Intro to Anesthesia
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Types of anesthesia
General anesthesia Monitored anesthesia Care “MAC” Regional anesthesia Local anesthesia
Ideal anesthetic Techniques
oOptimal patient safety oPatient satisfaction oExcellent operating condition for surgeon oAllows rapid recovery oAvoid postoperative side effects oLow cost oEarly transfer or discharge from PACU (cost)
Considerations that influence the choice of anesthetic/technique
oPatient safety oPatient comfort oPreference oCoexisting disease oSurgical site oPositioning oElective vs emergency airway oDuration of surgery oPatient age oRecovery time oPost anesthesia care unit discharge criteria
drug-induced depression of the CNS resulting in the loss of response to and perception of all external stimuli SA continuum of sedation: a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation
General anesthesia
Components of anesthetic
oUnconsciousness oAmnesia oAnalgesia oImmobility oAttenuation of autonomic response to noxious stimuli
Phases of General Anesthesia
Induction Maintenance Emergent
Candidate for total IV anesthetics
patient with severe refractory postop nasuea
Induction sequence
Room set up "SAM TIDE" - suction, airway, machine, tape, IV, drugs, equipment Apply monitors Position patient Baseline vitals Preoxygenate Administer induction agents (eyelid reflex) Mask ventilation \+/- NM blocking agent Airway instrumentation
ASA standard 5 minimum monitors include…
Pulse ox continuously - audible pulse and tone threshold along with clinical observaition and ABG analysis if needed Ventilation - verification of trachea placement of artifical airway through auscultation, chest excursion, and confirmation of expired CO2 (3 breaths), capnography EKG continuously, HR and BP at least every 5 minutes Thermoregulation NM (if NM blockade adminstered assess depth of blockade and degree of recovery) Positioning
Pre-induction preoxygenation is doen in order to …
Denitrogenate patient’s FRC in order to increase safety margin for periods of apnea giving the provider more time before they desaturate
Methods for pre-induction pre-oxygenation
Breath 100% O2 via face mask with normal tidal volume for 3-5 min OR Eight vital capacity breaths with 100% O2
oAdministering anesthetic drugs (inhaled or IV) to induce a state of anesthesia oInducing a state of unconsciousness
Induction
Desirable properties for induction agents
Rapid and smooth onset of recovery Analgesia Minimal cardiac and respiratory depression Antiemetic actions Lack of toxicity or histamine release Advantages pharmacokinets and pharmaceutics
Intravenous injection of an anesthetic to produce unconsciousness followed immediately by a neuromuscular blocking drug that produces a rapid onset of skeletal muscle paralysis
Rapid sequence induction
Situations that warrant a rapid sequence induction
Full stomach or risk of aspiration such as trauma patients, those with comorbidities such as DM and gastroparesis or achalasia
Main difference between standard induction and RSI
NO VENTILATION
Perform induction and ventilation, use standard induction without paralytics with this type of airway
Laryngeal mask airway (LMA)
Where does LMA sit
posterior pharynx and larynx and creates a seal around laryngeal opening, DOES NOT go past vocal cords
Most common method for inducing children in North America, scheduled for elective case
Inhalation induction
Agents used in inhalation induction
+/- 70% nitrous and 30% oxygen Can have oxygen + nitrous +sevo OR can have just sevo + oxygen
Steps for inhalation induction
Prime circuit Monitors (primarily pulse ox) Mask application Loss of consciousness Ventilation PIV placement Airway instrumentation (LMA/ETT) Verify placement
Maintenance goals
Maintain surgical anesthesia Maintain physiological homeostasis Monitoring is needed to ensure these goals are met
Maintenance phase provides
Unconsciousness, amnesia, analgesia, immobility, muscle relaxation, and control of system response to noxious stimuli
During maintenance phase the BP must be maintained
within 20% of baseline