lidocain ppt
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TRANSCRIPT
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LIDOCAINE::THE GOLD STANDARD DRUG
PRESENTED BY-VANDITA SINGH
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LidocaineLidocaine, the first amino amide-type local anesthetic,
was first synthesized under the name Xylocaine by Swedish chemist Nils Löfgren in 1943.
FDA Approved-November 1948
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IndicationsRapid acting local anesthetic for procedures
ranging from infiltration to regional nerve block Antiarrhythmic in the treatment of vent.
arrhythmias Treatment of status epilepticus (INVESTIGATIONAL)
Treatment of pain OperativeNeuropathic pain
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PharmacologyHalf life: 1.6 hrs(~90 min)Distribution: Lipo-philic, widely distributed into
bodypH of plain solution-6.5pH of vasoconstrictor containing solution-5.0-5.5Onset of action –rapidPregnancy clissification-BEffective dental concentration-2%Protein binding: 60-80 %
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MAXIMUM RECOMMENDED DOSE
The max. manufactures recommended dose of lidocaine with epinephrine is 7.0mg/kg body weight for adult patient,not to exeed dose of 500mg.
4.4mg/kg body weight dose of lidocaine without a vasoconstrictor
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ACTIONS
ON CNS
(i) Blocks conduction around a nerve
Anaesthesia(ii) Initially causes drowsiness & lethargy(iii) Higher doses cause excitation followed by depression
ON CVS
Heart Blood vessels
Abbreviates Vasodilatation in Effective the injected area Refractory Period
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MECHANISM OF ACTION
Alters depolarization inneurons by blocking the fastvoltage gated sodium (Na+)channels in the cellmembrane. With sufficientblockade, the membrane ofthe presynaptic neuron willnot depolarize and so fail totransmit an action potential,leading to its anaestheticeffects
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PHARMACOKINETICS
Absorption:Absorbed rapidly after parenteral administration & from GIT & Respiratory Tract
Metabolism: Metabolized in the liver Excretion: Metabolites and
unchanged drug are excreted by the kidneys in the urine
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ROUTES OF ADMINISTRATION
Intravenous injection (sometimes combined with epinephrine)
Dermal patch (sometimes combined with prilocaine)
Nasal instillation/spray (combined with phenylephrine)
Topical gel
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Its vasodilating effect limits
pulpal anesthesia to
only 5-10min.
This leads to higher blood
levels& increased
risk of adverse reaction
The inclusion of
epinephrine produces a decrease in blood flow leading to
decrease in bleeding at the site of injection.Increased duration-~60min of
pulpal anesthesia
Decreases blood flow .Increases
duration of action~60min of pulpal anesthesia.
2% WITHOUT VASOCONSTRICTOR(LIDOCAIN PLAIN)
2% WITH EPINEPHRINE1:50,000
2% WITHEPINEPHRINE1:100,000
The duration &depth obtained with both lidocaine-epinephrine solution are equivalent although not the same level of hemostasis.{2%lidocaine with 1:50,000
epinephrine is recommended because it decrease bleeding by 50% as compared with 1:100,000
epinephrene dilution}
DIFFERENT FORMS OF LIDOCAINE
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Intravenous Lidocaine for AmbulatoryAnesthesia
Christopher L. Wu, MD ,Inter Anes Research Society,Dec. 2009
Using 1.5–3 mg kg\ hlidocaine significantly reduced the incidence of nausea and vomiting (32% vs 52%), Marginally reduced pain scores .
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ADVERSE EFFECTS
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OVERDOSE
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CONTRAINDICATIONS
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EUTECTIC MIXTURE OF LOCAL ANESTHETICS (EMLA)- LIDOCAINE &
PRILOCAINEEutectic mixture refers to
lowering of melting point of two solids when they are mixed
Lidocaine+Prilocaine at 25oC
Oil emulsified into water to form a cream
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CLINICAL USES/ INDICATIONS
Dermal anaesthesia, specifically applied to prevent pain associated with intravenous catheter insertion, blood sampling, superficial surgical procedures on intact skin & mucous membranes
Topical anaesthesia for cleansing or debridement of ulcers, to numb the skin before tattooing as well as laser hair removal