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Sim Lab 2 > Bier Block > Flashcards

Bier Block Flashcards

1
Q

Advantages / Indications of Bier Block

6/3 things (BERM-RC / ETM)

A
  1. Bloodless field
  2. Ease of admin
  3. Rapid Onset
  4. Muscular Relaxation
  5. Rapid Recovery
  6. Control of Anesthesia

*Ease of procedure offset by potential systemic side effects
*Time is limiting factor for what procedures
*Mostly distal extremities and or superficial

BERM-RC / ETM

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2
Q

Contraindications of Bier Block

6 things (DIS-DIP)

A
  1. Do not use Bupivacaine or Ropivacaine
  2. Ischemic Limb
  3. Sickle-Cell
  4. Do not use Epi in anything
  5. Infection
  6. Patient refusal
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3
Q

Limitations of Bier Block

4 things (MNST)

A
  1. Must be inflated for at least 15-20 before deflating
  2. No analgesia once cuff is down
  3. Short duration: 45-60min
  4. Tourniquet Pain
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4
Q

Deflation of cuff before 15-20 mins

A
  1. Bounce cuff (deflate then rapid inflate)
  2. Eval pt for 5-10 mins (LAST symptoms)
  3. Deflate cuff again and continute to eval in OR for LAST
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5
Q

Topical LA

Skin

A
  1. Slow Onset
  2. Need EMLA (Eutectic Mixture of Local Anesthetic)
  3. Limited duration of action
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6
Q

Topical LA

Do not use on

A
  1. Mucous membrane
  2. Broken Skin
  3. Neonate (< Month old)
  4. If allergic
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7
Q

Mucous Membrane LA

Benzocaine

A
  1. Fast Onset
  2. Very Effective
  3. Much faster absorption
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8
Q

Systemic absorption of IV LA depends on blood flow

Site of injection fastest to slowest (I TIP-EBSS)

A
  1. IV or arterial
  2. Tracheal / Transmucosal
  3. Intercostal
  4. Paracervical
  5. Epidural / Caudial
  6. Brachial Plexus
  7. Sciatic
  8. Subcutaneous

I TIP-EBSS

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9
Q

What slows down absorption of LA

A
  1. Site of Injection
  2. Addatives (Epi)
  3. Higher lipid solubility
  4. Dosage and Volume
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10
Q

LA Distribution

A
  1. ⬆ perfused organs have quicker and ⬆ concentration levels
    -more susceptible for toxicity
  2. Lungs are the bulk of uptake and sequestration
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11
Q

Metabolized

Esters

A

Hydolyized by pseudocholinesterase
Rapid

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12
Q

Metabolized

Amides

A

Liver CYP450
Renal elimination

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13
Q

Ester LA’s

A

only one “i” in name
Metabolite PABA
* can cause anaphylaxis

Pseudocholinesterase deficiency at risk for toxicity
Cocaine is only oddball, hydrolized in liver

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14
Q

Amide LA’s

A
  1. Name has two “i’s”
  2. Prilocaine metabolizes into “o-toluidine” = methemoglobinemia
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15
Q

Rate of Amide hydrolysis

Short acting to long acting

A

Prilocaine>Lidocaine>Mepivicaine>Ropivicaine>Bupivicaine

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16
Q

LA Toxicity: Neurological

7 in order: CTDT-BIS

A
  1. Circumoral Numbness
  2. Tongue Paresthesia
  3. Dizziness
  4. Tinnitus
  5. Blurred Vision
  6. Impending Doom
  7. Seizures

In order of comminality

17
Q

LA Toxicity: Respiratory

A
  1. Lido depresses hypoxic drive
  2. Relaxes smooth muscle = bronchodilaiton
18
Q

LA Toxicity: Cardiovascular

4 things

A
  1. ⬇ contractability
  2. ⬇ conduction velocity (Chronotropy)
  3. Relaxes smooth muscle = vasodilation
  4. Higher doses=contractile depression, hypotension, and arrhythmias (possible cardiac arrest)
19
Q

LA Toxicity: Immunological

A
  1. Anaphylaxis
    * PABA
    Methylparaben = preservative similar to PABA
20
Q

LA Toxicity: Muscular

A

Mildly miotoxic
-4 week regen time

21
Q

LA Toxicity: Hematological

A
  • Lidocaine
    Reduced Thrombosis, Increased Fibrinolysis (⬇ DVT)
  • Methemoglobinemia (Oxidized Fe2+ to Fe3+)
    Prilocaine
    Benzocaine
22
Q

LA Toxicity: PaCO2 and pH

A

Respiratory depression causes ⬆ PaCO2 = ⬆ cerebral vasodilation (⬆ blood flow) = CNS toxcicity
pH decreases (acidodic) causes ⬆ in LA duration
Acidosis causes furhter cardiovascular collapse

23
Q

LAST Symptoms

5 things: SHARL

A
  1. Seizure
  2. Respiratory distress
  3. Arrythmias
  4. Hypotension
  5. Lastly cardiac arrest
24
Q

LAST Treatment

4 things: VICS

A
  1. Intralipid: 1.5-3.0 mL/kg
  2. Vent support
  3. Cardiac suport (Epi 10-100mcg)
  4. Seizure supression (Versed, Prop, Pentothal)
25
Q

Benzocaine

Ester

A
  • Technique: Topical
  • Conc: 20%
26
Q

Chloroprocaine

Ester

A
  • Technique: Epidural/Spinal, PNB, Local
  • Conc: 1%, 2%, 3%
  • Max Dose: 12 mg/kg
  • Duration: Short
27
Q

Lidocaine

Amide

A
  • Technique: Epidural/Spinal, PNB, Local, IV, Topical
  • Conc: 0.5%, 1%, 1.5%, 2%, 4%, 5%
  • Max dose: 4.5mg/kg (7mg/kg with epi)
  • Duration: Medium
28
Q

Bupivacaine

Amide

A
  • Technique: Epidural/Spinal, PNB, Local
  • Conc: 0.25%, 0.5%, 0.75%
  • Max dose: 3mg/kg
  • Duration: Long
29
Q

Ropivacaine

Amide

A
  • Technique: Epidural/Spinal, PNB, Local
  • Conc: 0.2%, 0.5%, 0.75%, 1%
  • Max dose: 3mg/kg
  • Duration: Long
30
Q

LA Mixtures in 24hr period

A

Look up powerpoint and practice math

31
Q

Bier Block Process

12 steps

A
  1. 20g-22g PIV (as distal as possible) [Surgical side]
  2. Double cuff tourniquet (test both to 250-300mmHg then deflate)
  3. Pt elevates arm
  4. Use esmarch from hand to tourniquet
  5. Distal Cuff Inflated, Proximal Cuff Inflated, Distal Cuff Deflated (Dr. Pepper Drinker)
  6. Remove esmarch (repeat if blotchy)
  7. Slowly inject local (slow slow slow)
    -[50mL 0.5% Lido hand/forearm/elbow/ankle/foot…100mL 0.5% Lido entire lower extremeity]
  8. PIV removed (PSR, and it will leak…no clotting factors)
  9. Surgical anesthesia within 5-10 mins
  10. After 20-30 mins tourniquet pain ensues (Inflate distal, deflate proximal. gain another 15-20mins)
  11. Surgery over deflate cuff procedure depends on time
    -Reduce pressure sequnetially
    -Bounce cuff (if under 15-20min)
    -if over 40 min then deflate rapidly (nothing further required)
  12. Watch for LAST

Sim Lab 2 (6 decks)

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