17: Anesthesia - Stefani Flashcards
goals of spinal anesthesia (injecting drug into subarachnoid space)
Prevention of pain
Adequate dermatomal level of anesthesia
Adequate duration of anesthesia
Skeletal muscle relaxation
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
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)
ideal position for spinal anesthesia
L3,L4 marked by iliac crest
sitting position
can use ultrasound guided spinal anesthesia
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 )
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
why do some people die with spinal anesthesia?
bradycardia and hypotension which has lead to death
treat vasopressors, raise legs, anticholinergic agent, epinephrine
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)
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
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
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
how does obesity affect lung volume?
limits the functional residual capacity - smaller reserve oxygen in case of emergency
get article on perioperative cardiovascular for reading
add it to your library
*** 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
fasting guidelines
clear liquid - 2 hrs
full liquid - 4 hrs
light meal - 6 hrs
heavy meal - 8 hrs
