Local Anesthetics from N932

Question 1

Does a spinal or epidural usually have a continuous infusion?

Answer 1

usually epidural has catheter with continuous infusion or the ability to bolus…

spinal is usually “one and done”

Question 2

How to prevent LAST?

Answer 2

ASPIRATE BEFORE INJECTION!!

inject NO MORE than 5mL

Question 3

What is the approximate volume of a “good” spinal dose?

Answer 3

2cc

THIS IS WHY WE GIVE A TEST DOSE FOR EPIDURALS

Question 4

What are the 2 “oh shit” s/s in LAST?

Answer 4

“do you hear that ringing?”

“I taste metal/metalic”

Question 5

Which local anesthetic is most often associated with LAST and what other drug can be used instead?

Answer 5

bupivacaine

ropivacaine can often be used instead

Question 6

Before a spinal or epidural what must be checked?

ongoing list that is being built as we learn :)

Answer 6

1. patient’s platelet level (must be 100)
2. does the drug formulation contain any preservatives? [MUST be preservative FREE]
3. ASPIRATE & USE TEST DOSE!!!