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41 Cards in this Set
- Front
- Back
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Put cocaine in his eyeball
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Koller
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Put cocaine directly on the nerve to put it to sleep
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Halsted and Hall
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Gave first spinal anesthetics to his dog
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Corning
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Credited with the first intrathecal use of local anesthetic
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Bier
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What is the order of nerve blockade
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B>C>A
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What areas will be blocked first with a nerve block
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proximal blocks first
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If you know the CM for sensory fibers, how do you dose for motor?
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2 X CM
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Which nerve fiber is easiest to block
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B
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Which fibers are more susceptible to tonic block
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A
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Which fibers are more susceptible to use dependent block
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C
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How does LA charge affect onset
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nonionized = faster onset
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Most potent isomer of LA
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R isomer
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What is the order of systemic absorption
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IV>intrathecal>intercostal>caudal>epidural>brachial> femoral>SQ
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2 LA that don't vasodilate
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cocaine
ropivicaine |
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How does epi affect onset of LA
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it doesn't it affects duration
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How does epi affect LA analgesia
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prolongs LA
A-2 agonist |
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How much epi is added to LA
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5-10 mcg/ml
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What does adding bicarb do to LA
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increases onset and intensity of block
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When are you going to mix opiates with your LA
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intrathecal
spinal epidural joints peripheral |
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Which LA can't be mixed with anything
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Chloroprocaine
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What does local anesthetic absorption relate to
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offset
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Max epi dose for an adult
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7.5 mcg/kg
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Max epi dose for a child
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10 mcg/kg
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LA drug class that has a lower incidence of toxicity d/t metabolism in plasma
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esters
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Can cause an anesthetic to get trapped in a body cavity
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ion trapping
ie acidosis |
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What is the order of systemic toxicity with LA
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Analgesia + lightheadedness
Tinnitus Tongue, mouth numbness or weird taste Seizures Unconsciousness Respiratory arrest CV arrest |
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What are 3 factors that increase the likelihood of CNS toxicity
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acidosis
hypercarbia hyperkalemia |
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How can you decrease the incidence of LA toxicity pharmacologically
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barbiturates
BZD epinephrine |
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At what site do you see the highest incidence of CNS toxicity with LA
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peripheral
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What are drug and metabolic conditions that can increase the risk for developing LA toxicity
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B-blockers, digoxin, Ca channel block
hypoxia hypercarbia acidosis |
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Rescue drug in OB
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chloroprocaine
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What are the LA esters
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cocaine
procaine chloroprocaine tetracaine benzocaine |
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What are the LA amides
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lidocaine
prilocaine mepivicaine ropivicaine bupivicaine |
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How is LA potency r/t toxicity
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usually more potent is less toxic because of less diffusion
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Where are LA amides metabolized
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liver
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Where are LA esters metabolized
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plasma esterase
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How do you treat LA toxcity
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do not allow pt to become hypoxic/hypercarbic
treat with Benzos and barbiturates give sch to stop muscle contraction |
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Why are LA cardiotoxic
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they slow phase 4
Block Na channels myocardial depressants |
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How do you treat htn seen with cocaine overdose?
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VA
NOT BB |
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Short acting ester
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chloroprocaine
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Long acting ester
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tetracaine
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