Understanding Anesthesiology - The Global Regional Anesthesia ...

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NITROUS OXIDE Class Nitrous oxide is an inhaled agent but not a volatile agent. It is used as an adjunct to general anesthesia. It has a weak effect and therefore cannot be used as the sole agent for general anesthesia and is most commonly used in combination with a volatile agent. It can be used on its own for sedation or analgesia as can be seen in the obstetric or dental setting. Mechanism of Action Uncertain Dose Delivered in concentrations of up to 70% in oxygen. Actual MAC is 104%. Onset Immediate due to very low solubility. Duration Offset of effect is rapid after discontinuation. Elimination Pulmonary Effects CNS N 2 O is a potent analgesic. It increases cerebral metabolic rate, cerebral blood flow and intracranial pressure and is therefore not a good choice for patients with decreased intracranial compliance. CVS N 2 O has a mild sympathomimetic effect but causes direct myocardial depression. <strong>The</strong> net effect is a modest decrease in blood pressure and heart rate. Increased coronary tone may exacerbate ischemia in susceptible patients. Respiratory N 2 O produces mild respiratory depression which is potentiated by opioids, hypnotics and volatile anesthetics. It has no bronchodilatory effect. It exacerbates pulmonary hypertension. Misc. N 2 O expands the volume of gas-containing spaces as N 2 O diffuses across membranes more readily than nitrogen can diffuse out. Thus the size of a pneumothorax, emphysematous bleb or distended bowel loop will increase when N 2 O is used. Bone marrow suppression due to inhibition of methionine synthetase, can occur if N 2 O is used for extended periods. N 2 O enhances opioid-induced rigidity. Finally, N 2 O is an operating room pollutant; N 2 O levels (in parts per million) in the operating room environment are measured regularly to comply with workplace safety regulations. Contraindications Raised intracranial pressure, pneumothorax or bowel obstruction. Should be used with caution in patients with coronary disease or emphysema. 133
SECTION 6 Anxiolytics Drugs 1. Midazolam Image courtesy of the Wood Library-Museum of <strong>Anesthesiology</strong>, Park Ridge, Illinois. Used with permission. 134
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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
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Contraindications to the inhaled ag
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Contraindications Opioids must not
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Table 15 Dose, onset, duration, eli
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tubation, leading to total airway o
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SECTION 4 Chapter 3 Review Review 3
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SECTION 1 Recovery In This Section
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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 and 120: SECTION 3 Anticholinesterase and An
Page 121 and 122: GLYCOPYRROLATE Class Anticholinergi
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: ISOFLURANE Class Volatile inhaled a
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
Page 171 and 172: Asepsis Asepsis is another word for
Page 173 and 174: Atracurium Class Nondepolarizing sk
Page 175 and 176: Autonomic nervous system The autono
Page 177 and 178: Bacterial endocarditis The 2007 Ame
Page 179 and 180: Balanced anesthesia Balanced anesth
Page 181 and 182: Bier Block An intravenous regional
Page 183 and 184: 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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