Maverick Modules (5-6) Drugs & Toxicity Basics

Question 1

_____ of Marcaine or Ropivacaine should be utilized in fractionated dosing, aspirating every ____ cc’s.

Answer 1

20 - 30 cc’s

Aspirate every 5 cc’s

Question 2

What is Marcaine?

Answer 2

Bupivacaine with epinephrine

Question 3

How do blocks work at the cellular level?

Answer 3

Na⁺ channel blockade and thus blockade of impulse transmission

Question 4

Potency is associated with ____ _______.

Answer 4

Lipid Solubility

Question 5

What determines the onset of a local anesthetic?

Answer 5

pKa (ionized constant)

Question 6

The higher the pKa, the _____ the onset.

Answer 6

slower

Question 7

Duration of a block is primarily effected by what factor?

Answer 7

Protein binding

Question 8

The higher the degree of protein binding, the ______ the duration of the block.

Answer 8

longer

Question 9

Increased patient age will increase local anesthetic ________.

Answer 9

Duration

Question 10

How are amides eliminated?

Answer 10

Hepatic metabolism

Question 11

How are esters eliminated?

Answer 11

Plasma cholinesterases

Question 12

Which anesthetic class has a greater propensity for allergic reactions? Why?

Answer 12

Esters (due to PABA preservative)

Question 13

Mass does not increase the ______ of the block, but will increase the _______ of the block.

Answer 13

density ; duration

Question 14

What is the standard recommended epinephrine dose for regional techniques?
What is the Maverick recommended dose?

Answer 14

Standard = 1:200,000 = 5 mcg/mL
Maverick = 1:400,000 = 2.5 mcg/mL

Question 15

Can epinephrine be used on “fingers, nose, and toes”?

Answer 15

Yes

(Old info suggested not)

Question 16

What effect does dexamethasone have on regional blocks?

Answer 16

Decadron = ↑ block duration

Question 17

What dose of dexamethasone is used as an adjunct for regional blocks?

Answer 17

4 - 8 mg

Question 18

How does clonidine serve as an adjunct for local anesthetics?

Answer 18

Prolongation of block

Question 19

What is the primary purpose of local anesthetic adjuncts?

Answer 19

Prolongation of block

Question 20

____ and ____ of absorption are the primary determinants of the occurrence of local anesthetic toxicity.

Answer 20

rate and extent of absorption

Question 21

Rate the following from Highest absorption (and thus greatest risk of toxicity) to Lowest absorption.

• Femoral
• Sciatic
• Lumbar Plexus
• Intercostals
• Epidural
• Brachial Plexus
• Caudal

Answer 21

1. Intercostals (Highest)
2. Caudal
3. Epidural
4. Brachial Plexus
5. Sciatic
6. Lumbar Plexus
7. Femoral (Lowest)

Question 22

How would the typical symptoms present for CNS toxicity secondary to LA’s?
What is the progression typically?

Answer 22

Excitatory

Disorientation/incoherence → Tonic-clonic seizures → respiratory depression → arrest

Question 23

Increases in ____ and ___ typically precede the hypotension, arrhythmias, and cardiac arrest associated with local anesthetic toxicity.

Answer 23

↑ HR and BP

Question 24

Not having 20% lipid infusions readily accessible with the block cart is considered _________.

Answer 24

Negligent

Question 25

What is the recommended dose of clonidine as an adjunct for regional anesthetics?

Answer 25

1 mcg/kg

Question 26

In the event of local anesthetic-induced cardiac arrest that is unresponsive to standard therapy, what drug should be given?

Answer 26

IntraLipid 20% bolus and infusion.

Question 27

What bolus dose of Lipid Rescue is necessary for LAST?

Answer 27

Intralipid 20% 1.5mL/kg over 1 minute

Question 28

What infusion dose of Intralipid is necessary after the bolus dose has infused?

Answer 28

0.25mL/kg/min 20% Intralipid

Question 29

What maximum dose of Intralipid is recommended?

Answer 29

8mL/kg