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Regional anesthesia > lecture 1 > Flashcards

lecture 1 Flashcards

1
Q

Name some weak acids

A

Na, Mg, Ca, or sodium drugs, magnesium drugs, calcium drugs,

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2
Q

name some weak bases

A

Cl or SO4, hydrochloride drugs and sulfate drugs

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3
Q

What is the resting membrane potential voltage

A

-70 to -90, during transfer of signal when the sodium channels close and it is at its greatest is +50

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4
Q

What are the 3 functional sates of Na channels

A

Resting, open, and inactive. The only time sodium is blocked is during the inactive form

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5
Q

name some esters

A

procaine, chloroprocaine, tetracaine, cocaine

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6
Q

name some amides

A

lidocaine, mepivacaine, prilocaine, bupivacaine, levobupivacaine, ropivacaine, etidocaine, articaine,

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7
Q

What do we need to know about bupivacaine

A

it is much more cardio toxic

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8
Q

Lipid solubility directly correlates to

A

LA potency

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9
Q

Protein binding directly correlates to

A

LA duration

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10
Q

Onset of Action indirectly correlates to

A

LA ionization

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11
Q

All LA produce relaxation of vascular smooth muscle except

A

Cocaine, Ropivacaine, and lidocaine

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12
Q

What LA have vasoconstrictive properties

A

Ropivacaine and lidocaine,,,, Cocaine provides vasoconstrictive properties due to blocking the reuptake of norepinephrine

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13
Q

What determines the peak plasma concentration

A

Total Dose,,, NOT- Volume or Concentration

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14
Q

What are some LA additives

A

adrenergic agonists, opioids, NaHCO3, ketorolac, hyaluronidase

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15
Q

Epinephrine, what is its uses for LA

A

serves as a marker for intramuscular injections, and reduces vascular absorption

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16
Q

Tissue sites with blood flow and absorption

A

In time I can please everyone but susie & sally IV, Tracheal, Intercostal, Caudal, Paracervical, Epidural, Brachial Plexus, Subarachnoid/sciatic/femoral , subcutaneous

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17
Q

Ion Trapping?

A

LA becomes more Ionized,, trapping LA within Fetal circulation LA injected into infected tissue renders it ineffective due to decreased lipid solubility

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18
Q

Fetal PH and LA?

A

the lower the fetal pH, the greater the amount of LA in the ionized form in the fetus

19
Q

Strategy for Acid base problems

A

1, is the drug a weak acid or weak base 2, what’s the drug’s pKa 3, Know pH of target solution

20
Q

Acid plus Acid

A

unionized

21
Q

Acid base

A

ionized

22
Q

esters LA’s are derivites of what acid

A

carboxalic acid

23
Q

What is the metabolism of esters

A

metabolism of esterase in plasma, red blood cells, and the liver, plasma chlinesterase

24
Q

3 names for the enzyme responsible for metabolizing succinylcholine

A

seudocholenesterase deficient or have atypical plasma cholenesterase

25
Q

Is normal Hgb Fe++ for Fe+++

A

Fe+++ binds hemaglobin to O2 and wont release it

26
Q

amide metabolism

A

Primarily in the liver by microsomal cytochrome P-450

27
Q

What will a increase in plasma concentration cause

A

lead to toxicity of the CV and CNS systems

28
Q

What is the most common cause of systemic toxicity

A

inadvertent intramuscular injection

29
Q

What is the effects of LA on the brian

A

depression of neuronal function

30
Q

CV toxicity is secondary to

A

closure of the sodium channels

31
Q

What is the amide preservative

A

methylparaben

32
Q

is as side effect of a amide LA that effects oxygenation

A

prilocaine can cause methemoglobinemia b/c of metabolite 0-toluidine which oxidizes Hgb and Met Hgb,

33
Q

What is the treatment for MetHgb

A

spontaneouos in 2-3 hours, or Methylene Blue 1mg/kg results in immediate reversal Avoid metHgb causing agents in OB, it can cause fetal cyanosis

34
Q

What are some prevention techniques of LAST

A

pretreat with Benzodiazepine to increase the seizure threshold, Know Toxic LA limits, Aspirate frequently

35
Q

What is the treatment for LAST

A

Bolus 20% intralipid 1.5ml/kg over 1 min Then continuous infusion 0.25ml/kg/min

36
Q

What should you know about eutectic local anesthetic

A

Toxicity is more likely seen in infants and small children, do not give to ages less than 12 months. Lidocaine 25mg, Prolocaine 25mg EMLA 5%

37
Q

What is tumescent

A

It is used for liposuction, It give local to large amount of subQ fat and allows for lipsuction. LA is very dilute

38
Q

Anatomy of a nerve

A
39
Q

lidocaine plasma concentration Toxicity levels

A
40
Q

Energy jumps between what? Where dose the signal travel

A

Node of ranvier

41
Q

How many nodes of Ranvner must you block to have caused sltitor conduction

A

must block 3

42
Q

What happens if you break the epineurium

A

you will have complications for 3-6 months

43
Q
A

Regional anesthesia (2 decks)

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