Understanding Anesthesiology - The Global Regional Anesthesia ...

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Laryngospasm Laryngospasm is the reflexive closure of the glottis. Laryngospasm is the airway’s response to irritation. It can occur immediately after extubation, leading to total airway obstruction, particularly in children and young adults. Extubating the patient at a deep plane of inhalational anesthesia, when the reflex is blunted, is one way to reduce the risk of laryngospasm but is an approach that is only safely applied to the pediatric patient. In adults (and pediatric patients), performing extubation when the patient is wide awake, (such that consciousness abolishes the reflex), will decrease the risk of post-extubation laryngospasm. Performing extubation when the patient is at a light plane of anesthesia (not awake, but not “asleep” either) is generally thought to increase the risk of post-extubation laryngospasm. Laryngospasm is more likely to occur in patients with inadequate reversal of muscle relaxation. It is more common in smokers. Laryngospasm may be an indication of aspiration. Treatment of laryngospasm must be individualized to the patient according to the presumed underlying cause and the severity of obstruction. Suctioning the airway clear of mucous or other irritants is important. Ensuring full reversal of muscle relaxation is also key. Simple maneuvers such as airway support and gentle positive pressure ventilation will often “break” the spasm. Very occasionally, administration of anesthetic agents (possibly including a very small dose of muscle relaxant) will be required to relieve the airway obstruction. It is important that the anesthesiologist remain alert to the airway after extubation to recognize laryngospasm (which can be silent when obstruction is complete) so that deep levels of hypoxia are not reached. Related Glossary Terms Airway obstruction, Aspiration, Extubation, Hypoxemia, Laryngeal mask airway (LMA), Larynx, Non-depolarizing muscle relaxants, Peripheral nerve stimulator, Residual block Index Find Term Chapter 1 - Airway Management Chapter 1 - Airway Management Chapter 1 - Airway Management Chapter 3 - General Anesthesia Chapter 3 - General Anesthesia Chapter 5 - Pediatric Anesthesia Chapter 6 - Induction Agents Chapter 6 - Inhaled Agents Chapter 6 - Inhaled Agents
Larynx The larynx is that part of the airway that connects the pharynx and hypopharynx to the trachea. It serves several functions: breathing, airway protection and phonation. The vocal cords are just part of the laryngeal structure. The larynx is located from the 3rd to 6th cervical vertebrae in adults. Related Glossary Terms Airway obstruction, Direct laryngoscopy, Epiglottis, Fibreoptic bronchoscope, Hypopharynx, Intubation, Laryngeal mask airway (LMA), Laryngoscope, Laryngospasm, Lower airway, Recurrent laryngeal nerve, Subglottis, Superior laryngeal nerve, Upper airway, Vallecula Index Find Term Chapter 1 - Airway Management Chapter 1 - Airway Management Chapter 1 - Airway Management Chapter 5 - Pediatric 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
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DANTROLENE Dantrolene is used in th
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Acetylcholine Acetylcholine (Ach) i
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Adjunct An adjunct is something add
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Airway assessment The purpose of th
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Aldrete score Phase 1 of recovery m
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Analgesia Pain relief Related Gloss
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Antecubital fossa The antecubital f
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Anticholinesterase Anticholinestera
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Antisialagogue An antisialogogue is
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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
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 and 202: Dantrolene Dantrolene is used in th
Page 203 and 204: Difficult airway The American Socie
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: Laryngoscope A laryngoscope is the
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
Page 253 and 254: Maintenance fluid requirements Main
Page 255 and 256: Mallampati classification The Malla
Page 257 and 258: Mechanical ventilation Mechanical v
Page 259 and 260: Metabolic acidosis Metabolic acidos
Page 261 and 262: Morphine Sulfate Class Opioid analg
Page 263 and 264: Muscarinic Muscarinic acetylcholine
Page 265 and 266: Myoglobinuria When pathological mus
Page 267 and 268: Nasotracheal intubation Nasotrachea
Page 269 and 270: Needle cricothyrotomy A needle cric
Page 271 and 272: Neonatal opioid depression The resp
Page 273 and 274: Neuromuscular junction The neuromus
Page 275 and 276: Nicotinic Nicotinic receptors are t
Page 277 and 278: Non-depolarizing muscle relaxants T
Page 279 and 280: Ondansetron Class Seratonin ( 5-HT
Page 281 and 282: Oxygen saturation The oxygen satura
Page 283 and 284: Oxytocin Oxytocin is used in obstet
Page 285 and 286: Parturient The parturient is the pr
Page 287 and 288: Patient controlled analgesia Patien
Page 289 and 290: Peripheral nerve stimulator A perip
Page 291 and 292: 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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