Anestesia en dermatología / Anesthesia in dermatology

En la práctica dermatológica, se realizan diversos procedimientos quirúrgicos y estéticos que pueden causar dolor a los pacientes. Actualmente en el mercado se dispone, de un amplio arsenal de drogas que permiten lograr una anestesia segura y eficaz. Existen diferentes modalidades y técnicas de anestesia, según el tipo de intervención y el segmento corporal en el cual se va a realizar el procedimiento. Los efectos adversos de los diferentes anestésicos están bien definidos y se deben tomar ciertas precauciones en poblaciones especiales donde el riesgo de complicaciones es mayor. Es de fundamental importancia que el clínico posea un acabado conocimiento de los diversos fármacos utilizados en anestesia, para poder minimizar las complicaciones derivadas de su administración.

In dermatological practice, various surgical and cos-metic procedures are performed that can cause pain to patients. A large stock of drugs is now available on the market to provide safe and effective anesthesia. There are different modalities and techniques of anesthesia, depending on the type of intervention and the body segment in which the procedure will be performed. The adverse effects of different anesthe-tics are well defined and certain precautions should be taken in special populations where the risk of complications is greater. It is fundamental that the clinician has a thorough knowledge of the various drugs that can be used in anesthesia, in order to minimize complications arising from its administration

Anesthetic Agents of Plant Origin: A Review of Phytochemicals with Anesthetic Activity.

The majority of currently used anesthetic agents are derived from or associated with natural products, especially plants, as evidenced by cocaine that was isolated from coca (Erythroxylum coca, Erythroxylaceae) and became a prototype of modern local anesthetics and by thymol and eugenol contained in thyme (Thymus vulgaris, Lamiaceae) and clove (Syzygium aromaticum, Myrtaceae), respectively, both of which are structurally and mechanistically similar to intravenous phenolic anesthetics. This paper reviews different classes of phytochemicals with the anesthetic activity and their characteristic molecular structures that could be lead compounds for anesthetics and anesthesia-related drugs. Phytochemicals in research papers published between 1996 and 2016 were retrieved from the point of view of well-known modes of anesthetic action, that is, the mechanistic interactions with Na⁺ channels, γ-aminobutyric acid type A receptors, N-methyl-d-aspartate receptors and lipid membranes. The searched phytochemicals include terpenoids, alkaloids and flavonoids because they have been frequently reported to possess local anesthetic, general anesthetic, antinociceptive, analgesic or sedative property. Clinical applicability of phytochemicals to local and general anesthesia is discussed by referring to animal in vivo experiments and human pre-clinical trials. This review will give structural suggestions for novel anesthetic agents of plant origin.

A genetic algorithm-based framework for wavelength selection on sample categorization.

In forensic and pharmaceutical scenarios, the application of chemometrics and optimization techniques has unveiled common and peculiar features of seized medicine and drug samples, helping investigative forces to track illegal operations. This paper proposes a novel framework aimed at identifying relevant subsets of attenuated total reflectance Fourier transform infrared (ATR-FTIR) wavelengths for classifying samples into two classes, for example authentic or forged categories in case of medicines, or salt or base form in cocaine analysis. In the first step of the framework, the ATR-FTIR spectra were partitioned into equidistant intervals and the k-nearest neighbour (KNN) classification technique was applied to each interval to insert samples into proper classes. In the next step, selected intervals were refined through the genetic algorithm (GA) by identifying a limited number of wavelengths from the intervals previously selected aimed at maximizing classification accuracy. When applied to Cialis®, Viagra®, and cocaine ATR-FTIR datasets, the proposed method substantially decreased the number of wavelengths needed to categorize, and increased the classification accuracy. From a practical perspective, the proposed method provides investigative forces with valuable information towards monitoring illegal production of drugs and medicines. In addition, focusing on a reduced subset of wavelengths allows the development of portable devices capable of testing the authenticity of samples during police checking events, avoiding the need for later laboratorial analyses and reducing equipment expenses. Theoretically, the proposed GA-based approach yields more refined solutions than the current methods relying on interval approaches, which tend to insert irrelevant wavelengths in the retained intervals. Copyright © 2016 John Wiley & Sons, Ltd.

Applicability of ultra-high performance liquid chromatography-quadrupole-time of flight mass spectrometry for cocaine profiling.

For the first time in China, the chemical profiling of cocaine specimens was performed at the National Narcotics Laboratory. An ultra-high performance liquid chromatography-quadrupole-time of flight mass spectrometry (UHPLC-QTOF-MS) method was developed and validated for simultaneous analysis of 14 cocaine alkaloids and 5 main adulterants. Among them, ecgonine methyl ester, ecgonine, benzoylecgonine, and norcocaine were identified by comparing with the standard materials; tropacocaine, 3,4,5-trimethoxycocaine, cis-/trans-cinnamoylcocaine were tentatively identified based on the exact masses of protonated molecules and product ions; six unidentified alkaloids of 182/1.47, 316/9.54, 659/9.85, 316/9.87, 420/10.34, and 420/10.85 were marked with 'extracted mass/retention time' for convenience. Minimum sample preparation and analysis time were required, which was suitable for routine analysis. Based on the semi-quantitative data set of 14 alkaloid impurities in 131 linked/unlinked cocaine samples, 50 combinations of pretreatment methods and distance/correlation measurements were tested for their potential discrimination power for cocaine profiling, and Logarithm/Pearson exhibited the best result. After hierarchical cluster analysis (HCA), 183 cocaine samples collected from 2011 to 2015 were classified into 7 major groups. Moreover, 37 groups of linked samples were found within and between provinces, which provide intelligence for the case connection and revealing of the distribution networks. Our results highlighted the practical utilities of drug profiling, especially to support the investigation through operational intelligence and to improve the knowledge related to the drug trafficking through strategic intelligence. Copyright © 2016 John Wiley & Sons, Ltd.

Rapid classification and quantification of cocaine in seized powders with ATR-FTIR and chemometrics.

Traditionally, fast screening for the presence of cocaine in unknown powders is performed by means of colour tests. The major drawbacks of these tests are subjective colour evaluation depending on the operator ('50 shades of blue') and a lack of selectivity. An alternative fast screening technique is Fourier Transform InfraRed (FTIR) spectrometry. This technique provides spectra that are difficult to interpret without specialized expertise and shows a lack of sensitivity for the detection of cocaine in mixtures. To overcome these limitations, a portable FTIR spectrometer using Attenuated Total Reflectance (ATR) sampling was combined with a multivariate technique, called Support Vector Machines (SVM). Representative street drug powders (n = 482), seized during the period January 2013 to July 2015, and reference powders (n = 33) were used to build and validate a classification model (n = 515) and a quantification model (n = 378). Both models were compared with the conventional chromatographic techniques. The SVM classification model showed a high sensitivity, specificity, and efficiency (99%). The SVM quantification model determined cocaine content with a root mean squared error of prediction (RMSEP) of 6% calculated over a wide working range from 4 to 99 w%. In conclusion, the developed models resulted in a clear output (cocaine detected or cocaine not detected) and a reliable estimation of the cocaine content in a wide variety of mixtures. The ATR-FTIR technique combined with SVM is a straightforward, user-friendly, and fast approach for routine classification and quantification of cocaine in seized powders. Copyright © 2016 John Wiley & Sons, Ltd.

Local and general anesthetics immediate hypersensitivity reactions.

Intraoperative anaphylaxis and hypersensitivity reactions in the setting of anesthesia contribute significantly to the morbidity and mortality of surgeries and surgical procedures. Because multiple medications and products are given in a short period of time, identifying the specific cause can be difficult. Neuromuscular blocking agents, antibiotics, and latex are the most common causes of anesthesia-related reactions, though other medications or exposures could be involved. Careful review of anesthetic charts and allergy testing can help identify the underlying cause. The identification of the cause and subsequent prevention of reactions are critical to reduce overall mortality and morbidity related to anesthesia.

[Pharmakological characteristic of some amide local anesthetics, currently used in dental clinics].

Along with the brief history of amide local anesthetics development, their most important properties (from the viewpoint of use in clinical dental practice), are also reviewed. In particular, some properties of most commonly used local anesthetics, such as lidocaine, mepivacaine, prilocaine, bupivacaine and articaine are analysed. The most important data concerning pharmacological mechanisms of mentioned anesthetics' action, that cause certain features and peculiarities of their clinical application are given in condensed form. Besides, some precaution measures that must be taken into account in specific clinical cases together with the history and current status of each patient are mentioned as well.

The negative predictive value of typing safe local anesthetics.

BACKGROUND: Although allergy to local anesthetics (LA) is rare, patients often report unwanted reactions after their administration. A history of anaphylaxis or an atypical reaction related to LA is an indication for typing a safe anesthetic for future surgical or dental procedures. AIM: The aim of the study was to determine the negative predictive value (NPV) of typing safe LA. METHODS: A total of 154 patients with a history of an unwanted reaction to LA were enrolled into the study. Stepwise typing of a safe anesthetic included skin prick tests (SPT) and intracutaneous tests (ICT) with two or three of the following LA: lidocaine, bupivacaine, mepivacaine, and articaine. Skin tests were followed by provocations with one or two LA. Telephone follow-up visits were performed 4-12 months after drug typing. On the basis of follow-up questionnaire results, the NPV of the protocol was calculated. RESULTS: The full protocol was performed in 148 patients. Positive results of SPT were observed in 2, of ICT in 19 and of provocations in 11 cases. Lidocaine was found safe in 44, bupivacaine in 14, mepivacaine in 34 and articaine in 61 patients. The drug typed at the clinical visit was administered in 78 patients, and 76 reported no reactions (NPV = 97%). CONCLUSION: Stepwise approach including SPT, ICT and provocations is safe and allows typing a safe anesthetic in a vast majority of patients.

Local anesthesia: agents, techniques, and complications.

This article outlines the different classes of local anesthetics available for dental procedures. It also gives an overview of the mechanism of action and metabolism of each different class of local anesthetic. Furthermore, it discusses indications and contraindications of each local anesthetic and the proper dosage of each. The techniques for the administration of local anesthetics with the relevant anatomy are explained. An overview is given of the possible complications that can occur because of local anesthetic use and their possible treatment options.

Anestésicos locales: generalidades / Local anesthetics: generalities

Se realiza una revisión bibliográfica actualizada sobre el uso de anestésicosLocales en actuaciones estomatológicas más frecuentes en nuestro medio y que demandan la utilización de estos fármacos. Se presenta una breve cronología histórica del surgimiento y algunas referencias de su fisiopatología, mecanismo de acción, estructura química, características, propiedades, así como la farmacocinética de estos fármacos (AU)

Selection factors for local anesthetic agents.

The decision to inject local anesthetic agents to achieve profound anesthesia is dependent upon many factors, particularly the depth and duration of anesthesia required, and the possible need for hemostasis. To maximize the safety of local anesthetic injections, it is necessary to weigh the risks against the benefits for each patient, for each anesthetic agent, for use of a vasoconstrictor, and for the delivery technique for the selected agent.

Hypersensitivity to local anaesthetics--update and proposal of evaluation algorithm.

Local anaesthetics (LA) are widely used drugs. Adverse reactions are rare but may be caused by delayed-type hypersensitivity reactions and probably also immediate-type reactions. As it is not always easy to clinically differ between these subtypes, allergy skin testing should be considered. Although numerous test protocols have been published, how patients with hypersensitivity reactions to LA are ideally evaluated remains a topic of discussion. This review attempts to generate a comprehensive update on allergic reactions to LA and to present an algorithm that can be used for the evaluation of patients suspected with immediate- and delayed-type immune reactions. Literature was examined using PubMed-Medline, EMBASE, Biosis and Science Citation Index. Based on the literature, the proposed algorithm may safely and rapidly distinguish between immediate-type and delayed-type allergic immune reactions.

Terapéutica anestésica en Estomatología: temas de actualización / Anaesthetic therapeutics in stomatological area: ap date information

Se realiza una revisión bibliográfica y actualización sobre el uso de los anestésicos locales en actuaciones estomatológicas más frecuentes en nuestro medio y que demandan de la utilización de estos fármacos. Se presenta una breve clasificación de los anestésicos locales, dosificación, fármacos más utilizados y de elección, con dosis y vías de administración. Se muestran los efectos indeseables y demostraciones de técnicas más utilizadas (AU)

Recent advances in local anaesthesia.

This paper describes developments in the field of dental local anaesthesia. Recently introduced injectable agents, advances in the field of topical anaesthesia and new delivery systems are discussed.

[Local anesthesia in ophthalmic surgery]. / Lokalanästhesie in der Ophthalmochirurgie.

In recent years anesthesia modalities have changed in ophthalmic surgery. A growing trend toward the use of topical anesthesia in cataract surgery is apparent. The present-day techniques used in ophthalmic surgery are retrobulbar anesthesia, peribulbar anesthesia, subtenon anesthesia, and subconjunctival anesthesia as injection techniques, topical anesthesia using drops, gel, or sponge, and intracameral anesthesia. Injectable anesthesia (RBA, PBA, STA) provides a higher level of analgesia and globe akinesia. With injection techniques the risks of vis a tergo and anesthetic complications increase; the level of analgesia after topical anesthesia could be improved by supplementation with i.v. narcotics.