PUTLA MO. ANEMIC KA NOH?! IKAW NANGI- NGITIM KA NA! CYANOTIC KA! INTUBATE KITA!
May 18, 2015
PUTLA MO.ANEMIC KA NOH?!
IKAW NANGI-NGITIM KA NA! CYANOTIC KA!INTUBATE KITA!
Anesthesia
Anesthesia
is the state of narcosis, analgesia, relaxation and loss of reflex
the client is not arousable even to painful stimuli
DEFINITION OF TERMS
ANESTHESIOLOGIST- physician trained to deliver anesthesia and to monitor patient during surgery
ANESTHETIST- health care professional, such as a nurse anesthetist, who is trained to deliver anesthesia and to monitor the patients condition during surgery
ANESTHETIC- the substance such as a chemical gas, used to induced anesthesia
Effects of Anesthesia
1.To produce muscle relaxation
2.Analgesia3.Loss of memory4.Artificial sleep
(unconsciousness)5.Relieves fear and anxiety
Factors considered in choice of Anesthesia
Physical conditionAgePresence of co-existing disease
Type, site, duration of surgery
Anesthesiologist’s preferencePatient’s preference
Stages of Anesthesia
1.Beginning2.Excitement3.Surgical4.Medullary
Types of anesthesia
1.GENERAL ANESTHESIA
2.REGIONAL ANESTHESIA
Types of Anesthesia
General anesthesiaLoss of all sensation and consciousness
Regional or Local anesthesiaLoss of sensation in ONE area with consciousness present
Type of Sedation
Minimal sedationanxiolysis
Moderate sedationconscious sedation
Deep Sedationanalgesia
General Anesthesia
Blocks the pain stimulus at the cortex
Total loss of consciousness and sensation
Produces amnesia, analgesia, hypnosis and relaxation
GENERAL ANESTHESIA
GENERAL ANESTHESIA
WHAT are the
ADVANTAGES:
DISADVANTAGE:
Administered by:
1. IV INFUSION2. INHALATION Mask Nasal Oral tracheal
INTRAVENOUS ANESTHETIC AGENTS:
1. TRANQUILIZERS AND SEDATIVE HYPNOTICS (Benzodiazepines)
a.Midazolam (Dormicum)b.Diazepam (Valium)c.Chlordiazepoxide (Librium)d.Droperidol (Inapsine)e.Lorazepam (Ativan)
INTRAVENOUS ANESTHETIC AGENTS:
2. OPIOIDS (Narcotics)a. Morphineb. Meperidine HCl
(Demerol)
INTRAVENOUS ANESTHETIC AGENTS:
3. NEUROLEPANALGESICSa. Fentanyl (Sublimaze)b. Sufentanil
4. DISSOCIATIVE AGENTSa. Ketamine (Ketaralac;
Ketajact)
INTRAVENOUS ANESTHETIC AGENTS:
5. BARBITURATESa. Thiopental Na (Pentothal)b. Methohexital Na (Brevital)
6. NONBARBITURATES HYPNOTICS
a. Etomidate (Amidate)b. Propofol (Diprivan)
INTRAVENOUS ANESTHETIC AGENTS:
5. BARBITURATESa. Thiopental Na (Pentothal)b. Methohexital Na (Brevital)
6. NONBARBITURATES HYPNOTICS
a. Etomidate (Amidate)b. Propofol (Diprivan)
GA Induction procedure1. Positioning2. IV line3. Monitoring4. Strap5. Rapid acting drugs
Thiopental (Pentothal) Propofol (Diprovan) Methohexital (Brevital)
6. O2 and Gas via mask7. Muscle relaxant
ADULT: Succiniylcholine chloride (Anectine)
PEDIA: ▪ Rocuronium (Zemuron)▪ Atracurium (Tracrium)▪ Vecuronium (Norcuron)
8. INTUBATION
Induction of GA
KEY POINTS DURING INDUCTION!1. Circulator should remain 2. Gentle and rapid approach3. Avoid stimulation of the patient
(mandatory) “noise avoidance” 4. Do not touch patient until
anesthesiologist says it is safe to do so5. Precaution: ECG, defib, chest stet, BP6. Positioning: if obese elevate head to
avoid pressure (protect diaphragm)7. If hypotensive- flat8. Children: circulator- to be less
frightening stay close to the child
INHALATION ANESTHETIC AGENTS:
1. VOLATILE LIQUIDS:a.Halothane (Fluothane)b.Methoxyflurane
(Penthrane)c. Enflutane (Ethrane)d.Isoflurane (Forane)e.Sevoflurane (Ultrane)f. Desflurane (Suprane)
INHALATION ANESTHETIC AGENTS:
2. GASES:a.Nitrous oxide
REGIONAL ANESTHESIA
Produces loss of sensation in only one region of the body and does not cause loss of consciousness
Blocks pain stimulus at its:1.Origin2.Along afferent neurons3.Along the spinal cord
Block pain stimulus at its ORIGIN
1.TOPICAL – directly applied into the area to be desensitized with the use of a solution
2.LOCAL INFILTRATION BLOCK – blocks only peripheral nerves around the area of incision
ALONG AFFERENT NEURONS
1. FIELD BLOCK – areas proximal to the incision site is injected and infiltrated a barrier (“WALL IN”)
2. PERIPHERAL NERVE BLOCK – anesthetizes individual nerves or nerve plexuses rather than all the nerves anesthetized by a field block
Infiltration or Field Block
Nerve Block Anesthesia
ALONG SPINAL CORD:
Blocks impulses along the spinal cord and nerve roots and may occur either in the subarachnoid or epidural space
ALONG SPINAL CORD:
1. SPINAL – produces a nerve block in the subarachnoid space
2. EPIDURAL – injection of local anesthetic into the spinal canal in the space surrounding the dura mater
3. CAUDAL (TRANS-SACRAL) – produces anesthesia of the perineum and occasionally, the lower abdomen
REGIONAL AnesthesiaExercises:
TOPICAL Applied directly on the skin
INFILTRATION Injected into a specific area of skin
NERVE BLOCK Injected around a nerve
SPINAL Subarachnoid
Low spinal anesthesia
EPIDURAL Epidural space is injected with anesthesia
LOCAL ANESTHETIC AGENTS:
1.Lidocaine (Xylocaine) and Mepivacaine (Carbocaine)
2.Bupivacaine (Marcaine)3.Etidocaine (Duranest)4.Procaine (Novocaine)5.Tetracaine (Pontocaine)
REGIONAL ANESTHETIC AGENTS:
1.Procaine (Novocaine)2.Tetracaine
(Pontocaine)3.Lidocaine (Xylocaine)4.Bupivacaine
(Marcaine)
procedures
Spinal Anesthesia
Epidural Anesthesia