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Dermatology
Anesthesia
Built from Dermatology, 5th Edition
What’s inside
9 sections · 87 slides
Overview
- What this topic covers
- Why local anesthesia matters
Physiology and Structure
How local anesthetics are built, and how they block nerve signals
- A short history of local anesthetics
- Local versus general anesthesia
- How local anesthetics block pain
- Three parts of a local anesthetic molecule
- Not all sensations are lost together
- Order in which sensations are lost
- Charged versus uncharged drug
- How local anesthetic reaches its target
- Why infected tissue is hard to numb
- Why an infected site resists numbing
Pharmacology
Amides and esters differ in metabolism, allergy risk, and use in special patients
- Two chemical families of local anesthetic
- Local anesthetics for infiltrative and nerve block anesthesia
- Local anesthetics for infiltrative and nerve block anesthesia (continued)
- What sets onset, duration, and potency
- Use in pregnancy and children
Additives to Local Anesthetics
Epinephrine, sodium bicarbonate, and hyaluronidase each change how the anesthetic behaves
- Why epinephrine is added
- Why epinephrine is added to local anesthetic
- Choosing an epinephrine concentration
- When epinephrine needs extra caution
- Epinephrine on fingers and toes
- Epinephrine's stability and the sting it causes
- Sodium bicarbonate: buffering for comfort
- Hyaluronidase: helping anesthetic spread
- Combining two anesthetics in one syringe
Side Effects and Overdosage
From a fainting spell to a true drug allergy or an anesthetic overdose
- Vasovagal reactions
- True allergic reactions are uncommon
- Managing a suspected anesthetic allergy
- Telling reactions apart by vital signs
- Recognizing local anesthetic systemic reactions
- Lidocaine toxicity by blood level
- Local side effects of injection
- Overdose: staying within safe doses
- Drug interactions that raise toxicity risk
- Toxicities specific to certain drugs
Topical Anesthetics
Numbing creams, gels, and sprays for skin and mucous membranes
- From weak beginnings to real skin numbing
- EMLA: the classic topical numbing cream
- Topical anesthetics for mucous membrane and intact skin anesthesia
- Topical anesthetics for mucous membrane and intact skin anesthesia (continued)
- EMLA: safety and precautions
- EMLA is avoided in some young children
- Maximum recommended application of eutectic mix of lidocaine 2.5%/prilocaine 2.5% (EMLA®) in children
- Other topical creams and how they compare
- Maximum recommended lidocaine 4% liposomal cream (LMX4®) application in children
- A peelable anesthetic membrane
- Techniques that boost topical penetration
- Topical anesthesia of mucous membranes
- Cryoanesthesia: numbing by cooling
Injection Techniques
Practical tricks that make local anesthesia far less painful
- Reducing the pain of needle insertion
- Reducing the pain of the injection itself
- Compressed air delivery systems for lidocaine
- Field block (ring block) anesthesia
- Tumescent anesthesia: numbing large areas
- Tumescent anesthesia formula
- How tumescent anesthesia is given
Nerve Block Techniques
Numbing a whole region with a few precisely placed injections
- General principles of nerve blocks
- Facial nerve blocks: an overview
- Sensory territories of the central face
- Where facial sensory nerves exit the skull
- Blocking the forehead and mid-forehead
- Needle insertion sites for central face nerve blocks
- Blocking the cheek, lip, and nose
- Intraoral approach to the infraorbital nerve block
- Blocking the nose, lower lip, and chin
- Intraoral approach to the mental nerve block
- Digital nerve blocks
- An alternative digital block, and penile block
- Anesthetizing the palm
- Sensory territories of the palm and back of the hand
- Blocking the median nerve at the wrist
- Landmarks for the median nerve block at the wrist
- Blocking the ulnar nerve, and the Bier block
- Anesthetizing the sole of the foot
- Sensory territories of the top and sole of the foot
- Blocking the posterior tibial and sural nerves
- Posterior tibial and sural nerve block sites
- Blocking the peroneal and saphenous nerves
- Superficial peroneal, saphenous, and deep peroneal nerve block sites
Higher Levels of Anesthesia
Adding sedation or gas for anxious patients or longer procedures
- Oral anxiolytics and narcotics
- Regulation, monitoring, and nitrous oxide
- Key takeaways
- References
- References (continued)
- References (continued)
- References (continued)
- Dermatology, 5th Edition (2-Volume Set)