Академический Документы
Профессиональный Документы
Культура Документы
CORPORAL) 1
GENERAL ANESTHESIA - Use Neuromuscular blocking agents
- If you are uncomfortable in intubating, the more there will be o muscle relaxation, ↓ risk of aspiration
edema unless patient is cyanotic - GCS 7-8: indication for intubation → protect the airway in case
o Do ventilation instead there will be vomiting (protective)
- Contraindication for ventilation: Full stomach (has eaten 6hrs - Alternatives: facemask; Laryngeal mask
before event)
o May vomit → regurgitate → aspiration pneumonia C. HYPOTHERMIA – body temp < 36
1. Lower core temp set point → thermoregulatory
5 components: vasoconstriction activated to defend against heat loss
1. Amnesia 2. Vasodilation redistributes heat from central to peripheral
2. Analgesia body compartments – decline in core temperature
3. Unconsciousness 3. Metabolic rate and total body oxygen consumption
4. Immobility in response to noxious stimulation o ↓ by 30% = ↓ heat generation
5. Attenuation of autonomic responses to noxious stimulation *Modalities to maintain normothermia
- Using warm IV fluids
Methods: - Heat exchangers in the anesthesia circuit
1. Inhalational Anesthesia - Forced-warm-air covers
2. Total IV Anesthesia (TIVA) – via dextrose - Water-filled garments with microprocessor feedback control to a
3. Mixed Inhalation and IV Anesthesia core temperature set point
ETOMIDATE
- GABAa receptor agonist
- Primary indication: anesthetic induction of patients at risk for
HYPOTENSION
o Propofol cannot be given to hypotensive px → bradycardia, ↓
BP
- Maintains CV stability in px with coronary artery dse,
cardiomyopathy, cerebral vascular disease or hypovolemia
- Pain on injection – reduced by lidocaine
- Induce hiccups
- No histamine release
- 2 major drawbacks
o Nausea and vomiting
o Inhibits adrenal biosynthetic enzymes required for the
production of cortisol and some other steroids
- Shows uptake of inhalational anesthetics
KETAMINE - Less solubility = faster equilibrium of alveolar and inspired
- NMDA ANTAGONIST anesthetic
- For patients at risk for hypotension and bronchospasm o Least soluble = Fastest: Nitrous Oxide, Desflurane,
o Indirect sympathomimetic activity Sevoflurane, Isoflurane, Halothane
o support BP on induction → ↑ MAP, HR, CO - High solubility → distributes in tissues → slower equilibrium
o potent bronchodilator Elimination
- ↑ myocardial O2 consumptioin - For agents with low blood and tissue solubility, recovery is fast,
- Metabolized to norketamine regardless of duration of anesthetic administration
- CATALEPTIC STATE - For inhalation agents w/ high blood and tissue solubility, recovery
o profound analgesia, unresponsiveness to commands, breathe will be function of the duration of anesthetic administration
spontaneously, amnesia, eyes open, nystagmus with pupillary - Accumulated amounts of anesthetic in the fat reservoir will
dilation, salivation, lacrimation, and spontaneous limb prevent blood(and therefore alveolar) partial pressures from
movements → DISSOCIATIVE ANESTHESIA falling rapidly
o Give atropine first – muscarinic antagonist → decreases
salivary secretions ISOFLURANE
- Nervous system: ↑ CBPF, ICP - Pungent odor, airway irritant, and can stimulate airway reflexes
o Emergence of delirium: hallucinations, vivid dreams, and during induction of anesthesia
delusions that can be reduced by giving benzodiazepene o coughing & laryngospasm
o Usually MEDAZOLAM → forgets dreams o Can use when patient is asleep
- Induction and recovery: faster
BARBITURATES - Relaxes uterine smooth muscle – not recommended for analgesia
- Sodium thiopental – induce anesthesia or anesthesia for labor and vaginal delivery
- Thiamylal – veterinary use o Used to deliver placenta
- Methohexital – px for electroconvulsive therapy o Then decrease when placenta is delivered to contract uterus
→ stops bleeding
- ↓ CMR, CBF, ICP anticonvulsant effect
- higher incidence of wheezing in asthmatics (histamine release) SEVOFLURANE
- Contraindicated in px with acute intermittent or variegate - Pleasant smell, rapid onset, lack of irritation to the airway
porphyria – can induce fatal attacks o preferred for inhalation induction
- Induce aminolevulinic acid synthase - Can undergo an exothermic reaction w/ dessicated CO2 absorbent
o an enzyme responsible for phorphobilinogen synthesis – (BARALYME) to produce airway burns or spontaneous ignition,
excessive phorphobilinogen levels explosion and fire