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37 Cards in this Set
- Front
- Back
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2-cholroprocaine is also called
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Nesacaine
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2-chloroprocaine pKa, max dose, %
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pKa 8.7, max 11(14), 3%
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2-chloroprocaine is used for_____ because
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Used for OB: can use high concentration which gets you fast onset, and also very short DOA. Low systemic toxicity
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How is protein binding related to local anesthetics? Which kinds?
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The more protein bound a local anesthetic is, the longer the DOA. Only applies to amides (esters metabolized too quickly)
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Closer the pH of the body and pKa of a LA are, the faster the ______
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Onset
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Metabolism of esters vs amides
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Esters metabolized by plasma cholinesterase
Amides metabolized by liver (so longer DOA) |
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Tetracaine is also called
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Pontocaine
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Tetracaine pKa, max, %
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pKa 8.5 max 1, 1%
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What is tetracaine used for?
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Hypobaric solution....used in perineal cases
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Lidocaine pKa, max, %protein binding
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pKa 7.9 max 4(7) 60% protein bound
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Stages of LA toxicity
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CNS excitation, CV excitation, CNS depression, CV depression, death
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What has longest DOA of all spinal agents? Shortest?
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Tetracaine is longest, 2-chloroprocaine is shortest
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Bupivicaine is also called
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Sensorcaine, marcaine
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Bupivicaine pKa, max dose, %protein binding
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pKa 8.1 max 2.5(3), 95% protein bound
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What can bupivicaine toxicity cause?
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Refractory cardiac arrest
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Ropivicaine is also called
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Naropin
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Ropivicaine pKa, max dose, %protein binding
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pKa 8.1 max 3(3.5), 95% protein bound
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Ropivicaine interesting facts (2)
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Causes mild vasoconstriction, causes less motor block with equipotent sensory block than bupivicaine
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Prilocaine pKa max %protein binding
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pKa 7.9 max 7(8.5) 55% protein bound
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Prilocaine side effect, from what metabolite?
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Methemoglobinemia, from orthotoluene
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Treatment of methemoglobinemia
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Methylene blue 1-2 mg/kg iv
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Intralipid dose & max dose
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1-3ml/kg followed by 0.25 ml/kg/min drip continued until CV sx have been gone for 10 min.
Max 10ml/kg over 30 min |
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Ways to raise the seizure threshold
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Oxygen and hypocarbia (decrease CBF so less LA to brain).
Also barbs and benzos |
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Potency of a LA correlates with _____
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Lipid solubility
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3top side effects of neuraxial anesthesia
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1. Puritis
2. N/V 3. Resp depression |
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Optimal spinal morphine dose in adults and elderly.
How long does it last? |
0.2 mg adult, 0.1mg elderly
Lasts 16 hours (8 hours) |
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Dose of morphine to add to a spinal. How long will pain relief last?
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0.2mg, 20 hours
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Dose of fentanyl to add to a spinal. What does adding fentanyl do to the block?
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15 mcg, get quicker onset and longer duration of sensory and motor blockade
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Adding sufentanil to spinal: dose, side effects
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1.5-15 mcg, >7.5 mcg has increased SE profile
Higher SE profile than fentanyl: transient fetal bradycardia and loss of variability even with small doses |
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How long do epidural opioids last?
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12-24 hours
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Dose of epidural morphine, DOA
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1.5-5 mg, 3 is optimal. Lasts 16 hours
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Dose for epidural fentanyl
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50 mcg
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Side effect of adding alpha 2 agonists to intrathecal or epidural
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Bradycardia, especially with clonidine
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Dose for intrathecal and epidural clonidine
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Intrathecal 12-30 mg
Epidural 75-150 mg |
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Dose for intrathecal dexmedetomidine
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3 mcg
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What does adding alpha 2 agonists achieve?
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Longer DOA, less need for postop opioids
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Dose of fentanyl to add to peripheral nerve blocks. What does this do?
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2.5 mcg/cc of LA (about 50mcg usually).
Doubles the DOA of the block |
