Exam 4: LA complications Flashcards
(24 cards)
What is the treatment for lidocaine tox?
list bolus and drip
1.5ml/kg bolus of 20% lipid emulsion
0.25ml/kg/minute for 10 minutes
1st 30 min 10ml/kg
How does lipid emulsion work?
Makes a space for the lidocaine to diffuse into and out of the myocardium
what if you still have cardiovascular collapse after the bolus and starting the drip?
you may redose the bolus
What is the max rate for lipid emulsion?
8ml/kg
Transient Neurologic Symptoms (TNS) is Moderate to severe pain (lower back, buttocks & posterior thighs) within__ to ___hours after uneventful single-shot SAB
6; 36
what is the most common LA that causes TNS?
lidocaine
What medication will you give to help TNS?
NSAIDS and trigger point injections
usually will recover in 1-7 days
What is Cauda Equina Syndrome?
What causes it?
Cauda Equina Syndrome (CES) is caused by compression of the cauda equina nerves — the bundle of spinal nerves at the lower end of the spinal cord (usually around L2-S5).
Causes (?)
- Spinal anesthesia, high concentration, compression or ischemia of cauda equina
What symptoms can you expect to have with CES?
Diffuse injury @ lumbosacral plexus
- urinary retention.
- bowel & bladder sphincter dysfunction
- weakness or paraplegia
What are causes of anterior spinal artery syndrome (APAS)
Causes (?):
effects of HToN or vasoconstrictors drugs; PVD, spinal cord compression d/t epidural abscess or hematoma
thrombosis or vasospasm of the bilateral anterior spinal arteryS
what are the SX of ASAS?
Lower extremity flaccid paresis with a variable sensory deficit
xpain/xtemperature
√proprioception
What are the drugs that cause Methemoglobinemia?
Anesthetic drugs + others
Prilocaine
Benzocaine
>
Lidocaine
nitro
sulfonamides
phenytoin
Methemoglobinemia treatment
1-2mg/kg over 5 minutes
max 7-8mg/kg
Reversal from metHgb (Fe3+) to Hgb (Fe2+) is within __ to__ minutes
20-60
Which drug depresses the ventilatory response to arterial hypoxemia?
lidocaine
susceptible populations are CO2 retainers
Hepatotoxicity is Caused by continuous or intermittent epidural _______ to treat postherpetic neuralgia.
What drug??
bupivacaine
liver enzymes will normalized after you stop the infusion
What is the MOA in cocaine toxicity?
SNS stimulation by blocking presynaptic uptake of NE and dopamine increased NE & dopamine postsynaptic levels
What is the treatment of cocaine tox?
Treatment: benzodiazepines, nitroglycerin, avoid beta-blockers
What preservative is in both esters and amides and it is similar to PABA?
Methylparaben
Can also cause allergic reactions
Your patient is having an allergic reaction to the local anesthetic. What do you do?
Management
Stop administration
Supportive Care (Airway, O2, fluids
Epinephrine, vasopressin (titratable) Antihistamine, Corticosteroid
Allergy testing: Skin test with preservative-free LA
The magnitude of the systemic absorption in LAST is dependent on what factors?
Dose
Vascularity of site
Epinephrine use at 5 mcg/ml decreases systemic absorption
Physicochemical properties
Ionized v non
Monitor plasma levels of lidocaine epidural > ____ mgs.
900
Hyper______ promotes seizures /c LAs.
Hyperkalemia promotes seizures /c LAs.
What are predisposing factors to LAST?
Predisposing factors:
Pregnancy
Hepatic and renal disease
Arterial hypoxemia, acidosis, or hypercarbia (in animals)
Beta blockers, Digitalis preparations, Ca+ Channel Blockers
Epinephrine & Phenylephrine Use
Bupivacaine > Ropivacaine > Lidocaine
