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What is Which of the following is not an ESTER? and explain in detail?
Ans. d (Bupivacaine ) (Ref. Lee anaesthesia 12th/ 591 & Anaesthesia by Ajya yadav, 2nd, pg 105)LOCAL ANESTHETIC AGENTSEstersAmidesAll metabolised by pseudocholinesterase except cocaineMetabolised in liverHigh chances of allergic reactionsLow chances of allergic reactionsUntable solutionStable solutionEg: Amethocaine (Tetracaine)BupivacaineBenzocaineEtidocaineCocaineLignocaineChlorprocaineMepivacaineProcainePrilocaineHint: Letter Y appears twice in the name of ail amides, while it appears only once in esters.Local anesthetic agentsSubclassMechanism of ActionEffectsClinical ApplicationsPharmacokinetics, ToxicitiesAmidesLidocaineBlockade of sodium channelsSlows, then blocks action potential propagationShort-duration procedures- epidural, spinal anesthesiaParenteral-duration 30-60 min - 2-6 h with epinephrine - Toxicity: CNS excitationBupivacaineSame as lidocaineSame as lidocaineLonger-duration proceduresParenteral-duration 2-4 h. Toxicity: CNS excitation-cardiovascular collapsePrilocaine, ropivacaine, mepivacaine, levobupivacaine: like bupivacaineEsters ProcaineLike lidocainelike lidocaineVery short proceduresParenteral.duration 15-30 min-30-90 min with epinephrine. Toxicity: Like lidocaineCocaineSame as above also has sympa- thomimetic effectsSame as aboveProcedures requiring high surface activity and vasoconstrictionTopical or parenteral, duration l-2h Toxicity: CNS excitation, convulsions, cardiac arrhythmias, hypertension, strokeTetracaine: Used for spinal, epidural anesthesia, duration 2-3 h