Anesthetic Agent

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• QWhat are the risks and side effects of an epidural?

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  A American Society of Anesthesiologists answered

  Although most women have epidurals with no problems during labor and delivery, there may be some drawbacks to using this pain relief method:

  • An epidural can cause your blood pressure to decrease. This, in turn, may slow your baby's heartbeat. To decrease this risk, you'll be given fluids through an intravenous line before the drug is injected. You also may need to lie on your side to improve blood flow.

  • After delivery, your back may be sore from the injection for a few days. However, an epidural should not cause long-term back pain.

  • If the covering of the spinal cord is perforated, you can get a bad headache. If it's not treated, this headache may last for days. This is rare.

  • When an epidural is given late in labor or a lot of medication is used, it may be hard to bear down and push your baby through the birth canal. If you cannot feel enough when it is time to push, your anesthesiologist can adjust the dosage. Serious complications are very rare.

  • If the drug enters a vein, you could get dizzy or, rarely, have a seizure.

  • If epidural medication enters your spinal fluid, it can affect your chest muscles and make it hard for you to breathe.

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• QWhat are side effects of benzodiazepines?

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  A Dr. John Preston, PsyD , Psychology, answered

  Here are side effects of benzodiazepines:
  
  Common side effects: These include drowsiness, dizziness, forgetfulness, and slurred speech.
  
  Less common side effects: These include confusion, nervousness, rash, and loss of balance and falls.

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• QWhat medications interact with benzodiazepines?

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  A Dr. John Preston, PsyD , Psychology, answered

  When taking benzodiazepines, any other type of medication that causes drowsiness or impaired alertness and reaction time can be potentially dangerous, especially if one has to drive an automobile. Alcohol should not be consumed when taking benzodiazepines.

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• QHow can anesthetics affect the brains of children?

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  A SmartTots-Pediatric Anesthesia Research Initiative answered

  "Anesthetic neurotoxicity is not just a topic of interest to anesthesiologists and researchers; it is now considered a public health concern, having attracted the attention of the U.S. Food and Drug Administration and the population at large. The molecular mechanisms linking anesthetic exposure and neuron cell death must be identified for this phenomenon to be prevented.
  
  Multiple animal studies have demonstrated that anesthetic exposure during a critical period of synaptogenesis causes cell death in the brains of young rodents and nonhuman primates; these animals demonstrate deficits in learning and memory later in life. How these findings translate to humans is still unclear. Retrospective analyses of select pediatric populations have suggested that children with multiple anesthetic exposures have an increased likelihood of developing learning disabilities and behavioral problems. However, the retrospective nature of these studies, which contain many confounding factors, makes it impossible to assign causality." (Katherine R. Gentry, MD, et al., "Early Developmental Exposure to Volatile Anesthetics Causes Behavioral Defects in Caenorhabditis elegans," Anesthesia & Analgesia, January 2013, pp. 185-189.)
• QWhen is the developing brain most vulnerable to anesthetics?

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  A SmartTots-Pediatric Anesthesia Research Initiative answered

  "The greatest vulnerability of the developing brain to anesthetics occurs at the time of rapid synaptogenesis or so-called brain growth spurt period. In rodents, this critical period lasts from approximately postnatal day 0 to 10. For rhesus monkeys, this period takes place after approximately 115 days of gestation and up to postnatal day 60. In humans, it starts from the third trimester and continues two to three years after birth. However, it is unclear whether anesthetic-induced neuronal death is the direct cause of long-term neurocognitive dysfunction. Many developmental events (e.g., neurogenesis, synaptogenesis and neuron structure remodeling) occur within this period.
  
  Multiple sequential steps are involved in neurogenesis including neural stem cell (NSC) proliferation and the differentiation of NSCs into neurons. Thus, neuronal cell death may not be the only consequence caused by general anesthetics. Anesthetics may perturbate neural development by influencing NSC proliferation, neurogenesis, synaptogenesis and neuronal survival." (Xiaowen Bai, MD, PhD, et al., "Ketamine Enhances Human Neural Stem Cell Proliferation and Induces Neuronal Apoptosis via Reactive Oxygen Species-Mediated Mitochondrial Pathway," Anesthesia & Analgesia, April 2013, pp. 869-880.)
• QWhat animal studies have been done to test the effects of anesthetics?

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  A SmartTots-Pediatric Anesthesia Research Initiative answered

  "In one of the earliest studies of anesthetic neurodegeneration in rodents, researchers demonstrated that exposure to midazolam, nitrous oxide, and isoflurane (ISO), in postnatal day seven rats, resulted in widespread histological evidence of apoptosis as well as deficits in spatial reference memory when subjected to behavioral testing. In the Morris water maze, exposed young adults had slower rates of memory acquisition than control animals; when retested as adults, exposed animals also demonstrated impaired retention performance. Similar results have been obtained in nonhuman primates. Neonatal rhesus monkeys exposed to 24 hours of ketamine demonstrated persistent cognitive defects when tested out to three years of age." (Katherine R. Gentry, MD, et al., "Early Developmental Exposure to Volatile Anesthetics Causes Behavioral Defects in Caenorhabditis elegans," Anesthesia & Analgesia, January 2013, pp. 185-189.)
• QWhat are the potential effects of anesthetics given during childhood?

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  A SmartTots-Pediatric Anesthesia Research Initiative answered

  Mounting evidence from animal studies shows that anesthetic exposure in early life leads to apoptosis in the developing nervous system. This loss of neurons has functional consequences in adulthood. Clinical retrospective reviews have suggested that multiple anesthetic exposures in early childhood are associated with learning disabilities later in life as well. Despite much concern about this phenomenon, little is known about the mechanism by which anesthetics initiate neuronal cell death.
  
  Studies have been conducted using caenorhabditis elegans, a nematode (roundworm). Nematodes provide a powerful genetic animal model, with precisely characterized neural development and cell death pathways; they affords an excellent opportunity to study anesthetic-induced neurotoxicity. In one study, researchers hypothesized that exposing the nematode to volatile anesthetics early in life would induce neuron cell death, producing a behavioral defect that would be manifested in adulthood.
  
  The results from this study indicated that anesthetics affect neurobehavior in nematodes, extending the range of phyla in which early exposure to volatile anesthetics has been shown to cause functional neurological deficits. This implies that anesthetic-induced neurotoxicity occurs via an ancient underlying mechanism." (Katherine R. Gentry, MD, et al., "Early Developmental Exposure to Volatile Anesthetics Causes Behavioral Defects in Caenorhabditis elegans," Anesthesia & Analgesia, January 2013, pp. 185-189.)
• QWhat kinds of dental pain does topical benzocaine relieve?

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  A Stacy Wiegman, PharmD , Pharmacy, answered

  The kind of dental pain topical benzocaine relieves can range from canker sores to discomfort caused by dentures in seniors. Benzocaine can be applied directly to a tooth and its surrounding gum to bring temporary relief of a toothache until you can get to the dentist. If you have to undergo a dental procedure that requires local anesthesia, your dentist may first apply a topical anesthetic such as benzocaine to your gums to numb the area to minimize discomfort caused by the needle.
  
  Benzocaine is found in many over-the-counter gels for teething babies, but the U.S. Food and Drug Administration says it should not be used in children under two years of age, because of the possibility of a rare but serious blood problem. For more information about benzocaine and ways to use it safely to reduce dental pain, talk to your dentist or pharmacist.
  

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• QDoes topical lidocaine interact with any other medications?

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  A Dr. Darria Gillespie, MD , Emergency Medicine, answered

  If you are taking fusidic acid, idelalisib, tizanidine, or conivaptan, lidocaine can lead to side effects and should be avoided.
  
  This answer was adapted from Sharecare's award-winning AskMD app. Start a consultation now to find out what's causing your symptoms, learn how to manage a condition, or find a doctor.
• QDoes topical lidocaine have any side effects?

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  A Dr. Darria Gillespie, MD , Emergency Medicine, answered

  Side effects may include redness, swelling, itching, or red or purple spots where the patch is applied. These may be worse if it is applied to broken or irritated skin. Children and the elderly may be more sensitive to lidocaine's systemic effects. Lidocaine should not be used where it could get into the ear.
  
  This answer was adapted from Sharecare's award-winning AskMD app. Start a consultation now to find out what's causing your symptoms, learn how to manage a condition, or find a doctor.