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Anesthesia Concepts

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Title: Anesthesia Concepts


1
Anesthesia Concepts
  • ST210
  • Concorde Career College, Portland

2
Anesthesia Concepts
  • Objectives
  • Define the term anesthesia.
  • Provide a timeline of the events leading up to
    modern anesthesia practice.
  • List and describe the two primary methods of
    anesthetic administration.

3
Anesthesia Concepts
  • Definition
  • Anesthesia - From the Greek meaning lack of
    sensation particularly during surgical
    intervention.

4
Anesthesia Concepts
  • 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

5
Anesthesia Concepts
  • Anesthesia History Timeline
  • 1846 William T.G. Morton performed surgery at
    Mass General Hospital in front of an audience
  • Ether Dome Mass General Hospital
  • 1905 Long Island Society Anesthetists (LISA)
    formed
  • 1936 LISA changed name to ASA (American Society
    of Anesthesiologists)

6
Anesthesia Concepts
7
Anesthesia Concepts
  • Ether Dome 1930s

8
Anesthesia Concepts
  • Ether Dome
  • (Following Restoration in 1996)

9
Anesthesia Concepts
  • Ether Dome at Massachusetts General Hospital
    (Boston)

10
Anesthesia Concepts
  • Two primary methods of anesthesia administration
  • 1. General Anesthesia
  • 2. Nerve Conduction Blockade

11
Anesthesia Concepts
  • General Anesthesia
  • Alteration in the patients level of
    consciousness
  • (patient is asleep)

12
Anesthesia Concepts
  • Nerve Conduction Blockade
  • Prevent initiation of conduction of nerve
    impulses along a nerve pathway
  • (patient is awake)

13
Anesthesia Concepts
  • Objectives
  • List the factors that affect selection of the
    type of anesthesia to be administered.
  • Describe the roles of the surgical team members
    during anesthesia administration.

14
Anesthesia Concepts
  • 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)

15
Anesthesia Concepts
  • 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)

16
Anesthesia Concepts
  • 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)

17
Anesthesia Concepts
  • ASA Risk Classification System (continued)
  • 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)

18
Anesthesia Concepts
  • ASA Risk Classification System (continued)
  • Class 5 Moribund
  • Class 6 Brain dead
  • E Emergency modifier

19
Anesthesia Concepts
  • Roles of the surgical team members (refer to the
    tables at the end of the chapter)
  • Preoperative case management duties
  • Intraoperative case management duties
  • Postoperative case management duties

20
Anesthesia Concepts
  • Objectives
  • Outline the preanesthetic evaluation and
    preparation processes.
  • Describe equipment and techniques used to monitor
    the patient undergoing anesthesia.
  • List and describe the methods of anesthetic
    administration.

21
Anesthesia Concepts
  • Preanesthetic evaluation and preparation
    processes
  • Preoperative routine
  • Preoperative education
  • Patient possessions
  • Preoperative procedures

22
Anesthesia Concepts
  • Preoperative Routine (refer to chapter 5)
  • Enema
  • Nail polish and makeup
  • Hygiene (shower and shave)
  • Attire
  • Sedation
  • Call to the OR
  • Family visit
  • Identification, chart, consent, transportation,
    transfer...

23
Anesthesia Concepts Equipment and techniques
used to monitor the patient
  • Blood pressure
  • O2 Sat
  • Temperature
  • IO
  • Heart
  • BIS
  • Respiration
  • SARA
  • Doppler
  • Peripheral Nerve Stimulator
  • ABG

24
Anesthesia Concepts Equipment and techniques
used to monitor the patient
  • Blood Pressure
  • Sphygmomanometer
  • (with stethoscope)

25
Anesthesia Concepts Equipment and techniques
used to monitor the patient
  • O2 Sat
  • Pulse Oximeter

26
Anesthesia Concepts Equipment and techniques
used to monitor the patient
  • Temperature
  • Thermometer
  • Esophageal Stethoscope with temperature probe

27
Anesthesia Concepts Equipment and techniques
used to monitor the patient
  • IO
  • Intake and Output

28
Anesthesia Concepts Equipment and techniques
used to monitor the patient
  • Heart
  • Apical Stethoscope Earpiece

29
Anesthesia Concepts Equipment and techniques
used to monitor the patient
  • Heart
  • Electrocardiogram
  • Electrodes

30
Anesthesia ConceptsEquipment and techniques
used to monitor the patient
  • Heart
  • Electrocardiogram
  • Leads

31
Anesthesia Concepts Equipment and techniques
used to monitor the patient
  • Heart
  • Electrocardiogram
  • (ECG)

32
Anesthesia Concepts Equipment and techniques
used to monitor the patient
  • BIS Monitor
  • (Bispectral Index)

33
Anesthesia Concepts Equipment and techniques
used to monitor the patient
  • Respiration
  • SARA
  • (System for Anesthetic and Respiratory Analysis)

34
Anesthesia Concepts
  • SARA is capable of several functions including
  • Capnography
  • Spirometry
  • Oxygen analysis

35
Anesthesia Concepts Equipment and techniques
used to monitor the patient
  • Doppler

36
Anesthesia Concepts Equipment and techniques
used to monitor the patient
  • Peripheral Nerve Stimulator

37
Anesthesia Concepts Equipment and techniques
used to monitor the patient
  • ABG
  • (Arterial Blood Gas)

38
Anesthesia Concepts
  • Methods of anesthetic administration
  • General
  • Balanced
  • Neuroleptanalgesia
  • Nerve Conduction Blockade
  • Regional
  • Local
  • Topical

39
Anesthesia Concepts
  • Objectives
  • List and describe common anesthetic agents.
  • List and describe the devices necessary for
    administration of the various types of
    anesthesia.
  • Identify the patient positions used while
    administering the various types of anesthesia.

40
Anesthesia Concepts
  • Common anesthetic agents
  • Inhalation Agents
  • Oxygen
  • Nitrous oxide
  • Waste gases

41
Anesthesia Concepts Common Anesthetic Agents
  • Oxygen
  • Inhalation agent
  • Not anesthetic agent
  • Necessary for life

42
Anesthesia Concepts Common Anesthetic Agents
  • Nitrous Oxide
  • Produces analgesia and amnesia
  • Produces little muscle relaxation
  • Decreases myocardial contractility and
    respiratory function

43
Anesthesia Concepts Common Anesthetic Agents
  • Waste gas scavenger system

44
Anesthesia Concepts Common Anesthetic Agents
  • Volatile Agents
  • Liquids with potent evaporative vapors
  • CNS depression produces general anesthesia
  • Myocardial and respiratory depression
  • Decrease muscle tone

45
Anesthesia Concepts
  • Volatile Agents
  • Halothane (Fluothane)
  • Enflurane (Ethrane)
  • Isoflurane (Forane)
  • Desflurane (Suprane)
  • Sevoflurane (Ultane)

46
Anesthesia Concepts
  • Halothane
  • Rapid acting
  • Sweet odor
  • Nonirritating to the respiratory tree
  • Used for induction and maintenance

47
Anesthesia Concepts
  • Enflurane
  • Halogenated
  • Sweet odor
  • Rapid induction
  • Rapid recovery
  • Hypotension (when not surgically stimulated)
  • Potentiates nondepolarizing NMB

48
Anesthesia Concepts
  • Isoflurane
  • Rapid induction and recovery
  • Musty smelling
  • Profound respiratory depression and hypotension
  • Markedly potentiates NMB
  • Increases ICP

49
Anesthesia Concepts
  • Desflurane
  • Halogenated
  • Requires heated vaporizer
  • Pungent aroma
  • Not biotransformed in the liver

50
Anesthesia Concepts
  • Sevoflurane
  • Odorless
  • No irritation to respiratory tree
  • Causes bradycardia,
  • hypotension, dysrhythmias, decreases cardiac
    output

51
Anesthesia Concepts
  • 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

52
Anesthesia Concepts
  • Intravenous Agents for Induction
  • Propofol (Diprivan)
  • Etomidate (Amidate)
  • Thiopental sodium (Pentothal Sodium)
  • Methohexital sodium (Brevital)

53
Anesthesia Concepts
  • 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

54
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.

55
Anesthesia Concepts
  • Etomidate
  • Non-barbiturate hypnotic
  • Produces minimal cardiovascular system effects
  • Causes nausea, vomiting, and adrenal suppression

56
Anesthesia Concepts
  • Thiopental sodium
  • Potent barbiturate
  • Short acting
  • Alkaline irritating to the vein
  • Less expensive than propofol

57
Anesthesia Concepts
  • 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

58
Anesthesia Concepts
  • Dissociative Agents
  • Interrupt the associative pathways of the brain
    (patient appears awake, but is unaware of
    surroundings
  • Produce amnesia and profound analgesia

59
Anesthesia Concepts
  • Dissociative Agents
  • Ketamine Hydrochloride (Ketalar)
  • Most commonly used
  • IM or IV administration
  • Rapid induction of dissociative state
  • Potentiated by other agents (narcotics/barbiturate
    s)
  • Increases muscle tone
  • Increases ICP and IOP

60
Anesthesia Concepts
  • 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

61
Anesthesia Concepts
  • Opiate/Opioids
  • Morphine sulfate
  • Meperidine (Demerol)
  • Fentanyl citrate (Sublimaze)
  • Sufentanil citrate (Sufenta)
  • Alfentanil hydrochloride (Alfenta)
  • Remifentanil hydrochloride (Ultiva)

62
Anesthesia Concepts
  • Narcotic Antagonists
  • Antagonize or reverse narcotic effects
  • Increased level of consciousness seen in 1-2
    minutes
  • Naloxone hydrochloride (Narcan)

63
Anesthesia Concepts
  • Benzodiazepines
  • Sedative tranquilizers
  • Reduce anxiety/apprehension
  • Adjunct to general anesthesia (reduce amount and
    concentration of other agents)
  • Do not produce analgesia

64
Anesthesia Concepts
  • Benzodiazepines
  • Diazepam (Valium)
  • Midazolam (Versed)
  • Droperidol (Inapsine)

65
Anesthesia Concepts
  • 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

66
Neuromuscular Junction
67
  • http//www.wisc-online.com/objects/ViewObject.aspx
    ?IDAP2804

68
Neuromuscular Junction
69
Anesthesia Concepts
  • 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

70
Anesthesia Concepts
  • 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

71
Anesthesia Concepts
  • Neuromuscular Blockers
  • 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

72
Anesthesia Concepts
  • Neuromuscular Blockers
  • Depolarizing Agents
  • Metabolized by plasma cholinesterase in the
    synapse reversing the effect of the agent
  • NO pharmacologic antagonist

73
Anesthesia Concepts
  • Neuromuscular Blockers
  • Depolarizing Agents
  • Succinylcholine (Anectine)
  • Most commonly used
  • Short acting
  • Known triggering agent for MH
  • Decamethonium (Syncurine)

74
Anesthesia Concepts
  • Neuromuscular Blockers
  • 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)

75
Anesthesia Concepts
  • Neuromuscular Blockers
  • Nondepolarizing Agents
  • Short Acting
  • Mivacurium chloride (Mivacron)
  • Vecuronium bromide (Norcuron)
  • Rocuronium bromide (Zemuron)

76
Anesthesia Concepts
  • Neuromuscular Blockers
  • Nondepolarizing Agents
  • Intermediate Acting
  • Atracurium Besylate (Tracrium)
  • Cisatracurium besylate (Nimbex)

77
Anesthesia Concepts
  • Neuromuscular Blockers
  • Nondepolarizing Agents
  • Long Acting
  • Tubocurarine chloride (Curare)
  • Pancuronium bromide (Pavulon)
  • Metocurine iodide (Metubine)

78
Anesthesia Concepts
  • Antimuscarinic (Anticholinergic)
  • Used to limit salivation and bradycardia
  • Two commonly used agents
  • Atropine sulfate
  • Glycopyrrolate (Robinul)

79
Anesthesia Concepts
  • 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

80
Anesthesia Concepts
  • 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

81
Anesthesia Concepts
  • Antiemetic
  • Used to prevent or alleviate nausea
  • Agents
  • Droperidol (Inapsine)
  • Metoclopramide (Reglan)

82
Anesthesia Concepts
  • Administration Devices
  • Anesthesia Machine
  • Vaporizer
  • Anesthesia Circuit
  • Airway Delivery/Maintenance Devices
  • Hypo/Hyperthermia Devices

83
Anesthesia Concepts Administration Devices
  • Anesthesia Machine

84
Anesthesia Concepts Administration Devices
  • Anesthesia Cart

85
Anesthesia Concepts Administration Devices
  • Vaporizer

86
Anesthesia Concepts
  • Vaporizer

87
Anesthesia Concepts Administration Devices
  • Anesthesia Circuit

88
Anesthesia Concepts
  • Anesthesia Machine with Circuit in Position

89
Anesthesia Concepts
  • Soda lime
  • (calcium hydroxide)
  • Chemically removes carbon dioxide from the
    breathing circuit with the aid of activators such
    as sodium, potassium, and barium hydroxide

90
Anesthesia Concepts Administration Devices
  • Airway Delivery/Maintenance Devices
  • Face Mask

91
Anesthesia Concepts Administration Devices
  • Airway Delivery/Maintenance Devices
  • Oxygen Mask

92
Anesthesia Concepts Administration Devices
  • Airway Delivery/Maintenance Devices
  • Nasal Cannula

93
Anesthesia Concepts Administration Devices
  • Airway Delivery/Maintenance Devices
  • Endotracheal Tube

94
Anesthesia Concepts Administration Devices
  • Airway Delivery/Maintenance Devices
  • Laryngoscope

95
Anesthesia Concepts
  • Positioning of Laryngoscope

96
Anesthesia Concepts
  • Cuffed ET Tube in Position

97
Anesthesia Concepts Administration Devices
  • Airway Delivery/Maintenance Devices
  • McGill Forceps

98
Anesthesia ConceptsAdministration Devices
  • Airway Delivery/Maintenance Devices
  • Oral Airway

99
Anesthesia Concepts Administration Devices
  • Airway Delivery/Maintenance Devices
  • Oropharyngeal Airway

100
Anesthesia Concepts Administration Devices
  • Airway Delivery/Maintenance Devices
  • Oropharyngeal Airway

101
Anesthesia Concepts Administration Devices
  • Airway Delivery/Maintenance Devices
  • Nasal Airway (Trumpet)

102
Anesthesia Concepts Administration Devices
  • Airway Delivery/Maintenance Devices
  • Nasal Airway (Trumpet)

103
Anesthesia Concepts Administration Devices
  • Airway Delivery/Maintenance Devices
  • Tracheotomy Tube

104
Anesthesia Concepts Administration Devices
  • Airway Delivery/Maintenance Devices
  • Tracheotomy Tube

105
Anesthesia Concepts Administration Devices
  • Airway Delivery/Maintenance Devices
  • Laryngeal Mask Airway
  • (LMA)

106
Anesthesia Concepts Administration Devices
  • Airway Delivery/Maintenance Devices
  • Laryngeal Mask Airway
  • (LMA)

107
Anesthesia Concepts
  • Ambu Bag

108
Anesthesia Concepts
  • Laryngeal Tracheal Anesthesia (LTA) Kit

109
Anesthesia Concepts
  • Hyper/Hypothermia Devices
  • Bair Hugger
  • Heating/Cooling Unit
  • Heat Lamp

110
Anesthesia Concepts Hypo/Hyperthermia Devices
  • Bair Hugger

111
Anesthesia Concepts
  • Heating/Cooling Unit
  • (Blanket)

112
Anesthesia Concepts
  • Heat Lamp

113
Anesthesia Concepts
  • Positioning for Anesthesia
  • Supine
  • Lateral
  • Sitting

114
Anesthesia Concepts
  • Objectives
  • Define the term general anesthesia.
  • List and define the four stages that relate to
    depth of general anesthesia.
  • Describe the four phases of general anesthesia.
  • List and describe the advantages, risks, and
    complications of general anesthesia.
  • Analyze the importance of cricoid pressure
    application during induction of general
    anesthesia.

115
Anesthesia Concepts
  • General Anesthesia
  • Alteration in the patients level of
    consciousness
  • Accomplished by agent inhalation, injection, or
    instillation

116
Anesthesia Concepts
  • Goals of General Anesthesia
  • Lack of sensation
  • Lack of movement
  • Muscle relaxation
  • Autonomic control (homeostasis)

117
Anesthesia Concepts
  • General Anesthesia
  • (Four Stages Depth)
  • Stage I Amnesia
  • Stage II Excitement
  • Stage III Surgical Intervention (4 planes)
  • Stage IV Overdose

118
Anesthesia Concepts
  • General Anesthesia
  • (Four Phases)
  • Induction
  • Maintenance
  • Emergence
  • Recovery

119
Anesthesia ConceptsGeneral Anesthesia
  • Advantages
  • Disadvantages

120
Anesthesia Concepts Cricoid Pressure
(Sellicks 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

121
Anesthesia Concepts
  • Sellicks Maneuver - Indications
  • Emergency surgery shortly after eating
  • NPO status cannot be verified
  • GI bleeding
  • Basic life support, if needed

122
Anesthesia Concepts
  • Objectives
  • Define the term nerve conduction blockade.
  • List and describe the various types of nerve
    conduction blockade.
  • List and describe the advantages, risks, and
    complications of nerve conduction blockade.

123
Anesthesia Concepts
  • 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.

124
Anesthesia Concepts
  • 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

125
Anesthesia Concepts
  • Nerve Conduction Blockade
  • Amino amide group
  • Lidocaine hydrochloride (Xylocaine, Lignocaine)
  • Mepivacaine hydrochloride (Carbocaine)
  • Bupivacaine hydrochloride (Marcaine, Sensorcaine)
  • Etidocaine hydrochloride (Duranest)

126
Anesthesia Concepts
  • Lidocaine hydrochloride
  • Rapid onset
  • Moderate duration
  • Topical, local, regional
  • Available with or without epinephrine
  • Has properties that affect the heart

127
Anesthesia Concepts
  • Mepivacaine hydrochloride
  • Action similar to lidocaine
  • Longer action than lidocaine
  • Does not produce significant cardiac effects

128
Anesthesia Concepts
  • 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

129
Anesthesia Concepts
  • Etidocaine hydrochloride
  • Prolonged onset
  • Long duration
  • Highly toxic
  • Contraindicated in children

130
Anesthesia Concepts
  • Nerve Conduction Blockade
  • Amino ester group
  • Cocaine hydrochloride
  • Procaine hydrochloride (Novocain)
  • Tetracaine hydrochloride (Cetacaine, Pontocaine)

131
Anesthesia Concepts
  • Cocaine hydrochloride
  • CNS stimulant
  • Controlled substance
  • Topical application only
  • Produces anesthesia and vasoconstriction causing
    shrinkage of mucous membranes

132
Anesthesia Concepts
  • Procaine hydrochloride
  • Similar properties to cocaine
  • Less toxic than cocaine
  • SC, IM, or intrathecal

133
Anesthesia Concepts
  • Tetracaine hydrochloride
  • Slow onset
  • Prolonged duration
  • Primarily used as a topical agent

134
Anesthesia Concepts
  • Nerve Conduction Blockade
  • Adjunctive Agents
  • Influence onset and duration of action
  • Two common agents
  • Hyaluronidase (Wydase)
  • Epinephrine (Adrenalin)

135
Anesthesia Concepts
  • MAC (Monitored Anesthesia Care)
  • Provides monitoring, sedation, analgesia, and
    amnesia
  • Used in conjunction with nerve conduction
    blockade

136
Anesthesia Concepts
  • Types of Nerve Conduction Blockade
  • Topical
  • Local
  • Regional

137
Anesthesia Concepts
  • 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

138
Anesthesia Concepts
  • 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

139
Anesthesia Concepts
  • 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

140
Anesthesia Concepts
  • 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

141
Anesthesia Concepts
  • 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.

142
Anesthesia Concepts
  • 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)

143
Anesthesia Concepts
  • 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)

144
Anesthesia Concepts
  • 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

145
Anesthesia Concepts 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

146
Anesthesia Concepts
  • Objectives
  • Outline the postanesthetic evaluation and
    recovery processes.
  • List and describe adjunctive anesthesia
    treatments.
  • List and describe alternative anesthesia
    treatments.

147
Anesthesia Concepts
  • 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

148
Anesthesia Concepts
  • Adjunctive Anesthesia Treatments
  • Induced Hypothermia
  • Induced Hypotension
  • Neuroleptanalgesia
  • Neuroleptanesthesia

149
Anesthesia Concepts
  • Alternative (Nontraditional) Anesthesia
    Treatments
  • Hypnoanesthesia
  • Acupuncture
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