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OBJECTIVE
As a Special Forces Medic given a patient requiring anesthesia,
administer anesthesia utilizing your knowledge of anesthesia
pharmacology and applying the five rights (right patient, right drug,
right amount, right route, right time) in accordance with JSOMTC
student manual of anesthesia.
REASON
As a Special Forces Medic the probability is high that you will be
the only health care provider available to administer anesthesia.
PROCEDURES
Review local/regional anesthesia pharmacology
Review anesthesia pharmacology adjuncts
Review intravenous anesthetics
Review intravenous anesthetics reversal agent
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 Local/Regional Anesthetics
Lidocaine
amide type anesthetic
the most commonly used local anesthetic
rapid onset and a duration of 60-75 minutes
extended when solutions with epinephrine are used for up to 2
hours
metabolized in the liver and excreted by the kidneys.
INDICATIONS Lidocaine
used to produce local and regional anesthesia for surgical and
diagnostic procedures
DOSE AND ROUTES Lidocaine
Percutaneous infiltration: 0.5%, 1.0%
Regional infiltration: 0.5%
Peripheral nerve: 1.0%, 1.5%, 2.0%
Max dose 4 mg/kg or 7 mg/kg with epinephrine
Toxic IV dose: 250 mg
ADVERSE REACTIONS, PRECAUTIONS, AND INTERACTIONS Lidocaine
contraindicated in patients with a known sensitivity to amide
type anesthetics
All local anesthetics can produce CNS stimulation, depression, or
both
Chloroprocaine
ester type local anesthetic
onset of action is rapid (6-12 min.) and duration of anesthesia is up
to 60 min.
rapidly metabolized in the plasma.
INDICATIONS Chloroprocaine
production of local and regional anesthesia for surgical and diagnostic
procedures
DOSE AND ROUTES Chloroprocaine
Local infiltration: 2.0%, 3.0% for motor block
Peripheral nerve block: 1.0%, 2.0%
Maximum dose 11 mg/kg or 13 mg/kg with Epinephrine
Toxic IV dose: 450 mg
ADVERSE REACTIONS, PRECAUTIONS, AND INTERACTIONS Chloroprocaine
contraindicated in patients with known hypersensitivity to
drugs of the PABA ester group
All local anesthetics can produce CNS stimulation,
depression, or both
Procaine
ester type local anesthetic
slower onset of action than Lidocaine
duration of action is approximately one hour
primarily metabolized in the plasma
INDICATIONS Procaine
used to produce local and regional anesthesia for surgical and
diagnostic procedures
DOSE AND ROUTES Procaine
Infiltration: 0.25%, 0.5%
Nerve block: 1.0%, 2.0%
Maximum dose 11 mg/kg or 13 mg/kg with Epinephrine
Toxic IV dose: 450 mg
ADVERSE REACTIONS, PRECAUTIONS, AND INTERACTIONS Procaine
Contraindicated in patients with a known hyper-sensitivity to PABA
ester type anesthetics
All local anesthetics can cause CNS stimulation, depression or both
Continue
to the PowerPoint Lecture...
From
SFC Hill
Joint Special Operations Medical Training Center
In
Operational
Medicine 2001
Bureau of Medicine
and Surgery
Department of the
Navy
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