Allergic
Systemic Toxicity
CNS effects
CV effects
LAST treatment
100

allergic reactions with LA mostly associated with which kind of LA

esters (PABA) metabolite

100

causes of LAST

excess plasma concentration of drug

entrance into the systemic circulation from inactive tissue redistribution and clearance metabolism

*accidental direct IV injection

100

what precedes seizures with systemic toxicity

drowsiness and facial twitch 

100

lidocaine at 5 mcg/mL has

circumoral numbness but no CV effects

100

Goal of treatment for systemic toxicity

prompt airway managemnt

circulatory support

removal of LA from receptor sites

200

what is methyparaben

preservative to both esters and amides

*similar structure to PABA

*use preservative free*

200

other factors that can LAST

patient comorbidities, medication, location and technique od block, LA used and dose

200

treatment for CNS systemic toxicity

100% O2 to inhibti hypoxemia and metabolic acidosis

hyperventilation

barbituates/benzodiazepines/ propofol

epi as an additive

200

high plasma concentrations of lidocaine 

block cardiac Na+ channels

slowing conduction of cardiac impulses prolonging PR intervals, and QRS widening

200

standard of care for intralipid - lipid emulsion 

creates lipid compartment; provides fat for myocardial metabolism

Bolus: 1.5 mL/kg of 20% lipid emulsion

Infusion: 0.25 mL/kg/min for at least 10 min

1st 30 min: 3.8 mL/kg (1.2-6 mL/kg)

300

is there a cross sensitivity between esters and amides

no

300

magnitude of LAST depends on 

dose

vascularity of site

epi use

physiochemical properties

300

seizure treatment for LAST

supplemental O2

benzo (versed/diazepam)

propofol, if hemodynamically stable

muscle relaxant (SCh or NDNMBD)

intralipid: lipid emulsion

300

accidental IV bupivicaine causes

precipitous hypotension, AV block and cardiac dysrhythmias: SVT, ST - T wave changes, PVCs, widening QRS, VTACH
300
if there's no response to lipid emulsion whats the next plan

cardiopulmonary bypass

400

sign of IgE mediated anaphlyaxis

rash, urticaria, laryngeal edema with our without hypotension and bronchospasm

400

when should plasma levels of lidocaine be monitored

epidural > 900 mg

400

what is transient neurologic symptoms (TNS); causes and treatment

Moderate to severe pain (lower back, buttocks, and posterior thighs) within 6 to 36 hours after an uneventful single-shot SAB

unknown cause, Lidocaine > other LAs

treatment: trigger point injections and NSAIDs (recovery in 1 to 7 days)

400

predisposing factors for CV system effects with LAST

pregnancy - low plasma cholinesterase/plasma protein

arterial hypoxemia, acidosis, or hypercarbia

beta-blockers, dig, ca++ channel blockers
epi and phenylephrine

400

supportive epi dose during LAST

10-100 mcg

500

majority of adverse responses that are often attributed to an allergic reaction are instead manifestations of 

excess plasma concentrations of LA

500

what electrolyte imbalance promotes seizures with LA

hyperkalemia
500

what is cauda equina syndrome (CES), and what is associated with it?

diffuse injury at the lumbosacral plexus, having a varying degree of sensory anesthesia, bowel and bladder sphincter dysfunction, and paraplegia

associated with lumbar disc herniation, prolapse, or sequestration with urinary retention

500

which LAs are most likely to cause CV effects with LAST

bupivicaine > ropivicaine > lidocaine

500

TXWES reference guide

bolus 1.5 mL/kg over 1 min 

gtt 0.25 mL/kg/min

Repeat bolus Q3-5 min up to 3 mL/kg total 

Increase gtt to 0.5 mL/kg/min

continue gtt until hemodynamically stable

max total dose 8 mL/kg