5. •Healthy 24 years – old man
scheduled for anterior crucial
ligament repair of the left knee
•Anesthesia Plan: Saphenous Block +
Spinal Anesthesia
•Saphenous Block for perioperative
pain relief : Adductive Canal Block
(Hunter Canal Block) Ultrasound –
Guided Single Shot
•Marcaine of 0.5%: 20ml
8. • 100% O2 MASK
VENTILATION
•MIDAZOLAM 5mg I.V, BUT
STILL SEIZURING
•PROPOFOL: 50mg
INTERVALS ( 200 mg TOTAL )
• LMA : AIRWAY SECURE
9. MANAGEMENT •CALLED FOR INTRALIPID 20%
FROM PHARMACY
• HAD LIPOFUNDIN 20% AFTER 30
MIN
•RESETUP MONITORING
•MODERATE HYPOTENTION ( 80/50
mm Hg) MODERATE
TARCHYCARDIA ( 90 beat/min)
• STILL UNCONSIOUSNESS
10. • LIPOFUNDIN 20%: BOLUS 100 ML IN 1 MIN
• INSTANT WAKE UP (~ 30 SEC)
• CONTINOUS LIPOFUNDIN 20% (400ml) IN
30 MIN
• ONE HOUR AFTER STABILITY: SPINAL
ANESTHESIA FOR SURGERY
19. • RESPECT DOSE
• TEST DOSE
• INTERVENCE INJECTION
• INJECTION PRESSURE
• ASPIRATION
• KEEP ALERT
• VITAL SIGNS
MONITORING
• DRUG CHOISE
• NON ANESTHESIA
STAFFS
• DRUG ERROR
20.
21. • DOSE MAY NOT PROVIDE ADEQUATE
THERAPEUTIC EFFECT (BLOCK)
• DOSES LOWER THAN RECOMMENDED
LIMITS HAVE CAUSED TOXICITY
• DOSES IN EXCESS OF RECOMMENDED
LIMITS HAVE NOT CAUSED TOXICITY
22.
23. Polley L, Columb M, Naughton N et al - Relative analgesic potencies of
ropivacaine and bupivacaine for epidural analgesia in labor:
Implications for therapeutic indexes. Anesthesiology, 1999;90:944-950.
29. Minimal Anesthesia Care
Maximum Anesthesia Care
Most Anesthesia Concern
Joan Rivers's doctor 'took a SELFIE' with the comedian as she was
under anesthesia and just moments before she went into cardiac arrest
that killed her: http://www.dailymail.co.uk/news/article-2758736/
30. • Livepool Heart and Chest Hospital,
U.K
• 50 % SURGEONS DO NOT KNOW TO
CALCULATE THE DOSE
• 25 % MEDICAL STAFFS DO NOT KNOW THE
MAXIMUM DOSE
• 7% KNOWN LIPID IS A DRUG TO TREAT THE
L.A.S.T
• 3% KNOWN THE INITIAL BOLUS DOSE OF
LIPID
• “Awareness of local anaesthetic toxicity
35. ASA Closed Claims
database (2012)
9,536 RELATED TO ANESTHESIA
18 RELATED TO LIPOSUCTION
8 DEATHS
4 PERMANENT BRAIN DAMAGES
Los Angeles study
9 DEATHS DUE TO
LIPOSUCTION
2 NO MEDICAL FILES (1996)
7 DEATHS FROM 1999 – 2010
ALL DEATHS: ANESTHESIA
OUTSITE HOSPITAL
As Liposuction Deaths Mount, Study Exposes Cracks in Safety
http://www.anesthesiologynews.com/ViewArticle.aspx?
d=Clinical+Anesthesiology&d_id=1&i=October+2012&i_id=890&a_id=2174
3
36. • “Moreover, it is necessary
that any physician using
local anesthetics be aware of
the current
recommendations for
managing local anesthetic
systemic toxicity, including
its prevention, diagnosis and
treatment,” Dr. Weinberg
• “Hơn lúc nào hết tất cả thày
thuốc sử dụng thuốc tê cần
phải cảnh giác với những
khuyên cáo hiện tại về xứ lý
ngộ độc thuốc tê toàn thần
bao gồm phòng ngừa, chẩn
đoán và điều trị” BS
Weinberg
37. • Hospital fined £100,000 after
wrong drug killed new mother
• Mayra Cabrera died after
giving birth in Swindon when
she was accidentally dosed
with bupivacaine, a potent
anaesthetic
• http://www.theguardian.com/s
ociety/2010/may/17/mother-killed-
myra-cabrera-bupivacaine
41. • HANOI UNIVERSITY
HOSPITAL
PAIN PACKAGE
A-Z RESPOSIBLE TEAMS
REWARDS
PATIENTS CENTER CARE
42.
43.
44.
45.
46. • 88 % AIVALABLE
• THE REST:
HOSPITAL STOCK
• AT LEAST: 95%
CAN PROVIDE
Lipid 20% <30 MIN
47. • “LIPID SINK”- LIPOPHILIC LOCAL ANESTHETIC
IS SEQUESTERED IN A LIPID PHASE IN THE
PLASMA
• METABOLIC EFFECTS:
• IMPROVED FATTY ACID TRANSPORT
• DIRECT INOTROPIC EFFECT
• ACTIVATION OF CALCIUM AND POTASSIUM
CHANNELS
48.
49.
50. LIPID 20% trong ngộ độc thuốc tê
58 YEARS OLD, INTRACALENE BLOCK
20 ML MARCAINE 0,5%, 20 ML MEPIVACAINE 1,5%
20 MIN OF CRP AND ALSR
100 ML INTRALIPID 2O% BOLUS, 0,5ML/KG/MIN
MAINTENANCE
FULL RECOVERY
51.
52. • VARIABLES, BUT CONSENSUS
DO NOT WAIT TILL THE CARDIAC COLLAPSE
EARLY LIPIDE INFUSTION CAN PROTECT
CARDIOVASCULAR COLLAPSE
DO NOT AGREE TO STRART TO USE IN LIGHT
CLINICAL SYMPOMS
MOST AGREE TO USE WHEN THE CARDIOVASCULAR
SYMPTOMS OCCUR OR RAPIDLY CLINICAL
DETERIORATION
