Local Anesthetics

Local anesthetics are among the most widely used drugs. Their development over the past century ranges from a documented influence on Freud's Interpretation of Dreams 1 to the synthesis of the ubiquitously popular lidocaine, as described in Chapter 1. For surgical procedures the use of regional, epidural and intrathecal local anesthesia has increased continuously during the past decade. Local anesthetics are also applied by physicians to ameliorate unpleasant sensations and reactions to other procedures, such as tracheal intubation. The presence or the threat of cardiac arrhythmias is often countered by chronic administration oflocal anesthetic-like agents, such as lidocaine or procainamide. Relief of acute pain, accompanying dental manipulations, for example, and of chronic pain are also accomplished with traditional local anesthetics. And over-the-counter formula tions of topical local anesthetics provide practitioners of solar indiscretion welcome relief from their otherwise unaccommodating sunburn. In all these applications the final effect of the local anesthetic is an inhibition of electrical activity, accomplished as a reduction or total blockade of action potentials. The primary site of action is the sodium channel, a transmembrane protein which is essential for the influx of sodium ions that subserves impulse generation and propagation in nerves, skeletal muscle, and heart. The detailed mechanisms oflocal anesthetic action are still being investigated and Chapter 2 of this volume provides a current overview of that subject.

This book, richly illustrated in full colour, is a comprehensive guide to the use of local anaesthesia in dentistry that will meet the needs of both students and dental practitioners. It provides the reader with ample background information on the origin of pain and the pharmacology of anaesthetics, and describes the anatomy of the trigeminal nerve in detail. Subsequent chapters cover key are as such as general practical aspects, local anesthaesia in the upper and the lower jaw, the use of local anaesthetics in children, local and systematic complications, and the prevention of side effects. Patients at particular risk of adverse effects are identified and attention drawn to significant legal aspects. This second edition has been completely revised, with more attention to safety, environment, and sterility. Additional injection techniques have been included, and a new chapter is devoted to microprocessor-assisted administration of anaesthetics. Throughout, care has been taken to ensure that the information is clearly presented and the text is easy to read.

This Second Edition is a significant revision of the leading text and clinical reference on pediatric pain. Written by an international group of experts from all relevant disciplines, this new edition is a vital reference for all pain practitioners, and for nurses, psychologists, PTs, anesthesiologists, and pediatricians dealing with acute and chronic pediatric pain. This edition includes new and expanded information on NSAIDs, opioids, and regional anesthesia. New chapters cover sedation, pain in the ICU, multidisciplinary pain services, palliative care, and the long-term consequences of pain. User-friendly new features include many more illustrations of techniques.

A practical, "how-to" guide to safe anesthesia practices in dentistry, Handbook of Local Anesthesia, 6th Edition covers all the latest advances in science, instrumentation, and pain control techniques. From basic concepts to specific injection techniques, from dosage charts to the proper care and handling of equipment, this book provides in-depth, full-color coverage of key anesthesia topics, including specific hazards and errors in technique that may result in complications. Written by Dr. Stanley Malamed, dentistry's leading expert on this subject, Handbook of Local Anesthesia is a valuable reference that will help you prevent, recognize, and manage complications of local anesthesia administration. Videos on an available companion DVD (sold separately) are narrated by Dr. Stanley Malamed, covering topics such as local anesthetic agents, anesthetic injection techniques, potential complications, and risk management. Full-color photographs and line drawings are included throughout the book. In-depth discussions cover the anesthetic agents used in dentistry, along with their clinical actions. Routes of administration are described for all anesthetics. The proper care and handling of equipment is addressed, along with the problems that may be encountered. Requirements for pain control and local anesthesia within various dental specialties are included. Comprehensive information on Articaine is included, a local anesthetic that is gaining widespread use in the United States. Numerous boxes and tables provide a quick reference and comparison of techniques, drugs, and dosages. Dosage charts, injection techniques, information on duration of action, and contraindications for local anesthetics are included at the end of the book for quick reference.

Local anesthetics are being increasingly applied in different surgeries. Lower side effects of neuroaxial anesthesia, regional anesthesia, and field block, in comparison to general anesthesia (volatile and intravenous agents), are the main reasons why physicians prefer to conduct surgeries under local anesthesia, especially in outpatient and day care surgeries. It is important to emphasize the presence of an anesthesiologist, and vigilant monitoring of the homodynamic parameters, in decreasing a patient's anxiety, exerting other modalities for analgesia and increasing the safety margin in many procedures.

The Essence of Analgesia and Analgesics is an invaluable practical resource for clinicians giving pain relief in any clinical setting, describing the pharmacologic principles and clinical use of all available pain medications. As well as detailed overviews of pain processing and analgesic theory, sections are dedicated to oral and panteral opioid analgesics, neuraxial opioids, NSAIDs, local anesthetics, anticonvulsant type analgesics, NMDA antagonists, alpha adrenergic analgesics, antidepressant analgesics, muscle relaxants, adjuvant medications, and new and emerging analgesics. The concise format of the chapters allows for quick and easy reading and assimilation of information. Enhanced by summary tables and figures, each chapter provides an overview of a particular drug, covering chemical structure, mode of activity, indications, contraindications, common doses and uses, advantages and disadvantages, and drug related adverse events. Key references are also provided. Edited by leading experts in pain management, this is essential reading for any clinician involved in pain management.

Featuring more than 4100 references, Drug-Induced Liver Disease will be an invaluable reference for gastroenterologists, hepatologists, family physicians, internists, pathologists, pharmacists, pharmacologists, and clinical toxicologists, and graduate and medical school students in these disciplines.

This concise, evidence-based board review book, organized according to the ABA keyword list, covers all the fundamental concepts needed to pass written and re-certification board examinations. Each chapter begins with a case scenario or clinical problem from everyday practice, followed by concise discussion and clinical review questions and answers. Discussion progresses logically from preoperative assessment and intraoperative management to postoperative pain management, enhancing the reader's knowledge and honing diagnostic and clinical management skills. New guidelines and recently developed standards of care are also covered. Serving as a companion to the popular textbook Essential Clinical Anesthesia, this resourceful work reflects the clinical experiences of anesthesia experts at Harvard Medical School as well as individually known national experts in the field of anesthesiology. This practical review is an invaluable resource for anesthesiologists in training and practice, whether studying for board exams or as part of continuing education and ABA recertification.

Local Anaesthesia in Dentistry is a practical guide for both students and general practitioners to this essential area of clinical practice. Highly illustrated in full colour throughout, the book provides clear and practical guidance to the administration of local anaesthesia. The book introduces the reader to the concept of nerve conduction and pain as well as providing an explanation of the anatomy of the trigeminal nerve. Further chapters cover such key areas of practice as regional anaesthesia, local anaesthesia in children, pharmacology, local and systemic complications, general practical aspects, the prevention of side effects and legal aspects.

Written by the foremost authority in the field, this volume is a comprehensive review of the multifaceted phenomenon of hepatotoxicity. Dr. Zimmerman examines the interface between chemicals and the liver; the latest research in experimental hepatotoxicology; the hepatotoxic risks of household, industrial, and environmental chemicals; and the adverse effects of drugs on the liver. This thoroughly revised, updated Second Edition features a greatly expanded section on the wide variety of drugs that can cause liver injury. For quick reference, an appendix lists these medications and their associated hepatic injuries. Also included are in-depth discussions of drug metabolism and factors affecting susceptibility to liver injury.