Incisions and Viscoelastics
In this episode I’m finally going to get to the microscope view. I’ll discuss the importance of a properly constructed incision and the use of viscoelastics.
Here is the formula for epi-Shugarcaine. This was developed by the late Joel Shugar, M.D. of Perry, Florida. You can substitute plain BSS for BSS Plus.
Combine 3cc’s of BSS Plus with 1cc of PF Lidocaine to make 4cc’s of (plain) Shugarcaine.
We make enough plain Shugarcaine for the entire day depending on the number of cases.
Ex. 15cc BSS plus with 5cc 4% PF Lidocaine to equal a total of 20cc’s of a PF Lidocaine 1% solution. Dr. Shugar uses 2.0 – 2.5cc’s per case.
This mixture is mixed in a 50cc sterile vial and then stored in the refrigerator. It is taken out of the refrigerator at the beginning of each case for the techs to draw up, and then replaced back. Using a sterile vial from an allergy lab makes it very easy and time efficient when transferring the solution to the sterile field.
Using the plain Shugarcaine “recipe” above, take 3cc’s of that (plain Shugarcaine) and add 1cc of Epinephrine PF 1:1000. This will give you a total of 4cc’s of Epi-Shugarcaine.
Again, this mixture is mixed and stored in empty sterile vials from an allergy lab.
Both Shugarcaine and Epi-Shugarcaine are mixed the morning of surgery and discarded after procedures are complete. We remix all mixtures with each surgical day. Generally we are done with surgery in less than 4 hours and then the mixtures are discarded.
We have found that if Epi-Shugarcaine is not protected from light it will begin to turn a soft rose color after 4 hours and continue to get darker. Therefore, to protect it from light we place the mixture in a dark bag (and as stated above the mixture is placed in the refrigerator immediately after mixing and returned after withdrawing for a case) and the solution will stay clear for up to 7 – 8 hours.
pH testing results 6/06:
Epinephrine PF (Sulfite Free) NDC 0517–1071-25 3.11
Epinephrine regular 2.77
Lidocaine PF 4% (label states “only for topical use and retrobulbar injection”) NDC 0409–4283-01 6.44
BSS Plus 7.35
BSS plain 6.98
* Shugarcaine (using BSS plus with 4% lido) 6.97
Shugarcaine Plain (using plain BSS with 4% lido) 6.72
* Epi-shugarcaine using BSS Plus 6.9
Epi-shugarcaine using BSS Plain 6.67
BSS Plain w/ Epi PF 1:1000 (3:1) No Lidocaine 6.75
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Theme song Runaway by Adam Woodall courtesy of Mevio’s Music Alley