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Clinicals > Pharm Review - Regional & CSE Labor Analgesia > Flashcards

Pharm Review - Regional & CSE Labor Analgesia Flashcards

1
Q

What are the 3 most common LAs we will use for regional blocks?

A
  1. Lidocaine
  2. Bupivacaine
  3. Ropivacaine
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2
Q

Which LA has a faster onset but shorter DOA?

A

Lidocaine

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3
Q

Which LAs (2) have a slower onset but longer DOA?

A

Ropivavaine & Bupivacaine

Cardiac Toxicity Risk ↑

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4
Q

What is the main determinant of DOA for LAs?

A
  • protein binding % of the LA
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5
Q

What is the main determinant of potency for LAs?

A
  • lipid solubility of the LAs
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6
Q

What 6 medications can we give to prolong DOA of LAs?

A
  1. Epinephrine
  2. Dexmedetomidine
  3. Magnesium
  4. Clonidine
  5. Ketamine
  6. Decadron
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7
Q

What 2 things can we do to increase the onset of LAs?

A
  1. Add HCO3 - not common
  2. combine a short acting and long acting LA
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8
Q

Lidocaine Max (mg/kg)
w/o Epi:
w/ Epi:

A
  • w/o: 5mg/kg
  • w/: 7mg/kg
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9
Q

Prilocaine Max Dose (mg/kg)
w/o Epi:
w/ Epi:

A
  • w/o: 6mg/kg
  • w/: 8.5mg/kg
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10
Q

Mepivacaine Max Dose (mg/kg)
w/o Epi:
w/ Epi:

A
  • w/o: 5mg/kg
  • w/: 7mg/kg
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11
Q

Bupivacaine Max Dose (mg/kg)
w/o Epi:
w/ Epi:

A
  • w/o: 2.5mg/kg
  • w/: 2.5mg/kg
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12
Q

Ropivacaine Max Dose (mg/kg)
w/o Epi:
w/ Epi:

A
  • w/o: 3mg/kg
  • w/: 4mg/kg
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13
Q

Procaine Max Dose (mg/kg)
w/o Epi:
w/ Epi:

A
  • w/o: 7mg/kg
  • w/: 8.5mg/kg
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14
Q

Chloroprocaine Max Dose (mg/kg)
w/o Epi:
w/ Epi:

A
  • w/o: 6mg/kg
  • w/: 14mg/kg
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15
Q

Tetracaine Max Dose (mg/kg)
w/o Epi:
w/ Epi:

A
  • w/o: 3mg/kg
  • w/: 3mg/kg
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16
Q

CSE Labor Analgesia

Bupivacaine Dosing
Epidural:
Spinal:

A

E: 0.0625 - 0.125%
S: 1.25 - 2.5 mg

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17
Q

CSE Labor Analgesia

Ropivacaine Dosing
Epidural:
Spinal:

A
  • E: 0.08 - 0.2%
  • S: 2.5 - 4.5mg
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18
Q

CSE Labor Analgesia

Lidocaine w/ Epi Dosing
Epidural:
Spinal:

A
  • E: 2% in 5mL bolus
  • S: none
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19
Q

CSE Labor Analgesia

Fentanyl Dosing
Epidural:
Spinal:

A
  • E: 50-100mcg
  • S: 10-25mcg
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20
Q

CSE Labor Analgesia

Sufentanil Dosing
Epidural:
Spinal:

A
  • E: 5 - 10mcg
  • S: 1.5 - 5mcg
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21
Q

CSE Labor Analgesia

Morphine Dosing
Epidural:
Spinal:

A
  • E: none
  • S: 0.1 - 0.2 mg
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22
Q

What 5 LAs are amides?

A

2 Is
1. Lidocaine
2. Prilocaine
3. Mepivacaine
4. Bupivacaine
5. Ropivacaine

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23
Q

What 3 LAs are Esters?

A
  1. Procaine
  2. Chloroprocaine
  3. Tetracaine
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24
Q

Lidocaine dosing
IV bolus:
IV gtt:

A
  • IV bolus: 1-2mg/kg IV over 2-4min
  • IV gtt: 1-2mg/kg/hr
    stop in 12-72hrs
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25
Q

Lidocaine Concentration → Effect

1-5mcg/mL =

A

Analgesia

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26
Q

Lidocaine Concentration → Effect

5-10mcg/mL =

A
  1. circum-oral numbness
  2. tinnitus
  3. skeletal muscle twitching
  4. HoTN
  5. myocardial depression
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27
Q

Lidocaine concentration → Effect

10-15mcg/mL =

A
  • seizures
  • unconsciousness
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28
Q

Lidocaine Concentration → Effect

15-25mcg/mL =

A
  • Apnea
  • Coma
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29
Q

Lidocaine Concentration → Effect

> 25mcg/mL

A
  • CV depression
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30
Q

How many nodes of Ranvier need to be blocked?

A
  • 3 nodes = 1cm
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31
Q

How are amide LAs metabolized?

A
  • CYP enzymes - Hepatic
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32
Q

How are ester LAs metabolized?

A
  • Hydrolysis - plasma cholinesterase enzymes
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33
Q

What ester LA is the one that IS metabolized in the liver?

A

Cocaine

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34
Q

Do Esters or Amides cause allergic reaction?

A

Ester

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35
Q

Which class of LAs is more likely to cross the placenta?

A

Amides
* non-ionized crosses
* Cautious w/ ion trapping

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36
Q

The metabolites of which LAs can lead to methemoglobinemia?

A

Lidocaine, Benzocaine, Prilocaine

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37
Q

Methylene blue dose to tx methemoglobinemia:

A
  • 1-2mg/kg
  • max: 7-8 mg/kg
38
Q

T/F: We can give pregnant women Mepivacaine

A

False: long E 1/2 time in fetus

39
Q

What LA is used to test plasma cholinesterase activity?

A
  • Dibucaine
  • MOA: inhibits activity of normal butyrylcholinesterase
40
Q

If a Dibucaine level is low, what drug should we avoid giving?

A
  • Succinylcholine - they won’t metabolize it
41
Q

Epi Concentration

1:200,000

A
  • 1,000,000/200,000 = 5mcg/mL
42
Q

Epi Concentration

1:500,000

A
  • 1,000,000/500,000 = 2mcg/mL
43
Q

Epi Concentration

1:10,000

A
  • 1,000,000/10,000 = 100mcg/mL
44
Q

Epi Concentration

1:1,000

A
  • 1,000,000/1,000 = 1,000mcg/mL
45
Q

LA Strengths

0.25% =

A

2.5mg/mL

46
Q

LA Strengths

0.5% =

A
  • 5mg/mL
47
Q

LA Strengths

1% =

A
  • 10mg/mL
48
Q

LA Strengths

2% =

A
  • 20mg/mL
49
Q

LA Strengths

4% =

A
  • 40mg/mL
50
Q

What does LTA stand for?

A

Lidocaine Transtracheal Anesthesia

51
Q

What is the Lidocaine dose for Tumescent Liposuction?

A
  • Lido w/ Epi: 35-55 mg/kg
  • diluted Lido: 0.05% - 0.10%
  • Epi: 1:100,000
52
Q

What are 5 absolute contraindications to Neuraxial?

A
  1. Coagulopathy
  2. Pt refusal
  3. site infection
  4. Infection
  5. severe valvular heart dz
53
Q

Is a spinal or epidural volume dependent?

A
  • Epidural

Spinal is dose-dependent

54
Q

Where does the spinal cord end?
Adult:
Pedi:

A
  • A: L1
  • P: L3
55
Q

Desired dermatome level for peri-anal/anal surgery (saddle block):

A
  • S2-S5
56
Q

Desired dermatome level for foot/ankle surgery:

A

L2

57
Q

Desired dermatome level for Thigh/lower leg/knee surgery:

A

L1

58
Q

Desired dermatome level for vaginal delivery, uterine, hip procedure, tourniquet pain, and TURP

A
  • T10
59
Q

Desired dermatome level for scrotum surgery:

A

S3

60
Q

Desired dermatome level for penile surgery:

A
  • S2
61
Q

Desired dermatome level for testicular procedures:

A
  • T8
62
Q

Desired dermatome level for Urologic, gynecologic, & lower abdominal procedures:

A
  • T6
63
Q

Desired dermatome level for C-section & upper abdominal surgery:

A
  • T4
64
Q

At what level does a “sympathectomy” occur?

A

T1-T4

65
Q

What 2 medications should we always have ready when doing a spinal/epidural?

A
  1. Ephedrine (HR low)
  2. Neosynephrine (HR high)
66
Q

What is a co-loading dose of fluids?

A
  • 15mL/kg during the procedure
  • NS/isotonic solution
67
Q

These medications/fluids can be used to Tx spinal anesthetic HoTN

A
  1. Vasopressors
  2. Anticholinergics (Atropine)
  3. Crystalloids - Colloids
68
Q

Organize the different regional anesthetic techniques that result in highest blood concentrations → lowest concentration

A

Highest → Lowest
1. Intravenous
2. Tracheal
3. Intercostal
4. Caudal
5. Paracervical
6. Epidural
7. Brachial
8. Sciatic
9. Subcutaneous

69
Q

isobaric density:

A
  • density equal to CSF - stays in place
70
Q

hyperbaric density:

A
  • density > CSF - sinks in the CSF
71
Q

hypobaric density:

A
  • density < CSF - rises in the CSF
72
Q

Bupivacaine 0.5%-0.75%
T10 dose:
T4 dose:

A
  • T10: 10-15mg
  • T4: 12-20mg
73
Q

Ropivacaine 0.5-1%
T10 dose:
T4 dose:

A
  • T10: 12-18mg
  • T4: 18-25mg
74
Q

What is the initial volume for epidural dosing?

A

1-2mL/segment

75
Q

What is the top-up vol. dosing for epidural?

A
  • 50-75% of initial dose

↓ by 2 dermatome levels

76
Q

LA Onset & Duration: fastest → slowest & shortest → longest

A

Onset fastest → slowest & DOA shortest → longest:
1. 2-Chloroprocaine
2. Lidocaine
3. Ropivacaine
4. Bupivacaine
5. Levobupivacaine

77
Q

Opioid Epidural Infusion Dosing

Sufentanil

A

10-20mcg/hr

78
Q

Opioid Epidural Infusion Dosing

Fentanyl

A

25-100mcg/hr

79
Q

Opioid Epidural Infusion Dosing

Hydromorphone

A

0.1-0.2 mg/hr

80
Q

Opioid Epidural Infusion Dosing

Meperidine (Demerol)

A
  • 10-60 mg/hr
81
Q

Opioid Epidural Infusion Dosing

Morphine

A
  • 0.1-1 mg/hr
82
Q

Dexmedetomidine dosing for spinal/epidural:

A

3 mcg

83
Q

Clonidine dosing for epidural/spinal:

A

15-45mcg

84
Q

Epinephrine dosing w/ LA:

A
  • 0.2-0.3mg “epi wash”
85
Q

Phenylephrine dosing w/ LA:

A

2-5mg

86
Q

T/F: Neuraxial is contraindicated in pts on thrombolytic therapy

A

True!

87
Q

What is the most cardiotoxic LA?

A
  • Bupivacaine
88
Q

LAST management:

A
  1. airway mgmt
  2. bzd for seizures
  3. modified ACLS (cautious w/ epi)
  4. Lipid emulsion 20%
89
Q

What is the epidural test dose?

A

3mL of 1.5% Lidocaine w/ 1:200,000 Epi

90
Q

Recommended “Top Up” time for Lidocaine:

A

60min

91
Q

Top up time for Bupivacaine & Ropivacaine

A

120min

Clinicals (7 decks)

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