Understanding Anesthesiology - The Global Regional Anesthesia ...

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NEOSTIGMINE Class Anticholinesterase. In anesthesia practice, neostigmine is used for the reversal of neuromuscular blockade. Internal Internal Medicine specialists use neostigmine (or its relative, pyridostigmine) for the treatment of myasthenia gravis. Mechanism of Action Anticholinesterases inhibit the breakdown of acetylcholine (Ach) in the synaptic cleft by inhibiting the cholinesterase enzyme. As a result, Ach concentrations in the synaptic cleft are increased. Ach is then better able to compete with muscle relaxants for the Ach receptors and achieve depolarization of the muscle cell. Dose For reversal of neuromuscular blockade: 0.05 mg/kg Dose should not exceed 5 mg Effects Most of neostigmine’s effects are related to its cholinergic action. It must be given with an anticholinergic (atropine or more commonly glycopyrrolate) in order to minimize these effects. CNS Seizures CVS Bradycardia, AV block, nodal rhythm, hypotension Respiratory Increased oral and bronchial secretions, bronchospasm GI/GU Increased peristalsis, urinary frequency Misc. Overdose may produce cholinergic crisis. Neostigmine does not antagonize succinylcholine and may prolong phase 1 block of succinylcholine. Must be administered with with atropine 0.015 mg/kg or glycopyrrolate 0.01 mg/kg Onset 5 minutes Duration 55-75 minutes Elimination Hepatic, plasma esterases 119
GLYCOPYRROLATE Class Anticholinergic. Clinical uses in anesthesia include the treatment of bradycardia; as a antisialagogue for awake intubation; or (most commonly) for counteracting the muscarinic effects of the anticholinesterases used for the reversal of neuromuscular blockade. Mechanism of Action An acetylcholine receptor blocker active at the muscarinic (not nicotinic) acetylcholine receptors. <strong>The</strong>refore, glycopyrrolate has an anti-parasympathetic effect. Dose Antisialogogue: 0.1-0.2 mg IV/IM/SC in adults or 4-6 ug/kg IV/IM/SC in children With anticholinesterase: 0.01 mg/kg IV Onset IV:
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1 ST EDITION Understanding Anesthes
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Preface ii
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GETTING THE MOST FROM YOUR IBOOK Th
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ACKNOWLEDGEMENTS Many individuals s
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THE ROLE OF THE ANESTHESIOLOGIST Dr
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CHAPTER 1 The ABC’s In this chapt
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There are many different laryngeal
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• Mouth opening: Three fingerbrea
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A patient who is deemed to be at ri
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Movie 1.1 Intubation technique The
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After intubation, correct placement
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The Difficult Airway Airway mismana
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volume, then the surgery should be
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Vascular Access Peripheral venous a
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Interactive 1.1 Body water distribu
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Complications of transfusion are nu
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CHAPTER 2 The Pre-operative Phase I
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are known to have cardiac disease o
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Premedication Pre-medication can in
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SECTION 2 Anesthetic Equipment and
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Monitoring The purpose of monitorin
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SECTION 3 Chapter 2 Review Review 2
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SECTION 1 Anesthetic Techniques In
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Table 9 Sedation VERBAL COGNITIVE A
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General Anesthesia General anesthes
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Epidural Anesthesia Epidural and sp
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Movie 3.1 Labour epidural insertion
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Figure 14 Sensory dermatomes tion i
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Figure 16 Anatomy relevant to spina
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cles (Figure 19).They then travel u
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SECTION 3 General Anesthesia In Thi
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amples of conditions which impair g
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and trauma surgery pose a higher ri
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Drugs for Maintenance of Anesthesia
Page 69 and 70: Contraindications to the inhaled ag
Page 71 and 72: Contraindications Opioids must not
Page 73 and 74: Table 15 Dose, onset, duration, eli
Page 75 and 76: tubation, leading to total airway o
Page 77 and 78: SECTION 4 Chapter 3 Review Review 3
Page 79 and 80: SECTION 1 Recovery In This Section
Page 81 and 82: Post-operative Nausea and Vomiting
Page 83 and 84: SECTION 2 Post-operative Pain Manag
Page 85 and 86: lead to a decreased stress response
Page 87 and 88: CHAPTER 5 Special Patients In this
Page 89 and 90: Successful treatment of an MH crisi
Page 91 and 92: SECTION 2 Obstetrical Anesthesia In
Page 93 and 94: There is good evidence that a labou
Page 95 and 96: SECTION 3 Pediatric Anesthesia In T
Page 97 and 98: tain types of noxious stimuli. Exam
Page 99 and 100: SECTION 4 Anesthesia Outside the Op
Page 101 and 102: SECTION 5 Chapter 5 Review Review 5
Page 103 and 104: Opioid agonists and antagonists •
Page 105 and 106: FENTANYL Class Synthetic opioid ana
Page 107 and 108: REMIFENTANIL Class Synthetic opioid
Page 109 and 110: MORPHINE SULFATE Class Opioid analg
Page 111 and 112: NALOXONE Class Opioid antagonist. U
Page 113 and 114: ROCURONIUM Class Non-depolarizing m
Page 115 and 116: PANCURONIUM BROMIDE Class Nondepola
Page 117 and 118: SUCCINYLCHOLINE CHLORIDE Class Depo
Page 119: SECTION 3 Anticholinesterase and An
Page 123 and 124: SECTION 4 Induction Agents Drugs 1.
Page 125 and 126: SODIUM THIOPENTAL Class Short-actin
Page 127 and 128: KETAMINE Class Phencyclidine deriva
Page 129 and 130: ETOMIDATE Class Short-acting hypnot
Page 131 and 132: DESFLURANE Class Volatile inhaled a
Page 133 and 134: ISOFLURANE Class Volatile inhaled a
Page 135 and 136: SECTION 6 Anxiolytics Drugs 1. Mida
Page 137 and 138: SECTION 7 Antiemetics Drugs 1. Onda
Page 139 and 140: DIMENHYDRINATE Class Antihistamine,
Page 141 and 142: SECTION 8 Vasoactive Agents Drugs 1
Page 143 and 144: EPHEDRINE SULFATE Class Sympathomim
Page 145 and 146: SECTION 9 Local Anesthetics Drugs 1
Page 147 and 148: LIDOCAINE Class Local anesthetic. U
Page 149 and 150: KETOROLAC TROMETHAMINE Class Non-st
Page 151 and 152: DANTROLENE Dantrolene is used in th
Page 153 and 154: Acetylcholine Acetylcholine (Ach) i
Page 155 and 156: Adjunct An adjunct is something add
Page 157 and 158: Airway assessment The purpose of th
Page 159 and 160: Aldrete score Phase 1 of recovery m
Page 161 and 162: Analgesia Pain relief Related Gloss
Page 163 and 164: Antecubital fossa The antecubital f
Page 165 and 166: Anticholinesterase Anticholinestera
Page 167 and 168: Antisialagogue An antisialogogue is
Page 169 and 170: Apneic threshold Apneic threshold i
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Asepsis Asepsis is another word for
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Atracurium Class Nondepolarizing sk
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Autonomic nervous system The autono
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Bacterial endocarditis The 2007 Ame
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Balanced anesthesia Balanced anesth
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Bier Block An intravenous regional
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Brachial plexus The brachial plexus
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Bupivacaine Class Local anesthetic.
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Capnograph The capnograph is a moni
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Cholinesterase Cholinesterase is a
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Cis-Atracurium Class Non-depolarizi
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CO2 (carbon dioxide) absorber The C
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Competitive inhibitor Competitive i
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Cormack Lehane Cormack Cormack Leha
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Cricoid cartilage The cricoid is a
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Dantrolene Dantrolene is used in th
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Difficult airway The American Socie
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Diphenhydramine Class Antihistamine
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Dura The dura is the outermost (and
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Ephedrine Sulfate Class Sympathomim
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Epidural anesthesia In epidural ane
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Epiglottis The epiglottis is a cart
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Esophageal intubation Esophageal in
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Euvolemia Euvolemia indicates that
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Fentanyl Class Synthetic opioid ana
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Flowmeter The anesthetic flowmeter
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Forced air warming system A forced
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Functional residual capacity Functi
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Glycopyrrolate Class Anticholinergi
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Hypothermia Hypothermia indicates a
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Induction Induction is the phase of
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Intralipid Intralipid is a fat emul
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Intravenous regional anesthetic An
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Isoflurane Class Volatile inhaled a
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Ketorolac Tromethamine Class Non-st
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Laryngoscope A laryngoscope is the
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Larynx The larynx is that part of t
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Lidocaine Class Local anesthetic. U
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Local anesthetic toxicity Local ane
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MAC MAC refers to the concentration
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Magill blade A Magill blade, used i
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Maintenance fluid requirements Main
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Mallampati classification The Malla
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Mechanical ventilation Mechanical v
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Metabolic acidosis Metabolic acidos
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Morphine Sulfate Class Opioid analg
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Muscarinic Muscarinic acetylcholine
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Myoglobinuria When pathological mus
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Nasotracheal intubation Nasotrachea
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Needle cricothyrotomy A needle cric
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Neonatal opioid depression The resp
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Neuromuscular junction The neuromus
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Nicotinic Nicotinic receptors are t
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Non-depolarizing muscle relaxants T
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Ondansetron Class Seratonin ( 5-HT
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Oxygen saturation The oxygen satura
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Oxytocin Oxytocin is used in obstet
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Parturient The parturient is the pr
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Patient controlled analgesia Patien
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Peripheral nerve stimulator A perip
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Phrenic nerve The phrenic nerve, ar
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Positive pressure ventilation Posit
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Post-operative nausea and vomiting
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Pre-operative assessment Every pati
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Pre-oxygenation The purpose of pre-
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Prone In the prone position, the pa
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Pseudocholinesterase deficiency Pse
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Pulse oximeter The oxygen saturatio
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Radiculopathies Radiculopathy descr
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Re-narcotization A narcotized patie
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Recurrent laryngeal nerve The recur
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Remifentanil Class Synthetic opioid
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Reticular activating system The ret
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Rocuronium Class Non-depolarizing m
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Second stage of labour The second s
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Serotonin syndrome Serotonin syndro
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Shock Shock occurs when perfusion o
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Sodium citrate Sodium citrate is a
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Spinal anesthesia Spinal anesthesia
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Subarachnoid space The subarachnoid
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Succinylcholine Class Depolarizing
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Superior laryngeal nerve The superi
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Sympathetic nervous system The symp
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Theophylline Theophylline is a medi
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Thrombocytopenia Low platelet count
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Tidal volume Tidal volume is the vo
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Transcutaneous electrical nerve sti
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Trendelenburg The trendelenburg pos
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Urticaria Hives. Urticaria is cause
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Vagolytic Drugs with a vagolytic ef
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Vallecula The vallecula is the spac
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Venous air embolism Venous air embo
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Videolaryngoscope The videolaryngos
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