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PORPHYRIA FACTS: ANESTHESIOLOGY DEFINITIONS


Anesthesia
Anesthesia is the loss of feeling or sensation.

Although the term is used for loss of tactile sensibility or of any of the other
senses, it is applied especially to loss of the sensation of pain, as it is induced to
permit performance of surgery or other painful procedures.

Anesthesiology
Anesthesiology is a specialty concerned with the study of anesthetics and
anesthesia.

Anesthetic.

Anesthetic is a substance used to abolish sensation.

SOURCE:
Lori Blackstone FNP
Anesthiology
++++++++++


Anesthetist
An anesthetist is a medical specialist practiced in the administration of all forms
of anaesthesia (general, spinal block, local, regional)

General anesthesia

A form of anesthesia that results in putting the patient to sleep.

SOURCE:
Lori Blackstone FNP
Anesthiology
++++++++++

Total body anesthesia. Any person with porphyria should notify the
anesthiologist in advance that they have porphyria in order to avoid UNSAFE
DRUGS.
Anesthetic. A substance used to abolish sensation.

SOURCE:
Lori Blackstone FNP
Anesthiology
++++++++++


General anesthesia.is a state of unconsciousness induced by a medication that
eliminates pain perception.

SOURCE:
Robert Johnson MD
Internal Medicine
++++++++++++

Unconsciousness which is induced by medication to elinibate the perception of
pain is known as general anesthesia.

SOURCE:
Pain Control
United Health Systems
1999
+++++++++++++





Epidural anesthesia.

An epidural anesthesia is a procedure used to provide anesthesia during labor
and some surgery.

Medication is given through a catheter placed in the back.

Also called an epidural block.

SOURCE:
Lori Blackstone FNP
Anesthiology
++++++++++

Field block injection

A field block injection is a procedure used to relax a muscle or to reduce muscle
pain and inflammation.

The targeted muscle is injected with a local anesthetic and corticosteroid.
The field block injection is also called trigger point injection.

SOURCE:
Lori Blackstone FNP
Anesthiology
++++++++++

Local anesthetic

Local anesthetic is a medication that blocks electrical signals in nerves. It
eliminates pain in a specific part of the body and causes intended, temporary
paralysis.

SOURCE:
Robert Johnson MD
Internal Medicine
++++++++++++

Local anesthetic is a medication that blocks electrical signals in nerves.

SOURCE:
Pain Management
United Health Care Systems
1999
++++++++++

Local anesthetic eliminates pain in a specific part of the body and causes
intended, temporary paralysis.

SOURCE:
Pain Management
United Health Care Systems
1999
++++++++++++




Nerve block

A nerve block is a local anesthetic that is injected around a nerve, preventing
pain messages traveling along that nerve pathway from reaching the brain.

Used most often to relieve pain for a short period, such as during a surgery.

Regional anesthesia. Medications used to block pain in a certain region of the
body without altering consciousness.

SOURCE:
Robert Johnson MD
Internal Medicine
++++++++++++

Regional anesthesia

Regional anesthesia is the use of medications used to block pain in a certain
region of the body without altering consciousness.

SOURCE:
Pain Control
United Health Systems
1999
+++++++++

In regional anesthesia are medications used to block pain in given specific
areasmof the body.

This is done without altering consciousness.

SOURCE:

Mayo Education & Research
Mayo Foundation
Rochester, Minnesota

Spinal nerve block

A spinal nerve block is a procedure that’s used to relieve pain affecting a broad
area, such as the abdomen or the legs.

A local anesthetic is injected in or near the spinal column, preventing pain
messages traveling along that nerve pathway from reaching the brain.

SOURCE:
Lori Blackstone FNP
Anesthiology
++++++++++

Stellate ganglion block.

A stellate ganglion block is a procedure designed to relieve pain that is caused
by overactivity of the sympathetic nervous system in the upper extremities, the
head or the neck.

A local anesthetic is injected into the front of the neck to block sympathetic
nerves without blocking sensory pathways.

SOURCE:
Lori Blackstone FNP
Anesthiology
++++++++++


Sympathetic nerve block. An injection of an anesthetic to relieve pain resulting
from abnormal activity of the sympathetic nervous system. The sympathetic
nerves control circulation and perspiration and are part of your autonomic
nervous system.


Total body anesthesia.

Total body anesthesia is any person with porphyria should notify the
anesthiologist in advance that they have porphyria in order to avoid UNSAFE
DRUGS..

SOURCE:
Lori Blackstone FNP
Anesthiology
++++++++++

General information on Anesthesia

Propofol has been used successfully during surgery of children with porphyria.

SOURCE:
Safe use of propofol in a child with acute intermittent porphyria."
Christian, A. S.
Anaesthesia \
6(5): 423-4.1991.
+++++++++++

Versed has been safely used as a conscious sedation during implantation of
PICC and PORTS for treatment of porphyria.

Versed is used successfully for many diferent medical procedures such as
sigmoids, colonscopies, liver biopsies etc.

SOURCE:
Robert Johnson MD
Internal Medicine
++++++++++

Drugs that have significant interactions with local anesthetics:

Atracurium (Tracrium®)
Etomidate (Amidate®)
Ketamine (Ketalar®)
Magnesium Sulfate
Methohexital (Brevital®)
Midazolam (Versed®) Most used for porphyria patients.
Pancuronium (Pavulon®)
Phenelzine (Nardil®)
Propofol (Diprivan®)
Propranolol (Betachron®, Inderal®) Safe for Porphyria
Succinylcholine (Anectine®, Quelicin®, Sucostrin®)
Thiopental (Pentothal®)
Tranylcypromine (Parnate®)
Tubocurarine
Vecuronium (Norcuron®)

SOURCE:
Randy Niefald RPhm
Pharmacology
+++++++++

Drugs used for local anesthesia
† not FDA-approved for this use

Benzocaine (Americaine® Otic, Hurricaine®, Orajel®)
Bupivacaine (Marcaine®)
Butamben Picrate (Butesin® Picrate)
Cocaine
Dibucaine (Nupercainal®)
Dyclonine (Dyclone®)
Ethyl Chloride
Etidocaine (Duranest®)
Levobupivacaine†
Lidocaine (Xylocaine®)
Mepivacaine (Carbocaine®, Polocaine®)
Midazolam (Versed®)
Prilocaine (Citanest®)
Procaine (Novocain®)
Proparacaine (Ophthetic Sterile Ophthalmic® , Ophthaine® ,
Parcaine Ophthalmic® , Ak-Taine® , Alcaine®)
Propoxycaine
Ropivacaine (Naropin®)
Tetracaine (Pontocaine®, Opticaine®)

SOURCE:
Randy Niefald RPhm
Pharmacology
+++++++++

Some commonly used brand names of anesthetics are:


In the U.S.—

Carbocaine 6
Carbocaine with Neo-Cobefrin 6
Citanest Forte 7
Citanest Plain 7
Dalcaine 5
Dilocaine 5
Duranest 4
Duranest-MPF 4
Isocaine 6
L-Caine 5
Lidoject-1 5
Lidoject-2 5
Marcaine 2
Marcaine Spinal 2
Nesacaine 3
Nesacaine-MPF 3
Novocain 8
Octocaine 5
Polocaine 6
Polocaine-MPF 6
Pontocaine 9
Sensorcaine 2
Sensorcaine-MPF 2
Sensorcaine-MPF Spinal 2
Xylocaine 5
Xylocaine-MPF 5
Xylocaine-MPF with Glucose 5
SOURCE:
Randy Niefald RPhm
Pharmacology
+++++++++


PORPHYRIA & ANESTHETIC DRUGS

UNSAFE

Intravenous agents

Barbiturates
Chlordiazepoxide
Etomidate
Flunitrazepam
Nitrazepam
Diazepam (questionable)
Ketamine (questionable)

Inhalation agents

Enflurane
Isoflurane (questionable)
Haolthane (questionable)

Nausea/vomiting

Metroclopramide
Reglan

NM Blockers

{ancuronium
Atracurium

Narcotics

Pentaxosine
Sufentanil

Local anesthetics

Lidocaine (questionable)

Cardiovascular medication

Alpha-methyl Dopa
Hydralazine
Phenoxybenzamine

Steroids
Endogenous steroids





SAFE

Versed (conscious sedation)
Lorazepam
Midazolam (conscious sedation)
Propofol (inducing anesthesia)

Bupivacaine (local anesthetic)
Procaine (local anethetic)

Fentanyl (pain - narcotic)
Morphone (pain- narcotic)


Isoflurane
Enflurane
Turbocurarine (muscle relaxant)
Succinylcholine (muscle relaxant)
Propranolol (cardiovascular - bp, pulse)
Atenolol (cardiovacular agent)
Labetolol (cardiovascular agent)
Resperine (cardiovascular agent)
Magnesium sulfate (seizures)
Chlorpramazine (nausea/vomiting)
Thorazine (nausea/vomiting)
Droperidol (nausea/vomiting)
Compazine (nausea/vomiting)
Promethazine (nausea/vomiting)
Zofran (nausea/vomiting)
Nitrous oxides
Opiods

SOURcE:
G.G. Harrison et. al.
Anesthesia for the porphyric patient
48: 417-421

++++++++++++
The following anesthetics have been researched and verified by
anesthesiologists and the list was distributed at a Nurse Anesthetist Conference
Spring 1999.

The following Anesthetics are considered safe for general surgery:

Anectine [Muscle relaxant]
Curarchloride [Muscle relaxant]
Diprivan [Used for inducing sleep]
Duragesic [A narcotic used for pain control]
Fentanyl [A narcotic used for pain control]
Midazolam [Used for inducing sleep]
Parulon [Muscle relaxant]
Propofol [Used for inducing sleep]
Recuronium [IV neuromuscular blocker]
Sevoflurane [Sleep inhalation gas]
Toredol [Intravenous preparation for pain]
Tubocurarine [Muscle relaxant]
Versed [Used for inducing sleep]
Zemuron [IV neuromuscular blocker]


Compiled By Michelle G. RNA 4/1999
Surgical nurse anethestist

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