Anesthesia

ANESTHESIA—-DANIEL TODD, MD TOPICAL COCAINE—-ONLY AGENT WITH BOTH ANESTHETIC AND VASOCONSTRICTIVE ACTIVITIES INHIBITS THE REUPTAKE OF CATACHOLAMINES FROM THE ADRENERGIC NERVE ENDINGS EXCITABILITY = THE EARLIEST SIGN OF TOXICITY PHENYLEPHRINE NASAL (TOPICAL)—-MULT CASE REPORTS OF RESULTANT PULM VASOCONSTRICTION–LEADING TO LVF AND PULM EDEMA AFRIN (OXTMETAZOLINE)—MAY BE JUST AS EFFICACIOUS AS COCAINE IN HEMOSTASIS TETRACAINE, CETACAINE, AND PONTOCAINE ARE AMIDES EMLA—LIDOCAINE AND PRILOCAINE LOCAL THOUGHT TO WORK THROUGH BLOCKING SODIUM CHANNELS IN CELL WALLS AMIDES (SAFER) LIDOCAINE (XYLOCAINE)—-4.5 MG/KG W/O EPI—-315MG (10 MG/CC)—TOTAL OF 30 CC IN A 70 KG ADULT—--5–7.0 MG/KG WITH EPI—-490MG (10MG/CC)—TOTAL OF 50 CC IN A 70 KG ADULT MEPIVICAINE(PONTOCAINE, CARBOCAINE)—-7.0MG/KG BUPIVICAINE (MARCAINE, SENSORCAINE)—LONG ACTING (WOULD NEVER USE MORE THAN 175MG TOTAL AS THIS CAN IRRIVERSIBLY BIND THE MYOCARDIUM)–NEVER GIVE IV—MAY BE USEFUL IN SATURATING MEROCELS ESTERS (ESTER LINKED—-METABOLIZED BY PLASMA PSEUDOCHOLINESTERASE—PTS WITH DEFICIENCY MUCH MORE LIKELY TO SUFFER A TOXIC OVERDOSE—–ALSO SHARE A COMMON PABA STRUCTURE—MORE LIKELY TO CAUSE AN ALLERGIC RXN—-IN SOME SUNSCREENS COCAINE (REALLY LIMITED TO TOPICAL USE) PROCAINE (NOVOCAINE) CHLOROPROCAINE (NESACAINE) TRIGEMINAL NERVES SUPPLY AFFFERENTS ANTERIOR TO A PLANE FROM THE MENTON TO THE VERTEX—-TYPE C CUTANEOUS SENSORY NERVES PREDOMINATE ON THE FACE TOXICITY CAN RESULT IN HALLUCINATIONS, GARBLED DYSARTHRIA, OR JERKY TREMORS PRIOR TO SIEZURE BENZOS CAN INCREASE THE SIEZING THRESHOLD 1MEQ SODIUM BICARB/10ML LIDO INCREASES THE RAPIDITY OF ONSET AND EFFECTIVENESS AND LESSENS THE INITIAL DISCOMFORT WYDASE = HYALURONIDASE–CLEAVES BONDS BETWEEN THE MOIETIES THAT FORM THE GROUND SUBSTANCE—-HELPFUL IN HYDRO DISSECTION CAVEATES: PROPOFOL IS MADE WITH EGGS—CHECK FOR ALLERGIES P O VERSED MAY BE A GOOD E R OPTION IN SOME CHILDREN—-SEE LOCAL STANDARDS—MONITOR AND HAVE RESCUSITATION EQUIPMENT READY—-GIVE 0.5-0.75 MG/KG—–GET LIQUID VERSED (IV SOLUTION)–5 MG/ML—MIX WITH A VERY SMALL VOLUME OF TYLENOL ELIXER (SMALLEST VOLUME POSSIBLE) MALIGNANT HYPERTHERMIA DESCRIBED IN 1960 SUSPECT EVERYONE-HIGH IN PEDS PTS ABNL IN THE SARCOPLASMIC RETICULUM HYPERMETABOLIC (HYPERPYREXIC) STATE CAUSED BY TRIGGERING SUBSTANCES–SUCCINYL CHOLINE AND VOLATILE GASES Dx: VASTAS LATERALIS Bx CAFFEINE-HALOTHANE CONTRACTURE TEST EARLY SIGNS OF HYPERMETABOLIC STATE TACHY, MET ACIDOSIS, HYPOXEMIA, HIGH END TIDAL CO2, SKIN MOTTLING, UNSTABLE BP, MASSETER STIFFNESS(RIDGIDITY),WHOLE BODY RIDGIDITY, HTN—–HYPERPYREXIA (BY THE TIME TEMP RISES IT IS TOO LATE!)—-PYREXIA > 43 DEGREES—DIC—MSOF—-DEATH MORTALITY > 10 % EVEN WHEN TREATED STOP ALL TRIGGERING AGENTS 100% O2 HYPERVENTILATE DANTROLENE 2.5 MG/KG IMMEDIATELY SODIUM BICARB 1MEQ/KG GLUCOSE 0.5GM/KG; INSULIN 0.15 U/KG IVF COOLING BLANKET LASIX—-PREVENT ATN FROM MYOGLOBINURIA TREAT TACHY–DYSRYTHMIAS (PROCAINAMIDE/PROCARDIA) 

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