Term
| What are the general goals in management of CNS local anesthetic toxicity? |
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Definition
| Control the respiratory drive/airway; stop the seizure |
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Term
| What amplifies local anesthetic toxicity? |
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Definition
| hypoxia, cardiovascular disease, renal and hepatic dysfunctionb |
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Term
| Why is wetting solution with epineprhine used in liposuction? |
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Definition
| distends and softens adipocytes; use of small of cannulas; epi allows minimal blood loss |
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Term
| What is the etiology of death in the patient who has cosmetic surgery? |
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Definition
| Pulmonary emboli (23%), perforated viscous (14%), fat emboli (8%), cardiorespiratory failure (4%) |
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Term
| What percent of deaths in cosmetic surgery is related to anesthesia factors? |
|
Definition
| 10% and usually due to loss of airway or can't ventilate |
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Term
| What increases fatality in cosmetic surgery? |
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Definition
| IV sedation, multiple concurrent surgeries, fat aspirate >5L, large doses of lidocaine used, excessive IV fluids |
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Term
| What diseases are associated with cosmetic surgeries? |
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Definition
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Term
| What is the deal with diazepam? |
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Definition
| It can interfere with lidocaine levels but also raises the seizure threshold - can be argued that it is good or bad to use benzo's |
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Term
| What does perioperative management of the cosmetic surgery involve? |
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Definition
| large bore IV with warm fluid, prep in standing position (hold sedation until after prep), increase room temp to prevent hypothermia, patient on sterile drape on table - monitors on after patient lies down, |
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Term
| How much lidocaine and epi is added to a 1 liter bag of NS? |
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Definition
| 50-100ml of 1% lido and 1ml of 1:1000 epi |
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Term
| How much tumescent fluid is reabsorbed? What does this mean for your managment? |
|
Definition
| 60-70%; tricky fluid management - can easily develop hypovolemia or fluid overload |
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Term
| How much aspirate is involved in small volume lipoplasty? Large volume lipoplasty? |
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Definition
| Small volume lipoplasty: <4L aspirate; large: >4L aspirate; |
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Term
| How should maintenance fluids be handled in general? In large volume lipoplasty? In small volume lipoplasty? |
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Definition
| General: 4-5 ml/kg/hr; large volume: 4-5ml/kg/hr + SC wetting solution + 0.25ml crystalloid per ml of aspirate >4L; small volume: 4-5ml/kg/hr + SC wetting solution |
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Term
| What type of injury is intentionally created in liposuction? |
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Definition
| An extensive, internal burn-like injury |
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Term
| What is the hematocrit of blood tinged aspirate? |
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Definition
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Term
| What does of lidocaine are used in tumescent? |
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Definition
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Term
| What are post op considerations for the cosmetic surgery patient? |
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Definition
| analgesia with tumescent lasts 18-24 hours, surgical binders may inhibit ventilation, PE is the #1 cause of mortality, may keep patient overnight if large volume liposuction (use pulse ox monitoring) |
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