Ossicle/General

General Surgical Concepts

Anesthesia

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