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## Meet the editors

Víctor M. Whizar-Lugo graduated from Universidad Nacional Autónoma de México and completed residencies in Internal Medicine at Hospital General de México and Anaesthesiology and Critical Care Medicine at Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in México City. He also completed a fellowship at the Anesthesia Department, Pain Clinic at University of California, Los Angeles, USA. Currently,

Dr. Whizar-Lugo works as anesthesiologist at Lotus Med Group, and belongs to the Institutos Nacionales de Salud as associated researcher. He has published many works on anesthesia, pain, internal medicine, and critical care, edited four books, and given countless conferences in congresses and meetings around the world. He has been a member of various editorial committees for anesthesiology journals, is past chief editor of the journal Anestesia en México, and is currently editor-in-chief of the *Journal of Anesthesia and Critical Care*. Dr. Whizar-Lugo is the founding director and current president of Anestesiología y Medicina del Dolor (www.anestesiologia-dolor.org), a free online medical education program.

Enrique Hernández-Cortez graduated from the Faculty of Medicine of the Universidad Michoacana de San Nicolás de Hidalgo, México. He completed his residency in Anesthesiology at the Anesthesia Department Hospital de Alta Especialidad, Instituto Mexicano del Seguro Social in León Guanajuato. He is past head of the Anesthesia Department at the Hospital de Alta especialidad de Gineco-Pediatría No. 48, Instituto Mexicano del Seguro

Social, León Guanajuato, México. Dr. Hernández-Cortez is editor-in-chief of the journal *Anestesia en México* and vice president of the Federación Mexicana de Colegios de Anestesiología, A.C. He is editor of the book *Complications of Pediatric Anesthesia,* has published a variety of articles on pediatric anesthesia, and has lectured at countless conferences and meetings around the world.

Contents

Local Anesthetics

*by Javier Marcos Michel-Levy*

*by Yazmín Guillén-Dolores*

Adjuvant Drugs to Local Anesthetics

*by Jeffrey M. Carness and Mark J. Lenart*

*by Margaretha Barbara Breebaart*

Local Anesthetics in Odontology

*and Juan Carlos Flores-Carrillo*

*by Víctor M. Whizar-Lugo, Karen L. Íñiguez-López,* 

Bupivacaine Pharmacokinetics in Pregnant Women

*by Nandita Mehta and Sayyidah Aasima tu Nisa Qazi*

Current Local Anesthetic Applications in Regional Anesthesia

Local Anaesthetics for Spinal Anaesthesia in Day-Case Surgery

Local Anesthetics Infiltration and Wound Healing Process *by João Abrão, Marcelo Antunes and Luis Vicente Garcia*

*by Enrique Hernández-Cortez, Cecilia G. Sandoval Larios* 

*Ana C. Cárdenas-Maytorena and Cristian D. Ramírez-Puerta*

Pharmacokinetics and Pharmacodynamics of Local Anesthetics

**Preface XI**

**Chapter 1 1**

**Chapter 2 31**

**Chapter 3 47**

**Chapter 4 57**

**Chapter 5 73**

**Chapter 6 99**

**Chapter 7 119**

**Chapter 8 135**

## Contents


#### **Chapter 9 151**

Complications Associated with Local Anesthesia in Oral and Maxillofacial Surgery *by Basak Keskin Yalcin*

#### **Chapter 10 165**

Local Anesthetic Systemic Toxicity *by Divya Garg, Shikha Soni and Rakesh Karnawat* Preface

Day after day, healthcare providers administer powerful drugs with a myriad of side effects. Local anesthetics are, by far, the drugs most used in daily clinical practice with the goal of producing optimal analgesia and anesthesia without patients losing control of their alertness, which is the greatest advantage of local anesthetics. Regional anesthesia has proven to be the technique of choice in patients with alterations of the immune system, for example, cancer patients, favoring a better short- and long-term recovery. These drugs have also been investigated as antimicrobials, anti-asthmatics,

This book, *Topics in Local Anesthetics*, reviews and updates some basic and selected clinical applications of anesthetics, as well as examines the prevention and management of complications related to their use. The first three chapters discuss the aspects of pharmacokinetics and pharmacodynamics, especially the pharmacokinetics of bupivacaine in pregnant women. These aspects are essential to decrease the possibilities of systemic toxicity as well as effects on the fetus and the newborn. The use of adjuvant drugs dates back to the beginning of the last century and the advent of novel drugs has resulted in the prolongation of analgesia and regional anesthesia, as well as the reduction of toxic effects as it is possible to decrease the dosage of local anesthetics.

The safe use of these drugs requires knowledge of anatomy and the various techniques used to administer anesthetics, including topical, local, intravenous, endotracheal anesthesia, peripheral nerve blocks, interpleural, intra-articular, epidural, spinal, or a combination of any of these. The book reviews some of these techniques, with special emphasis on dentistry, maxillofacial surgery, and spinal anesthesia in ambulatory surgery. It also provides updated information on the effect of local anesthetics on the wound healing process, and their potential non-anesthetic uses. There is also a chapter dedicated to systemic toxicity.

As the editor, I want to thank my friend and co-editor Enrique Hernández-Cortez for his invaluable support to finish the book. I also wish to thank the authors and

Finally, it is my pleasure to thank my beloved wife Teresa for her love, patience, and support in the edition of this book, as well as my children and grandchildren, from

**Victor Whizar-Lugo**

Lotus Medical Group, Tijuana BC, México

**Enrique Hernández-Cortez**

Instituto Mexicano del Seguro Social,

Associate Researcher at Institutos Nacionales de Salud,

friends who contributed to this project.

whom I used much of their family time to finish this project.

anti-inflammatories, anti-neoplastics, and anti-arrhythmics.
