Understanding Anesthesiology - The Global Regional Anesthesia ...

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Desflurane Class Volatile inhaled anesthetic. Used for maintenance of anesthesia. Mechanism of Action Uncertain Dose Titrated to effect; MAC (age 40) = 6.0% Onset Low solubility allows rapid uptake and equilibration. Onset of effect is hastened by using higher flows of carrier gases and by using higher concentrations of volatile agent. Duration Clinical recovery in less than 10 minutes (2-2.5 x faster washout than Isoflurane) Elimination Pulmonary (major); negligible hepatic (0.02%) Effects CNS Desflurane produces an additive central nervous system (CNS) depressant effect along with other sedative/hypnotics and analgesics. Sympatho-excitation can occur with rapid increase in concentration of desflurane. Has the potential to increase intracranial pressure which can be mitigated with hyperventilation. May cause headache, agitation, dizziness. CVS Dose-related hypotension (vasodilation). Tachycardia and hypertension may be seen due to sympathetic nervous system activation. Respiratory Respiratory depression with a rapid, shallow respiratory pattern. Loss of intercostal muscle function creates a rocking boat appearance. Desflurane is irritating to the airways and can cause breath-holding, cough, laryngospasm or bronchospasm in susceptible individuals, especially if used as sole agent for induction. GI Potential immune-mediated hepatotoxicity. Nausea, vomiting. MSK Potentiates neuromuscular blockade; malignant hyperthermia trigger. Misc. Significant carbon monoxide production occurs on exposure to dessicated CO 2 absorbing agents therefore must not be used with low-flow anesthesia. Rapid elimination requires initiation of post-operative analgesia prior to emergence. Contraindications Malignant hyperthermia susceptibility Related Glossary Terms Balanced anesthesia, Four A’s of anesthesia, Inhaled agents, Isoflurane, MAC, Malignant hyperthermia, Sevoflurane, Vapourizer, Volatile Index Find Term Chapter 2 - Anesthetic Equipment and Monitoring Chapter 3 - General Anesthesia Chapter 6 - Drug Finder Chapter 6 - Inhaled Agents
Difficult airway The American Society of Anesthesiologists Task Force has defined the difficult airway as follows: “The clinical situation in which a conventionally trained anesthesiologist experiences difficulty with mask ventilation, difficulty with tracheal intubation, or both.” The report contained some more specific definitions. For example, difficult laryngoscopy is when no part of the larynx is visualized with direct laryngoscopy; difficult endotracheal intubation is when intubation requires more than three attempts or more than 10 minutes. The incidence of the difficult airway has been reported to be greater in the obstetrical population (8%) than in the non-obstetrical surgical population (around 2%) although some studies have called this conventional thinking into question. The keys to the management of the difficult airway can be summarized as follows: a) to do a careful airway assessment in all patients in order to avoid the unanticipated difficult airway wherever possible. b) to prioritize the establishment of ventilation (with mask or laryngeal mask) when a difficult intubation is encountered. c) to avoid persistent, traumatic attempts at airway instrumentation. d) to be comfortable moving to a surgical airway if neither intubation nor bag mask ventilation can be achieved. e) to develop and maintain skills with a range of airway devices and adjuncts. Reference: Caplan RA, Benumof JL, Berry FA, et al: Practice guidelines for management of the difficult airway. A report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway, Anesthesiology 78:597,1993. Related Glossary Terms Adjunct, Airway assessment, Antisialagogue, Cormack Lehane, Direct laryngoscopy, Extubation, Fibreoptic bronchoscope, Hypoxemia, Intubation, Laryngeal mask airway (LMA), Laryngoscope, Macintosh blade, Magill blade, Mallampati classification, Mouth opening, Neck motion, Needle cricothyrotomy, Pre-oxygenation, Sniffing position, Stylet, Thyromental Distance, Videolaryngoscope Index Find Term Chapter 1 - Airway Management Chapter 1 - Airway Management Chapter 1 - Airway Management Chapter 3 - General Anesthesia Chapter 5 - Obstetrical Anesthesia Chapter 5 - Obstetrical Anesthesia
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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 1 Recovery In This Section
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Post-operative Nausea and Vomiting
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SECTION 2 Post-operative Pain Manag
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lead to a decreased stress response
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CHAPTER 5 Special Patients In this
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Successful treatment of an MH crisi
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SECTION 2 Obstetrical Anesthesia In
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There is good evidence that a labou
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SECTION 3 Pediatric Anesthesia In T
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tain types of noxious stimuli. Exam
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SECTION 4 Anesthesia Outside the Op
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Opioid agonists and antagonists •
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FENTANYL Class Synthetic opioid ana
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REMIFENTANIL Class Synthetic opioid
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MORPHINE SULFATE Class Opioid analg
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NALOXONE Class Opioid antagonist. U
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ROCURONIUM Class Non-depolarizing m
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PANCURONIUM BROMIDE Class Nondepola
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SUCCINYLCHOLINE CHLORIDE Class Depo
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SECTION 3 Anticholinesterase and An
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GLYCOPYRROLATE Class Anticholinergi
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SECTION 4 Induction Agents Drugs 1.
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SODIUM THIOPENTAL Class Short-actin
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KETAMINE Class Phencyclidine deriva
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ETOMIDATE Class Short-acting hypnot
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DESFLURANE Class Volatile inhaled a
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ISOFLURANE Class Volatile inhaled a
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SECTION 6 Anxiolytics Drugs 1. Mida
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SECTION 7 Antiemetics Drugs 1. Onda
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DIMENHYDRINATE Class Antihistamine,
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SECTION 8 Vasoactive Agents Drugs 1
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EPHEDRINE SULFATE Class Sympathomim
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SECTION 9 Local Anesthetics Drugs 1
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LIDOCAINE Class Local anesthetic. U
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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
Page 185 and 186: Bupivacaine Class Local anesthetic.
Page 187 and 188: Capnograph The capnograph is a moni
Page 189 and 190: Cholinesterase Cholinesterase is a
Page 191 and 192: Cis-Atracurium Class Non-depolarizi
Page 193 and 194: CO2 (carbon dioxide) absorber The C
Page 195 and 196: Competitive inhibitor Competitive i
Page 197 and 198: Cormack Lehane Cormack Cormack Leha
Page 199 and 200: Cricoid cartilage The cricoid is a
Page 201: Dantrolene Dantrolene is used in th
Page 205 and 206: Diphenhydramine Class Antihistamine
Page 207 and 208: Dura The dura is the outermost (and
Page 209 and 210: Ephedrine Sulfate Class Sympathomim
Page 211 and 212: Epidural anesthesia In epidural ane
Page 213 and 214: Epiglottis The epiglottis is a cart
Page 215 and 216: Esophageal intubation Esophageal in
Page 217 and 218: Euvolemia Euvolemia indicates that
Page 219 and 220: Fentanyl Class Synthetic opioid ana
Page 221 and 222: Flowmeter The anesthetic flowmeter
Page 223 and 224: Forced air warming system A forced
Page 225 and 226: Functional residual capacity Functi
Page 227 and 228: Glycopyrrolate Class Anticholinergi
Page 229 and 230: Hypothermia Hypothermia indicates a
Page 231 and 232: Induction Induction is the phase of
Page 233 and 234: Intralipid Intralipid is a fat emul
Page 235 and 236: Intravenous regional anesthetic An
Page 237 and 238: Isoflurane Class Volatile inhaled a
Page 239 and 240: Ketorolac Tromethamine Class Non-st
Page 241 and 242: Laryngoscope A laryngoscope is the
Page 243 and 244: Larynx The larynx is that part of t
Page 245 and 246: Lidocaine Class Local anesthetic. U
Page 247 and 248: Local anesthetic toxicity Local ane
Page 249 and 250: MAC MAC refers to the concentration
Page 251 and 252: 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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