Term
| What is the definition of a bier block? |
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Definition
| A method of providing analgesia of part of a limb with an IV injection of a local anesthetic while occluding circulation to the limb. |
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Term
| What are 2 benefits of using lidocaine in bier blocks? |
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Definition
Rapid onset
Amide (less toxicity) |
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Term
| What are the advantages of IV Regional anesthetic? |
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Definition
Reliable
Easy
Safe
Rapid onset
Control duration
Control location
Rapid recovery
Little infection risk |
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Term
| What are disadvantages of IV regional anesthesia? |
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Definition
Use of tourniquet
Exsanguination
Must have uninterrupted venous system
Loss of bloodless field
size and shape of patient arm
rapid recovery/little reserve pain control
toxic reactions |
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Term
| What limits the duration of surgery when using IV regional anesthesia? |
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Definition
| amount of tourniquet pain that can be tolerated by the patient |
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Term
| In order: what symptoms will a patient experience in a toxic reaction to local anesthetic? |
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Definition
tinnitus
dizziness
metallic taste
seizures
coma/arrest |
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Term
| What should be done if patient begins to experience symptoms of toxicity during injection of local anesthetic in IV regional anesthesia? During deflation? |
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Definition
Injection: immediately stop injection, observe patient, provide physiological support as needed
Deflation: immediately inflate the cuff and wait a few minutes, continue to inflate/deflate in intervals over a period of time |
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Term
| When are toxic reactions to local anesthetic likely to occur? |
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Definition
immediately after tourniquet is released
after local is injected
excessive local injected |
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Term
What is the key to avoiding toxic reactions to local anesthetic? |
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Definition
PREVENTION
use reliable tourniquet
do not release tourniquet until a minimum of 20 minutes has passed
do not exceed recommended dose |
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Term
| What type of local is most commonly used in IV regional anesthetia? |
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Definition
| 0.5% lidocaine, preservative free |
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Term
| Why is bupivicaine not recommended for IV regional anesthesia? |
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Definition
Can cause immediate cardiac arrest that is impossible to correct
"stone heart" |
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Term
| What is the treatment of local anesthetic toxicity? |
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Definition
Assist ventilation
Intubate if necessary
Support circulation
Treat seizures
Epinephrine if arrest
ACLS |
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Term
| What do I have on my anesthesia cart to treat seizures (even if not FDA approved)? |
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Definition
Pentothal 25-50mg (maybe)
Versed 1-2 mg prn
Valium 5-10 mg |
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