Anesthesia & local anesthetics

Question 1

Treatment of accidental Epinephrine injection

Answer 1

Treatment of accidental Epinephrine injection

• Epi-pen injection - treat with observation, will resolve in 90 minutes - intervention needed only if compartment syndrome (check for the 5 P’s)
• Phentolamine is a reversal agent for epinephrine but has not been clinically shown to help. additional injection may cause pressure necrosis
• Nitro paste and calcium channel blockers have not been shown to help with epi injection

Question 2

Post-Operative Nausea and Vomiting

• risk factors
• prevention

Answer 2

Post-Operative Nausea and Vomiting

Risk factors - female, non-smoker, volatile anesthestics (halothane, isoflurane), opioid use, history of PONV or motion sickness, long surgeries, facial rejuvention procedures

Prevention: decrease opioid use, scopolamine, decadron, zofran, avoid volatile anesthetics and general anesthesia, avoid nitrous oxide, use of serotonin antagonist (5-HT antagonist = ondansetron) in addition to anti-emetics

Question 3

HIV patients and risk stratification

Answer 3

HIV patients and risk stratification

• get CD4 count and viral load to determine activity of disease and their systemic condition
• HIV itself is not a risk factor for complications
• viral load >10,000 copies/mL means that the antiretroviral therapy is not working
• AIDS = CD4<200 (normal is 500-1200 cells/mm3)

Question 4

Signs of Malignant hyperthermia

Answer 4

Malignant hyperthermia - first sign is elevated end-tidal CO2, then elevated temp - Treat with dantrolene 10mg/kg - avoid sux and anesthetics that end in -ane - can give propofol

Question 5

Signs of Lidocaine toxicity

Answer 5

Lidocaine toxicity - Circumoral numbness, facial tingling, tinitus, restlessness, slurred speech, tonic-clonic seizures - in liposuction, peak plasma levels occur 10-14 hours after injection due to slow resorption through fat - OK levels when infiltrated into fat is 35mg/kg