Exam 4 LA's part 3 Flashcards
A Pt requiring a nerve block, has an allergy to PABA, what shout not be used?
Esters
Methylparaben is a preservative contained in?
Amides & esters
What LA injection sites result in highest to lowest blood concentration?
IV, Tracheal, Caudal, Paracervical, Epidural, Brachial, Sciatic, SQ
What are 2 signs a Pt is about to have a seizure d/t LA CNS toxicity?
Drowsiness & facial twitch
What is the first sign of accidental IV bupivacaine injection?
Hypotension
What 3 LA’s are the biggest culprits to adverse CV effects?
(B)upivacaine > (R)opivacaine > (L)idocaine
What is the bolus dose for 20% lipid emulsion?
1.5mL/kg
What is the infusion rate for lipid emulsion?
0.25 mL/kg/min for at least 10mins
What is the max dose for a 20% lipid emulsion drip?
3.8 mL/kg
20% lipid emulsion is equal to how many mg?
200 mg
What med is not recommended with ASRA?
Vasopressin
A Pt complains of severe lower back pain 24hrs after a SAB, what is he/she most likely experiencing?
Transient Neurologic syndrome
What is the treatment for TNS?
Trigger point injections & NSAIDs
What are the S/S of Cauda equina syndrome?
- Bowel & bladder sphincter dysfunction
- paraplegia
- urinary retention
What are possible causes of CES?
Lidocaine & the spinal needle
What are possible causes for anterior spinal artery syndrome?
- Hypotension
- vasoconstrictors
- PVD
- spinal cord compression
- thrombosis
- anterior spinal artery spasms
What is the next step after ASAS has been identified?
Consult Neurology
What are the most likely LA’s to cause methemoglobinemia?
Prilocaine & Benzocaine
What is the treatment & dose for methemoglobinemia?
Methylene blue 1 mg/kg over 5mins
What is the max dose for methylene blue?
8 mg/kg over 24hrs
How long does the reversal of Fe³⁺ to Fe²⁺ take?
20 – 60mins
Pts with what type of condition should not receive Lidocaine if possible?
COPD (CO2 retainers)
Continuous or intermittent Bupivacaine epidurals to treat postherpetic neuralgia can lead to what?
Hepatotoxicity
What is the effect of cocaine on a fetus?
Decreased UBF → fetal hypoxemia
What is the MOA of cocaine?
Blocks reuptake of NE & dopamine
What should be avoided for someone with a STEMI & cocaine on board?
Beta blockers
