Lecture IX Flashcards

1
Q

Drugs to give with Epinephrine

A
  • Lidocaine

* Mepivicaine

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2
Q

Drugs for which Epinephrine is less effective

A

Highly protein bound

  • Ropivicaine
  • Bupivicaine
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3
Q

Neuraxial Anesthesia

A

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).

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4
Q

Neuraxial Anesthesia Absolute Contraindications

A

Infection at site of insertion, bleeding diathesis, elevated ICP, patient refusal

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5
Q

Neuraxial Anesthesia Relative Contraindications

A

Bacteremia, pre-existing neurological disease, abnormal coagulation, cardiac disease

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6
Q

spinal block

A
  • Drug around cauda equina

* Can spread upwards

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7
Q

Epidural Block

A
  • Drug around nerve roots

* Sectioning areas

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8
Q

Neuraxial Anesthesia Respiratory Effects

A

Loss of proprioception

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9
Q

Neuraxial Anesthesia CV Effects

A
  • Hypotension

* Bradycardia

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10
Q

Absorption Depends on…

A
  • 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
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11
Q

Elimination of Esters

A

Esters have one i in the name

plasma cholinesterase

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12
Q

Elimination of Amides

A

Amides have two i’s in the name

Liver- hydrolyzed by cytP450

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13
Q

Bupivicaine Maximum Recommended dose

A

3 mg/kg for adults

2.5 mg/kg for infants

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14
Q

Lidocaine Maximum Recommended dose

A

5 mg/kg plain

7 mg/kg with epinephrine

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15
Q

Neurotoxicity of Local Anesthetics

A
  • 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.
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16
Q

Treatment for LA induced seizures

A
  • Hyperventilation to decrease blood flow to the brain
  • Benzodiazepines
  • Succinylcholine (decreases action potentials)
17
Q

Cardiovascular Toxicity

A

Cardiac sodium channel blockade: Bupivicaine disassociates from cardiac sodium channels more slowly than lidocaine

*Coronary vasospasms and arrhythmias

  • Heart Blocks
  • Tachycardia
  • Fibrillation
18
Q

Treatment of LA induced CV toxicity

A

Prevent:

Use NE first to see where the needle is positioned, if in the wrong place you get tachycardia.

Treat arrhythmias:
Epi, atropine, vasopressin, amiodarone
DO NOT USE LIDOCAINE
Defibrillation

20% Intralipid
1cc/kg bolus
0.5cc/kg/min infusion
Creates a “sink” that LA can be sequestered into

19
Q

Transient Neurological Symptoms

A

Sensory disturbances of pain in back or lower extremities

  • 4-40% with lidocaine
  • Not concentration dependent unlike neural toxicity

Possible etiologies:
*nerve stretch

20
Q

Post Dural Puncture Headache

A

CSF can continue to leak out and the brain sags. (headache that is frontal or occipital- they get better when they lay down worse when they sit up)

21
Q

PDPH Treatment

A

Analgesics
Blood Patch
Patients own blood, into epidural space and will increase pressure
Caffeine to vasoconstrict

22
Q

Allergic Reaction

A

Mostly always esters: one i in the name

Most likely from a preservative in the medication