TxWes Guide NMBs/LA/LAST

Question 1

Muscle Relaxants

Dose, Onset, Duration:
Succinylcholine

Anectine

Answer 1

Anectine
1-1.5 mg/kg
Onset 30-60sec ⏐Durations 5-10min

Question 2

Muscle Relaxants

Dose, Onset, Duration:
Cisatricurium

Nimbex

Answer 2

Nimbex
0.1 mg/kg
Onset 2-3min ⏐ Duration 40-75min

Hoffman Elimination

Question 3

Muscle Relaxants

Dose, Onset, Duration:
Vecuronium

Norcuron

Answer 3

Norcuron
0.1 mg/kg
Onset 2-3min⏐ 45-90min

Question 4

Muscle Relaxants

Dose (1st & 2nd), Onset, Duration:
Rocuronium

Zemuron

Answer 4

Zemuron
0.6 mg/kg Onset 2-3mins
1.2 mg/kg Onset 1.5 mins
Duration 35-75mins

Question 5

Muscle Relaxants

Dose, Onset, Duration:
Pancuronium

Pavulon

Answer 5

Pavulon
0.1 mg/kg
Onset 2-3min ⏐Duration 60-120min

Question 6

Muscle Relaxants Reversals

Dose, Onset, Duration, Anticholinergic buddy:
Neostigmine

Answer 6

0.04-0.07 mg/kg
Onset 5-10min ⏐ Duration 60min

Glycopyrrolate 0.2mg/ml of Neo to avoid bradycardia

Question 7

Muscle Relaxants Reversals

Dose, Onset, Duration:
Sugammadex

Answer 7

2-16 mg/kg (depends on TOF & PTP)
Onset 1 - 4min ⏐ Duration 1.5 - 3hrs

Question 8

REGIONAL MEDS

Amide/Ester?
Regional MAX dose (mg/kg) w/ & w/o EPI?
Lidocaine

Answer 8

Amide

Max
w/o Epi: 5 mg/kg
w/ Epi: 7 mg/kg

Question 9

REGIONAL MEDS

Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Prilocaine

Answer 9

Amide

Max
w/o Epi: 6 mg/kg
w/ Epi: 8.5 mg/kg

Question 10

REGIONAL MEDS

Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Mepivicaine

Answer 10

Amide.

Max
w/o Epi: 5 mg/kg
w/ Epi: 7 mg/kg

Question 11

REGIONAL MEDS

Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Bupivicaine

Answer 11

Amide.

Max
w/o Epi: 2.5 mg/kg
w/ Epi: 2.5 mg/kg

EPI DONT MAKE NO DIFFERENCE! 😅

Question 12

REGIONAL MEDS

Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Ropivicaine

Answer 12

Amide.

Max
w/o Epi: 3 mg/kg
w/ Epi: 4 mg/kg

Question 13

REGIONAL MEDS

Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Procaine

Answer 13

Ester.

Max
w/o Epi: 7 mg/kg
w/ Epi: 8.5 mg/kg

Question 14

REGIONAL MEDS

Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Chloroprocaine

Answer 14

Ester.

Max
w/o Epi: 6 mg/kg
w/ Epi: 14 mg/kg

Question 15

REGIONAL MEDS

Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Tetracaine

Answer 15

Ester.

Max
w/o Epi: 3 mg/kg
w/ Epi: 3 mg/kg

EPI MAKES NO DIFFERENCE 😅

Question 16

CSE LABOR ANALGESIA

Epidural (%) & Spinal (mg) doses?
Bupivicaine

Answer 16

Epidural: 0.0625-0.125%
Spinal: 5-15 mg

Question 17

CSE LABOR ANALGESIA

Epidural (%) & Spinal (mg) doses?
Ropivicaine

Answer 17

Epidural: 0.08 - 0.2%
Spinal: 2.5 - 4.5 mL

Question 18

CSE LABOR ANALGESIA

Epidural (%) & Spinal (mL) doses?
Lidocaine + Epi

Answer 18

Epidural: 2% in 5cc bolus
Spinal: N/A

No spinal dose.

Question 19

CSE LABOR ANALGESIA

Epidural & Spinal doses? (mcg)
Fentanyl

Answer 19

Epidural: 50-100 mcg
Spinal: 10-25 mcg

Question 20

CSE LABOR ANALGESIA

Epidural & Spinal doses? (mcg)
Sufentanil

Answer 20

Epidural: 5 - 10 mcg
Spinal: 1.5 - 5 mcg

Question 21

CSE LABOR ANALGESIA

Epidural (%) & Spinal (mg) doses?
Morphine

Answer 21

NO epidural dose.
Spinal: 0.1 - 0.2 mg

Question 22

List some symptoms of LAST.

Local Anesthetic Systemic Toxicity

Answer 22

• Analgesia, lightheadedness
• tinnitis
• tongue/circumoral numbness
• tingling of mouth, funny/metallic taste
• SZ, LOC
• respiratory arrest, cardiovascular arrest.

Question 23

Explain the lipid rescue for LAST.

Answer 23

In addition to CPR -

• BOLUS 20% intralipids 1.5mL/kg over 1min
• ⇒ Infusion 0.25mL/kg/min
• Circulate lipids w/ CPR
• Repeat bolus q3-5 mins UP TO 3ml/kg total dose until ROSC.
• ⬆ infusion to 0.5mL/kg/min if BP declines - continue infusion until hemodynamically stable.

MAX DOSE: 8ml/kg

If you dont have 20% lipids immediately handy - give what you have until you obtain the 20%.