Healng of wound with Ayurvedic Managment

Wound Healing

1. Local and Spinal Anaesthesia (Reginal anaesthesia ) PRESENTED BY DR. NITESH CHUNILAL RATHOD HOD Guided by Dr.Seema R. Giri Dr.Giri mam Dr.Lilke mam Dr.Kasle sir

2. ANAESTHESIA (संज्ञानाश) प्राक् शस्त्रकर्मणश्चेष्टं भोजयेदातुरं भिषक् । मधपं पाययेन्मद्यं तीक्ष्णं यो वेदनाऽसहः ।। - सु.सू.१७/११ व्यपगतगर्भशल्यां तु स्त्रियमाम गर्भा सुरशीध्वरिष्ट मधुमदिराससामर्थ्यतः पाययेद् ... प्रहर्षणार्थं च । - च.शा.८/२९

3. History of an a esthesia William Thomas Green Morton, American dental surgeon who in 1846 gave the first successful public demonstration of ether anaesthesia during surger y in boston

4. REGIONAL ANAESTHESIA 1.Peripheral neuraxial blockade 2.Central neuraxial blockade

5. GOLDEN RULE OF ANAESTHESIA Mnemonic: ANESTHESIA A: Assessment and preparation of patient N: Nil per oral E: Equipment and drugs checked S: Suction working T: Tipping table H: Have a vein open E: Evaluate vitals S: Somebody to help I: Intubation (Ventilation control) A: Airway clear

6. Local Anaesthesia Local anaesthetic are transiently inhibit sensory,motar and autonomic nerve function or combination of there function without loss of consciousness The drug are injected near nerve fibre local anaesthetic bind the sodium channel stop the depolarisation of sodium channel

7. Classification Of Nerve fibres (Erlanger-gasser) Fibre Modalities serve Diameter Myelination TYPE A Large Yes A α Motar,Proprioception A β Touch,Pressure A γ Muscle A δ Pain,Temperature TYPE B Preganglionic Autonomic fibre Medium Partially myelinated TYPE C Pain,Temperature post ganglionic autonomic fibre Small No

8. Sensitivity of nerve fibre to local anesthesia Order of blockade of fibres B>C>A γ >A δ >A α Order of block Autonomic(preganglionic Sympathetic) > sensory > Motor Among sensory blockade Temp(cold before heat) > pain >touch >deep pressure Myelinated before non myelinated

9. Structure of local anesthetic Consist of lipophilic group and hydrophobic group separated by intermediate chain that includes amide or ester linkage

10. Classification of local anesthestic Based on chemical struture Aminoesters Aminoamides Procaine Chlorprocaine Bemzicaine Cocaine Lignocaine Bupivacaine Prilocaine Ropivacaine Metabolise by psuedocholinesterase Except cocaine : Liver Metabolised by N-dealkylation and hydroxilayion in liver by cyt p450 Higher incidence of allergic reaction Low incidence of allergic reaction Not bind to plasma protein Bind to alpha acid glycoprotein

11. Indivisual local anesthetics 1.Cocain Oldest anaesthetic Only natural occuring anaesthetic Obtained from leaves of Erythroxylon coca Mainly used by topical anaesthesia Drug abuse:sniffing Dose 3 mg/kg

12. 2.Procaine 1 st synthetic LA Procaine and benzocaine are metabolised to p-aminobenzoic acid (PABA) : associated with rare anaphylactic reactions LA choice in malignant hyperthermia Dose 6mg/kg

13. 3.Chlorprocaine Shortest acting LA It is contraindicated in spinal anaesthesia as it caused paraplegia due to presence of neurotoxic preservative : sodium metabisulphate Now presevative free chlorprocaine is used Dose 11mg/kg

14. 4 Prilocaine It is metabolized to o- todudine Meth heamoglobinaemia Treatment of meth heamoglobinaemia : methylene blue Dose 4-7 mg /kg 5 . EMLA Eutectic mixture of 5% lignocaine and 5% prilocaine bases in an oil in water emulsion • Topical anesthetics • mainly used to prevent iv cannula pain

15. 6.Lignocaine Most common LA Different concentration used for different types of anesthesia Local Infiltration,lignocaine gel : 2% Surface (Topical) analgesia : 4% Spinal anesthesia:5% Lignocaine spray:10% Systemic toxicity less than bupivacaine CCNS ratio is 7 Safe dose of lignocaine without adrenalin 4.5mg/kg With adrenalin is 7mg/kg

16. 7.Bupivacaine ( sensorcaine,marcaine ) Second most commonly used LA after lignocaine Commonly used LA for spinal anaesthesia Concentration used for bupivacaine Spinal : 0.5%. Epidural : 0.25% to 0.5% Nerve block : 0.5% dose 2.5mg/kg

17. Most cardiotoxic LA CCNS ratio is 3 Max safest dose is 3mg/kg Levobupivacaine S(-) enatiomer of bupivacaine Less cardiotoxic and less prone to cause seizures

18. 8.Ropivacaine S(-) enatiomer of bupivacaine Propylene side chain is present in ropivacaine as compared to butyl side chain in bupivacaine Less cardiotoxic Less lipophilic than bupivacaine Therefore less likely to penetrate Large myelinated motar nerve fiber Hence degree of motor blokade is less than bupivacaine But degree of sensory and autonomic blockade is same as bupivacaine Labour analgesia(Epidural)

19. Use of local Anaesthetics • Topical Anaesthesia:lignocaine tetracaine • Local infiltration and peripheral nerve block : bupivacaine ropivacaine lignocaine • intravenous (Biers block): chlorprocaine,lignocaine •Spinal : lignocaine bupivacaine ropivacaine • Epidural : lignocaine bupivacaine ropivacaine

20. SPINAL ANAESTHESIA Also called as spinal block,subarachnoid block,intradural or intrathecal block It is regional anaesthesia type of central neuraxial blockade local anesthetic agent placed into sub arachnoid space.

21. Indication of spinal anaesthesia Surgeries done below umbilicus : Lower limb surgery Perineal surgery Most of urological surgery Obstetrics surgery Can be also used as analgesia

22. Contraindications ABSOLUTE RELATIVE Patient refusal Sepsis Infection at site of injection Uncooperative patient Coagulopathy or bleeding diathesis Preexisting neurological deficit,h /o Epilepy Severe hypovolaemia Spinal deformities (kyphosis,scoliosis) Increase intracranial tension Stenotic valvular heart disease Severe aortic stenosis and mitra stenosis

23. Spinal needle type Dura separating needle Dura cutting needle Whitacar – rounded tip with sharp side injection Quincke needle Sprotte - rounded tip with long side opening advantage of more CSF flow Sharp cutting needle with end injection Less traumatic More traumatic

24. Surface anatomy and patients position

25. Stucture which pierced in spinal anaesthesia

26. Spinal anaesthetic agents Only preservative free local anesthetic are used Hyperbaric LA : specific gravity of local anaesthesia is more than CSF Specific gravity of CSF is 1.003 to 1.008 at 37 degree celsius Hyperbaric by adding dextrose 5% lignocaine + 7.5% dextrose 0.5% bupivacain + 8% dextrose

27. Factors effecting spread of Spinal anaesthesia Most imp factor : • Baricity of anaesthetic solution Position of patient: during injection and immediate after injection Drug dosage Other factors Age Pregnancy Curvature of spine Intra abdominal pressure Patients height Needle direction

28. Level of spinal anaesthesia dermatome involved Saddle block - involve lower spinal and sacral segment (Area that sits on saddle) Low spinal - upto level of umbilicus T10 Mid spinal - costal margin T6 level High spinal – nipple line T4 Level

29. 1.CVS-Hypotension* Vasomotar tone : primarily determined by sympathetic fibres arising from T5 to L1 Blocking of these nerve will cause vasodilation of venous capacitance vessel and pooling of blood in viscera and lower extremities. Thereby decreasing effective circulating blood Volume and venous return to heart and decreases CO Compensatory mechanism above level of block T1 – T4

30. 2.Pulmonary Clinical Significant alterations in pulmonary physiology is minimal Diaphragm is innervated by phrenic nerve C3 – C5 Patient of COPD depends on accessory muscles (intercostal and abdominal) So block is high there is severe respiratory impairment

31. 3.Gastrointestinal Neuraxial block induce sympathectomy Increase in peristalsis Nausea and vomiting may occur

32. 4.Urinary system Neuraxial block at sacral level block both sympathetic and parasympathetic (S2,S3,S4)fiber Urinary retention may occur

33. POST SPINAL COMPLICATION Hypotension Headache Nausea and vomiting Cauda equina syndrome Septic meningitis Respiratory paralysis

34. THANK YOU