통증 약물 부작용

통증 약물 부작용

 

1.Systemic absorption(Highest -> Lowest)

 

Intravenous > Tracheal > Intercostal > Caudal > Paracervical > Epidural > Brachial plexus > Sciatic > Subcutaneous

 

2.Local anesthetic systemic toxicity(LAST, intravenous injection of a local anesthetic solution during a regional anesthetic procedure)

(1)CNS excitation : Agitation, confusion, seizure

(2)CNS depression : Drowsiness, apnea, coma

(3)Nonspecific CNS sign : Metallic taste, circumoral numbness, diplopia, tinnitus, dizziness

(4)Cardiovascular manifestation : Hypertension, hypotension, conduction block, bradycardia, ventricular arrhythmia, asystole

(5)Management

1)Controll of airway and circulation

2)BDZ : Seizure rapidly controlled

3)Lipid emulsion 20%, Intrapid : Lipophilic local anesthetic molecules

4)Allergic dermatitis, athmatic attact : PABA, methylparaven

 

3.Chronological order of LA(local anesthesia)

(1)Blocking of wympathetic nerves with 2nd vasodilatation(sensation of warmth)

(2)Inhibition of temperature and pain

(3)Loss of touch and pressure

(4)Motor function

(5)Function return in a reverse chronological order