Local Anesthetics

When they are applied locally, local anesthetics reversibly block the action potentials responsible for nerve conduction. The most commonly used local anesthetics are cocaine, lidocaine, bupivacaine, chloroprocaine, etidocaine, mepivacaine, prilocaine, ropivacaine, procaine, and tetracaine. Local anesthetics entering the systemic circulation produce adverse effects primarily on the CNS. Usually, when they are administered locally, they cannot reach sufficient systemic concentrations to interfere with the function of organs where conduction or transmission of impulses occurs. y Nevertheless, when systemic absorption

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occurs after topical use of local anesthetics, as is the case in children when tetracaine, adrenaline, and cocaine (TAC) is applied to mucous membranes, CNS toxicity has been described.'iai , y

The first sign of systemic toxicity following administration of local anesthetics is drowsiness, followed by tremor, restlessness, convulsions, and ultimately, CNS depression with respiratory failure. '20' Lidocaine and cocaine can produce changes in mood and behavior. Finally, local anesthetics can affect neuromuscular transmission. This effect is due to blockade of the ion channel of the acetylcholine receptor. y

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