Dr. Jeffrey Klein recommends using lidocaine with epinephrine in single commercial vials rather than using lidocaine and epinephrine in separate vials.
Safety tip number seven is a recommendation to use lidocaine with epinephrine in a single commercial vial rather than using lidocaine and epinephrine from separate files and my suggestion is that most people use lidocaine with epinephrine prepared in a single bottle this is a this contains 30 ml of lidocaine but you can purchase 50 ml wyles of lidocaine with
Epinephrine one percent and that could be used to be placed inside the bag of the iv bag for preparing tumescent like akane anesthesia alternatively you can use just plain lidocaine and then add epinephrine so here’s these little vials one milligram of epinephrine and this is 50 milliliters of lidocaine or 500 milligrams of lidocaine so two of these 50 ml files
Will take 1 gram 1000 milligrams of lidocaine and one milligram of epinephrine can be placed inside the bag for tumescent anesthesia but if you for some reason and this has happened the person who’s mixing the bag of tumescent lidocaine but flight akkadian but forgets to add the epinephrine as a separate addition then the lidocaine it has no epinephrine and the
Rate of systemic absorption of lidocaine will be greatly accelerated and then i can actually become dangerous and potential toxic levels of lidocaine certain lidocaine levels can be achieved so as a safety measure i recommend lidocaine with epinephrine be used we have often used patients are often given more than one liter of tumescent lidocaine so you’ll have two
Three or more bags of lidocaine tumescent lidocaine anesthesia each of those should be numbered and also each of the vials that are used should be placed in and in orders on a counter that can be easily seen so we will have for example a row of bottles of lidocaine with epinephrine and if we had three liters of saline of saving used for thomas mckean anesthesia
Then we would have three rows of these vials that were empty so that at any point in time i can look over the counter and see that yes there are three rows of vials they’re empty so that actually was placed in an iv bag and i know exactly what was placed in there there’s a bit of a danger if this is prepared out of the operating room because you can’t see it and
It’s even more of a danger if it’s prepared say in a central pharmacy because you have no idea what the pharmacist put in there usually there hopefully they’ll be accurate 99.99% of the time but at one time lawyer there’s a mistake you have no way of knowing what was actually in the bag and it’s a bit disconcerting not having that security i do know of one event
That did happen in which the best lidocaine was prepared in a central pharmacy and instead of using one milligram of epinephrine 10 milligrams different we used and the patient had a a cardiac arrest they survived the event but it was a unnecessary traumatic experience for everybody involved so it’s nice to have it prepared in the o.r the last thing is bicarbonate
We use bicarbonate in each of the each of the bags and this is to reduce the pain stinging pain of infiltration of tumescent lidocaine commercial vials of lidocaine such as this are have an acidic ph and the purpose is to to give better half-life for the epinephrine epinephrine will denature itself in a neutral ph within a matter of weeks so the shelf life is not
Very good unless it’s an acidic environment also an acidic environment improves the solubility of lidocaine and other other similar local anesthetics putting the 10 mil equivalents of by carpet in each bag decreases the burning sensation that can’t be associated with tumescent local anesthesia by decreasing that burning sensation you can and minimize the need for
Any other ancillary sedatives and or algae zzyx okay in our in our office our surgery center we do not give patients narcotics or heavy duty i am or iv analgesics it’s not necessary we infiltrate very gently and carefully and do not require any other occasions but if you don’t use the bicarbonate and it stings you’re forced to give patients other medications to
Overcome that i’m dr. jeffrey klein thank you for watching this informational video
Transcribed from video
Tumescent Safety Tips – Use Lidocaine with Epinephrine Vials By Tumescent.org
