LA doses - Exam 2 Flashcards
Highly protein bound LA (>90%)
Bupivacaine
Etidocaine
Ropivacaine
Tetracaine
Cocaine
Why is chloroprocaine the fastest LA even tho its pKa is 8.7?
Bc it’s given in larger conc
What is conc of Epi normally put in LA?
5mcg/mL ; 1:200,000
Nagelhout MAX dose Lidocaine (1% and 2%) with and without Epi
Lido: 4mg/kg
Lido + Epi: 7mg/kg
Nagelhout MAX dose Bupivacaine 0.75% with and without Epi
Bupi: 2.5mg/kg
Bupi + Epi: 3.5mg/kg (~3mg/kg usually)
Nagelhout MAX cocaine dose and route of admin
topical
200mg MAX (not per kg)
-only naturally occurring LA
-blocks reuptake of catecholamine - > vasoconstriction
LA Epi test dose of _-_mcg/mL (kg?) for adults.
10-15mcg/mL(kg?)
Watch for:
HR increase of >10bpm
BP increase of >15mmHg
LA Epi test dose of _ mg/kg for kids
0.5mg/kg
Watch for:
BP increase >15mmHg
LA Fentanyl test dose of _mcg for laboring pts
100mcg
-watch for sedation
Timing of LAST
-<1 min - 15min after injection
-monitor for 30 mins after injection (we obviously will as CRNAs)
LAST
20% Lipid dose
1.5ML(not mg) / kg bolus
infusion of 0.25ML/kg/min
-continue for 10 min after heart stabilizes
give another bolus and infuse at 0.5mL/kg/min if heart still unstable
-10mL/kg / 30 mins for max dose
LAST CPR
-Epi dose
10-100mcg boluses
How to handle max doses of LA when mixing them together:
give % of max dose similar to % of the solution of the drug you’re mixing in
-ex) I want 50/50 Lido and Bupi mixture.
Max Lido = 4mg/kg, Max Bupi = 2mg/kg
So, 2mg/kg Lido and 1mg/kg Bupi
Tumescent anesthesia Lido + Epi doses for liposuction:
35-55mg/kg
-peaks >12-16hr after infusion
Tumescent anesthesia Lido+Epi dose for NONliposuction:
28mg/kg or less
Components of tumescent anesthesia
Lido (500mg) +
Epi (1mg) +
Bicarb (12mEq of 8.4% amp) +
NS (1L)
Topical anesthetic
Tetracaine-epi-cocaine(TAC) MAX dose
-adults
-kids
A: 3-4mL
K: 0.05mL/kg
HSE dose range
0.75-300 units mL
Tetracaine-Epi-Cocaine (TAC) composition
0.5% tetracaine +
1:2000 Epi +
11.8% Cocaine
onset: 30 min
Tetracaine-Epi-Lidocaine (LET) composition
0.5% Tetracaine +
1:2000 Epi+
4% Lido
onset: 15-30 min
EMLA composition
2.5% Lido +
2.5% Prilocaine
onset: 30-120 min
EMLA risks:
contact derm
**methemoglobinemia
TAC risk:
seizure/ arrest
EMLA MAX dose
-0-3mo OR <5kg=
1g over 10cm^2 area
EMLA MAX dose
-3-12 mo AND >5kg=
2g over 20cm^2 area
EMLA MAX dose
-1-6yo AND <10kg
10g over 100cm^2 area
EMLA MAX dose
-7-12yo AND >20kg=
20g over 200cm^2 area
