Understanding Anesthesiology - The Global Regional Anesthesia ...

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CHAPTER 3 The Intra-operative Phase In this chapter, you will be presented an overview of the range of techniques that can be used to provide anesthesia. Regional and general anesthesia are discussed in greater detail. The pharmacology of each of the important drugs used in the delivery of anesthesia can be found in the “Drug Finder” (Chapter 6). 43
SECTION 1 Anesthetic Techniques In This Section 1. Local Anesthesia 2. Sedation 3. Regional Anesthesia 4. General Anesthesia Except in the most desperate of circumstances, surgical procedures are performed with the benefit of anesthesia. There are four types of anesthesia that may be employed alone or in combination: • local • sedation (minimal, moderate or deep) • regional • general The findings on pre-operative assessment, the nature of the surgery and the patient’s preference all factor into the choice of anesthetic technique. Contrary to popular belief, studies have failed to identify one technique as superior (lower morbidity and mortality) to the others in a general patient population. Regardless of the technique employed, the anesthesiologist must ensure patient comfort, maintenance of physiologic homeostasis and provision of adequate operating conditions. Local Anesthesia Local anesthesia refers to the infiltration of a local anesthetic agent at the surgical site and is usually performed by the surgeon. This technique is appropriate for superficial procedures such as dental surgery, breast biopsy or carpal tunnel release. Local anesthesia may be used in an unmonitored setting. However, often it is used in combination with sedation in which case monitoring is required. While local anesthesia is inadequate for more invasive procedures such as those involving the body cavities, local infiltration is often used as an adjunct in post-operative pain management. Care must be taken to avoid intravascular injection and to avoid exceeding the toxic dose of the local anesthetic in use. 44
Page 1 and 2: 1 ST EDITION Understanding Anesthes
Page 3 and 4: Preface ii
Page 5 and 6: GETTING THE MOST FROM YOUR IBOOK Th
Page 7 and 8: ACKNOWLEDGEMENTS Many individuals s
Page 9 and 10: THE ROLE OF THE ANESTHESIOLOGIST Dr
Page 11 and 12: CHAPTER 1 The ABC’s In this chapt
Page 13 and 14: There are many different laryngeal
Page 15 and 16: • Mouth opening: Three fingerbrea
Page 17 and 18: A patient who is deemed to be at ri
Page 19 and 20: Movie 1.1 Intubation technique The
Page 21 and 22: After intubation, correct placement
Page 23 and 24: The Difficult Airway Airway mismana
Page 25 and 26: volume, then the surgery should be
Page 27 and 28: Vascular Access Peripheral venous a
Page 29 and 30: Interactive 1.1 Body water distribu
Page 31 and 32: Complications of transfusion are nu
Page 33 and 34: CHAPTER 2 The Pre-operative Phase I
Page 35 and 36: are known to have cardiac disease o
Page 37 and 38: Premedication Pre-medication can in
Page 39 and 40: SECTION 2 Anesthetic Equipment and
Page 41 and 42: Monitoring The purpose of monitorin
Page 43: SECTION 3 Chapter 2 Review Review 2
Page 47 and 48: Table 9 Sedation VERBAL COGNITIVE A
Page 49 and 50: General Anesthesia General anesthes
Page 51 and 52: Epidural Anesthesia Epidural and sp
Page 53 and 54: Movie 3.1 Labour epidural insertion
Page 55 and 56: Figure 14 Sensory dermatomes tion i
Page 57 and 58: Figure 16 Anatomy relevant to spina
Page 59 and 60: cles (Figure 19).They then travel u
Page 61 and 62: SECTION 3 General Anesthesia In Thi
Page 63 and 64: amples of conditions which impair g
Page 65 and 66: and trauma surgery pose a higher ri
Page 67 and 68: Drugs for Maintenance of Anesthesia
Page 69 and 70: Contraindications to the inhaled ag
Page 71 and 72: Contraindications Opioids must not
Page 73 and 74: Table 15 Dose, onset, duration, eli
Page 75 and 76: tubation, leading to total airway o
Page 77 and 78: SECTION 4 Chapter 3 Review Review 3
Page 79 and 80: SECTION 1 Recovery In This Section
Page 81 and 82: Post-operative Nausea and Vomiting
Page 83 and 84: SECTION 2 Post-operative Pain Manag
Page 85 and 86: lead to a decreased stress response
Page 87 and 88: CHAPTER 5 Special Patients In this
Page 89 and 90: Successful treatment of an MH crisi
Page 91 and 92: SECTION 2 Obstetrical Anesthesia In
Page 93 and 94: There is good evidence that a labou
Page 95 and 96:
SECTION 3 Pediatric Anesthesia In T
Page 97 and 98:
tain types of noxious stimuli. Exam
Page 99 and 100:
SECTION 4 Anesthesia Outside the Op
Page 101 and 102:
SECTION 5 Chapter 5 Review Review 5
Page 103 and 104:
Opioid agonists and antagonists •
Page 105 and 106:
FENTANYL Class Synthetic opioid ana
Page 107 and 108:
REMIFENTANIL Class Synthetic opioid
Page 109 and 110:
MORPHINE SULFATE Class Opioid analg
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NALOXONE Class Opioid antagonist. U
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ROCURONIUM Class Non-depolarizing m
Page 115 and 116:
PANCURONIUM BROMIDE Class Nondepola
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SUCCINYLCHOLINE CHLORIDE Class Depo
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SECTION 3 Anticholinesterase and An
Page 121 and 122:
GLYCOPYRROLATE Class Anticholinergi
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SECTION 4 Induction Agents Drugs 1.
Page 125 and 126:
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
Page 137 and 138:
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
Page 147 and 148:
LIDOCAINE Class Local anesthetic. U
Page 149 and 150:
KETOROLAC TROMETHAMINE Class Non-st
Page 151 and 152:
DANTROLENE Dantrolene is used in th
Page 153 and 154:
Acetylcholine Acetylcholine (Ach) i
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Adjunct An adjunct is something add
Page 157 and 158:
Airway assessment The purpose of th
Page 159 and 160:
Aldrete score Phase 1 of recovery m
Page 161 and 162:
Analgesia Pain relief Related Gloss
Page 163 and 164:
Antecubital fossa The antecubital f
Page 165 and 166:
Anticholinesterase Anticholinestera
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Antisialagogue An antisialogogue is
Page 169 and 170:
Apneic threshold Apneic threshold i
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Asepsis Asepsis is another word for
Page 173 and 174:
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
Page 201 and 202:
Dantrolene Dantrolene is used in th
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Difficult airway The American Socie
Page 205 and 206:
Diphenhydramine Class Antihistamine
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Dura The dura is the outermost (and
Page 209 and 210:
Ephedrine Sulfate Class Sympathomim
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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
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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
Page 259 and 260:
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
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Ondansetron Class Seratonin ( 5-HT
Page 281 and 282:
Oxygen saturation The oxygen satura
Page 283 and 284:
Oxytocin Oxytocin is used in obstet
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Parturient The parturient is the pr
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Patient controlled analgesia Patien
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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 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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