Understanding Anesthesiology - The Global Regional Anesthesia ...

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Regional anesthesia Regional anesthesia is the anesthetic technique which relies on the blockade of a nerve or group of nerves to render the surgical field insensate. Regional anesthesia can be used on its own or in combination with sedation or general anesthesia. Related Glossary Terms Analgesia, Asepsis, Bier Block, Brachial plexus block, Epidural anesthesia, Neuropathy, Spinal anesthesia Index Find Term Chapter 3 - Anesthetic Techniques Chapter 3 - Regional Anesthesia Chapter 5 - Obstetrical Anesthesia Chapter 6 - Local Anesthetics Chapter 6 - Local Anesthetics
Remifentanil Class Synthetic opioid analgesic (ultra short-acting); adjunct to anesthesia. Mechanism of Action Acts at the mu-and kappa opioid receptors. Dose On induction of general anesthesia: 0.3-1 ug/kg For maintenance of general anesthesia: 0.1-1 $g/kg/minute (by infusion) For sedation: infusion 0.05 – 0.1 $g/kg/minute Onset After single bolus: 1-1.5 minutes After initiation of infusion: 3-5 minutes Duration 5-10 minutes; context sensitive half time 3 minutes Elimination Non-specific blood-tissue esterases (end-organ independent) Effects CNS Potent analgesic effects, sedation. “MAC sparing” allows up to 75% reduction in dose of coanesthetics. All of the depressant effects of remifentanil are potentiated by concurrent use of sedatives, volatile anesthetics and nitrous oxide. CVS Exaggerated bradycardia, hypotension (compared with other opioids). The synthetic opioids are not direct myocardial depressants but they do reduce sympathetic drive, which may result in decreased cardiac output in patients who are relying on sympathetic tone to support their circulation, such as those in hypovolemic or cardiogenic shock. Respiratory Profound respiratory depressant which often leads to apnea. GI Nausea, vomiting. Misc. Can cause profound muscle rigidity. Not suitable for spinal or epidural use due to glycine additive. Rapid elimination requires initiation of post-operative analgesia (usually morphine) prior to emergence . Related Glossary Terms Alfentanil, Analgesia, Apneic threshold, Balanced anesthesia, Continuous Infusion, Fentanyl, Four A’s of anesthesia, Morphine Sulfate, Naloxone, Opioids, Sufentanil, Total intravenous anesthesia Index Find Term Chapter 3 - General Anesthesia Chapter 3 - General Anesthesia 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
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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
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
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: Recurrent laryngeal nerve The recur
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
Page 323 and 324: Shock Shock occurs when perfusion o
Page 325 and 326: Sodium citrate Sodium citrate is a
Page 327 and 328: Spinal anesthesia Spinal anesthesia
Page 329 and 330: Subarachnoid space The subarachnoid
Page 331 and 332: Succinylcholine Class Depolarizing
Page 333 and 334: Superior laryngeal nerve The superi
Page 335 and 336: Sympathetic nervous system The symp
Page 337 and 338: Theophylline Theophylline is a medi
Page 339 and 340: Thrombocytopenia Low platelet count
Page 341 and 342: Tidal volume Tidal volume is the vo
Page 343 and 344: Transcutaneous electrical nerve sti
Page 345 and 346: Trendelenburg The trendelenburg pos
Page 347 and 348: Urticaria Hives. Urticaria is cause
Page 349 and 350: Vagolytic Drugs with a vagolytic ef
Page 351 and 352: Vallecula The vallecula is the spac
Page 353 and 354: Venous air embolism Venous air embo
Page 355 and 356: Videolaryngoscope The videolaryngos
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