Anestesi Lokal pada Lesi Superfisial

Huntal Napoleon

Local Anesthesia
Local anesthetics work by producing nerve conduction blockade at the level of nerve membrane receptors.

Routes of Local Anesthetic

Local anaesthetic drugs can reach their target by one of a number of routes: 1.infiltrationdiffusion to sensory receptors and the finest nerve branches (a similar retrograde diffusion occurs during intravenous regional analgesia); 2.injection close to (preferably not into) a nerve trunk; 3.injection into a plane or compartment through which a nerve runs (e.g. axillary sheath, epidural and subarachnoid spaces).

Indications
a. Anesthesia for surgical procedures b. Anesthesia for wounds that require irrigation, debridement, and/or repair

Advantage
The patient can remain conscious, and by doing so provides assurance of a safe airway and avoids complications caused by anaesthetic interference with breathing function. In contrast, most techniques for general anaesthesia interfere with the control of at least three major systems: consciousness, cardiovascular and respiratory function. For many patients it is the loss of control of these functions that causes them the greatest anxiety in relation to surgery.

Contraindications
a. Hipersensitivity b. Epinephrine should not be used at anatomic sites supplied by endarteries (fingers, toes, nose, ears, penis) or in infection-prone wounds (animal/human bites, contaminated wounds).

Local Anesthesi
Choose from the above chart and tailor choice to individual patient based on the duration of procedure; time to onset; and location, type, and extent of wound. Long-and short-acting anesthetics can be mixed in a 50:50 ratio to achieve benefits of both.

Local Anesthesia
No. Local Anesthetic Onset Maximum Dose mg/Kg) plain 1. 2. 3. 4. Bupivacaine (Marcaine) Lidocaine (Xylocaine) Procaine (Novocaine) Tetracaine (Pontocaine) slow rapid slow slow 2.5 5.0 6.0 1.5 With epi 3.5 7.0 9.0 2.5 Durations of Actions (hrs) plain 2.0-4.0 0.5-2.0 0.25-0.5 2.0-3.0 With epi 4.0-6.0 1.0-4.0 0.5-1.0 2.0-4.0

Equipment and Positioning

Equipment: a.Sterile prep solution b.Sterile gloves and towels c.25-gauge needle d.10-ml syringe Positioning: Varies with location of wound

Technique
Technique: a. Sterile prep wound with antiseptic such as Betadine, cleanse with alcohol swab. b. Stretch skin taut to facilitate penetration, and directly infiltrate local anesthetic through wound edges and inside wound with a long 25 gauge needle; minimize needle sticks by orienting needle longitudinally along axis of wound and injecting beneath skin edges c. Inject the anesthetic slowly

Complications and Management

Complications and Management overdose : Initial signs of toxicity include dizziness, restlessness, paresthesias, and twitching, and may lead to generalized seizures, hypotension, bradycardia, and cardiovascular collapse. Complications are generally self-limited but may require supportive care until effects wear off. Stop the local anesthetic and hyperventilate with 100% O2. Use IV diazepam (0.10.3 mg/kg) for seizures. Initiate ACLS protocols if necessary. Trendelenburg for hypotension and bradycardia. Prolonged CPR is indicated because the effects of the anesthetic will subside as the drug redistributes.

TERIMAKASIH