ANAESTHETICS AND AIRWAY
LOCAL ANAESTHETIC AND BLOCKS
METHAEMOGLOBINAEMIA in this question
PromptMaximum safe doses
ResponseBupivicaine 2mg/kg
Ropivicane - to 3mg/kg
Lignocaine 4 mg/kg, with adrenaline = 7 mg/kg
Ropivicane - to 3mg/kg
Lignocaine 4 mg/kg, with adrenaline = 7 mg/kg
PromptTechniques to reduce pain of infiltration of local anesthetic
ResponseBuffering with NaHCO3
Warming to room temperature
Warming to room temperature
PromptBenefits of regional anasthesia (block) vs local anaesthesia
ResponseOne injection vs multiple - less painful for patient
Better analgesia with regional block vs multiple sites
Smaller volume in block >> decreased risk of toxicity
Sometimes difficult to infiltrate (thick plantar foot skin)
Single injection limits risk of needlestick to MO
Better analgesia with regional block vs multiple sites
Smaller volume in block >> decreased risk of toxicity
Sometimes difficult to infiltrate (thick plantar foot skin)
Single injection limits risk of needlestick to MO
PromptClinical features in systemic local anasthetic toxicity
ResponseMetalic taste, perioral numbness/tingling
Tinnitus
Nystagmus/diplopia
Dizziness/lightheadedness
Adgitation
Confusion
Muscle twitching
Loquaciousness (talkative)
Tinnitus
Nystagmus/diplopia
Dizziness/lightheadedness
Adgitation
Confusion
Muscle twitching
Loquaciousness (talkative)
PromptLife threatening complications of local anasethetic toxicity
ResponseSeizure
Coma
Respiratory depression/arrest
Bradycardia and malignant tachyarrhythmia
Cardiovascular collapse/hypotension
Methaemoglobinaemia
Coma
Respiratory depression/arrest
Bradycardia and malignant tachyarrhythmia
Cardiovascular collapse/hypotension
Methaemoglobinaemia
PromptManagement of local anasthetic toxicity
ResponseIntralipid 20% - 1.5mL/kg bolus - repeat every 3 minutes followed by infusion (e.g. about 100 mL in a 70kg adult)
followed by
0.25 mL/kg/min for 30-60 minutes
(e.g. about 600 mL over 30 minutes in a 70kg adult)
Bolus could be repeated 1-2 times for persistent asystole
(e.g. at 5 minute intervals)
Infusion rate could be increased if blood pressure declines
(e.g. double the infusion rate)
followed by
0.25 mL/kg/min for 30-60 minutes
(e.g. about 600 mL over 30 minutes in a 70kg adult)
Bolus could be repeated 1-2 times for persistent asystole
(e.g. at 5 minute intervals)
Infusion rate could be increased if blood pressure declines
(e.g. double the infusion rate)
PromptEAR BLOCK
Response