Understanding Anesthesiology - The Global Regional Anesthesia ...

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Midazolam Class Short-acting benzodiazepine. Used for sedation or as an adjunct during general anesthesia. Midazolam has anxiolytic and sedative (but not analgesic) properties. Mechanism of Action Agonism at the inhibitory GABA receptor. Dose For sedation: 0.03-0.08 mg/kg IV Can also be given intramuscularly, intranasally and orally. Onset Within 3-5 minutes Duration Elimination half-time is 1-4 hours, making midazolam a much shorter acting agent than diazepam. Elimination Metabolized in the liver by microsomal enzymes and excreted in the urine. Effects CNS Induces anxiolysis, amnesia, hypnosis. Decreases cerebral blood flow. Minimal effects on intracranial pressure. May contribute to post-operative delirium in the elderly. CVS In larger doses, in the presence of hypovolemia or when used in combination with opioids, midazolam can lead to decreased blood pressure and increased heart rate. Cardiac output is unchanged. Respiratory Dose-related respiratory depression occurs. This response is exaggerated in the elderly, in those with COPD or when used in combination with opioids. Misc. Midazolam is water-soluble therefore the pain on injection and phlebitis that are seen with diazepam are uncommon. Related Glossary Terms Fibreoptic bronchoscope, Flumazenil Index Find Term Chapter 3 - Anesthetic Techniques Chapter 6 - Drug Finder Chapter 6 - Anxiolytics
Morphine Sulfate Class Opioid analgesic (long acting). In anesthetic practice, its main use is for postoperative analgesia. Morphine is commonly used intravenously and for spinal or epidural anesthesia/ analgesia. Mechanism of Action Active at the mu and kappa opioid receptors. Dose Adults: 2.5-15 mg IV/IM/SC Children: 0.05-0.2 mg/kg IV/IM/SC Onset IV 5-10 minutes IM 15-30 minutes Duration 2-5 hrs IV/IM/SC Elimination Hepatic Effects CNS Reliable analgesic effects; sedation. May cause blurred vision, syncope, euphoria, dysphoria. All of the depressant effects of morphine are potentiated by concurrent use of sedatives, volatile anesthetics, nitrous oxide and alcohol. Morphine’s depressant effects are also potentiated by antihistamines, phenothiazines, butyrophenones, MAOIs and TCAs. CVS May cause hypotension, hypertension, bradycardia, arrhythmias. Respiratory Respiratory depression which at the extreme leads to apnea. May cause bronchospasm or laryngospasm. GI Nausea, vomiting, constipation, biliary tract spasm. Misc. Releases histamine. May cause pruritis, urticaria, muscle rigidity, urinary retention. Related Glossary Terms Alfentanil, Analgesia, Apneic threshold, Epidural analgesia, Epidural anesthesia, Fentanyl, Naloxone, Opioids, Patient controlled analgesia, Re-narcotization, Remifentanil, Spinal anesthesia, Sufentanil Index Find Term Chapter 3 - General <strong>Anesthesia</strong> Chapter 4 - Post-operative Pain Management Chapter 4 - Post-operative Pain Management Chapter 5 - Obstetrical <strong>Anesthesia</strong> Chapter 6 - Drug Finder Chapter 6 - Opioid agonists and antagonists
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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
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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
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
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: Metabolic acidosis Metabolic acidos
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
Page 293 and 294: Positive pressure ventilation Posit
Page 295 and 296: Post-operative nausea and vomiting
Page 297 and 298: Pre-operative assessment Every pati
Page 299 and 300: Pre-oxygenation The purpose of pre-
Page 301 and 302: Prone In the prone position, the pa
Page 303 and 304: Pseudocholinesterase deficiency Pse
Page 305 and 306: Pulse oximeter The oxygen saturatio
Page 307 and 308: Radiculopathies Radiculopathy descr
Page 309 and 310: 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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