Barry - Local Anesthetics and Regionals
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| show | (-) charges on interior of cell, (+) charges on the extracellular surface
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| What makes the cell polarized? | show 🗑
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| What propagates the nerve impulse along an axon? | show 🗑
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| What follows the nerve impules? | show 🗑
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| show | It opens the Na channels and massive amounts of Na ions enter the cell - as the interior of the cell becomes more (+) action potential develops.
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| When is the cell membrane refractory? | show 🗑
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| show | Block Na channels by binding directly to intracellular voltage dependent Na channels - cell cannot depolarize due to blocking Na influx.
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| ***Does blocking the Na channels alter the membrane potential? | show 🗑
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| What are the 3 states of the membrane? | show 🗑
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| show | In the activated and inactive states. So LA activity is both voltage and time dependent
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| 4 things that affect sensitivity to blockade: | show 🗑
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| Chemistry of LA: | show 🗑
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| show | Either an ester or amide linkage.
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| LA are ***ALL weak bases: | show 🗑
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| Ester metabolism: | show 🗑
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| show | Intrathecal injections rely on their absorption into the blood stream for metabolism - most often Tetracaine
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| Amide metabolism: | show 🗑
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| What is Methemoglobinemia? | show 🗑
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| What causes Methemoglobinemia? | show 🗑
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| How do you treat methemoglobinemia? | show 🗑
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| Lipid solubility correlates with... | show 🗑
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| Protein binding correlates with... | show 🗑
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| show | Onset of action
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| Define pKa: | show 🗑
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| show | Unionized. The closer the pKa is to physiological pH the higher the concentration of nonionized that will cross the cell membrane.
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| pKa of LA: | show 🗑
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| show | All LA are weak bases so they are more unionized in a basic environment, meaning they will work better. Infected areas are acidic so LA will not work as well due to more of the drug being in the ionized state.
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| List Ester locals: | show 🗑
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| show | Lidocaine (xylocaine), Mepivicaine (carbocaine), Ropivicaine, Bupivicaine (marcaine), Etidocaine (duranest 1%) - they all have 2 I's in their name but know both names.
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| Novocaine/procaine dose: | show 🗑
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| show | Max: 12mg/kg Max with EPI: 14mg/kg DOA: 30-60m DOA with EPI: 30-90m
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| Pontocaine/tetracaine dose: | show 🗑
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| show | Max: 3mg/kg DOA: 30-60m
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| Lidocaine/xylocaine dose: | show 🗑
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| show | Max: 4mg/kg Max with EPI: 7mg/kg DOA: 45-90m DOA with EPI: 120-360m
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| Ropivicaine dose: | show 🗑
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| show | Max: 2.5mg/kg Max with EPI: 3.2mg/kg DOA: 120-240m DOA with EPI: 180-420m
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| show | Max: 6mg/kg Max with Epi: 8mg/kg DOA: 120-180m DOA with EPI: 180-420m
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| Why is max dose with EPI higher? | show 🗑
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| show | IV regional anesthetic on upper or lower extremity.
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| show | 2 IV's - one in hand of surgical arm, monitors, o2, and sedation. Esmarch to wrap arm from fingers to tourniquet.
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| show | Pt. may get pain at site of tourniquet so the lower portion can be inflated and the upper portion deflated.
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| show | Always inflate upper portion prior to surgery. Use 250mmHg for upper ext. and 300-350mmHg for lower extremity - may need higher pressure for HTN
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| Cuff time: | show 🗑
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| show | Lidocaine 0.5% without EPI, 40-50cc = 200-250mg then remove IV.
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| Bier Block complications: | show 🗑
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| show | Circumoral and tongue numbness, lightheadedness, tinnnitus, visual disturbances, muscle twitching, unconciousness, convultions, coma, respiratory arrest, CV collapse.
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| show | O2 to raise the seizure threshold, ETT, hyperventilate (to decrease CO2 and decrease blood flow to brain), benzos, barbs, support CV collapse.
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| show | Bupivicaine due to long 1/2 life, blocks cardiac Na channels and dissociates very slowly.
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| show | Digits, ankles, brachial plexus, lower extremities, penile.
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| show | NO - it can cause necrosis.
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| List structures you will go through with Epidurals: | show 🗑
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| show | Put drop of fluid in hub of needle and insert slowly and when fluid gets sucked in you are in epidural space.
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| show | Use a touhy syringe with a few cc's air or preservative free saline. Slowly advance and tap on plunger in increments until there is a loss of resistance in epidural space.
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| show | 3-7cm
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| show | 3cc's of 1.5% lidocaine with EPI 1/200K = Lido 45mg and EPI 15mcg.
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| show | To make sure you are not in the subarachnoid space or intravascular space.
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| What are ss if in IV space with test dose? | show 🗑
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| show | Pt will exhibit ss of spinal - they will have a block.
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| show | No - always pull back 1st and then give test dose.
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| show | 1-2cc per dermatome.
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| Where is the epidural placed? | show 🗑
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| Drugs used for epidurals: | show 🗑
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| show | Entering epidural space thru the sacral hiatus in kids. Penetrates sacrococcygeal ligament - between sacral cornua above the coccyx.
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| What drugs are used for Caudals? | show 🗑
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| show | 33 total - 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 4 coccygeal.
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| What types of needles are used for spinals? | show 🗑
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| List the spinal medications: | show 🗑
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| Spinal med baracity: | show 🗑
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| show | At superior iliac crest.
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| show | Nipples.
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| T6: | show 🗑
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| show | Umbilicus.
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| show | Pt. refusal, uncorrected coagulopathies, Severe aortic stenosis (will drop afterload), Hypovolemic shock, Increased ICP, Infection at site.
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| show | Sepsis, pt. uncooperative, pre-existing neuro deficits, severe spinal deformity, stenotic valve lesions.
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| Controversial contraindications: | show 🗑
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| What are the CV effects of spinals and epidurals? | show 🗑
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| What are the pulmonary effects of spinals and epidurals? | show 🗑
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| show | STPTPMVP Sympathetic, temp., pain, touch, pressure, motor, vibration, proprioception.
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| What is the dermatome blockade? | show 🗑
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| show | Hypotension, N&V (treat hypotension), PDPH (post dura puncture headache or wet tap)
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| How do you treat PDPH? | show 🗑
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| What are the s/s of PDPH? | show 🗑
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| How do you prevent PDPH? | show 🗑
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| What is a high spinal? | show 🗑
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| show | T1-4
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Created by:
Renetta
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