Local anesthetics Flashcards
What is the MOA of local anesthetic?
Binds to inactivated sodium channels subsequently preventing further depolarization and impulse propagation
Are local anesthetics acidic or basic?
Basic
What is added to improve onset, quality and duration of the nerve block?
Sodium bicarb
What does systemic absorption depend on?
the vascularity of the site.
What are the esters?
Cocaine, , procaine, chloroprocaine, tetracaine
How are the esters metabolized?
By cholinesterases
What are the amides?
Prilocaine, lidocaine, mepivacaine, bupivicaine, ropivacaine
What are the complications of local toxicity?
CV: decreased contractility
Hypotension
Decreased conduction
Which local anesthetic is most cardiotoxic?
Bupivicaine
What is lidocaine known to cause?
Apnea and decreased hypoxic drive
What are side effects of the CNS?
blurred vision, tinnitus, mouth paresthesia, restlessness, nervousness, agitation, seizure
What is the management of local anesthetic toxicity?
ABCs
Lipid emulsion
What can transient neurologic symptoms be treated with?
NSAIDs
Who is at higher risk for transient neurologic symptoms?
Obese patients in the lithotomy position
What is the order of local anesthetic systemic absorption from greatest to least?
IV>Tracheal> Intercostal>Caudal>Paraspinal>Epidural> Brachial Plexus > Sciatic
