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35 Cards in this Set
- Front
- Back
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Local anesthesia can be used in what procedures
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repair lacerations
skin surgery treatment of painful oral or genital lesions removal of superficial lesions |
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local anesthesia blocks nerve impulses by
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selectively binding volatage gated Na channels
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two parts of an anesthetic and what they do
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hydrophylic - allows to be injectedin solution. Binds to sodium channels
hydrophobic - enter the neuronal membrane |
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Nerve impulses are lost in what order
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temp, pain, touch, deep pressure, motor
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Variables that effect quality of local anesthesia
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Rate of conduction
Presence of myelin Nerve fiber diameter Vascularity of the location |
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Ester anasthetics
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benzocaine, cocaine, procaine, and tetracaine
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Amide anesthetics
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lidocaine, mepivacaine, bupivacaine, dibucaine, and prilocaine
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Epinephrine is more effective with which anesthetics
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less lipid soluble
ie: lidocaine and mepivacaine |
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why do anesthetics hurt when they are injected and how can this be avoided?
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the solutions are acidic but equilibrate to body pH on injection. Pain can be avoided by buffering the solution with sodium bicarb, however, this reduces the shelf life
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technique for painless injection
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inject at level of dermis and subQ fat
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which type of anesthetic is metabolized fastest
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ester
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Bupivicaine causes side effects in pt's with what and why
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severe liver disease
it is highly bound to plasma protiens made in the liver |
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Cocaine containing products should be avoided in:
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infants and neonates
fingers, nose, penis, toes, pinna of the ear |
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Non cocaine containing have a few contraindications in:
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premature infants
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Contraindications for use of local anesthesia
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severly unstable blood pressure
true allergy severe liver disease and amides severe renal disease and esters |
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Absolute Contraindications for epinephrine use
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untreated hyperthyroid or pheochromocytoma
body parts with single blood supply |
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relative contraindications for epinephrine
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untreated HTN
severe CAD or PVD Pregnancy Narrow angle glaucoma Pts using: beta blockers, phenothiazines, MAOIs, or tricyclic antidepressants |
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most common complication with local anesthesia (LA)
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anxiety over impending injection leading to vasovagal reaction
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Other local complications of LA
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Bruising
Edema Infection Nerve damage temporary motor n. paralysis |
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Systemic complications of LA
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Hypotension
Bradycardia CNS depression or stimulation |
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Systemic complications of epinephrine
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Cardiac dysrythmias
HTN Anxiety Cardiac arrest Cerebral hemorrhage Ischemia |
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True allergy is characterized by:
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skin rash
localized or general urticaria, angioedema anaphylaxis with hypotension |
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Pt prep
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Reassure
Pt supine and cannot see injection Conversation Inform Pt take deep slow breaths |
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Topical anesthesia can be used for
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Highly vascular like face and scalp
Wound closure if 5cm or less |
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Most commonly used injectable anesthesia
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Lidocaine
Mepivacine Bupivacaine Diphenhydramine if allergic *Onset of action lengthens L,M,B *Duration of action lengthens L,M, B |
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Procedure for topical
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Use EMLA or ELA-Max
Do not touch mucous membranes Remove blood clots from area Saturate gauze Fold into and around wound, tape in place Apply pressure 15-20 min (no more than 2 hrs)Wear gloves in order to avoid absorption. Anesthesia complete when blanching occurrs. Remove before start of procedure |
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Needle for injection of anesthesia
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27 or 30G
1/2 to 1 1/4 inch 1 to 3mL syringe |
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Direct wound infiltration for:
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minimally contaminated wounds
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How do you make sure the needle is not in a vessel
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Aspirate looking for blood
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Procedure direct infiltration of wound
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B/G injection on side where sensory inn. originates, and pocede distally
Insiert at dermis and sub Q fat Aspirate inject small amount reposition adjacent to but within injection area, aspirate, repeat until all edges are anesthetized |
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Procedure for intact skin
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Clean site
Pinch skin Initiate at dermis and subQ fat Repostition to epidermis and inject |
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Procedure for field block
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Use large bore long needle
Insert to hub parallel to dermis and subQ fat Aspirate Slow inject as needle withdrawn Reinsert at end of first track repeat until wall surrrounds area |
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Procedure digital block
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inject distal to web space in middle of digit
aspirate, inject 1mL into epidermis advance to bone withdraw slightly then move dorsal, aspirate, inject .5mL withdraw needle to midline, advance to bone, move ventral, inject .5-1mL Repeat on other side of digit |
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Digital lock recommended for
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nail avulsion, paronchyial drainage, repair of lacerations to the digit
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Follow up care and instruction LA
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notify office if:
unusual skin color, itching, pain or if sensation does not return after alotted time. |
