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Local Anesthetic
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Transcript of Local Anesthetic
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Carlos Darcy Alves Bersot TSA.SBACarlos Darcy Alves Bersot TSA.SBA MD RESPONSÁVEL PELO CET H.F.LAGOAMD RESPONSÁVEL PELO CET H.F.LAGOA
Médico Anestesiologista do Hospital Federal da Lagoa-SUSMédico Anestesiologista do Hospital Federal da Lagoa-SUSMédico Anestesiologista do Hospital Universitário Pedro Ernesto-UERJMédico Anestesiologista do Hospital Universitário Pedro Ernesto-UERJ
Ponto 9Ponto 9
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HistóriaHistória
“ “A possibilidade de produzir uma anestesia A possibilidade de produzir uma anestesia local por esse ou outros meios, local por esse ou outros meios, certamente é objetivo de muitos estudos, certamente é objetivo de muitos estudos, se um homem é capaz de ver uma se um homem é capaz de ver uma amputação de seu próprio membro e não amputação de seu próprio membro e não sentir isso levará a um progresso sentir isso levará a um progresso incalculável na área cirúrgica”incalculável na área cirúrgica”
James Young Simpson, 1848
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HistóriaHistória
Niemann em 1860 isolou cristais brancos da planta Niemann em 1860 isolou cristais brancos da planta Erythroloxon coca e nomeou como cocainaErythroloxon coca e nomeou como cocaina
Sigmund Freud com ajuda de Carl Koller, um Sigmund Freud com ajuda de Carl Koller, um oftalmologista, investigou as propriedades da oftalmologista, investigou as propriedades da cocainacocaina
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HistóriaHistória Koller descreveu a anestesia tópica Koller descreveu a anestesia tópica
no olho em setembro de 1884;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 Halsted and Hall executaram o primeiro bloqueio de nervo periférico primeiro bloqueio de nervo periférico 1885;1885;
• • August Bier executou o primeiro August Bier executou o primeiro bloqueio no neuroeixo em 1898.bloqueio no neuroeixo em 1898.
Carl Koller1857 -1944
William S. Halsted
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CRONOLOGIACRONOLOGIA
CocainaCocaina NiemannNiemann 18601860 ÉsterÉster
BenzocainaBenzocaina SalkowskiSalkowski 18951895 ÉsterÉster
ProcainaProcaina EinhornEinhorn 19041904 ÉsterÉster
TetracainaTetracaina EislerEisler 19281928 ÉsterÉster
LidocainaLidocaina LofgrenLofgren 19431943 AmidaAmida
CloroprocainaCloroprocaina Marks, RubinMarks, Rubin 19491949 ÉsterÉster
MepivacainaMepivacaina EkenstamEkenstam 19561956 AmidaAmida
BupivacainaBupivacaina EkenstamEkenstam 19571957 AmidaAmida
RopivacainaRopivacaina SandbergSandberg 19891989 AmidaAmida
Cartwright & Fyhr. Reg Anesth 1988;13:1-12
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Potencial de açãoPotencial de ação
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Potencial de açãoPotencial de ação
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Potencial de açãoPotencial de ação
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LOCAL DE AÇÃO DOS ALLOCAL DE AÇÃO DOS AL
D4S6 D4S6 MUTAÇÕES MUTAÇÕES REDUZ A REDUZ A
AFINIDADE,AFINIDADE,NaNa
vv1.2, 1.41.2, 1.4
Godwin. Biophys Chem 2005;113:1-7Ragsdale. Science 1994;265:1724-8
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Local anesthetics can bind to other membrane proteins (Butterworth and Strichartz, 1990).
Can block K+ channels (Strichartz and Ritchie, 1987).
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Effects of Levobupivacaine and Racemic Effects of Levobupivacaine and Racemic Bupivacaine in Anesthetized PigsBupivacaine in Anesthetized Pigs
Levobupivacaine
Dose (mg)
0.00
20.00
40.00
60.00
80.00
100.00
120.00
140.00
25% Difference
47% Difference
Incr
ease
in Q
RS
(m
s)
Bupivacaine
0.375 0.75 1.5 3.0 7.04.0
Morrison SG, et al. Anesth Analg 2000;90:1308-1314.
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Incremental Doses of Bupivacaine and Incremental Doses of Bupivacaine and Levobupivacaine in Sheep: CV EffectsLevobupivacaine in Sheep: CV Effects
Baseline Multiform VT VF
0 1 2 3 4 225 226 227 228 229 240 241 242 243
Bupivacaine, 200 mg IV for 3 min
Baseline Wide QRS Ventricular
Time (sec)
0 1 2 3 4 300 301 302 303 304 375 376 377 378 379
Levobupivacaine, 200 mg IV for 3 min
Time (sec)
Huang YF, et al. Anesth Analg 1998;86:797-804.
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PROPOFOL?
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Moshiri M. Etamad L. Fadaei
H.
2010
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Moshiri M. Etamad L. Fadaei
H.
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Lipid emulsion vs. saline Lipid emulsion vs. saline after bupivacaine in ratsafter bupivacaine in ratsLipid emulsion vs. saline Lipid emulsion vs. saline after bupivacaine in ratsafter bupivacaine in rats
Weinberg. Reg Anesth Pain Med 2002;27:568-75
BUPI 15 mg/kg
CPR CPR
CPR
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