Intro to NA Flashcards
Triad of Anesthesia
- Hypnosis
- Analgesia
- Muscle relaxation (dependent on the surgery/ what the surgeon is doing)
Dyad of Regional Anesthesia
- Analgesia
2. Muscle Relaxation
Analgesia
Main component of what we do NO PAIN
Sedative- hypnotics
- propofol (doesn’t help with pain)
- etomidate
- ketamine** (helps with pain and sedation)
- benzodiazepines (not used as frequent, longer 1/2 life)
- barbiturates
- anesthetic gases (desflurane, sevoflurane, isofluarne)
Prerequisites
- oxygen (any time you give an anesthetic)
- suction
- OR
- bed/ stretcher (drugs affect gait/ mobility)
- resuscitation bags
- monitors (EKG, BP, end tidal)
- Anesthesia provider
- drugs
- machine
- airway equipment
Recovery
- turn off agents
- reverse relaxants
- extubate/ remove LMA
- ensure return of motor/ sensory blockade (ex train of 4)
- monitor in pacu/ icu
Disadvantages of Anesthesia
- effects various systems
- allergic reaction
- recovery time varies
- post op N/V
- pain
- awareness
Local Anesthesia
**No anesthesia provider needed
-anesthetic drug usually injected into the tissue to numb the specific location requiring minor surgery
Regional Anesthesia
**Anesthesia Provider needed
-injection near a cluster of nerves will numb (larger) area that requires surgery; pt can be awake or given a sedative
ex; epidural, spinal, peripheral nerve blocks
Minimal sedation (anxiolysis)
**May or may not need Anesthesia provider
- responds normally to verbal commands, can follow instructions, pt feels relaxed, can be awake
- cognitive function and coordination may be impaired
- ventilation and cardiovascular functions are unaffected
Moderate sedation (conscious sedation)
- pt drowsy, may sleep through procedure, can wake them up with voice/ touch, can respond purposefully
- minimal memory
- no interventions required to maintain a patent airway, spontaneous ventilation is adequate
- cardiovascular function usually maintained
Deep sedation
- pt sleeps through procedure (not easily aroused, can respond purposefully to repeated/ painful stim)
- no memory
- breathing can slow, ability to maintain ventilation and airway can be impaired, supplemental oxygen given
- cardiovascular function usually maintained
General Anesthesia
**unconscious/ Not Arouseable/ No sensation
- ability to independently breath is impaired, requires assistance maintaining patent airway, + pressure ventilation may be required
- gases or vapor are inhaled through a breathing mask or tube and other drugs often given IV
- cardiovascular function may be impaired
- if risk of malignant hypothermia present, total IV propofol can achieve general (200-300 mcg/kg/min)
Monitored Anesthesia Care
(MAC)
MAC is a billing term
- uses sedatives and other agents
- dose low enough pt remains responsive and breaths without assistance
**simple procedures and minor surgery
Combination Technique
- MAC/ sedation and local/ regional anesthesia
- regional and general anesthesia
Pre-op medications
- patient comfort
- reduce anxiety
- prevent aspiration
- abx per surgeons request
Induction drugs
-can be IV or inhaled to induce anesthesia
Neuromuscular blockade
- facilitate intubation
- optimize surgical conditons
Inhalation Drug
- to maintain general anesthesia (can also be IV)
ex. propofol, etomidate, ketamine
Opioid
-minimize physiological effects of pain and promote comfort
Antiemetic
-prevent nausea likely with opioids/ inhalation agents
Neuromuscular Blockade Reversal Agent
-reverse the paralyzing effects
Alice Magaw
-published her work (ether and chloroform with open gtt; 14,000 anesthetics with no complications)
Agatha Hodgins
- taught physicians in Europe on nitrous/ oxygen anesthesia
- began first NA program and founded the AANA
Operating Room Areas
Restricted
Semi Restricted
Unrestricted
Unrestricted Area
- Traffic is NOT limited
- street clothes
- if in OR scrubs put lab coat on
ex. break room, administrative space
Semi-restricted
traffic IS limited
- surgical scrubs
- surgical caps
ex. storage area for clean medical supplies
Restricted
Traffic restricted to necessary personnel
-mask up if sterile field/supplies open
ex. where procedures are performed.
Sterile Team
- surgeon
- scrub tech
- first assist
Non- sterile team
- anesthesia
- OR. nurse
- other techs (x-ray)
OR temperature
68-75 F
Humidity
30-55%
less than 30%
- increased risk for fire
- alters sterile indicator strips
- increased infection risk
greater than 55%
- increased risk for infection
- mold/mildew
- uncomfortable
OR Ventilation
- Positive Pressure Room
- 80/20 mixture of recycled/ fresh air (from ceiling)
- 25 air exchanges per hour
- removes 90% of particles in the air
OR Noise
- normal operating room levels 75-90dB
* to be heard voices need to be 20dB above background noise
Ionizing Radiation
- enough energy to detach electron from atom
- nuclear decay (alpha, beta, gamma, neurons)
- gamma rays and X-rays
- ultraviolet light
Radiation Protection
-As little as reasonable practice (ALARP)
- Law of inverse squares (amount of radiation changes inversely with distance (1/d2)
ex. 16% less at 4m than 1m
Types of Shock
Macroshock
Microshock
Macroshock
- current applied to the body through intact skin
- measured in milliamps (mA)
- 1000 – 3000 mA Ventricular fibrillation
Microshock
- current applied directly to the heart/internal organs
- measured in microamps
- 30 microamps VF potential in humans
- 10 microamps in dogs
LASER
Light Amplification by the Stimulated Emission of Radiation (LASER)
class 4- medical lasers
Laser Safety Precautions
- room lights as bright as possible (pupils are really constricted bc light is on and small pupil less surface area for laser to damage)
- restrict access to area
- close doors/windows, signs on doors
- eye protection you and pt (human eye very vulnerable to laser beams)
- cover all skin
- n95 mask (smoke plume from cautery/ laser surgery, fine particles can be 0.1-0.8 micrometer)can be deposited into lower airways)
- remove all extra shiny things
- alarm to indicate when laser in use
- keep LASER beam above/below normal line of sight, avoid looking into the primary beam at all times
LASER safety with Anesthesia
- oxygen <30%
- avoid N20
- don’t wrap ETT in foil
- double cuff tube to prevent leaking of gas if cuff ruptures
- LMAs can be sensitive to Lasers
Waste Anesthesia Gas
-if you can smell it you are over the limit
threshold for smell 5-300ppm
Equipment cleaning
- Critical: sterilization
ex. surgical instruments - Semi- critical: highly disinfected
ex. anesthesia blades/scopes - Non-critical: wipe down in between cases
ex. BP cuff, cables
Single use: 1 and done, single pt
