Anastesi Local Infiltrasi

Beberapa hari ini lagibanyak sekali kasus-kasus kecelakaan yang membuhtuhkan anestesi lokal.. yah sedikit mereview ulang deh, biar otak ter-refresh.. Jangan sampai ter-delete. Diambil dari ebook..

Method of Injection
Infiltration of a local anesthetic agent is performed gently near the edge of the wound or directly into the wound with a small needle(Size No. 25-30) . Pain associated with local infiltration is partly due to the stretching of sensitive nerve endings in the dermis and may also be due in part to the difference in acidity of some anesthetics (the pH of commercial preparations of lidocaine is 5.0-7.0). Associated pain can be reduced by using smaller amounts of more concentrated anesthetic solutions and slower infiltration rates or, in the case of lidocaine, by preparing it as a buffered solution (9 mL of 1% lidocaine, to which 1 mL of sodium bicarbonate solution, 44 mEq/50 mL, is added). Restrict the dose of anesthetic to the least amount that will provide adequate anesthesia. This is particularly true for facial lacerations, where infiltration distorts important landmarks and makes precise matching of wound edges difficult. Infiltration of anesthetic directly into the wound is less painful but may spread infection in heavily contaminated wounds.

Epinephrine Hemostasis
Lidocaine and similar agents cause relaxation of spastic vessels, and bleeding may start again following local anesthesia. Addition of epinephrine overcomes this tendency and also prolongs the anesthetic effect. The concentration of epinephrine does not need to be higher than 1:400,000, and at least 7 minutes should be allowed for the full vasoconstrictive effect. Use a fresh vial of 1:1000 epinephrine, and dilute it with plain 1% or 2% lidocaine. Premixed solutions of epinephrine-containing local anesthetics may lose their potency during prolonged storage.

Although epinephrine has been shown to have little adverse effect on survival of experimental cutaneous flaps, its use in patients with traumatically elevated skin flaps or in tissues with questionable viability is not recommended. Never administer epinephrine in areas where segmental blood supply is critical (eg, fingers and toes). Epinephrine is contraindicated in heavily contaminated wounds, because it severely compromises local wound defense mechanisms. Consider the systemic side effects of epinephrine in patients with cardiovascular and peripheral vascular disease.