Introducing OpenAnesthesia Summaries

2-Chloroprocaine is considered a safe and favorable choice for emergent/urgent dosing of an epidural for cesarean section. It is favorable because of its rapid onset, which is independent of its pKa (based on pKa alone, one would expect a very slow onset). The rapid onset is thought to be due to the high concentrations that are used. It is safe because it is metabolized by plasma cholinesterases (it is an ester local anesthetic), so intravascular injection is clinically inconsequential. A down side of its use is its relatively short duration; repeat boluses must be given about every 30 minutes to maintain surgical anesthesia. The use of 2-chloroprocaine is associated with a decreased efficacy of subsequent epidural opioids, rather than increased efficacy.