Local Anesthetics

Question 1

Esters

Answer 1

cocaine, procaine, tetracaine, benzocaine

Question 2

Amides

Answer 2

lidocaine, mepivacaine, bupivicaine, ropivicaine.

Question 3

Elimination of esters

Answer 3

plasma cholinesterases

Question 4

elimination of amides

Answer 4

liver

hydrolysis by cytochrome P450

Question 5

Max dose of bupivicaine

Answer 5

3mg/kg

2.5 mg/kg for neonates

Question 6

max dose for lidocaine

Answer 6

5 mg/kg

7 mg/kg epi

Question 7

Local anesthetic toxicity

Answer 7

toxicity : light-headed, peri-oral numbness, tinnitus, seizures. worsoned by acidosis due to decreased protein binding in the blood and increased cerebral blood flow = increased free drug delivered to brain. cardiovascular toxicity occurs at higher concentrations, Na channel blockade, vasodilation, inhibition od SNS reflexes, heart block. intralipid.

treatment: benzodiazapines, profolol, thiopental, succinylcholine, hyperventilaiton.