ANAESTHESIA – LOCAL AND GENERAL WITH BRAND NAMES AND COMPANY MANUFACTURER

Anaesthetics – local & genral
….
1.Bupivacaine

Used as

👉 Percutaneous infiltration anaesthesia ,

👉 peripheral nerve block

👉Sympathetic nerve block
,
👉retrobulbar block ,

👉Cadual block

👉Lumbar epidural block

Brand names.

🙏Buloc by celon
Inj – 0.25 % & in 0.5 % ( 20ml )
.
🙏Bupivan by Sun pharma
Inj :- 0.25% (20ml)
0.5% ( 20ml )
0.5% ( 4ml )
.
🙏 Marcain by AHPL
Inj:- 0.5 % ( 20ml )
Inj :- 1 % ( 2ml )
.

  1. Halothane
    Inhalation anesthesia

👉 used in Induction & maintenance of general anaesthesia
.
🙏Fluothane by AhPL
I:vap :- 100% in ( 200 , 250 , 30, 50 ml ) soln
.
3.Isoflurane
Inhalation anaesthesia

👉 Induction & maintenance of general anaesthesia
.
🙏 Forane by abbott
Inhalant :- 100% in ( 100, 250 ml )

🙏Isorane by AhPL
I:sol :- 5mg/5ml in ( 100,250,30 ml )
.

  1. Ketamine
    Intramuscular
    & Intravenous anesthesia


.
,🙏Ketam by sun
Inj 10mg/ ml (10ml )
Inj 50mg / ml ( 2ml )
.
🙏Ketmin by Themis medicare
Inj 50mg /ml ( 10 ml )
Inj 50 mg/ ml ( 2ml )
.
🙏Ketsia by celon
Inj 100mg ( 2ml )
Inj 500mg ( 10ml )

Abbreviation
I sol :- inhalation solution
Ivap :- inhalation vapour

  1. Lidocaine ( used as )
    Epidural
    👉 as Epidural anesthesia
    Injection
    👉Pulp dilatation during phaco-emulsification cataract surgery
    Intraspinal
    👉Spinal anaesthesia
    as Intravenous
    👉Intravenous regional anaesthesia
    Parenteral
    👉 Sympathetic nerve block
    👉 Peripheral Nerve Block
    👉 Percutaneous infiltration anaesthesia
    Urethral
    👉Surface anesthesia
    Mouth / throat
    👉Surface anesthesia
    as for Opthalmic region
    👉Surface anesthesia
    Rectal & topical / cutaneous
    .
    Company names


    ..

🙏Gesican 2% gelly by AHPL ( 30ml )

🙏Lidopatch by zydus cadila
T:patch- 5%

🙏Xylocaine by AstraZeneca
T:sol:- 2% 100ml
Oint :- 5% w/w ( 20mg )
Jelly :- 2% w/w ( 30mg )
..

🙏Xylocard 2 % by AstraZeneca
Inj (21.3mg/ml ) 50ml soln
.

🙏 Xylocaine viscous by astra zeneca
T:sol :- 21.3mg/ml ( 100ml )

🙏 Xylocaine topical 4% by AstraZeneca
T:sol :- 42.7mg/ml ( 30ml )

🙏Nummet by icpa
Spy :- 15% w/w ( 100g )

.
Some Combinations
Lidocaine + epinephrine

🙏 Lignosafe by stedman
( Lignocaine hcl 21.3mg & adrenaline 0.0125mg/ml )
Inj in 30ml

🙏 Xylocaine with adrenaline 2% by AstraZeneca
( Lidocaine hcl 21.3mg , adrenaline 0.005mg , nacl 6mg /ml )
Inj 30ml
.

Some other combination
🙏 Xylocaine 5% heavy ( lignocaine hcl 53.3mg/ml , Dextrose 75mg ) inj in 2ml
.

& Xylocaine soln ( same dosage as above ) T:Sol 100ml by AstraZeneca

🙏 Xylocaine spray by AstraZeneca
( Lidocaine hcl 100mg , ethanol 28.29% ) 500ml
.
🙏Xicaine by icpa
( Lignocaine 2 percent , adrenaline 0.022mg) inj 30ml
&
( Lignocaine hcl 2% , adrenaline 0.009 mg ) inj 30ml
.
🙏Asthesia by unichem
( Lidocaine 2.5% w/w , prilocaine 2.5% )
CRM (15,30,5 )g
.
Abbreviation
Crm :- cream
Tsol :- topical solution

HEMATOLOGICAL INVESTIGATIONS

Also known as: CBC; Hemogram

Sample Required?

  • A blood sample drawn from a vein in your arm or a fingerstick or heelstick (newborns)

Test Preparation Needed?

  • None

Why get tested?

  • To determine your general health status; to screen for, diagnose or monitor any one of a variety of diseases and conditions that affect blood cells, such as anemia, infection, inflammation, bleeding disorder or cancer.

Also known as: Hgb; Hb; H and H (Hemoglobin and Hematocrit)

Sample Required?

  • A blood sample drawn from a vein in your arm or a fingerstick or heelstick (newborns)

Test Preparation Needed?

  • None

Why get tested?

  • To evaluate the hemoglobin content of your blood as part of a general health check-up; to screen for and help diagnose conditions that affect red blood cells (RBCs); If you have anemia (low hemoglobin) or polycythemia (high hemoglobin), to assess the severity of these conditions and to monitor response to treatment

• When to get tested?

  • With a hematocrit or as part of a complete blood count (CBC), which may be ordered as a component of a general health screen; when you have signs and symptoms of anemia (weakness, fatique) or polycythemia (dizziness, headache); at regular intervals to monitor these conditions or response to treatment

Also known as: Thrombocyte count; PLT; Platelet distribution width; PDW; Mean Platelet volume; MPV.

Sample Required?

  • A blood sample drawn from a vein in your arm or a fingerstick or heelstick (newborns)

Test Preparation Needed?

  • None

Why get tested?

  • To determine the number of platelets in a sample of your blood as part of a health exam; to screen for, diagnose, or monitor conditions that affect the number of platelets, such as a bleeding disorder, a bone marrow disease, or other underlying condition.

• When to get tested?

  • As part of a routine complete blood count (CBC); when you have episodes of unexplained or prolonged bleeding or other symptoms that may be due to a platelet disorder

What is being tested?

  • Platelets, also called thrombocytes, are tiny fragments of cells that are essential for normal blood clotting. They are formed from very large cells called megakaryocytes in the bone marrow and are released into the blood to circulate. The platelet count is a test that determines the number of platelets in a person’s sample of blood. When there is an injury to a blood vessel or tissue and bleeding begins, platelets help stop bleeding.

Also known as: Leukocyte differential count; Peripheral differential; WBC count differential; Diff; blood differential; Differential Blood Count

Formal name: White blood cell differential

• Why get tested?

  • To help determine the cause of abnormal results on a WBC count; to help diagnose or monitor an illness affecting your immune system, such as an infection or inflammatory condition, or cancers that affect your white blood cells, such as leukemia.

• When to get tested?

  • As part of a CBC; when you have a routine health examination; when results of a CBC fall outside the reference range; when you have any number of signs and symptoms that may be related to a condition affecting white blood cells, such as infection, inflammation, or cancer, when you are receiving treatment that is known to affect WBCs, such as chemotherapy.

• What is being tested?

  • WBCs, also called leukocytes, are cells that circulate in the blood and the lymphatic system that help protect the body against infections. They are an important part of the body’s immune system and also have a role in inflammation, allergic responses, and protection against cancer. A WBC differential totals the number of each of the different types of WBCs in a person’s sample of blood.
  • There are five types of white blood cells, each with different functions.

  • Also known as: TLC; WBC count
  • Total WBC count is used as one of the index of presence of systemic infection and to rule out the possibility of leukemia & malignant neutropenia
  • Calculated with haemocytometer/ automated cell counts
  • RBCs are lysed by diluting the blood sample with dilute acetic acid leaving the WBCs intact.

  • Also known as: Red Blood Cell Count, RBC count
  • Red blood cells, also known as erythrocytes, make up the cellular part of blood, giving it its red color and also the ability to bind and carry oxygen to all parts of the body. Under a microscope, they appear to be circular and biconcave in shape.
  • Gives us the number of erythrocytes per cubic mm in circulating blood & Hb in blood.
  • Procedure done by office or chairside method and also automated procedure.
  • Hematological diseases of RBCs are anemia & polycythemia.

  • Categorized by mean corpuscular volume, anemia can be differentiated into microcytic, macrocytic and normocytic anemias. Normocytic anemia can be further divided into intrinsic and extrinsic RBC defect and blood loss.
  • MCV – Mean corpuscular volume is the average volume of red blood cells and is reflective of RBC size. When RBCs increase or decrease in size, the mean corpuscular volume changes; this helps physicians determine the type of anemia and its causes. Normal MCV is 80–96 µm³.
  • MCH stands for “mean corpuscular hemoglobin.” An MCH value refers to the average quantity of hemoglobin present in a single red blood cell.
  • MCHC is short for mean corpuscular hemoglobin concentration. MCHC refers to the average amount of hemoglobin inside a single red blood cell.
  • Hematocrit is the measure of the total volume % of red blood cells in the blood. The normal value for hematocrit is 45% for men and 40% for women. It is an important component of a patient’s complete blood profile.

Indications:

  • To prepare smears from paper points removed from root canals for evaluation of microcytic status of canal prior to filling.
  • A scraping or swab of an oral lesion is needed to confirm diagnosis of thrush
  • A scraping of gingival region or mucosal ulcer is sometimes used to confirm diagnosis of Acute Necrotising ulcerative stomatitis.
  • Identification of giant cells that accompany vesicular infections
  • Identification of Acantholysis

Dentowesome|@drmehnaz🖊


References: Google.com, lecturio.com, Study Notes✍🏻

CORTICOSTEROIDS IN DENTISTRY

🔷 Introduction:

Steroids are a group of hormones produced naturally in the body.

The adrenal cortex consists of 3 zones:

  1. Zona Glomerulosa synthesizes Aldosterone, the most potent Mineralocorticoid in humans.
  2. Zona Fasciculata – produces hydrocortisone (a glucocorticoid)
  3. Zona Reticularis produces Adrenal Androgens

• Glucocorticoid secretion is regulated by ACTH produced in the anterior pituitary. Cortisol has a -ve feedback on ACTH production.

• In Addison diseases, Glucocorticoid secretion impaired & ACTH is ⬆️

🔷 Corticosteroid Action & its regulation

  • Glucocorticoid – Hepatic Glycogen deposition
  • Mineralocorticoid – Sodium, electrolyte-fluid balance.
  • Glucocorticoid play critical role in body’s response to stress.

Stress

⬇️

Release of cytokines (IL-1)

⬇️

⬆️ cortisol levels

🔷 Classification:

Adrenocortical Hormones & Related Drugs

🔷 Steroid synthesis:

The substrate for steroid production is cholesterol. It is mobilized from the outer to the inner mitochondrial membrane by the steroidogenic acute regulatory (StAR) protein.

🔷 Glucocorticoids:

1) Hydrocortisone

Action: Anti-allergy, anti-inflammatory

Therapeutic Uses:

  • intralesional injection in dose of 20-50 mg/mL
  • Topical application
  • Tablet in dose of 100mg/day can be given systemically to relieve burning sensation.
  • Tab. Cortisol(25mg) combined with dexamethasone(90mg) can be given at biweekly interval.*

Action: Fibrinolytic,Anti-allergic, anti-inflammatory*

It causes ⬇️ fibroblastic production & deposition of collagen*

  • Topical application with orabase
  • Intralesional injection of hydrocortisone acetate (25mg/ml)
  • Topical application (0.25-0.5%) to the affected area
  • Intra-articular injection (25mg/ml)
  • 20-30mg/day in divided doses

Trade Name: CORTEF, ORABASE-HCA

• Preparation:

  1. Oral: 5 – 20 mg tab.
  2. Topical – 1% eye drop solution; 0.025 nasal drops, 0.25-2.5% skin creams

• Hydrocortisone acetate 25-50 mg/mL for soft tissue suspensions

• Hydrocortisone sodium phosphate: 50mg/mL IV, IM, SC

2) Cortisone:

• Uses:

  1. OSMF
  2. Addison disease
  3. Hodgkin lymphoma

3) Prednisolone:

Action: Anti-allergic, anti-inflammatory, immunosuppressive

• Uses:

  1. Rheumatoid arthritis: 10mg/day in divided doses
  2. Collagen disease: 1mg/kg
  3. SLE: IM/IV; Topical application 2-3 times daily
  4. Leukemia: ALL as maintenance dose
  5. Erythema multiforme, pemphigus, bullous pemphigoid, behchet’s syndrome
  6. Bronchial asthma: 40-60 mg
  7. Post-herpetic neuralgia
  8. Amyloidosis, cyclic neutropenia, purpura

Trade name: DELTA-CORTEF, PRELONE

4) Triamcinolone:

• Uses:

  1. Lichen planus: Topical application 3-4 times daily
  2. Erythema multiforme: 40-100 mg/day or inhalation doses
  3. Recurrent aphthae: Oral (2-4 mg/day)
  4. Desquamative gingivitis, OSMF, contact chelitis – intralesional (2-3 mL/day)

Trade name: Kenolog cream

5) Dexamethasone:

Uses:

👉🏻Mainly used for adrenal cortical suppression

  • Allergic diseases, serum sickness, urticaria, hay fever, angioneurotic edema: IV; topically 2-4 times a day
  • Benign migratory glossitis: Topical application
  • Shock, cerebral edema, occular diseases.

Trade name: DECADRON

6) Betamethasone:

Action: Anti-allergy, anti-inflammatory

Uses: Lichen planus, pemphigus, Aphthae ulcer

Dr. Mehnaz Memon🖊


References: Self Notes, Image chart source: Classification of Drugs with DOC by Vikas Seth (Third Edition)

Disorders of pituitary gland

Hyperactivity of anterior pituitary gland:

  • Gigantism : it is a rare condition that causes abnormal growth in children.
  • Cause : a pituitary tumour is almost always the cause of gigantism. Gigantism is due to hypersecretion of GH in childhood or in the preadult life before the fusion of epiphysis of bone with shaft.
  • Other less common causes of gigantism include McCune-Albright syndrome causes abnormal growth in bone tissues, patches of light brown skin, and gland abnormalities
  • Carney complex is an inherited condition that causes non cancerous tumours on connective tissue, cancerous or non cancerous endocrine tumours
  • Signs of gigantism – very large hands and feet, thick toes and fingers, a prominent jaw and forehead, coarse facial features, excessive sweating, insomnia, delayed puberty, deafness
  • Treatment – surgery (removing the tumour), bromocriptine and cabergoline are drugs that can be used to lower growth hormones, Gamma knife radiosurgery
  • Acromegaly : it is the disorder characterized by enlargement, thickening and broadening of bones.
  • Cause : acromegaly is due to hypersecretion of GH in adults after the fusion of epiphysis with the shaft of the bone and a benign tumour affecting the pituitary called adenoma
  • Signs : vision loss, protrusion of supra orbital ridges, broadening of nose, thickening of lips, prognathism, carpal tunnel syndrome, uterine fibroids in women, arthritis, sleep apnea
  • Treatment : surgery, medication – somatostatin analogs, GH receptor antagonists, dopamine agonists, radiation
  • Acromegalic Gigantism: it is a rare condition with symptoms of both acromegaly and gigantism.
  • Cushing’s disease : it is a hormonal disorder caused by high levels of the hormone cortisol in your body. It’s also known as hypercortisolism.
  • Causes : most common cause is related to medications called glucocorticoids, one can also get the disease from injectable steroids, such as repeated shots for joint pain, bursitis, back pain
  • Symptoms – buffalo hump, rounded and rosy face, thinning skin, acne, being very tired, kidney stones, sleep problems
  • Treatment : surgery, hormone replacement medications, life style changes

Hypoactivity of anterior pituitary gland:

  • Dwarfism : it is a pituitary disorder in children characterized by stunted growth
  • Causes : reduction of GH secretion in infancy or early childhood due to deficiency of GHRH from hypothalamus or somatomedin C, atrophy or degeneration of acidophilic cells in the anterior pituitary, achondroplasia
  • Signs : stunted skeletal growth, head becomes slightly larger in relation to the body, reproductive function is not affected, mental activity is normal
  • treatment : corrective surgeries, surgery to widen spinal cord, extended limb lengthening
  • Acromicria : it is characterized by the atrophy of the extremities of the body
  • Causes : deficiency of GH releasing hormone from hypothalamus, tumour of chromophobes, panhypopituitarism (reduction in secretion of all hormones of anterior pituitary gland)
  • Signs : atrophy and thinning of extremities of body, hypothyroidism, person becomes lethargic and obese
  • Simmonds’ disease : it is also called pituitary cachexia
  • Cause : occurs mostly in panhypopituitarism
  • Symptoms : rapidly developing senile decay, loss of hair over body and loss of teeth, skin on face becomes dry and wrinkled

Hyperactivity of posterior pituitary gland:

  • Syndrome of inappropriate hypersecretion of antidiuretic hormone : it is characterized by loss of sodium through urine duebto hypersecretion of ADH
  • Cause : due to cerebral tumours, lung tumours and lung cancers
  • Signs and symptoms : loss of appetite, weight loss, nausea and vomiting, headache, muscle weakness, spasm, cramps

Hypoactivity of posterior pituitary gland:

  • Diabetes inspidus : it is characterized by excess excretion of water through urine
  • Cause : deficiency of ADH which occurs due to lesion or degeneration of supra optic and paraventricular nuclei of hypothalamus, atrophy of posterior pituitary
  • Signs : polyuria, polydypsia (intake of excess water) and dehydration
  • Medication – desmopressin

Source : essentials of physiology by sembulingam

10 Steps to Accurate Manual Blood Pressure Measurement

Image Via: medical.docs

Step 1 – Choose the right equipment: 
What you will need: 
1. A quality stethoscope 
2. An appropriately sized blood pressure cuff 
3. A blood pressure measurement instrument such as an aneroid or mercury column sphygmomanometer or an automated device with a manual inflate mode.

Step 2 – Prepare the patient:Make sure the patient is relaxed by allowing 5 minutes to relax before the first reading. The patient should sit upright with their upper arm positioned so it is level with their heart and feet flat on the floor. Remove excess clothing that might interfere with the BP cuff or constrict blood flow in the arm. Be sure you and the patient refrain from talking during the reading.

Step 3 – Choose the proper BP cuff size: Most measurement errors occur by not taking the time to choose the proper cuff size. Wrap the cuff around the patient’s arm and use the INDEX line to determine if the patient’s arm circumference falls within the RANGE area. Otherwise, choose the appropriate smaller or larger cuff.

Step 4 – Place the BP cuff on the patient’s arm: Palpate/locate the brachial artery and position the BP cuff so that the ARTERY marker points to the brachial artery.  Wrap the BP cuff snugly around the arm.

Step 5 – Position the stethoscope: On the same arm that you placed the BP cuff, palpate the arm at the antecubical fossa (crease of the arm) to locate the strongest pulse sounds and place the bell of the stethoscope over the brachial artery at this location.

Step 6 – Inflate the BP cuff:Begin pumping the cuff bulb as you listen to the pulse sounds. When the BP cuff has inflated enough to stop blood flow you should hear no sounds through the stethoscope. The gauge should read 30 to 40 mmHg above the person’s normal BP reading. If this value is unknown you can inflate the cuff to 160 – 180 mmHg. (If pulse sounds are heard right away, inflate to a higher pressure.)

Step 7 – Slowly Deflate the BP cuff: Begin deflation. The AHA recommends that the pressure should fall at 2 – 3 mmHg per second, anything faster may likely result in an inaccurate measurement.

Step 8 – Listen for the Systolic Reading: The first occurence of rhythmic sounds heard as blood begins to flow through the artery is the patient’s systolic pressure. This may resemble a tapping noise at first.

Step 9 – Listen for the Diastolic Reading: Continue to listen as the BP cuff pressure drops and the sounds fade. Note the gauge reading when the rhythmic sounds stop. This will be the diastolic reading.

Step 10 – Double Check for Accuracy: The AHA recommends taking a reading with both arms and averaging the readings. To check the pressure again for accuracy wait about five minutes between readings. Typically, blood pressure is higher in the mornings and lower in the evenings. If the blood pressure reading is a concern or masked or white coat hypertension is suspected, a 24 hour blood pressure study may be required to assess the patient’s overall blood pressure profile.


References:

https://www.suntechmed.com/blog/entry/4-bp-measurement/