LA Complications and Rescue Flashcards
Allergic Rxns with LAs and Recsues
* _____: <1%
* Attributed to manifestations of excess ____ levels
* Esters (PABA) ___ Amides
- Rare
- plasma
- >
Allergic Rxn can be caused by:
* ________: preservative in esters and amides
* similiar in structure to ______
* Use preservation ______ if you are concerned about allergic reactions.
- Methylparaben
- PABA
- free
Their is no cross-sensitivity between _____ and _____.
- esters
- amides
IgE anaphylaxis can cause rash, urticaria, and ______ edema with or without hypotension and __________.
* __________ test using preservative-free LA.
- laryngeal
- bronchospasm
- Intradermal
L.A.S.T acronym
- LA
- Systemic
- Toxicity
LAST: LA Systemic Toxicity:
* due to excess ____ concentration of the drug
* Entrance into the systemic circulation from _____ tissue redistribution and _______ metabolism.
* Accidental direct ___ injection.
- plasma
- inactive
- clearance
- IV
Other factors of LAST are:
* patient ________
* medications, location and ______ of block.
* LA used and ______.
- co-morbidities
- technique
- dose
Systemic Toxicity: Magnitude of systemic absorption depends on:
1. dose
2. _______ of site
3. _______________ use
4. Physicochemical _________
- Vascularity
- epinephrine
- properties
Systemic Toxicity CNS Effects:
* Drowsiness, _____ twitch prior to seizure
* Monitor _____ levels of ________ epidural > 900 mgs
* __________ promotes seizures w/ LAs
- facial
- plasma
- lidocaine
- Hyperkalemia
Plasma Lidocaine Concentration of 1-5 mcg/mL symptoms
- Analgesia
Plasma Lidocaine Concentration of 5 - 10 mcg/mL
- Circumoral numbness
- Tinnitus
- Skeletal Muscle Twitching
- Systemic HoTN
- Myocardial depression
Plasma Lidocaine Concentration of 10 -15 mcg/mL
- Seizures
- Unconsciousness
Plasma Lidocaine Concentration of 15 - 25 mcg/mL
- Apnea
- Coma
Plasma Lidocaine Concentration of > 25 mcg/mL
- Cardiovascular Depression
Systemic Toxicity: Cardiovascular System Effects
* Lidocaine @ __ mcg/mL with _____ numbness but NO CV
* High concentrations = block cardiac ___ channels.
* Accidental ___ Bupivacaine
- 5
- circumoral
- sodium
- IV
High Plasma Levels of LA:
* Block Cardiac ____ Channels
* ______ conduction of cardiac impulses causing prolonged _____ interval and _____ widening.
- Sodium
- Slow
- PR
- QRS
Accidental IV Bupivacaine causes:
* Precipitous _______, AV Block.
* Cardiac Dysrhythmias: SVTs, ST - ___ wave changes, PVC, ______ of QRS, and V-tach.
- Hypotension
- T wave
- widening
Toxicity Cardiovascular Effect Predisposing Factors:
* ___________
* Arterial _______, acidosis, or hypercarbia (animals)
* ______ Blockers, _______ preparations, Ca+ Channel Blockers
* Epinephrine and _____________
- Pregnancy
- hypoxemia
- Beta
- Digatalis
- Phenylephrine
Name the (3) LAs that cause cardiovascular toxicity in order from most to least
- Bupivacaine > Ropivacaine > Lidocaine
Treatment of Systemic Toxicity Goals:
1. Prompt ______ Management
2. ________ support
3. Removal of LA from ________ site.
- airway
- Circulatory
- receptor
Treatment of CNS Systemic Toxicity:
1. 100% O2 inhibits hypoxemia and _____ acidosis
2. hyperventilation
3. ___________
4. Benzodiazepines
5. Epinephrine as ________.
- metabolic
- barbiutates
- additive
Systemic Toxicity Seizure Management:
* Supplemental _____
* benzodiazepine (____ or ______)
* ________: if hemodynamically stable
* Muscle Relaxant (______ or NMDA)
* _______: Lipid Emulsion
- Oxygen
- Midazolam or diazepam
- Propofol
- Succinylcholine
- Intralipid
MOA of Intralipid Lipid Emulsion: creates _____ compartment; provides _____ for ______ metabolism.
- lipid
- fat
- myocardial
Intralipid~ Lipid Emulsion:
* Bolus: ____ mL/kg of 20% lipid emulsion
* Infusion: _____ ml/kg/min for ____ minutes
* 1st 30 mins: ____ ml/kg (1.2 to 6 mL/kg)
- 1.5
- 0.25
- 3.8
If Intralipid~ Lipid Emulsion does not work:
* Epinephrine dose: __ to ___ mcg
* No Response: __________ ___________.
- 10 to 100 mcgs
- Cardiopulmonary Bypass
Lipid Rescue for LAST: If Unresponsive to therapy in addition to CPR.
1. Bolus ______ 20% IV 1.5 mL/kg over 1 min
2. Intralipid 20% ____ mL/kg/min
3. Continue CPR to circulate lipids
4. repeat bolus q __- 5 mins up to ___mL/kg.
5. Increase infusion up to ___ mg/kg/min if BP declines. Continue infusion until hemodynamically stable
6. MAC total dose __ mL/kg
- Intralipid
- 0.25
- 3
- 3
- 0.5
- 8
Neural Tissue Toxicity aka Neurotoxicity can be either ________ or _________ neurological injury.
- Transcient
- Permanent
Three Categories of Neurotoxicity include:
* _____ Neurological Symptoms
* _______ _______ Syndrome
* _____ Spinal Artery Snydrome
- Transcient
- Caudal Equina
- Anterior
Transcient Neurological Synptoms is moderate to severe _________ (lower back, buttocks and posterior thighs) within ___ to ___ hours after uneventful single-shot _____.
- pain
- 6 to 36
- SAB
Causes of Transient Neurologic Symptoms are ________, but though to be b/c of _________ more than any other LA.
- unknown
- lidocaine > other LAs
Treatment for Transient Neurological Symptoms include _____ point injections and ______.
- Trigger
- NSAIDs
Recovery of Transient Neurologic Symptoms takes ________
- 1 to 7 days
Cauda Equina Syndrome is caused by a diffuse injury at ______ plexus, causing varying degrees of _____ anesthesia and ___ and _______ sphincter dysfunction and paraplegia.
- lumbosacral
- sensory
- bowel and bladder
Caudal Equina is associated with large ___ disc herniation, prolapsed or sequestration with ______ retention.
- lumbar
- urinary
Causes of Caudal Equina is __________
unknown
Anterior Spinal Syndrome is _____ extremity paresis with a variable ______ deficit.
- lower
- sensory
Anterior Spinal Artery Syndrome: uncertain if its ______ or ________ of the bilateral anterior spinal artery
- thrombosis
- spasm
Other Etiologies of Anterior Spinal Syndrome include:
* Effects of ______ or ______ drugs
* PVD
* Spinal Cord compression d/t Epidural absess or ______.
- HoTN
- Vasoconstrictor
- hematoma
Methemoglobinemia is a potenially _____-threatening complication d/t ________ O2 carrying capacity. ( metHGB > ___%)
- life
- decreased
- 15%
Methemoglobinemia is caused by:
* _______, _______> Lidocaine
* Nitroglycerine
* _______
* Sulfonamides
- Prilocaine
- Benzocaine
- Phenytoin
Treatment of Methemoglobin is __________ ______
* Reverals of met Hgb (Fe 3+) to Hgb (Fe 2+) in ___ to ____ mins
- methylene Blue
- 20 to 60 mins
Methylene Blue dose/max
- 1 mg/kg over 5 mins
- 7 to 8 mg/kg
Ventilatory Response to Hypoxia
* Lidocaine __________ the ventilary response to arterial hypoxemia.
* Suseptible Patients: ______ retainers
- depresses
- CO2
Hepatoxicity:
* caused by continous or intermittent epidual ________ to treat postherpetic neuralgia.
* Stop infusion —-> normalize liver transaminase ________
- bupivacaine
- enzyme
Cocaine Toxicity:
* 2009: Europe __ million
* 2010: US ____ million
- 4
- 1.5
Cocaine MOA is the SNS stimulation by blocking _______ uptake of NE and dopamine increased ________ levels
- presynaptic
- postsynaptic
Cocaine Adverse Effects:
* last up to ___ weeks
* CV: HTN, tachycardia, coronary ____, MI, ventricular dysrythmias (v-___)
* Parturient: decreased Uterine Blood Flow (UBF) causes ______ hypoxemia
* Hyperpyrexia causes _________
- 6 weeks
- vasospasm
- fetal
- seizures
Cocaine associated chest pain is treated with ____ and _______.
- ASA
- Benzodiazepines
Cocaine Associated persistent Hypertension is treated with:
* ____ Nitroglycerine
* _______________
* Phentolamine
- IV
- Nitroprusside
Cocaine Toxicity, High Risk w/ STEMI presentation gets a __________ _______
- Primary PCI
Cocaine Toxicity, High Risk w/ NSTE ACS presentation gets a _________ ______________.
- Cardiac Catherization
Cocaine Toxicity, Low-Moderate, you observe in a ______ _______ unit
Chest pain
You want to avoid giving _______ _________ and acutely __________ and ___________ medications to anyone with Cocaine Toxicity.
- Beta Blockers
- antithrombin
- antiplatelet
Cocaine Toxicity discharge therapy includes:
- ASA
- clopidogrel
- statin
- ACE-I
- Beta Blockers
- Drug abuse counseling
