Lecture IX Flashcards
Drugs to give with Epinephrine
- Lidocaine
* Mepivicaine
Drugs for which Epinephrine is less effective
Highly protein bound
- Ropivicaine
- Bupivicaine
Neuraxial Anesthesia
type of regional anesthesia that involves injection of anesthetic medication in the fatty tissue that surround the nerve roots as they exist the spine (also known as an epidural) or into the cerebrospinal fluid which surrounds the spinal cord (also known as a spinal).
Neuraxial Anesthesia Absolute Contraindications
Infection at site of insertion, bleeding diathesis, elevated ICP, patient refusal
Neuraxial Anesthesia Relative Contraindications
Bacteremia, pre-existing neurological disease, abnormal coagulation, cardiac disease
spinal block
- Drug around cauda equina
* Can spread upwards
Epidural Block
- Drug around nerve roots
* Sectioning areas
Neuraxial Anesthesia Respiratory Effects
Loss of proprioception
Neuraxial Anesthesia CV Effects
- Hypotension
* Bradycardia
Absorption Depends on…
- Lipophilic drugs get sequestered in tissue
- High blood flow to an area increases the consumption
- Renal failure patients need more charged molecules due to the acidosis
Elimination of Esters
Esters have one i in the name
plasma cholinesterase
Elimination of Amides
Amides have two i’s in the name
Liver- hydrolyzed by cytP450
Bupivicaine Maximum Recommended dose
3 mg/kg for adults
2.5 mg/kg for infants
Lidocaine Maximum Recommended dose
5 mg/kg plain
7 mg/kg with epinephrine
Neurotoxicity of Local Anesthetics
- Inhibition of inhibitory neurons>excitatory Neurons
- Lightheadedness, Peri-oral numbness, Seizures, Tinnitus
- Worsened by acidosis because of: If you have acidosis you will have more blood delivery to the brain and that can lead to seizures. Decreased protein binding.