Anesthesia Analgesia f1
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Transcript of Anesthesia Analgesia f1
Anesthesia
General Anesthesia Components :
• Analgesia
• Consciousness control (hypnosis, induced)
• Muscle relaxation
• Stability of the autonomic nervous system
Complications of Acute Pain
Pulmonary- respiratory muscle spasm- immobility- suppression of cough- abdominal distension from decreased GI motility- atelectasis from impaired ventilation - mucus plugging from suppression of clearing
mechanisms- V/Q mismatching and hypoxemia- Pulmonary infections
Complications of Acute Pain
Hematologic - increase thrombus formation by increasing blood
viscosity- increasing activity of clotting factors
- increasing platelet aggregation
Cardiovascular Acute rise in HR, BP, Cardiac Output =
increased cardiac work and oxygen consumption.
This could be disastrous for patients with ischemic heart diseases and may lead to myocardial infarction and /or CHF
Complications of Acute Pain
Gastrointestinal - Ileus- Nausea - Vomiting- Decreased bowel motility
Urinary - hypomotility of the urethra and bladder - difficulty with urination
Complications of Acute Pain
Neuroendocrine and Metabolic- increased sympathetic tone & hypothalamic
stimulation- increased catecholamine and catabolic hormone
secretion- increased metabolism and O2 consumption
Complications of Acute Pain
Psychological
- fear - anxiety- depression- frustration
Complications of Acute Pain
- ANESTHESIA - Partial or complete loss of sensation with or with out loss of consciousness as result of disease, injury, or administration of an anesthetic agent, usually by injection or inhalation.
Anesthesia
The main goal is control of the vital functions of the human body in the framework of the surgery in order to protect the patient from the operative stress
HISTORY OF ANESTHESIAPRIMITIVE TECHNIQUES
Club Cerebral concussion achieved by placing a wooden bowl over the head of the patient, and striking this until the patient became unconscious
Strangulation Practiced in Italy as late as the seventeenth century
Alcohol Popular in the eighteenth and nineteenth centuries. Mesmerism In 1779 Friedrich A. Mesmer of Vienna
demonstrated a capacity to bring certain subjects under hypnotic influence. First surgical procedure under mesmerism was performed by J. Cloquet, a French surgeon in 1829. Mesmerism failed because it was less efficient than ether.
Plants Opium, Mandragora (Romans)
HISTORY OF ANESTHESIAINHALATION AGENTS
• Modern Agents• Halothane 1956• Enflurane 1972• Isoflurane 1981• Sevoflurane and
Desflurane
• Nitrous Oxide1799 Davy1824 Hickman1844 Wells• Ether 1842 Long1847 Snow
• Modern Agents• Halothane 1956• Enflurane 1972• Isoflurane 1981• Sevoflurane and
Desflurane
Components of Anesthesia (detailed)
1st Line: Measures designed to diminish body reaction to surgical trauma
- Systemic Analgesia- Local Anesthesia- Control of consciousness - Control of Neuro-vegetative Response (Atar-algesia &
Neurolept-analgesia)- Muscle Relaxation- Artificial/Deliberate Hypotencion- Artificial/Controlled Hypothermia
2nd Line : Measures to control vital functions of the body (respiration, circulation, metabolism)
I. Evaluation of the Patient and Preoprative Preparation
- Preoperative Assessment- Preoperative Medication
II. Equipment PreparationIII. Patient PositioningIV. Immediate Preinduction Period and InductionV. Anesthesia Course and MonitoringVI. Ending Anesthesia and Weaning the Patient
Anesthesia Management
Preoperative AssessmentI. Anesthetic Management Plana. Previous anesthetic experience (malignant hypepyrexia
and adverse r.)b. Allergies (analgesics, antibiotics, radiographic dyes, latex)c. Review patients medical status (extent of the disease)d. Medications (can adversely interact with anesthetics)e. Fasting (to prevent aspiration pneumonitis)f. Physical Examinationg. Laboratory tests (hemoglobin and ECG)h. The surgical procedure (choosing anesthesia and
monitoring techniques) I. The anesthesia management plan
Preoperative AssessmentII. Risk and Anesthesia
ASA Classification of Physical Status
ASA Category Description
Healthy patientMild systemic disease – no functional limitationSevere s. disease – definite functional limitationSevere s. disease that is a constant threat to lifeMonitored patient not expected to survive 24 hours with or without an operation
E Emergency procedure
I.
II.
III.
IV.
V.
Preoperative Medication
Goals for Preoperative Medication– Anxiety relief – Sedation – Amnesia– Analgesia– Drying of airway secretions– Prevention of autonomic nervous system responses– Reduction of gastric fluid volume and increased pH– Antiemetic effects– Reduction of anesthetic requirements– Facilitate induction of anesthesia– Prophylaxis against allergic reactions
Anesthesia Equipment
Anesthesia Equipment
Immediate Preinduction Period and Induction
Airway Management
Airway Management
Airway Management
Airway Management
Anesthesia Course and MonitoringInhalation Anesthesia
Blood/Gas Partitition Coefficient & MAC
Halothane 2.4 0.75% Enflurane 1.9 1.7 % Isoflurane 1.4 1.2 % Nitrous Oxide 0.47
105% Desflurane 0.42 1.0 %
Intravenous Anesthetic Agents
A. Non-Narcotic AnestheticsBarbiturates (Thiopental, Thiamylal, Methoxexital)Benzodiazepines (Diazepam, Midazolam)KetaminePropofol
B. Narcotic Analgetics (Morphine, Fentanil, Alfentanil, Remifentanil, Meperidine)
Muscle RelaxantsFactors that influence use of muscle relaxants as part of general anesthesiaSurgical Procedure
- anatomic location- patient positioning
Anesthetic technique- inhalation v/s injection- airway management (mask vs endotracheal)- ventilation management (spontaneous vs controlled)
Patient factors- body habitus (lean vs obese)- ASA status- Age
Muscle Relaxants ClassificationDepolarizing
- Succinylcholine (5-10 min)Nondepolarizing Long – acting (60 – 90 min)
- d- Tubocurarine- Metocurine- Pancuronium- Doxacurium
Intermediate – acting (20 - 30 min)- Atracurium - Vecuronium
Short – acting (10 – 20 min)- Mivacurium
AnesthesiaMonitoring Requirements & Standards
I. Routine Monitoring– Presence of an Anesthetist – Heart Rate (q 5 min)– Blood Pressure (non-invasive vs invasive)– ECG (continuous)– Ventilation (observing the r. bag; auscultation; ET CO2)– Disconnect Monitors (pressure alarms)– Oxygen analyzer (inspired oxygen concentration)– Pulse Oximeter– Temperature– Diuresis
II. Advanced Hemodynamic Monitoring (CVP, PCWP, CO, etc)
Local / Regional Anesthesia
A. Peripheral Nerve Blockade
B. Spinal and Epidural
Spinal and Epidural AnesthesiaSpinal Cord Anatomy
Spinal and Epidural AnesthesiaPatient positioning
Spinal and Epidural AnesthesiaPatient positioning
Epidural AnesthesiaLumbar and Thoracic Techniques