Monitored Anesthesia Care Flashcards
The standards for________ are no
different from those for a general, or regional anesthetic.
preoperative evaluation, intraoperative monitoring, and the continuous presence of a member of the anesthesia care team
As a general principle, to avoid excessive levels of
sedation, drugs
should be titrated in small increments, or by adjustable infusions, rather than administered in larger doses
The important mechanisms whereby respiratory
functions may be compromised during monitored
anesthesia care include
the effects of sedatives and opioids on the respiratory drive, upper airway patency, and protective airway reflexes (PUR)
It’s been said, doing a great MAC is much more difficult
than doing a general anesthetic.
Monitored Anesthesia Care usually involves the administration of drugs with _______either alone or as a
supplement to a local or regional anesthetic.
anxiolytic, hypnotic, analgesic, and amnestic properties,
Standard Monitoring parameters
ETCO2
ASA Guidelines: Sedation/analgesia=
usually performed by non-anesthesia personnel, nurses
with training in sedation principles
MAC: (AKA “Twilight sleep”)
Potential for a deeper level of sedation than that provided by sedation/analgesia and is always administered
by an anesthesia professional.
The ASA states that all institutional regulations pertaining to anesthesia services shall be observed and all the usual services performed by the anesthesia professional shall be furnished, including but not limited to:
Usual non-invasive cardiocirculatory and respiratory
monitoring
Oxygen administration (when indicated)
Administration of sedatives, tranquilizers, antiemetics,
narcotics, other analgesics, beta-blockers,
vasopressors, bronchodilators, antihypertensives, or
other pharmacologic therapies as may be required in
the judgement of the anesthesia professional.
Apgar score
Lower when maternal score has been used.
Fetal ion trapping
Acidosis
may take place under the administration of larger doses of Propofol, can interrupt, or even increase the difficulty of the procedure for the surgeon
Coughing
The ultimate objective of every dosing regimen is to
deliver a therapeutic concentration of drug to the site of
action, which is determined by the unique
pharmacokinetic properties of that drug in that specific
patient.
Excessive sedation may result in
cardiac and/or respiratory depression.
Inadequate sedation may result in
patient discomfort and potential morbidity from lack of cooperation.
Following the administration of IV anesthetic drugs, the immediate
distribution phase causes a rapid decrease in the plasma levels as the drug is transported to the rapidly equilibrating vessel-rich group of tissues.
Over time, the drug is also distributed to the poorly-perfused tissues,
such as bone and fat.
Although the bone and fat compartment are poorly perfused, they may
accumulate significant amounts of lipophilic drugs during
prolonged administration, contributing to a delayed awakening and recovery when the drug is eventually released back into the central compartment after it’s administration is discontinued.
CONTEXT SENSITIVE HALF-TIME
During the early part of an infusion of a lipophilic drug, distributive factors will tend to decrease the plasma concentration as the drug is transported to the “unsaturated” peripheral tissues. Later, after the infusion has been discontinued, the drug will return from the
peripheral tissues and re-enter the “central circulation” .
The “CONTEXT SENSITIVE HALF-TIME” Definition
describes the time required for the plasma drug concentration to decline by 50% after terminating infusion
of a particular duration
The difference between the plasma concentration at
the time of discontinuance of the drug’s infusion, and
the plasma concentration
below which awakening can be predicted, is important. If the plasma concentration is above that of the level of awakening, recovery will be delayed.
No single drug can provide all the components of MAC;
(analgesia, anxiolysis, and hypnosis)
200 mg of propofol with
20 mg of Ketamine
Propofol and ketamine (KETAFOL)
Increase CO Decrease airway resistance Dilate smooth muscle Amnestic properties with ANALGESIA (ketamine) therefore synergistic effect. Decrease opioid requirements.
