LOCAL ANESTHETICS Flashcards
· Lidocaine
o Induction Dose: 1-1.5mg/kg, max of 100mg
o Onset: rapid
o Duration: 60-120 minute
o Post-Continuous Lumbar Epidural (CLE) Dose (dose after CLE is running when the patient has breakthrough pain): 4mL 2% Lidocaine with 4mL 0.2% Ropivacaine
o Maximum Infiltration Dose: 300mg
o Tumescent Anesthesia Max Dose Range: 55mg/kg
o EMLA Dose Range: concentration:5% EMLA is 50/50 2.5% lidocaine and 2.5% prilocaine. Max dose: 1g for area of 10cm2 if < 5kg (0-3 mo), 2g for 20cm2 if > 5kg (or 3-12mo), 10g for 100cm2 if > 10kg (1-6 yo), 20g for 200cm2 if > 20kg (7-12 yo)
o Precautions: prolonged clearance with pregnancy induced HTN (more sensitive to LA). Pregnancy causes lower levels of plasma cholinesterase. Amides can cross placenta.
· Ropivacaine
o Maximum Infiltration Dose: 200mg
o Regional preparation: 0.2% or 0.5% Ropivacaine w/wo 1:200,000 epi concentration in 20mL syringe (We use Ropivacaine for blocks at ARMC)
o CLE Bolus: 6-8mL (depends on patient size/height)
o CLE gtt: 0.15% Ropivacaine c 2mcg/mL fentanyl (L&D nurse will have for you to hook up)
o Post-Continuous Lumbar Epidural (CLE) Dose (dose after CLE is running when the patient has breakthrough pain): 4mL 0.2% Ropivacaine c 4mL 2% Lidocaine
o Onset: slow
o Duration: 240-480 minutes
o Metabolite: can accumulate with uremic patients, less toxic than bupivacaine
· Bupivacaine (Only used with spinal at ARMC)
o Maximum Infiltration Dose: 175mg
spinal: 0.75%
fast onset
DOA 60-240 min
recommended max single dose 20 mg
o Spinal Dosing: depends on height of patient closer to 5 feet 1.2-1.4mL, closer to 5’5’’ 1.4ml-1.6mL, closer to 6’=1.6mL-1.8mL up to T4, no higher! Position patient to facilitate movement
o Onset: slow
o Duration: 240-480 minute
o Precautions: ɑ1-acid glycoprotein and albumin binding are quickly saturated with accidental IV injection, free drug to conducting tissue of heart leads to PVCs, widened QRS complex, V Tach, SVT, AV heart block, and ST-T wave changes. Slower to dissociate off channels than lidocaine therefore is more cardiotoxic. Toxic level 8-10mcg/ml.
