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12 Cards in this Set

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  • Back
what are the two classes of local anesthetics?
amides
esters
to which class of local anesthetics can patients have a true allergy?
esters (d/t byproduct of metabolic degradation)
what is the most important factor in duration of local anesthetics?
protein binding
what is the relationship between pKa and onset of action?
lower pKa means faster onset of action
max dose of epi (when added to LA)
10 mcg/kg peds
200-250 mcgs adults
what can you add to LA to speed onset of blockade?
NaHCO3 (increases pH, which lowers pKA --> faster onset of action)
rank the following fibers from first to last onset of blockade:
A alpha
A beta
A delta
A gamma
B fibers
C fibers
1. B fibers
2. C fibers
3. A-delta

then:
4. A-alpha
5. A-beta
6. A-gamma
rank blood flow of tissue (with respect to possible toxicity -- higher blood flow associated with greater risk of toxicity)
TICPEBSS
Tracheal
Intercostal
Caudal
Paracervical
Epidural
Brachial plexus
Subarachnoid, sciatic, femoral
Subcutaneous
one of the earliest signs of toxicity of LA
1. circumoral/tongue numbness
(lightheadedness, tinnitus would be next, followed by visual disturbance)
one of the latest signs of LA toxicity
CV collapse (only cure is bypass until drug metabolized)
Another symptom of LA toxicity?
methemoglobinemia (from prilocaine doses >500mg)

benzocaine, cetacaine, EMLA also

rarely with NTG, SNP, sulfonamides
Treatment of methemoglobinemia
methylene blue 1.5mg/kg