![]() Was this an appropriate dose of Ropivacaine? What would have been the maximum dose a patient with this weight can receive?Ī. ![]() After a few moments, she becomes increasingly confused and somnolent.ģ. Immediately following the injection, the patient reports circumoral numbness, tinnitus, and she appears anxious. 30cc of 0.5% Ropivacaine is administered. In the preoperative area, the patient receives mild sedation to facilitate placement of the block/catheter using a nerve stimulator. Particularly, children less than 4 months of age are at particularly high risk. Extremes of age secondary to reduced clearance of the anesthetics. What other chronic or acute conditions/risk factors would make a patient susceptible to developing LAST?Į. Acidosis (Metabolic acidosis, also due to DKA)Ģ. ![]() Electrolyte abnormality (hypokalemia secondary to ketoacidosis)ĭ. Known cardiac conduction abnormality (WPW Syndrome)Ĭ. Small sized patient/low BMI (BMI 18.3, 45kg)ī. What patient-factors increase her risk of developing Local Anesthetic Systemic Toxicity (LAST)?Ī. After a full pre-op and assessment, you as the anesthesiologist decide to give the patient a femoral nerve block and place a catheter for an adjunct to the anesthetic and for post op pain management.ġ. ![]() However, due to the severity of the fracture and the compromised vascular supply, the orthopedic surgeon would like to proceed to the OR as soon as possible. Upon arrival to the hospital, she was found to be in DKA, and is currently being treated with insulin, potassium, and intravenous fluids. She has a past medical history of Wolf-Parkinson-White syndrome and Type I Diabetes Mellitus. A 31-year-old woman who is 157cm tall and weighs 45kg (BMI 18) presents for repair of a distal femur fracture sustained after a significant fall while mountain climbing. ![]()
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