– Local anesthetics.
trenbolone acetate dosage is a local anesthetic of the amide type. Its effect is about 4 times stronger than lidocaine. At a concentration of 5 mg / ml after a single epidural administration of the effect duration is from 2 to 5 hours, while blockade of peripheral nerves -12 hours. Blockade develops more slowly than in the case of lidocaine, especially for relatively large nerve anesthesia. At low concentrations (2.5 mg / ml or less) motor nerve fibers are blocked to a lesser extent and thus shorter duration of effect. Mostly low concentrations, however, can occur during the extended treatment of pain, such as pain relief during delivery or post-operative analgesia. The addition of a vasoconstrictor, such as epinephrine, can reduce the rate of absorption of the anesthetic.
Indications for use.
trenbolone acetate dosage in anesthesia can be used for a number of regional anesthesia techniques, including local infiltration, blockage of large and small nerve, epidural blockade.
- Individual hypersensitivity to local anesthetics of the amide type or to other components of the drug;
- Heart failure;
- Cardiogenic or hypovolemic shock;
- Liver failure;
- Children under the age of 12 years;
- Carrying intravenous regional anesthesia (blockade on Viru) as accidental penetration of bupivacaine in the blood stream can cause the development of acute systemic toxicity.
Use with caution in patients with impaired cardiovascular function as backup capabilities compensation functional changes during treatment with the drug and the possible extension of AV-conduction reduced in these patients.
It is metabolized by the liver, so caution is required after repeated administration in patients with impaired liver function.
Dosing and Administration
During the epidural anesthesia is necessary to conduct a test dose of 3-5 ml. During the test dose for 5 min is necessary to maintain verbal contact with the patient and determine the heart rate regularly.
Aspirate should be carried out before the introduction of the main dose, which should be administered slowly, 25-50 mg / min under constant review.
When the minimum toxic effects of further administration was stopped. When used in adults to block the trigeminal nerve, enter 1-5 ml (2,5-12,5 mg) for blockade of the stellate ganglion – 10-20 ml (25-50 mg) for continuous epidural anesthesia – 20 ml (50 mg), first, and then 6-16 ml (15-40 mg) every 4-6 hours for interkostalnoy blockade – 2-3 ml (10-15 mg) per one nerve (nerve 30 only), for large closures (sacral, brachial, etc.) – 15-30 ml (75-150 mg). For anesthesia in obstetrics using the following initial doses (can be repeated every 2-3 hours) for epidural and caudal anesthesia (with vaginal delivery and vacuum extraction) – 6-10 ml (15-25 mg); for epidural block for cesarean section – 15-30 ml (75-150 mg); for bilateral pudendal blockade -5-10 ml (12.5-25 mg). The maximum recommended dose for a 4 hour period – 2 mg / kg (150 mg). The maximum recommended dose – 400 mg / day. The total dose should be calculated taking into account the patient’s physical status.
Adverse reactions to local anesthetics are rare in the absence of overdose or inadvertent intravascular injection. They must be distinguished from the physiological manifestations of the blockade itself, such as lowering blood pressure or the appearance of bradycardia during epidural anesthesia. Manifestations of overdose or accidental intravascular injection can be serious. tongue numbness, feeling of lightheadedness, dizziness, blurred vision function, tremors, convulsions, unconsciousness, respiratory arrest, decreased cardiac output, AV block, decrease in blood pressure, bradycardia, ventricular arrhythmia (including ventricular paroxysmal tachycardia, fibrillation ventricular asystole), urinary incontinence (impaired control of pelvic functions).
Treatment of patients with toxic phenomena is to maintain adequate ventilation and relief of cramps. ventilation must be accompanied by oxygenation. With the development of seizures, must be in / in the introduction of succinylcholine – 50-100 mg and / or 5-15 mg diazepam can be used 100-200 mg thiopentone. With the development of ventricular fibrillation or cardiac arrest is necessary to carry out resuscitation. Possible introduction of repeated doses of sodium bicarbonate.
Paracervical block may largely affect the fetus, other than the blockade.
The introduction of small doses of local anesthetic in the head, neck, as well as in the retrobulbar space or area of the stellate ganglion can give a negative reaction similar to systemic toxic effects (up to respiratory arrest), and therefore the need to have ready the necessary medicines and equipment.
Pregnancy and lactation
Caution is advised to use the drug during pregnancy and lactation. Side effects caused by the action of the local anesthetic in the fetus, such as bradycardia, most ,, apparently found at paracervical blockade. Such effects may be due to the fact that the anesthetic reaches a fetus with a high concentration.
Like other local anesthetics, trenbolone acetate dosage can penetrate into breast milk, but in such small amounts that do not pose a risk to the newborn.
Interaction with other medicinal products.
Monoamine oxidase inhibitors or tricyclic antidepressants increase the risk of prolonged hypotension.
Preparations containing oxytocin or ergotamine, promote sustainable development of hypertension with possible complications from cardiovascular and cerebrovascular system.
Phenothiazines and butirfenony reduce the pressor effect of adrenaline.
The combination of a general inhalation anesthesia with halothane increases the risk of arrhythmia.
Structurally similar drugs with local anesthetics, such as tocainide, potentiate the development of toxic additive effect.
Bupivacaine reduced solubility at pH> 6.5, it should be taken into account when added to alkaline solutions, as can form a precipitate.
0.25% and 0.5% solution for injection in vials of 5 ml, 10 ml, 20 ml or 5 ml ampoules.