17: Anesthesia - Stefani Flashcards Preview

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Flashcards in 17: Anesthesia - Stefani Deck (20)
1

goals of spinal anesthesia (injecting drug into subarachnoid space)

Prevention of pain
Adequate dermatomal level of anesthesia
Adequate duration of anesthesia
Skeletal muscle relaxation

2

contraindications for spinal anesthesia

Sepsis (hemodynamic instability)
Bacteremia (with caveats)
Skin infection at injection site (tatoos?)
Severe hypovolemia
Coagulopathies and anticoagulants
Increased ICP
Patient refusal
Stenotic heart disease

3

Technique for spinal anesthesia

Lateral, sitting, or prone position
Between L2-3 and L5-S1
A larger gauge introducer can be placed through the skin into the interspace and the spinal needle is introduced through it
Approach can be midline or lateral (paramedian)

4

ideal position for spinal anesthesia

L3,L4 marked by iliac crest
sitting position
can use ultrasound guided spinal anesthesia

5

major factors for height of spinal block ****

Dose of drug given - primary factor ***

Weight (baricity) of injected local
anesthetic solution

Patient position – Sitting or lying ( if they are lying are they head up or head down)

CSF volume ( the “X” factor )

6

drug usually used for LE surgery

isobaric bupivacaine spinal

- Has a concentration of 0.5% and a baricity ( or specific gravity ) approaching that of CSF
- Is given in a larger volume in the sitting or lateral position
- Does not spread cephelad and settles in the lordotic area of the spinal cord
- Has a longer duration of action

7

why do some people die with spinal anesthesia?

bradycardia and hypotension which has lead to death

treat vasopressors, raise legs, anticholinergic agent, epinephrine

8

contraindications for conscious sedatation

History of adverse reaction to sedative medication
Unstable cardiorespiratory status
Nonfasting state – relative contraindication since a lot of sedation is done in ER’s on patients with full stomachs
First trimester of pregnancy (elective cases)

9

aka conscious sedation ********

moderate sedatation/analgesia

- Drug induced depression of consciousness
- Pt.’s respond purposely to verbal commands
- Airway remains patent
- Spontaneous ventilation & cardiovascular function usually maintained

10

risk factors for conscious sedation

Age
Single or multiple organ system disease
History of drug or alcohol use
Anatomic problems
-- Airway anomalies
-- Sleep apnea
Delayed mental development
Uncooperative
Emergencies
Morbid obesity

11

position for conscious sedation

- keep them in a position in which they can breathe on their own
- ear should be on same line as chest

12

how does obesity affect lung volume?

limits the functional residual capacity - smaller reserve oxygen in case of emergency

13

get article on perioperative cardiovascular for reading

add it to your library

14

*** pt had a drug eluding stent and you want to take them to surgery, what should you do to meds?

dont stop ASA unless VERY good reason
stop plavix if taking

15

fasting guidelines

clear liquid - 2 hrs
full liquid - 4 hrs
light meal - 6 hrs
heavy meal - 8 hrs

16

what medications are used for conscious sedatation and why? *****

Sedation: Benzodiazepines

Analgesia: Opiates

Why these agents?...because they their effects can be reversed

17

reversal agents for conscious sedation drugs

flumazinil/romazicon for benzos

naloxone/narcan for opiates

18

What agents are used for deep sedation and should you use them?

Thiopental, Propofol, Etomidate, Ketamine should not be used unless credentialed to do so by hospital. ***

Person giving these drugs must be able to rescue from deep sedation or general anesthesia

19

___ mcg Fentanyl = ___ mg Morphine =___ mg Meperidine

50 mcg Fentanyl = 5 mg Morphine = 50 mg Meperidine

20

watch video on conscious sedation for minor procedures in adults

NEJM

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