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Local Anesthetics: Chemistry and Structure-Activity Relationship

Local Anesthetics: Chemistry and Structure-Activity Relationship

Local anesthetics (LAs) are drugs that induce a temporary loss of sensation in a limited body area, preventing pain. Cocaine was the first local anesthetic discovered in the late 19th century. Cocaine is a benzoic acid ester obtained from the leaves of coca shrubs and was often used for its psychotropic effects. Cocaine was first isolated in 1860 by Albert Niemann. Sigmund Freud studied the physiological actions of cocaine. Carl Koller later introduced it into clinical practice in 1884 as a...

Local Anesthetics: Common Agents and Their Applications

Local Anesthetics: Common Agents and Their Applications

Local anesthetics (LAs) are commonly used for various applications in medical and dental procedures. Some of the common agents used are cocaine, lidocaine, and bupivacaine.
Cocaine is an ester of benzoic acid and methylecgogine. It is used to anesthetize and vasoconstrict locally. Currently, it is used primarily for topical applications. It is beneficial for surgeries on the upper respiratory tract, providing anesthesia and shrinking the mucosa. Cocaine in the form of cocaine hydrochloride is...

Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia

Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia

Depending on the target organ, local anesthetics (LAs) can be administered via various routes. In surface anesthesia, LAs are applied directly to the surface of the skin or mucous membranes. It is widely used for topical skin numbing before venipuncture or minor surgical procedures. Commonly used surface local anesthetics are lidocaine or benzocaine sprays or creams. Surface anesthesia occurs within 5 minutes and lasts for about 60 minutes. One of the main disadvantages of topical anesthesia is...

Local Anesthetics: Clinical Application as Spinal Anesthesia

Local Anesthetics: Clinical Application as Spinal Anesthesia

Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...

General Anesthesia: Overview

General Anesthesia: Overview

Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...

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Related Experiment Video

Updated: Jul 14, 2026

Topical Airway Anesthesia for Awake-endoscopic Intubation Using the Spray-as-you-go Technique with High Oxygen Flow

Topical Airway Anesthesia for Awake-endoscopic Intubation Using the Spray-as-you-go Technique with High Oxygen Flow

Published on: January 13, 2017

Origin of oncologic anesthetic techniques.

¹Memorial Sloan-Kettering Cancer Center, New York.

Seminars in Surgical Oncology

|January 1, 1990

Summary

Anesthesia for cancer patients is complex due to cancer, chemotherapy, and surgery effects. Advances in oncologic anesthesia, pioneered at Memorial Sloan-Kettering Cancer Center, have significantly reduced patient mortality.

Area of Science:

Anesthesiology
Oncology
Cancer Research

Background:

Cancer patients present unique anesthetic challenges due to the disease itself (e.g., altered hemostasis, immune suppression, airway compromise).
Chemotherapy introduces further complications, affecting major organs (myocardium, lungs, kidneys, bone marrow) and enzyme function (pseudocholinesterase), alongside hormonal imbalances (syndrome of inappropriate antidiuretic hormone secretion).
Radical cancer surgery necessitates managing massive blood loss and prolonged anesthesia durations.

Purpose of the Study:

To trace the historical development of anesthetic techniques specifically for cancer patients.
To highlight the contributions of the Department of Anesthesiology at Memorial Sloan-Kettering Cancer Center in advancing oncologic anesthesia.
To discuss how these anesthetic innovations have impacted and improved patient outcomes, particularly in reducing operative mortality.

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Last Updated: Jul 14, 2026

Topical Airway Anesthesia for Awake-endoscopic Intubation Using the Spray-as-you-go Technique with High Oxygen Flow

Topical Airway Anesthesia for Awake-endoscopic Intubation Using the Spray-as-you-go Technique with High Oxygen Flow

Published on: January 13, 2017

An In Vivo Mouse Model of Total Intravenous Anesthesia During Cancer Resection Surgery

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Non-Intubated Video-Assisted Thoracoscopic Surgery

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Main Methods:

Historical review of anesthetic practices in oncology.
Examination of the evolution of anesthetic management strategies for cancer patients.
Analysis of the impact of developed anesthetic techniques on surgical outcomes.

Main Results:

The development of specialized anesthetic techniques was crucial for managing the complexities of cancer patient care.
Pioneering work at Memorial Sloan-Kettering Cancer Center laid the foundation for modern oncologic anesthesia.
Significant reductions in operative mortality have been achieved through these advancements.

Conclusions:

Modern oncologic anesthesia has evolved significantly to address the multifaceted challenges posed by cancer patients.
Specialized anesthetic approaches are vital for improving the safety and outcomes of cancer surgery.
The historical progression of anesthetic care in oncology demonstrates a clear positive impact on reducing patient mortality.