Anethesia & Pain Mangement

8/13/2019 Anethesia & Pain Mangement

1/12

Christine Du 12/22/10http://www.youtube.com/watch?v=ZTbKNA0XGGI
http://www.youtube.com/watch?v=ZTbKNA0XGGIhttp://www.youtube.com/watch?v=ZTbKNA0XGGI


2/12

5231 Spring Ridge Dr E. Macungie 18062Please do NOT

Park in front of the mailboxes.

Wear socks cause you wont be wearing shoes. Vomit on my nice carpet!

Please DOBring the family.Bring money for some texas hold em. Bring some liquid courage cause you WILLkaroake!

OVER THE HUMP CELEBRATION


3/12

Sodium ThiopentalPropofol- Amnesic, sedative but NOT analgesic

Rapid inductionCleared by hepatic metabolism & plasma cholinesteraseSE: Hypotension, respiratory depressionContra: egg allergy

Ketamine- amnesia/analgesiaPhencyclidine derivativeDissociation between thalamus and limbic systems

No respiratory depressionVisual/auditory hallucinations delirium (tx: benzos)Indirect sympathetic nervous system stimulatory effects

Increases myocardial oxygen consumption and ICPEtomidate

Continuous infusion can lead to adrenocortical suppression.


4/12

Inhalation Agents (unconsciousness,amnesia, some analgesia)

Generalized depressants

Myocardial depression/vasodilationCerebral function/ metabolic rateLoss of autoreguationLoss of heat conservation

MAC Lipid soluble Potency Speed of

induction

Nitrous Oxide Halothane Enflurane Isoflurane Sevoflurane

Fastestinduction;

minim cardiacdepression

Slow; highestdegree cardiacdepress/arrhy;

Hepatits;Least pungent

Seizures Fastonset/offset;Less cardiac

depress;Less

laryngospasm


5/12

AmnesicsBenzodiazepinesShort-acting- Versed . Contra: pregnancy crosses placenta.Long acting- ativan/valium

Flumazenil- competitive inhibitor seizure/arrhythmias,contra in elevated ICP or status epilepticusAnalgesics

Narcotics act on mu receptors.Respiratory depression. Blunting of sympathetic vascular

toneChest wall rigidity with high IV doses- muscle relaxantNaloxone- SE: acute pulmonary edema and myocardialischemiaAvoid w/ MAO-I= Serotonin syndrome


6/12

Depolarizing (noncompetitiveinhibitor) agent Nondepolarzing Agents

SuccinylcholineHydrolyzed in plasma by

cholinesteraseMalignant hyperthermia

Defect in calcium metabolismMuscle excitation-contractionsyndromeFirst sign- increased end-tidal CO2.fever/tachycardia/rigidity/acidosis/hyperkalemiaDantrolene 10mg/kg. inhigbits carelease and decouples excitationcomplex. Cooling balnkets, hco3, glc

Contra: burn pts, neurologic injury(increased ICP), neuromuscular d/o,SCI, massive trauma, ARF

Cisatracurium- Hoffmandegradation, histamine releaseMivacurium- fast, short, plasmacholinesterasesRocuronium- fast, intermediate,liver

Pancuronium- slow, long ,renalSE tachycardiaReversal

Neostigmine- blocksacetylcholinesterase

EdrophoniumAtropine or glycopyrrolate


7/12

Temporarily block nerve conduction by binding toneuronal sodium channels. Preventing Na influx.

Autonomic sensory motor nerve transmissionAcute CNS toxicity 2/2 excessive plasma

concentrationHemodynamic/respiratory consequences 2/2excessive conduction block of sympathetic or motornervesAllergic rxns

Esters vs amides (less allergy- if so, preservatives)Spinal/epidural blocks

Progressive blockade of sympathetic nervous system vasodilation/bradycardia

LMWH


8/12

HTNHoTN & MI intra-op higher in untreated HTN pts than those adequatelytreated if pre-op DBP >110Inadequately tx HTN more neurologic deficits after CEA.h/o prior MI have increased incidence of reinfarction

CADPreop CHF, recent MI, unstable angina, age >70DM, m>40yo, f>50yo need pre-op ECGAll elective surgery is delayed 6mos after MI.

Pulmonary Disease

Restrictive- intrinsic (ARDS) vs. extrinisic (deformity/obesity)Obstructive- FEV1/FVC


9/12

Preoperative Health Status Comments, Examples

ASA 1 Normal healthy patient

ASA 2 Patients with mild systemic disease

No functional limitations; has a well-controlled disease of one body s(ex. controlled hypertension or diabetes without systemic effects, cismoking without chronic obstructive pulmonary disease (COPD); milobesity, pregnancy)

ASA 3 Patients with severe systemic disease

Some functional limitation; has a controlled disease of more than onsystem or one major system; no immediate danger of death;(ex. controlled congestive heart failure (CHF), stable angina, old hearattack, poorly controlled hypertension, morbid obesity, chronic renalfailure; bronchospastic disease with intermittent symptoms)

ASA 4 Patients with severe systemic disease thatis a constant threat to life

Has at least one severe disease that is poorly controlled or at end stapossible risk of death(ex. unstable angina, symptomatic COPD, symptomatic CHF, hepatofailure)

ASA 5 Moribund patients who are not expected tosurvive without the operation

Not expected to survive > 24 hours without surgery; imminent risk of(ex. multiorgan failure, sepsis syndrome with hemodynamic instabilihypothermia, poorly controlled coagulopathy)

ASA 6 A declared brain-dead patient who organsare being removed for donor purposes


10/12


11/12


12/12

Anethesia & Pain Mangement

Documents

Transcript of Anethesia & Pain Mangement