LA Complications and Rescue Flashcards
(54 cards)
Allergic Rxns with LAs and Recsues
* _____: <1%
* Attributed to manifestations of excess ____ levels
* Esters (PABA) ___ Amides
- Rare
- plasma
- >
Allergic Rxn can be caused by:
* ________: preservative in esters and amides
* similiar in structure to ______
* Use preservation ______ if you are concerned about allergic reactions.
- Methylparaben
- PABA
- free
Their is no cross-sensitivity between _____ and _____.
- esters
- amides
IgE anaphylaxis can cause rash, urticaria, and ______ edema with or without hypotension and __________.
* __________ test using preservative-free LA.
- laryngeal
- bronchospasm
- Intradermal
L.A.S.T acronym
- LA
- Systemic
- Toxicity
LAST: LA Systemic Toxicity:
* due to excess ____ concentration of the drug
* Entrance into the systemic circulation from _____ tissue redistribution and _______ metabolism.
* Accidental direct ___ injection.
- plasma
- inactive
- clearance
- IV
Other factors of LAST are:
* patient ________
* medications, location and ______ of block.
* LA used and ______.
- co-morbidities
- technique
- dose
Systemic Toxicity: Magnitude of systemic absorption depends on:
1. dose
2. _______ of site
3. _______________ use
4. Physicochemical _________
- Vascularity
- epinephrine
- properties
Systemic Toxicity CNS Effects:
* Drowsiness, _____ twitch prior to seizure
* Monitor _____ levels of ________ epidural > 900 mgs
* __________ promotes seizures w/ LAs
- facial
- plasma
- lidocaine
- Hyperkalemia
Plasma Lidocaine Concentration of 1-5 mcg/mL symptoms
- Analgesia
Plasma Lidocaine Concentration of 5 - 10 mcg/mL
- Circumoral numbness
- Tinnitus
- Skeletal Muscle Twitching
- Systemic HoTN
- Myocardial depression
Plasma Lidocaine Concentration of 10 -15 mcg/mL
- Seizures
- Unconsciousness
Plasma Lidocaine Concentration of 15 - 25 mcg/mL
- Apnea
- Coma
Plasma Lidocaine Concentration of > 25 mcg/mL
- Cardiovascular Depression
Systemic Toxicity: Cardiovascular System Effects
* Lidocaine @ __ mcg/mL with _____ numbness but NO CV
* High concentrations = block cardiac ___ channels.
* Accidental ___ Bupivacaine
- 5
- circumoral
- sodium
- IV
High Plasma Levels of LA:
* Block Cardiac ____ Channels
* ______ conduction of cardiac impulses causing prolonged _____ interval and _____ widening.
- Sodium
- Slow
- PR
- QRS
Accidental IV Bupivacaine causes:
* Precipitous _______, AV Block.
* Cardiac Dysrhythmias: SVTs, ST - ___ wave changes, PVC, ______ of QRS, and V-tach.
- Hypotension
- T wave
- widening
Toxicity Cardiovascular Effect Predisposing Factors:
* ___________
* Arterial _______, acidosis, or hypercarbia (animals)
* ______ Blockers, _______ preparations, Ca+ Channel Blockers
* Epinephrine and _____________
- Pregnancy
- hypoxemia
- Beta
- Digatalis
- Phenylephrine
Name the (3) LAs that cause cardiovascular toxicity in order from most to least
- Bupivacaine > Ropivacaine > Lidocaine
Treatment of Systemic Toxicity Goals:
1. Prompt ______ Management
2. ________ support
3. Removal of LA from ________ site.
- airway
- Circulatory
- receptor
Treatment of CNS Systemic Toxicity:
1. 100% O2 inhibits hypoxemia and _____ acidosis
2. hyperventilation
3. ___________
4. Benzodiazepines
5. Epinephrine as ________.
- metabolic
- barbiutates
- additive
Systemic Toxicity Seizure Management:
* Supplemental _____
* benzodiazepine (____ or ______)
* ________: if hemodynamically stable
* Muscle Relaxant (______ or NMDA)
* _______: Lipid Emulsion
- Oxygen
- Midazolam or diazepam
- Propofol
- Succinylcholine
- Intralipid
MOA of Intralipid Lipid Emulsion: creates _____ compartment; provides _____ for ______ metabolism.
- lipid
- fat
- myocardial
Intralipid~ Lipid Emulsion:
* Bolus: ____ mL/kg of 20% lipid emulsion
* Infusion: _____ ml/kg/min for ____ minutes
* 1st 30 mins: ____ ml/kg (1.2 to 6 mL/kg)
- 1.5
- 0.25
- 3.8
