Download - Anethesia & Pain Mangement
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Christine Du 12/22/10http://www.youtube.com/watch?v=ZTbKNA0XGGI
http://www.youtube.com/watch?v=ZTbKNA0XGGIhttp://www.youtube.com/watch?v=ZTbKNA0XGGI -
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5231 Spring Ridge Dr E. Macungie 18062Please do NOT
Park in front of the mailboxes.
Wear socks cause you wont be wearing shoes. Vomit on my nice carpet!
Please DOBring the family.Bring money for some texas hold em. Bring some liquid courage cause you WILLkaroake!
OVER THE HUMP CELEBRATION
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Sodium ThiopentalPropofol- Amnesic, sedative but NOT analgesic
Rapid inductionCleared by hepatic metabolism & plasma cholinesteraseSE: Hypotension, respiratory depressionContra: egg allergy
Ketamine- amnesia/analgesiaPhencyclidine derivativeDissociation between thalamus and limbic systems
No respiratory depressionVisual/auditory hallucinations delirium (tx: benzos)Indirect sympathetic nervous system stimulatory effects
Increases myocardial oxygen consumption and ICPEtomidate
Continuous infusion can lead to adrenocortical suppression.
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Inhalation Agents (unconsciousness,amnesia, some analgesia)
Generalized depressants
Myocardial depression/vasodilationCerebral function/ metabolic rateLoss of autoreguationLoss of heat conservation
MAC Lipid soluble Potency Speed of
induction
Nitrous Oxide Halothane Enflurane Isoflurane Sevoflurane
Fastestinduction;
minim cardiacdepression
Slow; highestdegree cardiacdepress/arrhy;
Hepatits;Least pungent
Seizures Fastonset/offset;Less cardiac
depress;Less
laryngospasm
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AmnesicsBenzodiazepinesShort-acting- Versed . Contra: pregnancy crosses placenta.Long acting- ativan/valium
Flumazenil- competitive inhibitor seizure/arrhythmias,contra in elevated ICP or status epilepticusAnalgesics
Narcotics act on mu receptors.Respiratory depression. Blunting of sympathetic vascular
toneChest wall rigidity with high IV doses- muscle relaxantNaloxone- SE: acute pulmonary edema and myocardialischemiaAvoid w/ MAO-I= Serotonin syndrome
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Depolarizing (noncompetitiveinhibitor) agent Nondepolarzing Agents
SuccinylcholineHydrolyzed in plasma by
cholinesteraseMalignant hyperthermia
Defect in calcium metabolismMuscle excitation-contractionsyndromeFirst sign- increased end-tidal CO2.fever/tachycardia/rigidity/acidosis/hyperkalemiaDantrolene 10mg/kg. inhigbits carelease and decouples excitationcomplex. Cooling balnkets, hco3, glc
Contra: burn pts, neurologic injury(increased ICP), neuromuscular d/o,SCI, massive trauma, ARF
Cisatracurium- Hoffmandegradation, histamine releaseMivacurium- fast, short, plasmacholinesterasesRocuronium- fast, intermediate,liver
Pancuronium- slow, long ,renalSE tachycardiaReversal
Neostigmine- blocksacetylcholinesterase
EdrophoniumAtropine or glycopyrrolate
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Temporarily block nerve conduction by binding toneuronal sodium channels. Preventing Na influx.
Autonomic sensory motor nerve transmissionAcute CNS toxicity 2/2 excessive plasma
concentrationHemodynamic/respiratory consequences 2/2excessive conduction block of sympathetic or motornervesAllergic rxns
Esters vs amides (less allergy- if so, preservatives)Spinal/epidural blocks
Progressive blockade of sympathetic nervous system vasodilation/bradycardia
LMWH
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HTNHoTN & MI intra-op higher in untreated HTN pts than those adequatelytreated if pre-op DBP >110Inadequately tx HTN more neurologic deficits after CEA.h/o prior MI have increased incidence of reinfarction
CADPreop CHF, recent MI, unstable angina, age >70DM, m>40yo, f>50yo need pre-op ECGAll elective surgery is delayed 6mos after MI.
Pulmonary Disease
Restrictive- intrinsic (ARDS) vs. extrinisic (deformity/obesity)Obstructive- FEV1/FVC
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Preoperative Health Status Comments, Examples
ASA 1 Normal healthy patient
ASA 2 Patients with mild systemic disease
No functional limitations; has a well-controlled disease of one body s(ex. controlled hypertension or diabetes without systemic effects, cismoking without chronic obstructive pulmonary disease (COPD); milobesity, pregnancy)
ASA 3 Patients with severe systemic disease
Some functional limitation; has a controlled disease of more than onsystem or one major system; no immediate danger of death;(ex. controlled congestive heart failure (CHF), stable angina, old hearattack, poorly controlled hypertension, morbid obesity, chronic renalfailure; bronchospastic disease with intermittent symptoms)
ASA 4 Patients with severe systemic disease thatis a constant threat to life
Has at least one severe disease that is poorly controlled or at end stapossible risk of death(ex. unstable angina, symptomatic COPD, symptomatic CHF, hepatofailure)
ASA 5 Moribund patients who are not expected tosurvive without the operation
Not expected to survive > 24 hours without surgery; imminent risk of(ex. multiorgan failure, sepsis syndrome with hemodynamic instabilihypothermia, poorly controlled coagulopathy)
ASA 6 A declared brain-dead patient who organsare being removed for donor purposes
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