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