1. all block routes 2. topical 3. neb

Exam 3 Part VI Flashcards by Brandon Edmondson

cause of cauda equina syndrome with chloroprocaine

high dose 2. low pH 3. preservative sodium metabisulfite

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what are the local tissue toxicities that LA can cause

cauda equina syndrome 2. transient neurologic syndrome

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transient neurologic syndrome is associated with which LA

5% single dose spinal lidocaine

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sx with transient neurologic syndrome

pain in back and lower extremities 2. burning and itching, cramp-like pain that radiates to the anterior posterior thigh 3. no permanent issues 4. only lasts up to 5 days post-spinal

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tx of transient neurologic syndrome

supportive with NSAIDS

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mixing lidocaine 1:1 with ______________ has been found to decrease irritation to the spinal cord decreasing risk of transient neurologic syndrome

CSF

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lidocaine can be used in what type of blocks

all blocks

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use of lidocaine in _______________ anesthesia has decreased 2/2 transient neurologic syndrome

spinals

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Lido + Epi can prolong the DOA by as much as __________%

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lido causes _________________ at most concentrations, but causes ____________ at low doses

vasodilation; vasoconstriction

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what is the least systemically toxic amide

prilocaine

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_________________ causes metHb 2/2 metabolite O-toluidine

prilocaine

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why is epi not needed with prilocaine

does not significantly vasodilate

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prilocaine is administered what routes

infiltration 2. IV 3. regional 4. PNB 5. spinal 6. epidural

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routes of lido

all block routes 2. topical 3. neb

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_________________ is very similar to lido but has a slightly longer DOA

mepivacaine

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___________________ is c/i with OB bc metabolism is prolonged with fetus and newborn

mepivacaine

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_________________ is an amide anesthetic can cause sudden cardiac arrest

bupivicaine

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with bupivicaine the ________________ block lasts longer than the _________

sensory; motor

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routes of bupivicaine

regional 2. local 3. spinal 4. epidural

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effects of PNB with bupivicaine last __________________ hours

24-Dec

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intrathecal anesthesia with bupivicaine has an onset in _________________, with _______________hours of analgesia

2-3; 4-6

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____________________ is an amide LA that is a racemic mixture used with epi

bupivicaine

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_____________ is an s-enantiomer of bupivicaine

levobupivicaine

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benefit of levobupivicaine compared to bupivicaine

decreased toxicity --> allows for larger doses

levobupivicaine & ropivacaine, at low doses will cause ______________________

vasoconstriction

____________________ is a single enantiomer of bupivacaine with less toxicity, less lipid soluble, less potent than bupiv

ropivacaine

epidural use of ropivacaine allows for _________________ > ______________ blockage

sensory; motor

____________________ was used in infiltration & spinal blocks before lidocaine became popular

procaine

___________________ is the ester LA that causes an allergic rxn 2/2 PABA metabolite the most

procaine

procaine has a ____________ potency and a _____________ duration

low; short

chloroprocaine has a _____________ potency and a ________________ toxicity

low; low

what LA is the LEAST toxic of all agents currently in use

chloroprocaine

______________________ can interfere with subsequent doses of epidural amides or opioids

chloroprocaine

_____________________ is an ester LA that is used in high concentrations, rapidly metabolized, has virtually no fetal transmission

chloroprocaine

__________________ is used in C/S with Bicarb for rapid onset of surgical block

chloroprocaine

tetracaine has a ____________ onset and a ______________ duration

slow; intermediate-long

T/F: tetracaine has a low potency

FALSE

current use of __________________ LA is mainly topical via mucous membranes or skin wounds, & sometimes for spinals

tetracaine

_________________ is VERY toxic and can cause cauda equina syndrome with repeated spinal dosing

tetracaine

what is the only natural LA

cocaine

____________________ is a LA that inhibits neuronal reuptake of catecholamines --> HTN, arrhythmias, tachycardia, and potentially cardiac arrest

cocaine

which LA is a secondary amine

benzocaine

which LA is permanently non-ionized

benzocaine

benzocaine has a _____________ onset and a ___________ DOA

slow; short

benzocaine is limited to _________________ anesthesia

topical

pKa of benzocaine

2.5-3.2 (why it is permanently non-ionized and has a high risk of toxicity/methoglobinemia)

dosage guideline of chloroprocaine w/o epi

11 mg/kg; max 800 mg total dose

dosage guideline of chloroprocaine with epi

14 mg/kg; max 1000 mg

dosage guideline of lidocaine without epi

4-5 mg/kg; max 300 mg

dosage guideline of lidocaine with epi

7 mg/kg

dosage guideline of bupivacaine without epi

2.0 mg/kg; max - 175 mg

dosage guideline of bupivacaine with epi

2.5 mg/kg ; max 225 mg

dosage of ropivacaine w/ or w/o epi

3 mg; max 200 mg

dosage guideline of procaine

7 mg/kg max 350-600 mg

dosage guideline of mepivacaine

7 mg/kg; max 400 mg

dosage guideline of prilocaine for body weight less than 70 kg

6 mg/kg; max = 500 mg

what other receptors other than the VG Na channels have LA been found to work on/effect (however, clinical significance is unclear)

1. GCPR (inflammatory modulation) 2. suppression of polymorphonuclear leukocyte priming (iflammatory modulation) 3. K+ channels 4. Ca++ channels

LA binding to K+ or Ca++ channels leads to significantly _____________ potent LA effects

less

how does diameter & myelination influence sensitivity of LA

1. larger the nerve - longer the onset time 2. greater myelination = greater diffusion barrier to LA

which nerve fibers are your largest and most heavily myleinated?

A-alpha

which nerve fibers have the fastest conduction velocity of ALL fibers

A-alpha

which fiber(s) have the second fastest conduction

A-beta; A-gamma

which fiber is responsible for reflexes

A-gamma

which has the slowest conduction velocity of all alpha fibers

A-delta

which fiber has the function of preganglionic autonomic vasomotor

B fibers

which fibers have the function of postganglionic autonomic vasomotor

sympathetic C fiber

which fibers are responsible for pain, temperature, and touch

DRG (C fibers) and A-delta fibers

which fibers are responsible for motor tone

A-gamma

which fibers are repsonsible for motor, touch, and pressure

A-beta

which fibers are responsible for proprioception and motor

A-alpha

order in which nerve fibers are affected by LA

sympathetic C and B fibers --> DRG C and A - delta --> A-beta --> A-gamma --> A-alpha