principles of anesthesia
DESCRIPTION
Principles of Anesthesia. ST210 Concorde Career College. Objectives. Assess the action, uses, and modes of administration of drugs and anesthetic agents used in the care of the surgical patient Recognize general terminology and abbreviations associated with anesthesia - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/1.jpg)
Principles of Anesthesia
ST210Concorde Career College
![Page 2: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/2.jpg)
Objectives
• Assess the action, uses, and modes of administration of drugs and anesthetic agents used in the care of the surgical patient
• Recognize general terminology and abbreviations associated with anesthesia
• Recognize the side effects and contraindications for the use of various anesthetic drugs
![Page 3: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/3.jpg)
Objectives
• Interpret factors that influence anesthesia selection for individual patients
• List the equipment used during anesthesia administration
• Analyze how sterile technique is used in relation to anesthesia procedures
• Compare and contrast the roles of the surgical technologist and circulator during the administration of anesthesia
![Page 4: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/4.jpg)
Definitions
Anesthesia - From the Greek meaning lack of sensation; particularly during surgical intervention.
![Page 5: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/5.jpg)
Definitions
• Review• HYPNOSIS• ANESTHESIA• AMNESIA• MUSCLE RELAXATION• POSITIONING• HOMEOSTASIS
![Page 6: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/6.jpg)
Anesthesia History Timeline
• 1500s: Coca leaves used as local anesthetic during trephination of the skull
• 1725: Ether was discovered by Spanish chemist Raymundus Lillius
• 1800s: Social use of ether - “ether frolics”
• 1842: Crawford W. Long may have been the first to use ether for surgical pain control, but did not publish his findings until 1848
![Page 7: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/7.jpg)
Anesthesia History Timeline
• 1846: William T.G. Morton performed surgery at Mass General Hospital in front of an audience– First Surgical Use of Anesthetics – Click Here– Ether Dome: Mass General Hospital
• 1905: Long Island Society Anesthetists (LISA) formed• 1936: LISA changed name to ASA (American Society
of Anesthesiologists)
![Page 8: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/8.jpg)
Anesthesia History Timeline
![Page 9: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/9.jpg)
Anesthesia History Timeline
![Page 11: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/11.jpg)
Anesthesia Administration
Two primary methods of anesthesia administration:
1.Inhalation Agents– Typically for General Anesthesia
2.Injectable Agents– Typically for Nerve Conduction Blockade, or– Regional Anesthesia
![Page 12: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/12.jpg)
General Anesthesia
Alteration in the patient’s level of consciousness (patient is “asleep”)
Accomplished by:• Agent inhalation• Agent injection• Agent instillation
![Page 13: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/13.jpg)
Nerve Conduction Blockade
Prevent initiation of conduction of nerve impulses along a nerve pathway
(patient is “awake”)
![Page 14: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/14.jpg)
Anesthesia Selection
Factors that affect selection of the type of anesthesia:
• Planned procedure and estimated duration• Patient position• Age, size, and weight of the patient• Patient status (emotional, mental, and physical) • General health of the patient (comorbid conditions)
![Page 15: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/15.jpg)
Anesthesia Selection
Factors that affect selection of the type of anesthesia: (continued)
• Medication status• Allergy status• History of substance abuse• Emergency conditions• Preference (surgeon, anesthesia provider, patient)
![Page 16: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/16.jpg)
ASA Risk Classification System
• Class 1 – No organic, physiological, biochemical, or psychiatric disturbance
• Class 2 – Mild to moderate systemic disease or disturbance (e.g., controlled hypertension or diabetes, asthma, anemia, smoking, mild obesity, age – less than 1 or greater than 70)
![Page 17: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/17.jpg)
ASA Risk Classification System
• Class 3 – Severe systemic disease or disturbance (e.g., stable angina, previous MI, poorly controlled hypertension or diabetes, symptomatic respiratory disease, massive obesity)
• Class 4 – Severe (life threatening) systemic disease or disturbance (e.g., unstable angina, CHF, debilitating respiratory disease, hepatorenal failure)
![Page 18: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/18.jpg)
ASA Risk Classification System
Class 5 – Moribund
Class 6 – Brain dead
E – Emergency modifier
![Page 19: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/19.jpg)
Roles of the Surgical Team Members
(refer to the tables on pp. 257-261)
• Preoperative case management duties
• Intraoperative case management duties • Postoperative case management duties
![Page 20: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/20.jpg)
Anesthesia Evaluation & Preparation
Preanesthetic evaluation and preparation processes
• Preoperative routine• Preoperative education• Patient possessions• Preoperative procedures
![Page 21: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/21.jpg)
Preoperative Routine
– Enema– Nail polish and makeup– Hygiene (shower and shave)– Attire– Sedation– Call to the OR– Family visit– Identification, chart, consent, transportation,
transfer...
![Page 22: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/22.jpg)
Anesthesia EquipmentEquipment and techniques used to monitor the patient
• Blood pressure• O2 Sat
• Temperature• I&O• Heart• BIS
• Respiration– SARA
• Doppler• Peripheral Nerve
Stimulator• ABG
![Page 23: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/23.jpg)
Anesthesia Equipment Equipment and techniques used to monitor the patient
Blood Pressure
Sphygmomanometer(with stethoscope)
![Page 24: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/24.jpg)
Anesthesia Equipment Equipment and techniques used to monitor the patient
O2 Sat
Pulse Oximeter
![Page 25: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/25.jpg)
Anesthesia Equipment Equipment and techniques used to monitor the patient
Temperature
ThermometerEsophageal Stethoscope
with temperature probe
![Page 26: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/26.jpg)
Anesthesia Equipment Equipment and techniques used to monitor the patient
I&O
Intake and Output
![Page 27: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/27.jpg)
Anesthesia Equipment Equipment and techniques used to monitor the patient
Heart
Apical Stethoscope Earpiece
![Page 28: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/28.jpg)
Anesthesia Equipment Equipment and techniques used to monitor the patient
Heart
ElectrocardiogramElectrodes
![Page 29: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/29.jpg)
Anesthesia Equipment Equipment and techniques used to monitor the patient
Heart
ElectrocardiogramLeads
![Page 30: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/30.jpg)
Anesthesia Equipment Equipment and techniques used to monitor the patient
Heart
Electrocardiogram(ECG)
![Page 31: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/31.jpg)
Anesthesia Equipment Equipment and techniques used to monitor the patient
BIS Monitor(Bispectral Index)
![Page 32: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/32.jpg)
Anesthesia Equipment Equipment and techniques used to monitor the patient
Respiration
SARA(System for Anesthetic
and Respiratory Analysis)
![Page 33: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/33.jpg)
Anesthesia Equipment
SARA is capable of several functions including:
• Capnography
• Spirometry
• Oxygen analysis
![Page 34: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/34.jpg)
Anesthesia Equipment Equipment and techniques used to monitor the patient
Doppler
![Page 35: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/35.jpg)
Anesthesia Equipment Equipment and techniques used to monitor the patient
Peripheral Nerve Stimulator
![Page 36: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/36.jpg)
Anesthesia Equipment Equipment and techniques used to monitor the patient
ABG(Arterial Blood Gas)
![Page 37: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/37.jpg)
Methods of Anesthetic Administration
• General– Balanced– Neuroleptanalgesia
• Nerve Conduction Blockade– Regional– Local– Topical
![Page 38: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/38.jpg)
Common Anesthetic Agents
• Inhalation Agents– Oxygen– Nitrous oxide– Waste gases
![Page 39: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/39.jpg)
Common Anesthetic Agents
Oxygen
• Inhalation agent• Not anesthetic agent• Necessary for life
![Page 40: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/40.jpg)
Common Anesthetic Agents
Nitrous Oxide
• Produces analgesia and amnesia
• Produces little muscle relaxation
• Decreases myocardial contractility and respiratory function
![Page 41: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/41.jpg)
Common Anesthetic Agents
Waste gas scavenger system
![Page 42: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/42.jpg)
Common Anesthetic Agents
Volatile Agents
• Liquids with potent evaporative vapors• CNS depression produces general anesthesia• Myocardial and respiratory depression• Decrease muscle tone
![Page 43: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/43.jpg)
Volatile Agents
• Halothane (Fluothane)• Enflurane (Ethrane)• Isoflurane (Forane)• Desflurane (Suprane)• Sevoflurane (Ultane)
![Page 44: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/44.jpg)
Halothane
• Rapid acting• Sweet odor• Nonirritating to the
respiratory tree• Used for induction
and maintenance
![Page 45: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/45.jpg)
Enflurane
• Halogenated• Sweet odor• Rapid induction• Rapid recovery• Hypotension (when not
surgically stimulated)• Potentiates
nondepolarizing NMB
![Page 46: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/46.jpg)
Isoflurane
• Rapid induction and recovery
• Musty smelling• Profound respiratory
depression and hypotension
• Markedly potentiates NMB
• Increases ICP
![Page 47: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/47.jpg)
Desflurane
• Halogenated• Requires heated
vaporizer• Pungent aroma• Not biotransformed in
the liver
![Page 48: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/48.jpg)
Sevoflurane
• Odorless• No irritation to
respiratory tree• Causes bradycardia, hypotension,
dysrhythmias, decreases cardiac output
![Page 49: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/49.jpg)
Intravenous Agents
• Permit rapid pleasant transition from consciousness to unconsciousness
• Produce marked sedation and amnesia• Produce hypotension and respiratory depression• Some induction agents may also be used for
maintenance
![Page 50: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/50.jpg)
Intravenous Agents for Induction
• Propofol (Diprivan)• Etomidate (Amidate)• Thiopental sodium (Pentothal Sodium)• Methohexital sodium (Brevital)
![Page 51: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/51.jpg)
Propofol
• Sedative hypnotic• Soy oil in water emulsion
(inhibits microbial growth)• Induction or conscious
sedation• Alkaline – irritating to the
vein• Causes increased ICP and
hypotension
![Page 52: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/52.jpg)
Propofol• Formulations of intravenous anesthetic propofol emulsions
are provided which contain sufficiently low concentrations of soybean oil to produce a stable emulsion and simultaneously provide reduced nutrients, which inhibit microbial growth thereby providing protection against accidental microbial contamination during long-term IV infusions. In addition to the inhibition of microbial growth due to a reduction of nutrients, the formulation exhibits unanticipated additional microbial inhibition due to an increased availability of propofol. The low concentration of soybean oil also provides a formulation that reduces the chances of fat overload when administered over an extended period of time to chronically ill patients.
![Page 53: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/53.jpg)
Etomidate
• Non-barbiturate hypnotic
• Produces minimal cardiovascular system effects
• Causes nausea, vomiting, and adrenal suppression
![Page 54: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/54.jpg)
Thiopental Sodium
• Potent barbiturate• Short acting• Alkaline – irritating to
the vein• Less expensive than
propofol
![Page 55: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/55.jpg)
Methohexital Sodium
• Similar in action to propofol and thiopental sodium
• Ultrashort onset and duration of action
• Ideal agent for short term loss of consciousness during nerve conduction blockade
![Page 56: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/56.jpg)
Dissociative Agents
• Interrupt the associative pathways of the brain (patient appears awake, but is unaware of surroundings
• Produce amnesia and profound analgesia
![Page 57: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/57.jpg)
Dissociative Agents
Ketamine Hydrochloride (Ketalar)
• Most commonly used• IM or IV administration• Rapid induction of dissociative state• Potentiated by other agents (narcotics/barbiturates)• Increases muscle tone• Increases ICP and IOP
![Page 58: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/58.jpg)
Opiate/Opioids
• Narcotic (Class II) analgesics(decrease pain impulse transmission from CNS and spinal cord receptors)
• Also produce sedation • Produce euphoria and decrease anxiety• High doses lead to unconsciousness and respiratory
depression
![Page 59: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/59.jpg)
Opiate/Opioids
• Morphine sulfate• Meperidine (Demerol)• Fentanyl citrate (Sublimaze)• Sufentanil citrate (Sufenta)• Alfentanil hydrochloride (Alfenta)• Remifentanil hydrochloride (Ultiva)
![Page 60: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/60.jpg)
Narcotic Antagonists
• Antagonize or reverse narcotic effects• Increased level of consciousness seen in 1-2
minutes• Naloxone hydrochloride (Narcan)
![Page 61: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/61.jpg)
Benzodiazepines
• Sedative tranquilizers• Reduce anxiety/apprehension• Adjunct to general anesthesia (reduce amount
and concentration of other agents)• Do not produce analgesia
![Page 62: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/62.jpg)
Benzodiazepines
• Diazepam (Valium)• Midazolam (Versed)• Droperidol (Inapsine)
![Page 63: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/63.jpg)
Benzodiazepine Antagonist
• Flumazenil (Mazicon)– Reverses the sedative effects, but may not reverse
the amnesia effects– May cause convulsions– Rebound sedation and respiratory depression may
occur
![Page 64: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/64.jpg)
Neuromuscular Junction
![Page 65: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/65.jpg)
Neuromuscular Junction Review
• http://www.wisc-online.com/objects/ViewObject.aspx?ID=AP2804
![Page 66: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/66.jpg)
Neuromuscular Junction
![Page 67: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/67.jpg)
Neuromuscular Blockers (NMBs)
• Skeletal muscle relaxants (cause weakness – paralysis)
• Interfere with passage of impulses from motor nerves to skeletal muscles
• May use only one dose or re-administer throughout procedure
![Page 68: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/68.jpg)
Neuromuscular Blockers (NMBs)
• Used to relax the jaw for ease of endotracheal intubation
• Muscles of respiration are affected (mechanical ventilation required)
• Surgical site relaxation to allow for tissue retraction
![Page 69: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/69.jpg)
Neuromuscular Blockers (NMBs)
Depolarizing Agents
• Mimic release of acetylcholine across the neuromuscular junction
• Causes muscle contraction (fasciculation) followed by a period of muscle fatigue
• Patient may experience postprocedure muscle ache
![Page 70: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/70.jpg)
Neuromuscular Blockers (NMBs)
Depolarizing Agents
• Metabolized by plasma cholinesterase in the synapse reversing the effect of the agent
• NO pharmacologic antagonist
![Page 71: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/71.jpg)
Neuromuscular Blockers (NMBs)
Depolarizing Agents
• Succinylcholine (Anectine)– Most commonly used– Short acting– Known triggering agent for MH
• Decamethonium (Syncurine)
![Page 72: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/72.jpg)
Neuromuscular Blockers (NMBs)
Nondepolarizing Agents
• Compete for post synaptic receptors• Prevents stimulation of muscle contraction• Duration (short, intermediate, long)• Spontaneous recovery may occur• Pharmacologic antagonist available
– Edrophonium chloride (Tensilon)– Neostigmine (Prostigmin)
![Page 73: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/73.jpg)
Neuromuscular Blockers (NMBs)
Nondepolarizing Agents
Short Acting
• Mivacurium chloride (Mivacron)• Vecuronium bromide (Norcuron)• Rocuronium bromide (Zemuron)
![Page 74: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/74.jpg)
Neuromuscular Blockers (NMBs)
Nondepolarizing Agents
Intermediate Acting
• Atracurium Besylate (Tracrium)• Cisatracurium besylate (Nimbex)
![Page 75: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/75.jpg)
Neuromuscular Blockers (NMBs)
Nondepolarizing Agents
Long Acting
• Tubocurarine chloride (Curare)• Pancuronium bromide (Pavulon)• Metocurine iodide (Metubine)
![Page 76: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/76.jpg)
Antimuscarinic (Anticholinergic)
• Used to limit salivation and bradycardia
• Two commonly used agents– Atropine sulfate– Glycopyrrolate (Robinul)
![Page 77: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/77.jpg)
NSAIDs
Nonsteroidal Anti-Inflammatory Agents
• Aid in pain management
• Main agent– Ketoralac (Toradol) – May be given IM
intraoperatively to aid in emergence and recovery pain management
![Page 78: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/78.jpg)
Gastric Acid Management
• Used to alter the pH of gastric secretions and reduce gastric acid volume
• Reduce the risk of stress ulcer• Agents
– Oral agent citric acid (Bicitra)– IV agent cimetidine (Tagamet)– IV agent ranitidine (Zantac)– Metoclopramide (Reglan) – promotes pyloric emptying
![Page 79: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/79.jpg)
Antiemetic
• Used to prevent or alleviate nausea• Agents
– Droperidol (Inapsine)– Metoclopramide (Reglan)
![Page 80: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/80.jpg)
Administration Devices
• Anesthesia Machine• Vaporizer• Anesthesia Circuit • Airway Delivery/Maintenance Devices• Hypo/Hyperthermia Devices
![Page 81: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/81.jpg)
Administration Devices
Anesthesia Machine
![Page 82: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/82.jpg)
Administration Devices
Anesthesia Cart
![Page 83: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/83.jpg)
Administration Devices
Vaporizer
![Page 85: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/85.jpg)
Administration Devices
Anesthesia Circuit
![Page 87: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/87.jpg)
Administration Devices
Soda lime (calcium hydroxide)
• Chemically removes carbon dioxide from the breathing circuit with the aid of activators such as sodium, potassium, and barium hydroxide
![Page 88: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/88.jpg)
Administration Devices
Airway Delivery/Maintenance
Devices
Face Mask
![Page 89: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/89.jpg)
Administration Devices
Airway Delivery/Maintenance
Devices
Oxygen Mask
![Page 90: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/90.jpg)
Administration Devices
Airway Delivery/Maintenance
Devices
Nasal Cannula
![Page 91: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/91.jpg)
Administration Devices
Airway Delivery/Maintenance
Devices
Endotracheal Tube
![Page 92: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/92.jpg)
Administration Devices
Airway Delivery/Maintenance
Devices
Laryngoscope
![Page 93: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/93.jpg)
Administration Devices
Positioning of Laryngoscope
![Page 94: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/94.jpg)
Administration Devices
Cuffed ET Tube in Position
![Page 95: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/95.jpg)
Administration Devices
Airway Delivery/Maintenance
Devices
McGill Forceps
![Page 96: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/96.jpg)
Administration Devices
Airway Delivery/Maintenance
Devices
Oral Airway
![Page 97: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/97.jpg)
Administration Devices
Airway Delivery/Maintenance
Devices
Nasal Airway (Trumpet)
![Page 98: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/98.jpg)
Administration Devices
Airway Delivery/Maintenance
Devices
Nasal Airway (Trumpet)
![Page 99: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/99.jpg)
Administration Devices
Airway Delivery/Maintenance
Devices
Tracheotomy Tube
![Page 100: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/100.jpg)
Administration Devices
Airway Delivery/Maintenance
Devices
Tracheotomy Tube
![Page 101: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/101.jpg)
Administration Devices
Airway Delivery/Maintenance
Devices
Laryngeal Mask Airway(LMA)
![Page 102: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/102.jpg)
Administration Devices
Airway Delivery/Maintenance
Devices
Laryngeal Mask Airway(LMA)
![Page 103: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/103.jpg)
Administration Devices
Ambu Bag
![Page 104: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/104.jpg)
Administration Devices
Laryngeal Tracheal Anesthesia (LTA) Kit
![Page 105: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/105.jpg)
Hyper/Hypothermia Devices
• Bair Hugger• Heating/Cooling Unit• Heat Lamp
![Page 106: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/106.jpg)
Hypo/Hyperthermia Devices
Bair Hugger
![Page 107: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/107.jpg)
Hyper/Hypothermia Devices
Heating/Cooling Unit(Blanket)
![Page 108: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/108.jpg)
Hyper/Hypothermia Devices
Heat Lamp
![Page 109: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/109.jpg)
Positioning for Anesthesia
• Supine
• Lateral
• Sitting
![Page 110: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/110.jpg)
General Anesthesia
• Alteration in the patient’s level of consciousness
• Accomplished by agent inhalation, injection, or instillation
![Page 111: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/111.jpg)
General Anesthesia
Goals of General Anesthesia
• Lack of sensation• Lack of movement• Muscle relaxation• Autonomic control (homeostasis)
![Page 112: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/112.jpg)
General Anesthesia
(Four Stages – Depth)
• Stage I – Amnesia
• Stage II – Excitement
• Stage III – Surgical Intervention (4 planes)
• Stage IV – Overdose
![Page 113: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/113.jpg)
General Anesthesia
(Four Phases)
• Induction
• Maintenance
• Emergence
• Recovery
![Page 114: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/114.jpg)
General Anesthesia
Advantages Disadvantages
![Page 115: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/115.jpg)
Cricoid Pressure (Sellick’s Maneuver)
Purpose – To minimize the risk of aspiration
• Apply external pressure to the cricoid cartilage using the thumb and first finger to form a “V”
• Pressure occludes the esophagus between the cricoid ring and the body of the 6th vertebral body
• Must apply prior to induction and maintain until patient is intubated
• Do NOT release pressure without permission from the anesthesia provider
![Page 116: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/116.jpg)
Cricoid Pressure (Sellick’s Maneuver)
Indications
• Emergency surgery shortly after eating
• NPO status cannot be verified
• GI bleeding
• Basic life support, if needed
![Page 117: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/117.jpg)
Nerve Conduction Blockade
• Anesthetic agent is used to prevent initiation and/or transmission of impulses along an individual nerve pathway or at a nerve plexus to provide anesthesia to tissues adjacent or distal to the site.
![Page 118: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/118.jpg)
Nerve Conduction Blockade
• Two types of agents used to accomplish nerve conduction blockade– Amino amide group
• Metabolized in the liver• Excreted by the kidneys
– Amino ester group• Biotransformed by pseudocholinesterase in the plasma
![Page 119: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/119.jpg)
Nerve Conduction Blockade
• Amino amide group– Lidocaine hydrochloride (Xylocaine, Lignocaine)– Mepivacaine hydrochloride (Carbocaine)– Bupivacaine hydrochloride (Marcaine,
Sensorcaine)– Etidocaine hydrochloride (Duranest)
![Page 120: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/120.jpg)
Lidocaine Hydrochloride
• Rapid onset• Moderate duration• Topical, local, regional• Available with or
without epinephrine• Has properties that
affect the heart
![Page 121: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/121.jpg)
Mepivacaine Hydrochloride
• Action similar to lidocaine
• Longer action than lidocaine
• Does not produce significant cardiac effects
![Page 122: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/122.jpg)
Bupivacaine Hydrochloride
• Four times as potent as lidocaine
• Longer onset of action than lidocaine
• Longer duration of effect than lidocaine
• Available with or without epinephrine
![Page 123: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/123.jpg)
Etidocaine Hydrochloride
• Prolonged onset• Long duration• Highly toxic• Contraindicated in
children
![Page 124: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/124.jpg)
Nerve Conduction Blockade
• Amino ester group– Cocaine hydrochloride– Procaine hydrochloride (Novocain)– Tetracaine hydrochloride (Cetacaine, Pontocaine)
![Page 125: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/125.jpg)
Cocaine Hydrochloride
• CNS stimulant• Controlled substance• Topical application
only• Produces anesthesia
and vasoconstriction causing shrinkage of mucous membranes
![Page 126: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/126.jpg)
Procaine Hydrochloride
• Similar properties to cocaine
• Less toxic than cocaine
• SC, IM, or intrathecal
![Page 127: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/127.jpg)
Tetracaine Hydrochloride
• Slow onset• Prolonged duration• Primarily used as a
topical agent
![Page 128: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/128.jpg)
Nerve Conduction Blockade
Adjunctive Agents
• Influence onset and duration of action• Two common agents
– Hyaluronidase (Wydase)– Epinephrine (Adrenalin)
![Page 129: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/129.jpg)
MAC
(Monitored Anesthesia Care)
• Provides monitoring, sedation, analgesia, and amnesia
• Used in conjunction with nerve conduction blockade
![Page 130: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/130.jpg)
Nerve Conduction Blockade
Types of Nerve Conduction Blockade
• Topical
• Local
• Regional
![Page 131: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/131.jpg)
Topical Anesthesia
• Placement of a nerve conduction blocking agent onto a tissue layer (skin or mucous membrane)
• Anesthesia is limited to the area in contact with the anesthetic agent
• In addition to pharmaceutical agents, cryoanesthesia is another example of topical anesthesia
![Page 132: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/132.jpg)
Local Anesthesia
• Placement of a nerve conduction blocking agent onto a tissue layer
• Only the nerve or nerves that supply that limited (localized) area are affected
![Page 133: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/133.jpg)
Regional Anesthesia
• Nerve conduction blocking agent is injected along a major nerve pathway blocking conduction of impulses from all tissue (the entire region) distal to the injection site
• Examples of regional anesthesia include:– Bier Block– Nerve Plexus Block– Spinal– Epidural– Caudal
![Page 134: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/134.jpg)
Bier Block
• Provides anesthesia to the distal portion of an extremity• Used on procedures expected to last one hour or less• Procedure is as follows:
– IV catheter is inserted– Double cuffed tourniquet is applied– Exsanguination is achieved with the use of an Esmarch bandage– Proximal cuff of tourniquet is inflated– Nerve conduction blocking agent is injected intravenously distal to the
tourniquet– Distal cuff of tourniquet may be inflated and then the proximal cuff
may be deflated
![Page 135: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/135.jpg)
Nerve Plexus Block
• Anesthetic solution is injected at a major nerve plexus – usually located at the base of a structure. For example the brachial plexus is at the base of the arm.
![Page 136: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/136.jpg)
Spinal (Intrathecal) Block
• Anesthetic solution is injected into the subarachnoid space (into the CSF)
• Provides loss of sensation below the diaphragm (patient should be able to breathe independently)
![Page 137: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/137.jpg)
Epidural Block
• Anesthetic solution is injected in the epidural (outside the dura) space and is absorbed into the CSF through the dura
• Provides loss of sensation below the diaphragm (patient should be able to breathe independently)
![Page 138: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/138.jpg)
Caudal Block
• Type of epidural that is administered with the patient in the lithotomy position.
• Agent is injected into the epidural space of the sacral canal
• Used primarily in obstetrics
![Page 139: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/139.jpg)
Nerve Conduction Blockade
Advantages
• Patient is awake• May be used to avoid
undesirable cardiac and respiratory side effects
• Recovery time from anesthesia is decreased
Disadvantages
• Patient is awake• Patient maintains
sensory awareness• Patient retains ability to
move• Positioning may be
difficult to maintain
![Page 140: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/140.jpg)
Postanesthesia Care (Recovery)
• May occur in the PACU or the ICU• Duration approximately 1 hour or longer, if
necessary – Patient is transferred or discharged when ready
• Patient is monitored• Ventilatory support is provided, as needed• Medications (e.g., analgesic, antibiotic) and fluids
(e.g., blood) are provided as needed• Dressings are maintained• Emotional support provided, as needed
![Page 141: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/141.jpg)
Adjunctive Anesthesia Treatments
• Induced Hypothermia• Induced Hypotension• Neuroleptanalgesia• Neuroleptanesthesia
![Page 142: Principles of Anesthesia](https://reader033.vdocuments.us/reader033/viewer/2022061608/5681486c550346895db5788c/html5/thumbnails/142.jpg)
Alternative (Nontraditional) Anesthesia Treatments
• Hypnoanesthesia
• Acupuncture