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 Medicine specialists use neostigmine 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 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 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. Related Glossary Terms Anticholinergic, Anticholinesterase, Cholinesterase, Neuromuscular junction, Nondepolarizing muscle relaxants Index Find Term Chapter 3 - General Anesthesia Chapter 4 - Recovery Chapter 6 - Drug Finder Chapter 6 - Anticholinesterase and Anticholinergics
Neuromuscular junction The neuromuscular junction is located where the nerve terminal meets the motor end-plate. The motor end-plate is a specialized area of the muscle cell that is responsible for the initiation of an action potential which then propagates through the entire muscle cell. A stimulated nerve releases acetylcholine from nerve terminal into the synaptic cleft, where it attaches to acetylcholine (Ach) receptors on the motor end-plate, triggering a muscular contraction. Muscle relaxants exert their action at the neuromuscular junction. Related Glossary Terms Acetylcholine, Anticholinergic, Cholinesterase, Competitive inhibitor, Muscarinic, Myasthenia gravis, Neostigmine, Nicotinic, Non-depolarizing muscle relaxants, Peripheral nerve stimulator Index Find Term Chapter 3 - General Anesthesia Chapter 3 - General Anesthesia Chapter 3 - General Anesthesia Chapter 6 - Muscle Relaxants Chapter 6 - Muscle Relaxants Chapter 6 - Muscle Relaxants Chapter 6 - Muscle Relaxants Chapter 6 - Muscle Relaxants
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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
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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
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 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: Neonatal opioid depression The resp
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
Page 311 and 312: Recurrent laryngeal nerve The recur
Page 313 and 314: Remifentanil Class Synthetic opioid
Page 315 and 316: Reticular activating system The ret
Page 317 and 318: Rocuronium Class Non-depolarizing m
Page 319 and 320: Second stage of labour The second s
Page 321 and 322: 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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