hi everyone now one of the trickiest things with ophthalmic anesthesia is actually drawing
up the solution there's so many different solutions i've used over the last decade or so
and i've pretty much come back to this pretty simple formula which is a combination of really
fast acting and long acting enough which is two percent lignicane with 30 units per ml highlights
now the other solution that i've used is two percent lignicane with 0.6 percent of pivot cane
and 30 units per mil highlise i've tried a number of different combinations
for example when i just use ropicane it's not fast onset enough and when i don't use
highlights again for a really fast cataract list it's just not fast enough for a good
block so this is what i do for the two percent lignicane 30 units per mil high lace formula
so first of all i've got this equipment here a whole bunch of two mil
lignicaine solutions sterile vials there got a 10 mil syringe a 20 mil syringe
you can you don't really need this device but it does help and also i've just got a drawing
up needle finally i've got the highlights 1 500 international units and it's as a powder
so the first thing i do drop 10 mils of the two percent lignicane
and again i'm being really careful to check these vials
as i do so because getting these wrong getting the wrong solution can be a really devastating mistake
and i just inject here i inject a few mils into the vial and i stir
with my drawing up needle and that dissolves the powder really well
and then i just draw it up a few times just to make sure it's all into my syringe i've now got
a solution with 10 mils of 2 ligand cane then there's 1500 units in that so now it's 150 units
per mil of highlays just to be specific okay i cap that and keep that safe and now here's the kind
of tricky part as i dissolve and mix this up so what i do now depending on how many blocks every
block needs three to four mils so i just make a rough calculation of what i need so say i've got
six more blocks today six times four is 24 so i'm going to have say 25 mils in this so what i'm
going to do is i'm going to drop 20 mils of two percent lignicane i'm going to have now 20 mils
20 ml of this combined with five mils of this solution here will dilute the
high layers down to 30 units per mil so you really don't want more than 30 units per mil
of highlights unnecessary really i then cap that with this little device or i can put up a drawing
drawing up needle on the end of that and i just really make sure that i label this really
well of course you don't want to be giving this accidentally intravenously so sometimes what i
do is i label these syringes by actually attaching the vials on it and that way i can't accidentally
use this intravenously because that's what i and my non-intravenous solutions i'll always do this
for now to do my original solution what i do is i use 10 ml of 10 percent lignicain
and i use that in a 10 mil syringe i then put the 1 500 units of highly
into that 10 ml syringe instead of what i did previously i then combine that
with my repivocane so let's say i take 0.75 percent of pivot cane and in a five mil syringe
i might draw up four mils of the point seven fiber pivot cane and just one mil of this solution and
then i get two percent liquid cane 30 inch more highlights and point six percent of pivot cane
you