1. Bier Block Flashcards
BB Advantages
bloodless field
easy
fast onset
fast recovery
muscular relaxation
control of anesthesia
BB disadvantages
systemic SE
time-limited
uncomfortable
BB indications
distal/superficial extremity
- carpal tunnel
- ligament/tendon
BB limitations
- must be inflated 15-20 mins
- no analgesia once cuff is down
- short duration (45-60 min)
- tourniquet pain
BB absolute CI
- no bupi or ropi
- no epi
- infection
- pt refusal
- allergy to local
what drugs can you not use in BB?
bupivacaine
ropivacaine
epinephrine
BB relative CI
- raynauds
- beurgers
- homozygous sickle cell
- ischemic limb
IV LA systemic absorption (fastest to slowest)
FASTEST
IV/Arterial
Tracheal/Transmucosal
Intercostal
Paracervical
Epidural/Caudal
Brachial Plexus
Sciatic
Sub Q
SLOWEST
I TIP EB SS
5 factors that slow LA absorption
- injection site
- additives (epi)
- high lipid solubility
- incr dosage
- incr volume of dist
Amide hydrolysis
(Short to long acting)
SHORT
Prilocaine
Lidociane
Mepivacaine
Ropivacaine
Bupivacaine
LONG
PLMRB
LA SE
Circumoral/tongue numbness
Lightheadedness
Unconsciousness
Seizures
Tinnitus
Eyesight
Respiratory arres
Fibrillation
Urticaria
CV collapse
Muscle twitching
Altered mental state
Slurred speech
Seizure
LAST Symptoms
- seizure
- hypotension
- arrhythmias
- resp distress
- cardiac arrest
SHARC
LAST treatment
- intralipid
- vent support
- cardiac support
- seizure suppression
intralipid dosing
1.5-3 ml/kg
LAST cardiac drugs/dosing
10-100 mcg epinephrine
seizure suppression drugs
versed
propofol
pentothal
hand/forearm BB dosing
3 mg/kg of 0.5% lido
cuff below knee BB dosing
50 mL of 0.25% lido
cuff on thigh BB dosing
100 mL of 0.25% lido
BB surgical anesthesia
5-10 mins
BB tourniquet pain
20-30 mins
in what order do you inflate the cuffs for a BB
distal
then
proximal
then deflate distal
how long should you monitor pt for LAST after taking down cuff
5-10 mins in OR
after how long can you take cuff down without stressign about LAST
40 mins
how long does the cuff have to stay up after injection of LA
15-20 mins
what can you do if you need to take the cuff down early?
bounce the cuff
eval for LAST
deflate cuff
eval for LAST
ester metabolism
psuedocholinesterase
cocaine metabolism
liver
amide metabolism
CYP450 enzymes
liver
ester metabolite
PABA
(causes anaphylaxis)
prilocaine metabolite
o-toluine
(methemoglobinemia)
which amide has the worst CV symptoms
bupivacaine
what is similar to PABA
methyparaben preservative
lidocaine hematology effects
decr thrombosis
incr fibrinolysis
excessive LA use causes
respiratory acidosis
intralipid _______ the volume of distribution
increases the volume of distribution
short LA block drugs
chloroprocaine
medium LA block drugs
lido
mepivacaine
prilocaine
long LA block drugs
procaine
tetracaine
bupivacaine
ropivacaine
what should you inflate the tourniquet to
2.5x systolic
or
systolic + 100
what can you do if pt complains of tourniquet pain
inflate distal cuff
deflate proximal cuff
epinephrine contraindications
nose
hose
fingers
toes
