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Local Anesthetic
- 1. Carlos Darcy Alves Bersot TSA.SBA MD RESPONSÁVEL PELO CET H.F.LAGOA Médico Anestesiologista do Hospital Federal da Lagoa-SUS Médico Anestesiologista do Hospital Universitário Pedro Ernesto-UERJ Ponto 9
- 2. História “A possibilidade de produzir uma anestesia local por esse ou outros meios, certamente é objetivo de muitos estudos, se um homem é capaz de ver uma amputação de seu próprio membro e não sentir isso levará a um progresso incalculável na área cirúrgica” James Young Simpson, 1848
- 4. História Niemann em 1860 isolou cristais brancos da planta Erythroloxon coca e nomeou como cocaina Sigmund Freud com ajuda de Carl Koller, um oftalmologista, investigou as propriedades da cocaina
- 5. História Koller descreveu a anestesia tópica no olho em setembro de 1884; Wandam LD. Some aspects of the history of local anesthesia. In: Arthur GR, Strichartz GR.Handbook ofExperimental Pharmacology. Berlin, Springer-Verlag, 1987, p. 1-19 • Halsted and Hall executaram o primeiro bloqueio de nervo periférico Carl Koller 1857 -1944 1885; • August Bier executou o primeiro bloqueio no neuroeixo em 1898. William S. Halsted
- 6. CRONOLOGIA Cocaina Niemann 1860 Éster Benzocaina Salkowski 1895 Éster Procaina Einhorn 1904 Éster Tetracaina Eisler 1928 Éster Lidocaina Lofgren 1943 Amida Cloroprocaina Marks, Rubin 1949 Éster Mepivacaina Ekenstam 1956 Amida Bupivacaina Ekenstam 1957 Amida Ropivacaina Sandberg 1989 Amida Cartwright & Fyhr. Reg Anesth 1988;13:1-12
- 15. LOCAL DE AÇÃO DOS AL Godwin. Biophys D4S6 Chem 2005;113:1-7 MUTAÇÕES Ragsdale. Science REDUZ A 1994;265:1724-8 AFINIDADE,Nav 1.2, 1.4
- 17. Local anesthetics can bind to other membrane proteins (Butterworth and Strichartz, 1990). Can block K+ channels (Strichartz and Ritchie, 1987).
- 49. Effects of Levobupivacaine and Racemic Bupivacaine in Anesthetized Pigs 140.00 Increase in QRS (ms) 120.00 47% Difference 100.00 80.00 60.00 25% Difference 40.00 20.00 Bupivacaine Levobupivacaine 0.00 0.375 0.75 1.5 3.0 4.0 7.0 Dose (mg) Morrison SG, et al. Anesth Analg 2000;90:1308-1314.
- 50. Incremental Doses of Bupivacaine and Levobupivacaine in Sheep: CV Effects Baseline Multiform VT VF Time Bupivacaine, 200 mg IV for 3 min (sec) 0 1 2 3 4 225 226 227 228 229 240 241 242 243 Baseline Wide QRS Ventricular Time (sec) Levobupivacaine, 200 mg IV for 3 min 0 1 2 3 4 300 301 302 303 304 375 376 377 378 379 Huang YF, et al. Anesth Analg 1998;86:797-804.
- 55. PROPOFOL?
- 59. 20 1 0 Moshiri M. Etamad
- 61. Lipid emulsion vs. saline after bupivacaine in rats CPR BUPI 15 mg/kg CPR CPR Weinberg. Reg Anesth Pain Med 2002;27:568-75
Notas do Editor
- Compared with bupivacaine, significantly higher doses of levobupivacaine were required to achieve the same degree of QRS prolongation. To produce 40-millisecond increase in QRS duration, a 25% higher dose of levobupivacaine was required. Similarly, to produce a 90-millisecond increase in the QRS interval, a 47% higher dose of levobupivacaine was required. The clinical significance of these data is unknown. Reference Morrison SG, Dominguez JJ, Frascarolo P, Reiz S. A comparison of the electrocardiographic cardiotoxic effects of racemic bupivacaine, levobupivacaine, and ropivacaine in anesthetized swine. Anesth Analg 2000;90:1308-1314.
- The electrocardiograms shown here illustrate the different outcomes that occur following intravenous administration of 200 milligrams of bupivacaine or levobupivacaine over 3 minutes. Bupivacaine administration resulted in a multiform ventricular tachycardia within approximately 4 minutes, which rapidly progressed to ventricular fibrillation 15 seconds thereafter. In contrast, levobupivacaine widened the QRS interval after approximately 6 minutes, with bigeminy developing prior to the spontaneous restoration of sinus rhythm. Reference Huang YF, Pryor ME, Mather LE, Veering BT. Cardiovascular and central nervous system effects of intravenous levobupivacaine and bupivacaine in sheep. Anesth Analg 1998;86:797-804.