Hall Obstetrics Flashcards
You have a patient with working epidural who needs emergency c-section. Options to raise her epidural level FAST?
15-20 ml of BICARBOANTED 3% 2-chloroprocaine with epi (1:200K) or
2% lidocaine with epi (1:200K)
Alkalinization of the local anesthetic with bicarbonate shifts more of the local anesthetic molecules to the nonionized and more lipid-soluble form for a faster onset (and a more solid block); however, it does take a little time to mix the solution. Typically, 1 mL of 8.4% sodium bicarbonate (1 mEq/mL) is added to each 10 mL of 3% 2-chloroprocaine with epinephrine 1:200,000 or 2% lidocaine with epinephrine 1:200,000, and those solutions in a dose of 15 to 20 mL can usually raise a labor epidural to cesarean levels in < 5 minutes. If you do not add the bicarbonate to 2% lidocaine with epinephrine 1:200,000, the onset time is twice as long, or about 10 minutes. Fentanyl can be added (75-100 μg) to the local anesthetic solution for a more solid block and for some postoperative analgesia.
