Understanding Anesthesiology - The Global Regional Anesthesia ...

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Sedation Sedation involves the delivery of agents (usually intravenous) for the purpose of achieving a calm, relaxed patient, able to protect his own airway and support his own ventilation. The range of physiologic effects of sedation is varied and is dependent on the depth of sedation provided: minimal, moderate or deep. A patient under minimal sedation will be fully responsive to verbal commands although his or her cognitive functions and coordination would be impaired. He or she would appear calm and relaxed and would have normal cardiorespiratory function. At the other extreme, a patient receiving deep sedation would be rousable only to repeated or painful stimuli. In some instances, the patient may require assistance in maintaining a patent airway. In this case, the line between deep sedation and general anesthesia is not easily identifiable. Table 9 outlines the physiologic effects of each of the three levels of sedation as defined by the American Society of Anesthesiologists (ASA). Sedation may be used alone for minimally painful procedures such as endoscopy. Often it is used in combination with local or regional anesthesia to provide a more palatable experience for the patient. In any case, the sedated patient must be monitored due to the depressant effects of the agents used. Care must be taken to reduce the dose administered to the frail, elderly or debilitated patient, in whom depressant effects may be exaggerated. In any patient, sedation may cause disinhibition, resulting in an uncooperative, agitated patient. Many different agents have been used for sedation. The term “neurolept anesthesia” refers to the (now historical) use of high doses of droperidol (a butyrophenone, in the same class as haloperidol) in combination with fentanyl (an opioid). Side effects were prominent. Currently, agents are chosen with specific effects in mind. Opioids. such as fentanyl or remifentanil, may be given alone if analgesia is the primary goal. The short-acting benzodiazepine, midazolam, is a popular choice because it provides amnesia as well as anxiolysis. Propofol, an anesthetic induction agent, can be infused in sub-anesthetic doses to produce a calm, euphoric patient. 45
Table 9 Sedation VERBAL COGNITIVE AIRWAY RESPIRATORY CARDIOVASCULAR RESPONSE FUNCTION PATENCY FUNCTION FUNCTION Light Sedation Normal Conscious, but cognitive function and coordination Normal Normal Normal would be impaired Moderate Sedation Would respond purposefully to verbal Depressed consciousness Normal Normal Normal commands Deep Sedation Not easily aroused; verbal response only to Depressed consciousness Airway might require support to remain patent Spontaneous ventilation may be inadequate Usually maintained painful or repeated physical stimuli 46
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 and 44: SECTION 3 Chapter 2 Review Review 2
Page 45: SECTION 1 Anesthetic Techniques In
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
Page 111 and 112:
NALOXONE Class Opioid antagonist. U
Page 113 and 114:
ROCURONIUM Class Non-depolarizing m
Page 115 and 116:
PANCURONIUM BROMIDE Class Nondepola
Page 117 and 118:
SUCCINYLCHOLINE CHLORIDE Class Depo
Page 119 and 120:
SECTION 3 Anticholinesterase and An
Page 121 and 122:
GLYCOPYRROLATE Class Anticholinergi
Page 123 and 124:
SECTION 4 Induction Agents Drugs 1.
Page 125 and 126:
SODIUM THIOPENTAL Class Short-actin
Page 127 and 128:
KETAMINE Class Phencyclidine deriva
Page 129 and 130:
ETOMIDATE Class Short-acting hypnot
Page 131 and 132:
DESFLURANE Class Volatile inhaled a
Page 133 and 134:
ISOFLURANE Class Volatile inhaled a
Page 135 and 136:
SECTION 6 Anxiolytics Drugs 1. Mida
Page 137 and 138:
SECTION 7 Antiemetics Drugs 1. Onda
Page 139 and 140:
DIMENHYDRINATE Class Antihistamine,
Page 141 and 142:
SECTION 8 Vasoactive Agents Drugs 1
Page 143 and 144:
EPHEDRINE SULFATE Class Sympathomim
Page 145 and 146:
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
Page 155 and 156:
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
Page 167 and 168:
Antisialagogue An antisialogogue is
Page 169 and 170:
Apneic threshold Apneic threshold i
Page 171 and 172:
Asepsis Asepsis is another word for
Page 173 and 174:
Atracurium Class Nondepolarizing sk
Page 175 and 176:
Autonomic nervous system The autono
Page 177 and 178:
Bacterial endocarditis The 2007 Ame
Page 179 and 180:
Balanced anesthesia Balanced anesth
Page 181 and 182:
Bier Block An intravenous regional
Page 183 and 184:
Brachial plexus The brachial plexus
Page 185 and 186:
Bupivacaine Class Local anesthetic.
Page 187 and 188:
Capnograph The capnograph is a moni
Page 189 and 190:
Cholinesterase Cholinesterase is a
Page 191 and 192:
Cis-Atracurium Class Non-depolarizi
Page 193 and 194:
CO2 (carbon dioxide) absorber The C
Page 195 and 196:
Competitive inhibitor Competitive i
Page 197 and 198:
Cormack Lehane Cormack Cormack Leha
Page 199 and 200:
Cricoid cartilage The cricoid is a
Page 201 and 202:
Dantrolene Dantrolene is used in th
Page 203 and 204:
Difficult airway The American Socie
Page 205 and 206:
Diphenhydramine Class Antihistamine
Page 207 and 208:
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 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 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 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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