- AKA denitrogenation - increases patients ability to sustain apnea - fills reservoir of O2 in lungs allowing time to intubate w/o desaturation

- preoxygenate thoroughly - IA dose (propofol) - succinylcholine (rapid acting MR)

Lecture 1 Flashcards by Kira Harms

anesthesia

chemically initiating and maintaining loss of sensation in a patient while maintaining hemodynamic stability in order to allow the surgical team to complete their task

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goals of anesthesia (5)

1) antinociception
2) amnesia
3) akinesia
4) hemodynamic stability
5) unconsciousness

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antinociception

no pain

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amnesia

no memory

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akinesia

no movement

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hemodynamic stability

stable BP and HR

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unconsciousness

“going to sleep”

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phases of anesthesia

1) preoperative
2) intraoperative
3) postoperative

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preoperative phase definition

all necessary steps prior to delivery of anesthesia including

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intraoperative phase definition

patient is in the operating room

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intraoperative phase steps

preinduction
induction
maintenance
cessation of surgery/anesthesia

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preoperative phase steps

testing (labs, EKG, echo, respiratory)
evaluation of anesthetic plan
patient consent
place lines (catheters, A lines, IV)
premedication (anxiolytic, analgesic, antiemetic, antibiotics)
workspace setup

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intraoperative phase monitoring devices

pulse ox (heme-bound O2)
blood pressure
temp
EKG

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preoxygeneation

AKA denitrogenation
increases patients ability to sustain apnea
fills reservoir of O2 in lungs allowing time to intubate w/o desaturation

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safe apnea time period definition

time it takes for patient to reach 88-90% saturation

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preoxygenation safe apnea time period

up to 11 min (high)
typically 9 for healthy adult

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preoxygeneation methods

1) 100% O2 for 3 min
2) 8 deep breaths of 10 LPM O2 at 100%

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Induction definition

delivery of drugs to patient to achieve necesssary anesthetic plan

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3 methods of induction

1) IV
2) Mask
3) Ketamine dart (IM)

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Rapid Sequence Induction

decreases time between loss of airway reflexes and intubation
reduces likelihood of patient aspiration

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RSI candidates

Full stomach patients
- trauma
- non-NPO emergency
- pregnant
- bowel obstruction
- appendectomy
- morbidly obese
- diabetic w/gastroparesis

gastroesophageal reflux disease

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RSI general steps

preoxygenate thoroughly
IA dose (propofol)
succinylcholine (rapid acting MR)

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IV induction advantages

faster = safer (10-20s)
less prolonged excitatory phase = decreased risk of laryngospasm and aspiration

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IV induction disadvantages

rapid loss of airway protective reflexes and airway patency

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Mask induction advantages

no iv needed prior to anesthetic

Mask induction disadvantages

slower prolonged stage II phase

Mask induction (peds dose)

4 LPM N2O + 2 LPM O2 sevoflurane at 8%

IM induction

"ketamine dart" 4-6mg ketamine IM 21 ga 1 1/2" needle

IM induction advantages

useful for non-compliant patient

IM induction disadvantages

non-compliant patient can cause injury to themselves/others

Basic Positions

supine prone lateral decubitus lithotomy

other positions

beach chair trendelenburg reverse trendelenburg sphinx

Patient monitoring

Check: EKG/HR BP EtCO2 IV fluid administration Urine output Blood loss

Anesthetic cessation

prep for PACU/ICU Gas/TIVA OFF Reverse MR adequate antinociceptic

postoperative phase

-patient transport to PACU or ICU -evaluate pain management

PACU report

necessary Hx surgery fluids (blood loss, urine, fluids given) drugs given other pertinent info

general anesthesia

anesthetic where the anesthetis accomplished all 5 goals of anesthesia

general anesthesia stage 1

analgesia/induction - period from initial administration of induction drugs to loss of consciousness

general anesthesia stage 2

excitement/delerium - period from loss of consciousness

GA stage 2 physical signs

uncontrolled movements pupillary dilation irregular respiration increased HR

GA stage 3

surgical anesthetic

Plane 1

from return of regular respirations to cessation of REM

Plane 2

from cessation of REM to paresis of intercostal muscles

Plane 3

from Intercostal paresis to complete paralysis of intercostals

Plane 4

from paralysis of intercostal muscles to diaphragmatic paralysisS

GA stage 4

overdose

Regional anesthesia

blocking pain and motor neuron firing in specific regions of the body with local anesthetic without exposing patient to risk of GA

Neuraxial anesthesia types

spinal epidural caudal

peripheral anesthesia

ultrasound guidance to identify nerves proximal to surgical site with infiltration of local anesthetic and other adjuncts to disrupt nerve transmission

epidural space

potential space between ligamentum flavum and dura

Dermatomes

spinal roots project to level of skin

C3-5

keep diaphragm alive

T1-4

cardiac accelerator fibers

nipple line

xiphoid process

T10

umbilicus

L1-5

bowel function

S1-3

innervation to perineum

Absolute contraindications to spinal/epidural

- infection at injection site - lack of consent - severe hypovolemia - coagulopathy - increased intracranial pressure (ICP)

Relative contraindications to spinal/epidural

- sepsis - uncooperative patient - preexisting neurological deficits (MS) - stenotic valvular heart lesions (aortic stenosis) - left ventricular outflow tract obstruction - severe spinal deformity

peripheral nerve blocks

ultrasound guided infitration of local anesthetic around a nerve in order to block transmission of sensory nerve impulses

monitored anesthetic care (MAC)

pharmacologic sedation using opioids or hypnotic agent with monitoring during sedation

MAC risk

respiratory depression UA obstruction hypoventilation hypoxemia

MAC failure reasons

patient intolerance patient discomfort patient complication (hemodynamic instability, hypoxemia) procedural factors (bleeding, prolonged surgical time, procedure change)