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Ossicle/General

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General Surgical Concepts

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Anesthesia

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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
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