General Surgical Concepts
- Local Anesthesia
- CNS Response usually biphasic - stimulation then depression.
- Cardiovascular effects are usually depression.
- Cocaine: (esther) 3mg/kg toxicity or 200mg. Causes htn, immediate onset with duration 45min
- Lidocaine: (amide) 4mg/kg s epi, 7mg/kg with epi toxicity. CNS depression then arrhythmia
- Epinephrine: max 10cc of 1:100,000 over 10mins with halothane
- Most common complication of V3 block is cheek hematoma.
Halothane: sensitizes myocardium to catecholamines (epi). Caution.
Ecothiopates: (for glaucoma), are cholinesterase inhibitiors. Don't use succinylcholine.
- Malignant Hyperthermia
- Triggers: succinylcholine, halthone, ethrane, forane
- 1:50k adults, 1:15k kid
- Signs: increased CO2, HR, RR, temperature, muscle rigidity
- Pathophysiology: incr Ca++ release from sarcoplasm w/ incr excitation-contraction coupling
- Rx: dantrolene, procainamide, O2, insulin, glucose, lasix, bicarbonate