Taxonomy of Anesthesia Flashcards
Meaning of anaisthsia
Lack of sensation
What is anesthesia
a drug induced reversible depression of the CNS resulting in loss of response to and perception of all stimuli
Anesthesia is a
deafferented state
Amnesia and unconciousness are
equally important
Do all general anesthetics do produce equal depression of sensation?
No
Anesthesia
total of partial loss of sensation induced by a disease stat injury, accupuncture, trauma, anesthetics (iNO) to local or general insensibility to pain w/ or w/o a loss of consciousness
Analgesia
dampening or absence of pain without LOC
Components of General Anesthesia
amnesia, analgesia, unconsciousness, immobility, areflexia
areflexia
attenuation of autonomic responses to noxious stimulation
Components of Anesthesia
analgesia
amnesia
areflexia
Types of Anesthesia
Monitored Anesthesia Care
General Anesthesia (inhalation or IV induction)
Regional- topical or infiltration, peripheral nerve block, plexus blocks, central neuraxial blocks (spinal/epidural)
spinal Block
subarachnoid/intrathecal
Epidural block
peridural/caudal
Thiopental/Propofol
-/+ amnesia
Benzodiazepines
+ amnesia
Narcotics
Analgesia
+/- amnesia
Inhalation Agents (Nitrous Oxide)
-/+ anaglesia and amnesia
Isoflurane
+/-, +/- analgesia
-/+ muscle relaxation
Ketamine
analgesia, amnesia
Regional Technqiue
Analgesia, +/- muscle relaxation
Room Preparation
MAchine Check and Monitors
suction (Oral and ETT size)
Or table and accessaory equipment (arm boards, stirrups)
warming devices (Fluid warmer, warming blanket, etc)
other equipment: arterial line, infusion pumps, precordial doppler, cerebral oximeter
Airway Supplies
face mask oral airways/ tongue blades nasal airways/lubricant laryngoscope blade various blades ett, stylets, 10 cc syringes ambu bag lma/ airway adjuncts difficult airway and MH carts
Other Supplies
IV Supplies (IV fluids, extension tubing, volume expanders)
Anesthesia Cart (fully stocked, other neccessary supplies)
Positioning Equipment
head rest, arm boards/ pads, prone pillow, axillary roll, extra pillows/padding, eye pads/ padding, lubricant, anesthesia circuit extenders
Holding Area
greet patient and family
properly identify partient (armband, verbally)
reaffirm type/site of surgery
interview and re-assess
airway assessment and planning
review patient and chart for changes since interview
formulate anesthestic plan (ind for surgery/pt)
obtain anesthesia constent
lines (iv, invasive monitoring)
Choosing the Anesthetic
anesthesia is patient specific, not a formula or recipe
plan should promote patient stability and patient outcomes
adapt plan to consider patient and surgical needs
integrate:
anatomical and physical findings
functional status
patient’s medical/surgical history
surgical considerations
plan A, plan B, plan C
What to consider
patient's current phsyical condition type and site of surgery surgical position costs elective or emergent surgery NPO status patient bias surgeon skill level anesthetist's skill and preference
Goals for Pharamcologic Premeds
anxiolysis, sedation, analgesia, amnesia, antisialagoue effect, antiemetic, increase gastic fluid pH, decrease gastric fluid volume, allergic prop, antimicrobial protection
Failure to Emerge
residual NMB
excessive opioid or benzo administeration
intraoperative CVA
pre-existing conditions (CNS dx, hepatic insufficiecy, ETOH)
electrolyte abnormalities
acidosis
hypothermia
