By Janyce L. Cornick-Seahorn DVM MS DACVA DACVIM
* Thorough but concise and transportable overview of veterinary anesthesia * contains easy-to-use drug dosage and protocol tables for a large choice of species * perfect for scholar use in the course of medical rotations * integral quickly reference for veterinarians with new perform
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Extra info for Veterinary Anesthesia (The Practical Veterinarian Series)
Example text
The availability and convenience of a variety of general anesthesia options minimized the need to apply these agents in small animals. However, with the ever-increasing awareness of pain management in all veterinary species, local and regional techniques are gaining popularity in small animal practice. Application of local and regional agents in animals undergoing general anesthesia will provide preemptive analgesia and spare anesthetic requirements. While historically such techniques have been associated with the local anesthetic agents, other drugs, including opioids, alpha2 agonists, and ketamine have been reported to possess analgesic 53 54 Local/Regional Anesthetic Techniques properties when applied by these routes.
The time to effect, potency, and duration of effect depend on the agent’s physical and chemical properties (see Table 3–1). Lipid solubility influences intrinsic potency and protein binding is probably the primary determinant of duration. The dissociation constant (pKa) is thought to determine the speed of action. The 1 2 2 8 8 Ester Amide Amide Amide Ester *Potency is relative to procaine (1). 9 pKa 80% 95% 75% 65% 7% 6% Protein Binding Intermediate Slow Fast Fast Fast Slow Onset of Effect 180–600 180–600 120–240 90–200 30–60 60–90 Duration (min) Properties of Selected Local Anesthetic Agents Used in Veterinary Procaine (Novocaine) Chloroprocaine (Nesacaine) Lidocaine (Xylocaine) Mepivacaine (Carbocaine) Bupivacaine (Marcaine) Tetracaine (Pontocaine) Agent (Trade Name) Table 3–1 Medicine Local/Regional Anesthetic Techniques 55 56 Local/Regional Anesthetic Techniques Table 3–2 Potential Toxic Effects of Local Anesthetics • Central nervous system Muscle tremors Convulsions Respiratory depression Generalized CNS depression • Cardiovascular system Depression of myocardial contractility Hypotension Bradycardia Ventricular tachycardia/fibrillation: This response has been reported with bupivacaine and may be refractory to treatment and fatal • Methemoglobinemia This response most often is linked to benzocaine but has been reported with other agents • Allergic reactions Associated with para-aminobenzoic acid (PABA), a metabolite of the ester local anesthetics and of methylparaben, a preservative used in many of the local anesthetics • Tissue toxicity Local anesthetic injection has been shown to cause reversible skeletal muscle damage and, rarely, neuronal damage Local/Regional Anesthetic Techniques 57 uncharged base form is most lipid soluble, diffusing readily across the nerve sheath; dissociation is favored by increasing pH.
Two classes (based on the intermediate chain of the molecule), the esters and the amides (Table 3–1), determine drug biotransformation. Esters are readily hydrolyzed in the blood by plasma cholinesterase made in the liver, while amides require biotransformation by liver microsomal enzymes. Even though lidocaine is well-known for its usefulness intravenously to treat cardiac ventricular arrhythmias, it and local anesthetic agents have several potential adverse effects, including formation of cardiac arrhythmias (Table 3–2).