and decreased blood pressure

prevention

Pre-anesthetic medications: diazepam, barbiturates

Do not use more than the tolerated amount at one time

Aspiration without blood return and injection again

Add vasoconstrictor to the solution

Dosing slowly

treat

Stop immediately and take oxygen

Mild: Injection of diazepam\midazolam Convulsions or convulsions: intravenous thiopental sodium Hypotension: ephedrine\metahydroxylamine Slow heart rate: Atropine

Respiratory and cardiac arrest: cardiopulmonary resuscitation, intravenous administration of fat emulsion

allergic reaction

Amides are rare

prevention

Skin test

treat

Stop medication, inhale oxygen

Stabilize circulation and replenish blood volume

Appropriate use of vascular medications

Common local anesthetics

Procaine

local infiltration anesthesia

The metabolite PABA can weaken the effect of sulfa drugs

Tetracaine

Strong mucosal penetration

Topical anesthesia, nerve block, spinal anesthesia, epidural anesthesia

lidocaine

Nerve block, epidural anesthesia

Repeated drug use - drug resistance

Bupivacaine

Nerve block, spinal anesthesia, epidural block

High plasma protein binding

Cardiotoxicity

Ropivacaine

motor sensory dissociation

Epidural pain, labor analgesia

Local anesthesia method

topical anesthesia

mucosal surface

local infiltration anesthesia

Within the tissue of the surgical area

area block

Surrounding and bottom of the surgical site

lump removal

nerve block

Nerve trunks, plexuses, and perinodes

brachial nerve block

C5~8, T1

interscalene path

Bilateral interscalene nerve block cannot be performed - it inhibits the diaphragm and affects breathing

Incomplete ulnar nerve block

shoulder surgery

supraclavicular path

axillary path

Complete ulnar nerve block Incomplete musculocutaneous nerve block

Forearm and hand surgery

Indications

Upper limb surgery

complication

Phrenic nerve palsy, recurrent laryngeal nerve palsy

Horner syndrome (stellate ganglion block)

pneumothorax

high epidural block

total spinal anesthesia

cervical plexus block

C1~4

deep plexus block

Anterior cervical block

interscalene block

Bilateral deep cervical plexus block is not possible - phrenic nerve suppression

superficial plexus block

Indications

Neck surgery: thyroid surgery, tracheotomy

complication

Rare in superficial parts

Deep

local anesthetic toxic reactions

Accidental injection into the subarachnoid/epidural space

Phrenic nerve palsy

recurrent laryngeal nerve palsy

Horner syndrome

intercostal plexus block

T1~12

Rib angle/posterior axillary line

There is no blood and no air in the withdrawal

complication

pneumothorax

toxic reactions

digital nerve block

Each finger is innervated by 4 nerves

Do not add epinephrine - vasoconstriction, tissue necrosis

finger root block

intermetacarpal block