Understanding Anesthesiology - The Global Regional Anesthesia ...

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Subglottis The subglottis is the region just below the larynx. It is located at the level of the cricoid cartilage. In adults, this is at the level of the 6th cervical vertebrae; in children, it is higher, at C4. The sublgottis is the narrowest region of the pediatric airway. The pediatric patient, therefore, is susceptible to airway obstruction at this level, when the subglottic region is swollen either through viral inflammation (croup) or traumatic airway maneuvers. Related Glossary Terms Airway obstruction, Aspiration, Cricoid cartilage, Larynx, Lower airway, Needle cricothyrotomy, Sellick’s maneuver, Upper airway Index Find Term Chapter 5 - Pediatric Anesthesia
Succinylcholine Class Depolarizing muscle relaxant; ultra short-acting; Used for rapid sequence induction. Mechanism of Action Succinylcholine (Sch) attaches to nicotinic cholinergic receptors at the neuromuscular junction. There, it mimics the action of acetylcholine thus depolarizing the post-junctional membrane. Neuromuscular blockade (paralysis) develops because a depolarized post-junctional membrane cannot respond to subsequent release of acetylcholine. Dose Intubaton: 1-1.5 mg/kg IV or 2.5-4 mg/kg IM Onset 30-60 seconds after IV administration 2-3 minutes after IM dose Duration Duration is 4-6 minutes after IV dose 10-30 minutes after IM dose Elimination Hydrolysis by plasma pseudocholinesterase Effects CNS Raised intracranial pressure and raised intraocular pressure. CVS Because of cross-reactivity at the muscarinic acetylcholine receptors, Sch causes vagal cardiac dysrhythmias. Bradycardia, junctional rhythm and sinus arrest can occur particularly if a second dose is administered and particularly in children. Respiratory Occasionally leads to bronchospasm and excessive salivation due to muscarinic effects. Intragastric pressure is increased thereby theoretically increasing the risk of regurgitation. Misc. Most of the other effects are secondary to the depolarization and subsequent contraction of skeletal muscle. Sch elevates serum potassium 0.3-0.5 mEq/L in normal patients It can cause an exaggerated release of potassium (leading to fatal hyperkalemia) in those with neuromuscular or muscle disease. Post-operative myalgia is common particularly in young adults. Succinylcholine is a potent trigger of malignant hyperthermia. Contraindications There is a long list of absolute and relative contraindications which can be found in any Anesthesia text. A brief summary follows: • Malignant Hyperthermia (MH) or presence of conditions associated with MH. • Pseudocholinesterase deficiency. Deficiency can result as a genetic defect, as a consequence of various medications or a result of liver disease. The latter two causes are usually relative while the genetic defect can produce a complete lack of pseudocholinesterase activity in homozygous individuals. The use of succinylcholine in a patient with pseudocholinestersase deficiency leads to prolonged paralysis. • Hyperkalemia. • Presence of neurologic or muscular condition which would predispose to hyperkalemia after Sch-induced muscle contraction. Examples include recent paralysis (spinal cord injury or stroke), amyotrophic lateral sclerosis (ALS), Duchenne’s muscular dystrophy and recent burn or crush injury. Myotonia congenita or myotonia dystrophica can manifest sustained contraction with Sch. Related Glossary Terms Acetylcholine, Dantrolene, Malignant hyperthermia, Myoglobinuria, Neuromuscular junction, Non-depolarizing muscle relaxants, Pseudocholinesterase deficiency, Rapid sequence induction, Ryanodine Index Find Term Chapter 3 - General Anesthesia Chapter 3 - General Anesthesia Chapter 3 - General Anesthesia Chapter 5 - Malignant Hyperthermia Chapter 6 - Drug Finder 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
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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
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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
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
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: Subarachnoid space The subarachnoid
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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