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Chapter 1. The History of Local Anesthesia

In 1653, the first person to describe the anesthetic effects of coca was:

A. Blas Valera

B. Bernabé Cobo

C. Pedro Pizarro

D. Paolo Mantegazza

B is correct. Bernabé Cobo, who spent his life bringing Christianity to the Incas, was the first to describe the anesthetic effects of coca.

The local anesthetic properties of cocaine were first appreciated, in 1884, for the treatment of:

A. Peripheral neuromas

B. Cutaneous lesions

C. Morphine addiction

D. Glaucoma

D is correct. Carl Koller performed the first ophthalmologic surgical procedure using local anesthesia on a patient with glaucoma.

An important advancement in local anesthetic drugs was due to the introduction of:

A. Prilocaine, as it is metabolized to end products that are nontoxic

B. Lidocaine, as it is an amide local anesthetic with lower side effects

C. Ropivacaine, as the racemic mixture reduces the risk of cardiac toxicity

D. Procaine, as there are fewer allergic reactions than tetracaine

B is correct. Lidocaine is an amino amide derivative, a stable compound not influenced by exposure to high temperatures, and, most importantly, one that does not have the allergic potential of the ester-type local anesthetics. The metabolite of prilocaine is implicated in methemoglobinemia. Ropivacaine is an S-enantiomer formulation. Procaine has the same allergic potential as tetracaine; both are ester anesthetics.

Tumescent anesthesia refers to:

A. Intraneural injections of local anesthetics into peripheral nerves causing swelling and conduction block

B. Use of large volumes of dilute local anesthetic solutions for cutaneous procedures

C. Cutaneous infiltration of physiologic sterile water and local anesthetic solutions to effect conduction block

D. Large volumes of a dilute solution of 2% cocaine with physiologic sterile saline for cutaneous procedures

B is correct. Karl Ludwig Schleich’s approach still seems to be relevant, particularly with the recent European enthusiasm for tumescent anesthesia, in which sometimes-huge volumes of very dilute local anesthetic are used for surface surgery.

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