Electrocautery is a surgical technique used for tissue cutting, coagulation (sealing blood vessels), and tissue destruction through the application of high-frequency electrical current. There are two primary types of electrocautery: monopolar and bipolar.
Principle: Monopolar electrocautery consists of a handheld device that delivers electrical current to the target tissue via an active electrode. The current flows from the active electrode, through the tissue, and returns to the generator via a grounding pad attached to the patient's skin at a distant site.
Settings and Indications:
Principle: Bipolar electrocautery utilizes two closely spaced electrodes within the handheld device. The electrical current flows directly between these electrodes, effectively confining the energy to the target tissue without requiring a distant grounding pad.
Settings and Indications:
These settings and indications are general guidelines, and actual parameters may vary based on factors such as tissue type, thickness, and surgical technique. Surgeons should adjust settings based on individual patient characteristics and procedural requirements to achieve optimal outcomes while minimizing tissue damage and complications.
Lidocaine (Xylocaine): - Maximum Dose without Epinephrine: 4.5 mg/kg (without epinephrine) - Maximum Dose with Epinephrine: 7 mg/kg (with epinephrine) - Toxicity: Symptoms of lidocaine toxicity may include dizziness, confusion, seizures, cardiovascular collapse, and cardiac arrest.
Bupivacaine (Marcaine): - Maximum Dose without Epinephrine: 2 mg/kg (without epinephrine) - Maximum Dose with Epinephrine: 3 mg/kg (with epinephrine) - Toxicity: Bupivacaine toxicity can cause significant cardiotoxicity, leading to cardiac arrhythmias, cardiac arrest, and central nervous system (CNS) effects such as seizures and dizziness.
Mepivacaine (Carbocaine): - Maximum Dose without Epinephrine: 4.5 mg/kg (without epinephrine) - Maximum Dose with Epinephrine: 7 mg/kg (with epinephrine) - Toxicity: Symptoms of mepivacaine toxicity are similar to other local anesthetics and may involve CNS and cardiovascular effects.
Procaine (Novocaine): - Maximum Dose without Epinephrine: 7 mg/kg (without epinephrine) - Maximum Dose with Epinephrine: Not typically used with epinephrine - Toxicity: Procaine toxicity may present with symptoms similar to other local anesthetics but is less frequently used today due to its shorter duration and higher allergenic potential.
Articaine (Septocaine): - Maximum Dose without Epinephrine: 7 mg/kg (without epinephrine) - Maximum Dose with Epinephrine: 7 mg/kg (with epinephrine) - Toxicity: Articaine has a longer duration of action but can cause similar toxicity symptoms as other local anesthetics if administered excessively or if there's accidental intravascular injection.
Hypokalemia (Low Potassium Levels):
- Mild to Moderate Hypokalemia (3.0-3.5 mEq/L):
- Oral potassium supplementation: Potassium chloride tablets or liquid, 20-40 mEq orally per day in divided doses.
- Severe Hypokalemia (<3.0 mEq/L):
- IV potassium chloride: Start with 10-20 mEq/hour, under continuous cardiac monitoring.
Hyperkalemia (High Potassium Levels):
- Mild Hyperkalemia (5.1-6.0 mEq/L):
- Dietary potassium restriction and discontinuation of potassium supplements.
- Severe Hyperkalemia (>6.0 mEq/L or with ECG changes):
- Calcium gluconate or calcium chloride IV to stabilize cardiac membranes.
- Insulin with glucose IV, beta-agonists (e.g., albuterol), or sodium bicarbonate to shift potassium into cells. - Loop diuretics or exchange resins (e.g., sodium polystyrene sulfonate) to enhance potassium removal.
Hypocalcemia (Low Calcium Levels):
- Mild Hypocalcemia (8.0-8.5 mg/dL):
- Oral calcium supplements: Calcium carbonate or calcium citrate, doses vary based on elemental calcium content.
- Severe Hypocalcemia (<8.0 mg/dL or symptomatic):
- IV calcium gluconate or calcium chloride, dosages depend on severity and symptoms.
Hypercalcemia (High Calcium Levels):
- Mild Hypercalcemia (10.5-11.9 mg/dL):
- Hydration with IV saline and loop diuretics.
- Severe Hypercalcemia (>12 mg/dL or symptomatic):
- Bisphosphonates, calcitonin, or corticosteroids may be used for severe cases.
Hypomagnesemia (Low Magnesium Levels):
- Mild to Moderate Hypomagnesemia (1.2-1.8 mg/dL):
- Oral magnesium supplements: Magnesium oxide, magnesium citrate, or magnesium glycinate, dosages vary.
- Severe Hypomagnesemia (<1.2 mg/dL or symptomatic):
- IV magnesium sulfate, doses vary based on severity and response.
Hypermagnesemia (High Magnesium Levels):
- Mild to Moderate Hypermagnesemia (2.5-3.0 mg/dL):
- Discontinuation of magnesium-containing medications.
- Severe Hypermagnesemia (>3.0 mg/dL or with symptoms):
- IV calcium gluconate for severe symptoms.
- Dialysis may be necessary in extreme cases.
