Flashcards in Pharm2 9 Anesthesia & Sedation pt1 Deck (22)
Analgesia: the diminution or elimination of pain in the otherwise conscious patient
Local anesthesia: the elimination of sensations, especially pain, in ONE PART of the body by the topical application or regional injection of a drug
General anesthesia: the elimination of all sensation, accompanied by the loss of consciousness and protective reflexes (gag reflex)
Risk: aspiration (puke in in the lungs)
Lidocaine injections directly into a laceration. how does it feel? how well does it work?
When this is injected you first feel: pinch of needle, the ejection which feels like burning, then numbness. Then the second injection. – after the first injection, they shouldn’t feel anything (in the same laceration, multiple lacerations you’ll feel the first injection in each area)
There are techniques to minimize discomfort.
What color is Lidocaine's label?
What if it was red?
If this blue label was red = contains epinephrine
What happens if you injected lidocaine containing epinephrine?
red label. May be dangerous b/c it contains epinephrine. Wouldn’t use that on nose, ear, toe, finger, penis – anything with a closed end. Will decrease vascular supply, causing lidocaine to stay in the tissue longer. You would wanna do this if you have to put in a whole bunch of stiches. Downside: much less circulation, higher risk of infxn.
What's the problem with dentists and their novocaine?
Dentist’s novocaine almost always contains epinephrine – your heart races. – shouldn’t be used on patients with heart problems, or at least ask before they go and use it on anybody.
Subungal hematoma. What's the best way to manage it? (2)
Inject 5 cc’s of lidocaine locally into the finger tip
Digital block - Inject in the webbed spaces (in btwn on both sides)b/c there’s a nerve and blood vessel running down finger on both sides. Then the whole finger goes numb. Then tourniquette on finger to stop bleeding, sew up fingernail or w/ no difficulty, bleeding.
fastest growing area of lawsuits in medicine is:
Local Anesthesia Techniques (3 categories, 2 in each)
Topical: Ophthalmic, Cutaneous
Local: Cutaneous, Injectible
Regional: Nerve Blocks, Bier IV Regional Blocks
Corneal abrasion and all its pain: give ___ and within seconds they are pain free.
All anesthetics end in
Examples of Cutaneous local anesthetics (4)
LET - lidocaine + epi + tetracaine;
TAC – tetracane, adrenaline (epi), and cocaine
What does TAC stand for (anesthetic) and when is it used?
tetracane, adrenaline (epi), and cocaine – used by ENT’s for nasal surgery.
3 injectable local anesthetics
lidocaine, novocaine, bupivacaine
What is Bupivacaine? When's it used?
an injectable local anesthetic, but has a much longer half life than lidocaine. For a very long procedure.
What are Bier Blocks? When is it used?
Bier Blocks – seen w/ carpal tunnel syndrome. Wrap it up to the shoulder, to block off arterial blood supply.
How do -caine's work? mech of action (pimp question)
Na+ channel blocker. Prevents nerve impulses from being conducted.
pimp question: What is the max dose of of Lidocaine? What happens if you give too much?
max dose of 3 mg/kg in a given hour. b/c 4 is toxic and will cause them to seize! If you add epinephrine to it and don’t give it IV, you can give more. Never approach the toxic level.
What's the Opthalmic Anesthetic?
What is EMLA cream? How long must you wait for it to work?
What conclusion do you draw from this?
(seen in hemonc, neuro) kids who need multiple invasive oncologic procedures. Rub it on the skin, wait 45 minutes and it works.
45 min: that’s why it’s not realistic in the emergency room.
3 local anesthetics
Lidocaine hydrochloride +epi, + sodium bicarb
What sensations are felt when Lidocaine (local anesthetic) is used? Why? What can you do about this?
it’s acidic – burning sensation
For every 9 cc of lidocaine, draw 1 cc of sodium bicarbonate – nearly neutral pH.
they don’t just make it this way b/c: the shelf life is only 12 hours if it’s pH neutral.