Beruflich Dokumente
Kultur Dokumente
GENERAL
ANESTHESIA
1
GENERAL
ANESTHESIA
Maintenance
of
Patent
Airway
reversible
state
of
unconsciousness
produced
by
1. Chin/Jaw
Thrust
maneuver
anterior
displacement
of
anesthetic
agents
mandible
lift
epiglottis
and
base
of
tongue
from
airway
Effects:
2. Pharyngeal
airways
augments
elevation
of
epiglottis
and
o loss
of
sensation
of
pain
over
the
whole
body
base
of
tongue;
airway
bypasses
tongue
and
displaces
it
o Anterograde
Amnesia
anteriorly
o Muscle
relaxation
3. Tracheal
intubation
insertion
of
tube
through
Mechanism
of
Action
mouth/nose
to
the
trachea;
supraglottic
device
o Result
of
reversible
changes
in
neurologic
Advantages
of
ET
Intubation:
function
airway
patency
is
assured
o Inhalational:
inhibition
of
synapses
in
region
of
protection
from
aspiration
and
regurgitation
neuro-basal
thalamus
gastric
distention
is
prevented
o Intravenous:
drug-receptor
interactions
Disadvantage:
not
being
adept
to
the
technique
Indication
for
General
Anesthesia
Complications
of
General
ET
Anesthesia:
Infants
and
children
1. Trauma
Extensive
surgical
procedures
2. Endobronchial
intubation
Patient
with
mental
disease
3. Esophageal
intubation
Prolonged
surgery
4. ET
tube
obstruction
Surgery
where
local
anesthesia
is
impractical
5. Laryngospasm
With
history
of
toxic/allergic
reactions
to
local
anesthesia
Patients
on
anticoagulant
treatment
Complication
of
General
Anesthesia
(Intra-Op)
Adults
who
prefer
general
anesthesia
1.
Respiratory
complications
Hypoventilation
Order
of
Descending
Depression
Upper
airway
obstruction
caused
by
falling
back
of
1. Cortical
and
psychic
centers
tongue,
foreign
bodies
above
glottis,
endobronchial
2. Basal
ganglia
and
cerebellum
intubation,
laryngeal
spasm/hiccup
3. Spinal
cord
Lower
airway
obstruction
aspiration,
bronchospasm
4. Medullary
centers
2.
Cardiovascular
complications
Hypotension
4
Components
of
General
Anesthesia
Hypertension
1. Sensory
block
loss
of
sensation
or
analgesia
Arrhythmias
2. Motor
block
loss
of
muscle
tone
3.
Ocular
complications
corneal
abrasions
due
to
ill
fitting
mask
3. Block
of
the
reflexes
loss
of
reflexes
4.
Malignant
Hyperthermia
rapid
increase
in
body
temperature
of
4. Mental
block
loss
of
consciousness
at
least
2
degrees/hour;
high
mortality
Clinical
Signs
Prevention
of
Post-Op
Complications
Breath
holding,
delirium,
involuntary
1. Continuous
monitoring
of
VS
Insufficient
Depth
movement,
retching,
increase
mucus
2. Avoid
excessive
sedation
secretions
3. O2
inhalation
Stable
CV
response,
adequate
muscle
4. Turn
from
side
to
side
Sufficient
Depth
relaxation,
amnesia,
absence
of
troublesome
5. Deep
breathing
reflexes
6. Steam
inhalation
liquefy
secretions
No
response
or
ability
to
resume
normal
Excessive
Depth
ventilatory
function
at
end
of
operation;
BP
INTRAVENOUS
ANESTHESIA
and
obtundation
Depression
of
CNS
Blocking
of
pain
stimuli
at
level
of
cerebral
cortex
Types
of
General
Anesthesia
1. By
Inhalation
through
pulmonary
blood
alveolar
BARBITURATES
interface
MOA:
enhances
and
mimic
action
of
GABA
by
binding
to
a. Mask
Inhalation
using
fitted
mask
receptor
b. Nasal
insufflation
rubber
anesthesia
tubing
Thiopental
ultra-short
acting;
blocks
central
brain
core
catheter
inserted
to
nasopharynx
(RAS)
unconsciousness;
rapid
onset,
short
duration
of
c. Endotracheal
intubation
tube
in
between
action;
lethal
injection
glottic
opening
up
to
near
carina
Indications
d. Tracheal
stoma
o Induction
of
anesthesia
2. Intravenously
o Sole
anesthetic
agent
3. Intramuscularly
o Supplementation
4. Rectally
o Conjunction
with
regional
anesthesia
o Treatment
of
Status
Epilepticus
o Cerebral
protection
with
raised
ICP
Jena
Dominguez
UST-FMS
Batch
2019
ANESTHESIOLOGY:
GENERAL
ANESTHESIA
2
Contraindications
o Severe
shock
or
hypovolemia
4.
Ketamine
o Status
asthmaticus
profound
analgesic,
rapid
o Porphyria
intravenous
NMDA
receptor
antagonist
o Absence
of
IV
access
or
GA
equipment
interrupt
cerebral
association
pathways
dissociative
anesthesia
NON-BARBITURATES
intact
laryngeal
reflexes
1.
Benzodiazepines
BP,
CR,
IOP,
ICP,
CVP
MOA:
potentiation
of
neural
inhibition
mediated
by
GABA-
aminobutyric
acid
5.
Balanced
Anesthesia
addition
of
nitrous
oxide,
oxygen
and
Pharmacologic
effect:
muscle
relaxants
o Anxiolytic
o Sedative
ADJUNCTS
TO
ANESTHESIA
o Hypnotic
OPOIDS
o Muscle
relaxant
Bind
to
morphine
receptors
o Amnesic
(Anterograde)
Both
analgesic
and
sedative
properties
o Anticonvulsant
Agonists:
morphine,
fentanyl,
sufentanil,
remifentanil,
Diazepam
meperidine
Premedication;
for
seizures
Agonist-Antagonists
nalbuphine,
butorphanol
Water
insoluble
pain
during
injections
Antagonist
Naloxone
No
significant
effects
on
CO,
BP
or
cerebral
blood
flow
Effects:
analgesia,
depression
of
sensorium
and
Relieves
muscle
spasm
respirations
Lorazepam
Morphine
Premedication
- Depressant
effect
analgesia,
sedation,
depress
Water
insoluble
respiration
and
cough
reflex,
decrease
GI
motility
5-10
times
as
potent
as
diazepam
- Excitatory
effect
euphoria,
miosis,
N/V,
bradycardia,
profound
anterograde
amnesia
release
of
ADH
- Increases
smooth
muscle
tone
Midazolam
- HISTAMINE
RELEASE
bronchospasm,
erythema
same
action
as
diazepam
shorter
duration
of
action
Nalbuphine
rapid
metabolism
in
liver
- Sealing
effect
water
soluble
to
2-3
times
- >
60mg
it
reverses
itself
useful
drug
for
sedation
in:
outpatient
anesthesia,
minor
procedures
and
regional
anesthesia,
intensive
care
Meperidine
- action
similar
to
morphine
2.
Propofol
- shorter
duration
of
respiratory
depression
increase
inhibitory
neurotransmission
mediated
by
GABA
- not
as
marked
euphoria
highly
lipid
soluble
rapid
loss
of
consciousness
- more
pronounced
N/V
has
minimal
accumulation
even
on
repeated
doses
- mild
quinidine
like
effect
has
more
cardio
and
respi
depressant
effect
than
- less
histamine
release
pentothal
- less
or
no
GIT
actions
Severe
pain
on
venous
injection
Naloxone
Contraindicated
with
egg
allergy
- pure
opioids
antagonist
For
grand
mal
seizures
- competitive
antagonist
at
opioid
receptor
sites
Effective
in
N/V
- rapid
onset,
short
duration
Bolus
dose:
2mg/kg
in
4-5
mins
Advantages:
NEUROMUSCULAR
BLOCKING
AGENTS
o Rapid
clearance
and
few
residual
effects
on
muscle
relaxants
awakening
blocking
action
of
Ach
at
junction
of
nerve
ending
and
o ICP,
IOP,
arterial
BP
motor
end
plate
o effective
in
treating
N/V
facilitate
intubation
3.
Neuroleptanalgesia
1.
Depolarizing
muscle
relaxant
drugs
combination
of
potent
analgesic
and
neuroleptic
- mimic
affect
of
Ach
depolarize
postsynaptic
membrane
tranquilizer
(fentayl
+
droperidol)
at
NM
junction
prolong
or
making
persistent
produce
state
of
mental
detachment
and
indifference
to
depolarization
pain
MOA:
competitive
antagonism
at
dopaminergic
receptors
Jena
Dominguez
UST-FMS
Batch
2019
ANESTHESIOLOGY:
GENERAL
ANESTHESIA
3
- Succinylcholine
rapidly
metabolized
by
pseudocholinesterases;
rapid
onset
of
action;
excellent
agent
for
intubation
2.
Nondepolarizing
muscle
relaxant
drugs
- Compete
with
Ach
released
at
NM
junction
- Block
action
of
Ach
prevent
depolarization
prevent
transmission
of
nerve
impulses
to
muscle
fibers
- Pancuronium,
Rocuronium,
vecuronium
- Short-acting
15-30
mins
by
mivacurium
- Intermediate-acting
30-40
mins
by
atracurium
3.
Reversal
agents
for
Neurouscular
Blockade
- used
during
GA
to
reverse
effects
of
muscle
relaxants
- enables
spontaneous
breathing
to
recommence
earlier
- Anticholinesterase
reverse
effect
of
nondepolarizing
muscle
relaxant
- Sugammadex
first
selective
relaxant
binding
agent
(SRBA);
does
not
rely
on
inhibition
of
acetylcholinesterase
Jena
Dominguez
UST-FMS
Batch
2019