Title: Anesthetics
题目：局麻药在儿科中的应用
Author 作者: Mimi Lu

In children, it is important to consider the maximum doses of local anesthetics when performing a laceration repair or painful procedure like abscess drainage. If there are multiple lacerations, or large lacerations, it may be possible to exceed those doses if one is not careful.
对于儿童来说，在做撕裂伤的修复或象脓肿引流这样痛苦的操作时，一定要考虑到局麻药的最大剂量。如有多发或大的撕裂伤，不小心很可能会超量的。
Max doses of common anesthetics 常用局麻药的最大剂量
Lidocaine WITHOUT epinephrine – 4 mg/kg (0.4 mL/kg of 1% lidocaine)
没有肾上腺素的利多卡因－4mg／kg（0.4ml／kg的1％利多卡因）
Lidocaine WITH epinephrine – 7 mg/kg (0.7 mL/kg of 1% lidocaine)  
有肾上腺素的利多卡因－7mg／kg（0.7ml／kg的1％利多卡因）
Bupivicaine WITHOUT epinephrine – 2 mg/kg (0.8 mL/kg of 0.25% bupivicaine)
没有肾上腺素的布比卡因－2mg／kg（0.8ml／kg的0.25％布比卡因）
Bupivicaine WITH epinephrine – 3 mg/kg (1.2 mL/kg of 0.25% bupivicaine)
有肾上腺素的布比卡因－3mg／kg（1.2ml／kg的0.25％布比卡因）

Pearls 要点:
For added safety, some advocate not exceeding 80% of the max dose in children < 8 years of age
为安全起见，有人建议对8岁以下的儿童不要超过80％的最大剂量
Higher concentration of lidocaine beyond 1% does not improve the time of onset or duration of action and may increases the risk of toxicity
浓度在1％以上的利多卡因并不改善起效或作用时间，反而有增加毒性的危险
The addition of epinephrine increases the maximum dose and duration of action, but may be more painful during infiltration
加入肾上腺素虽然可增加最大量和作用时间，但在注射时可能会更疼
If the repair requires large amount of local anesthetic, consider doing an regional block
如修复需要大剂量的局麻药，要考虑做局部神经阻滞