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Anesthetic Agents and Surgery during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Local anesthetics have an aromatic ring with an intermediate alkyl chain with either (1) an amide or (2) an ester linkage. Protein-bound fraction is directly related to anesthetic potency, and duration of action is determined by the amount of binding. Anesthetics that are highly protein bound are lipid soluble and readily cross the placenta (Morishima et al., 1966; Pedersen and Finster, 1987). The frequency of birth defects among offspring of women who used lidocaine (n = 293), benzocaine (n = 47), or tetracaine (n = 23) during the first trimester, showed there were no adverse fetal effects when these agents were used any time during pregnancy (Heinonen et al., 1977). The Swedish Birth Defects Registry reported 20 infants whose mothers used tetracaine during the first trimester for local anesthesia, and no birth defects were reported (Kallen, 2019). The meaning of these small sample sizes is unclear. No animal teratology studies of these agents have been published.
Benzocaine
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Benzocaine is a local anesthetic and the prototype of the PABA esters commonly used as a topical pain and itch reliever. It is the active ingredient in many over-the-counter analgesic ointments and anti-itch preparations, e.g. for insect bites, hemorrhoids and anal pruritus. It is also indicated for general use as a lubricant and topical anesthetic on intratracheal catheters and pharyngeal and nasal airways to obtund the pharyngeal and tracheal reflexes, on nasogastric and endoscopic tubes, urinary catheters, laryngoscopes, proctoscopes, sigmoidoscopes and vaginal specula (1). The high risk of sensitization to and allergic contact dermatitis from benzocaine has been well recognized for a long time and therefore, in recent decades, benzocaine has been largely replaced in many countries with other less sensitizing local anesthetics such as lidocaine.
Local Anesthetics
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Elena González Burgos, Luis Luis García-García, M. Pilar Gómez-Serranillos, Francisca Gómez Oliver
Benzocaine is metabolized by plasma and hepatic cholinesterases to yield the renal metabolite p-aminobenzoic acid. The main potentially fatal complication of the use of benzocaine is methemoglobinemia. Most of the reported methemoglobinemia cases are related to its prolonged used or overdoes as well as the use of benzocaine oral spray for orogastric intubation. Previous in vitro studies have demonstrated that the metabolite benzocaine hydroxylamine (BenzNOH) is responsible to form methemoglobinemia. Moreover, the blood levels of methemoglobin (MetHb) are greater with benzocaine than with lidocaine (Cooper, 1997).
The pharmacological management of dental pain
Published in Expert Opinion on Pharmacotherapy, 2020
Joseph V. Pergolizzi, Peter Magnusson, Jo Ann LeQuang, Christopher Gharibo, Giustino Varrassi
Dental pulp is a connective tissue in which nerves, blood vessels, and lymphatics reside. Most dental pain involves insult to the pulp which may be traumatic, infectious, or due to inflammation. Damage to earlier dental work can also cause the pulp to become inflamed and painful [67]. In many cases, such dental pain can be temporarily relieved with a nonopioid analgesic, an opioid analgesic, or a combination product, but the underlying cause of the pain must be addressed with endodontic therapy or extraction of the offending tooth. Topical treatments can relieve pain temporarily, such as a topical anesthetic gel (20% benzocaine or 5% lidocaine). Topical pain relievers for oral pain must be regarded as temporary solutions aimed at facilitating examination and assessment in emergency situations [66]. A topical bactericidal intraoral solution (such as Ora-5) may be helpful although the use of antibiotics should be limited to only those cases where they are clearly indicated [68]. Benzocaine, such as 20% gel, can be effective and is well tolerated by patients with toothache [69,70]. See Table 2.
Topical anesthetics for pediatric laser treatment
Published in Journal of Cosmetic and Laser Therapy, 2019
Marija Stevic, Ana Vlajkovic, Branislav Trifunovic, Ivan Rakic, Nina Ristic, Ivana Budic, Vesna Marjanovic, Marija Jovanovski-Srceva, Dusica Simic
The Food and Drug Administration (FDA), in 2011, announced a drug safety communication in terms of potentiality for serious side effects with the use of topical benzocaine products. Most reported cases of topical anesthetic-induced methemoglobinemia in children have been due to benzocaine (48,49). Benzocaine products should not be used in children younger than 2 years (50). To decrease the incidence of topical benzocaine toxicity in the pediatric population, clinicians should be aware of adequate indications, certain concentrations and doses, and application instructions (48). Topicaine is available as a lidocaine 4% and 5% water-based gel. Friedman and authors showed it is an effect equivalent to EMLA and LMX at 15 and 30 min of application, but not at 60 min of application (51). Lidoderm is a 5% lidocaine adhesive patch, but still, no clinical studies have been guided to investigate its utility in cosmetic procedures (51).
Drug treatment options for premature ejaculation
Published in Expert Opinion on Pharmacotherapy, 2018
Since the 1930s, drug treatment of PE has repeatedly been advocated as its first choice of treatment [5]. In 1932, Präjaculin, has even been launched as the first oral drug for PE [14]. But also the use of topical local anesthetics, containing benzocaine or lidocaine, has become a popular pharmacological way to treat PE [5]. Nevertheless, the prevailing view throughout the years has been that PE is caused by psychological problems [15]. Notably, similar to the fact that there is no evidence that psychotherapy “cures” PE, there is no evidence that drug treatment cures PE [13]. Drug treatment only delays ejaculation as long as the drug is taken by the patient [13]. On the other hand, counseling may have beneficial effects on how to cope with PE [16].