Podcast
Questions and Answers
What amount of long-acting insulin should patients with type 1 diabetes take on the day of surgery?
What amount of long-acting insulin should patients with type 1 diabetes take on the day of surgery?
- One quarter of their usual dose
- Their full usual dose
- No insulin
- One third of their usual dose (correct)
Which class of medication should be discontinued 24 hours before elective surgery?
Which class of medication should be discontinued 24 hours before elective surgery?
- Thiazide diuretics
- SGLT2 inhibitors (correct)
- Non-insulin antidiabetic medications
- COX-2 inhibitors
How long before surgery should warfarin be discontinued for most patients?
How long before surgery should warfarin be discontinued for most patients?
- 7 days
- 1 day
- 3 days
- 5 days (correct)
Which of the following medications should be continued on the day of surgery?
Which of the following medications should be continued on the day of surgery?
What action should be taken with topical medications on the day of surgery?
What action should be taken with topical medications on the day of surgery?
What is the recommended preoperative discontinuation time for Ephedra: ma huang due to its sympathomimetic effects?
What is the recommended preoperative discontinuation time for Ephedra: ma huang due to its sympathomimetic effects?
Which of the following herbal medications is associated with irreversible inhibition of platelet aggregation?
Which of the following herbal medications is associated with irreversible inhibition of platelet aggregation?
What is the physiological impact of nicotine found in e-cigarettes?
What is the physiological impact of nicotine found in e-cigarettes?
Which of the following statements is true regarding Ginger: Zingiber officinale and its preoperative guidelines?
Which of the following statements is true regarding Ginger: Zingiber officinale and its preoperative guidelines?
Which substance found in e-cigarettes is known to generate pulmonary toxicity?
Which substance found in e-cigarettes is known to generate pulmonary toxicity?
What is the impact of long-term alcohol intake on anesthetic requirements?
What is the impact of long-term alcohol intake on anesthetic requirements?
What is the required cessation time for Ginkgo: duck foot tree before surgery?
What is the required cessation time for Ginkgo: duck foot tree before surgery?
Which constitutes a significant risk factor for perioperative complications?
Which constitutes a significant risk factor for perioperative complications?
How long should Kava: awa be discontinued before surgery to minimize sedation and anxiolysis risk?
How long should Kava: awa be discontinued before surgery to minimize sedation and anxiolysis risk?
Which herbal medication does not have a specified preoperative discontinuation time?
Which herbal medication does not have a specified preoperative discontinuation time?
What should be done with antihypertensive medications on the day of surgery?
What should be done with antihypertensive medications on the day of surgery?
How should aspirin be managed for patients with prior percutaneous coronary intervention on the day of surgery?
How should aspirin be managed for patients with prior percutaneous coronary intervention on the day of surgery?
What is the recommended action regarding the discontinuation of insulin for patients on the day of surgery?
What is the recommended action regarding the discontinuation of insulin for patients on the day of surgery?
Which statement is true regarding the management of P2Y12 inhibitors before surgery?
Which statement is true regarding the management of P2Y12 inhibitors before surgery?
What is a key consideration for corticosteroid use in patients undergoing surgery?
What is a key consideration for corticosteroid use in patients undergoing surgery?
What is recommended concerning the continuation of antidepressants on the day of surgery?
What is recommended concerning the continuation of antidepressants on the day of surgery?
Which category of medications is explicitly stated as needing to be discontinued on the day of surgery?
Which category of medications is explicitly stated as needing to be discontinued on the day of surgery?
What should be documented regarding allergies before surgery?
What should be documented regarding allergies before surgery?
Which of the following substances is NOT typically considered an illicit drug?
Which of the following substances is NOT typically considered an illicit drug?
What does the acronym LEMON stand for in airway evaluation?
What does the acronym LEMON stand for in airway evaluation?
Which of the following is NOT part of the physical examination process as outlined?
Which of the following is NOT part of the physical examination process as outlined?
Which factor is assessed during the airway evaluation concerning the patient's anatomy?
Which factor is assessed during the airway evaluation concerning the patient's anatomy?
Obesity is defined in relation to what measurement?
Obesity is defined in relation to what measurement?
What is the primary purpose of the physical examination in the context described?
What is the primary purpose of the physical examination in the context described?
Which condition is a co-morbidity that can impact the administration of anesthesia?
Which condition is a co-morbidity that can impact the administration of anesthesia?
The Mallampati Airway Classification assesses the visibility of what anatomical structure?
The Mallampati Airway Classification assesses the visibility of what anatomical structure?
What is the primary goal of the preanesthetic evaluation?
What is the primary goal of the preanesthetic evaluation?
Which component is NOT typically included in a preanesthetic evaluation?
Which component is NOT typically included in a preanesthetic evaluation?
What is the purpose of the ASA classification system in a preoperative setting?
What is the purpose of the ASA classification system in a preoperative setting?
Which fasting recommendation is appropriate for a patient before surgery according to general guidelines?
Which fasting recommendation is appropriate for a patient before surgery according to general guidelines?
What is an important strategy to prevent aspiration pneumonitis in at-risk populations?
What is an important strategy to prevent aspiration pneumonitis in at-risk populations?
What should the preanesthetic evaluation focus on regarding the patient's medical history?
What should the preanesthetic evaluation focus on regarding the patient's medical history?
Which best describes an outcome of inadequate preoperative planning?
Which best describes an outcome of inadequate preoperative planning?
What should a patient be educated about before surgery to reduce anxiety?
What should a patient be educated about before surgery to reduce anxiety?
How does the preanesthetic evaluation help with surgical efficiency?
How does the preanesthetic evaluation help with surgical efficiency?
What is a crucial aspect to confirm during the preoperative drug history assessment?
What is a crucial aspect to confirm during the preoperative drug history assessment?
Why is preoperative fasting important?
Why is preoperative fasting important?
What combination of factors does the content of the preanesthetic evaluation assess?
What combination of factors does the content of the preanesthetic evaluation assess?
What key information should be prioritized during the patient interview component of preanesthetic assessment?
What key information should be prioritized during the patient interview component of preanesthetic assessment?
Which of the following factors is least likely to directly influence anesthetic technique selection?
Which of the following factors is least likely to directly influence anesthetic technique selection?
What is the primary characteristic of general anesthesia?
What is the primary characteristic of general anesthesia?
Which anesthesia type is typically preferred for pediatric cases?
Which anesthesia type is typically preferred for pediatric cases?
What is the ideal outcome regarding postoperative side effects when selecting an anesthetic technique?
What is the ideal outcome regarding postoperative side effects when selecting an anesthetic technique?
Which of the following is typically NOT a consideration for anesthesia in critical care?
Which of the following is typically NOT a consideration for anesthesia in critical care?
What is one of the main components of the anesthetic state that is typically inferred but not directly measured?
What is one of the main components of the anesthetic state that is typically inferred but not directly measured?
Which patient consideration is crucial for determining the anesthesia technique for outpatient surgery?
Which patient consideration is crucial for determining the anesthesia technique for outpatient surgery?
Alice Magaw is recognized for her contributions primarily to which area?
Alice Magaw is recognized for her contributions primarily to which area?
What is the primary patient characteristic that disqualifies someone from being a good candidate for monitored anesthesia care?
What is the primary patient characteristic that disqualifies someone from being a good candidate for monitored anesthesia care?
Which sedation level allows patients to respond purposefully to verbal commands with adequate spontaneous ventilation?
Which sedation level allows patients to respond purposefully to verbal commands with adequate spontaneous ventilation?
What is a key reason inhalation induction is commonly used for children scheduled for elective cases?
What is a key reason inhalation induction is commonly used for children scheduled for elective cases?
What is included in the maintenance phase of anesthesia after induction?
What is included in the maintenance phase of anesthesia after induction?
What is a common risk associated with monitored anesthesia care, as indicated by the ASA Closed Claims Project database?
What is a common risk associated with monitored anesthesia care, as indicated by the ASA Closed Claims Project database?
What is the role of the anesthesia provider during monitored anesthesia care?
What is the role of the anesthesia provider during monitored anesthesia care?
Which volatile anesthetic is known for being the most common, non-pungent, and non-irritating?
Which volatile anesthetic is known for being the most common, non-pungent, and non-irritating?
What is a correct statement about the administration of drugs during monitored anesthesia care?
What is a correct statement about the administration of drugs during monitored anesthesia care?
Which of the following is a crucial step in the inhalation induction process?
Which of the following is a crucial step in the inhalation induction process?
In maintaining physiologic homeostasis during surgery, which goal is critical for normotensive patients?
In maintaining physiologic homeostasis during surgery, which goal is critical for normotensive patients?
What is the primary focus of post-standard induction management?
What is the primary focus of post-standard induction management?
What defines the 'Valley of Anesthesia' period?
What defines the 'Valley of Anesthesia' period?
What is NOT a goal of anesthesia maintenance?
What is NOT a goal of anesthesia maintenance?
Which factor should be monitored to ensure adequate ventilation during inhalation induction?
Which factor should be monitored to ensure adequate ventilation during inhalation induction?
What is the primary purpose of pre-oxygenation during the induction of anesthesia?
What is the primary purpose of pre-oxygenation during the induction of anesthesia?
Which of the following anesthetic agents is known for providing rapid onset of unconsciousness?
Which of the following anesthetic agents is known for providing rapid onset of unconsciousness?
What does the application of cricoid pressure during rapid sequence induction aim to achieve?
What does the application of cricoid pressure during rapid sequence induction aim to achieve?
Which monitor is specifically used when consistent and continuous monitoring of blood pressure is necessary?
Which monitor is specifically used when consistent and continuous monitoring of blood pressure is necessary?
What is a common characteristic of an ideal intravenous anesthesia induction drug?
What is a common characteristic of an ideal intravenous anesthesia induction drug?
Which reflex is considered a protective reflex during anesthesia induction?
Which reflex is considered a protective reflex during anesthesia induction?
In the context of pre-induction, what is the primary use of special monitors like cerebral oximeters?
In the context of pre-induction, what is the primary use of special monitors like cerebral oximeters?
What factor determines the choice of anesthetic agent used during induction?
What factor determines the choice of anesthetic agent used during induction?
During a rapid sequence induction, which of the following is a critical step following the administration of induction agents?
During a rapid sequence induction, which of the following is a critical step following the administration of induction agents?
What is the primary goal of the standard induction sequence in anesthesia?
What is the primary goal of the standard induction sequence in anesthesia?
What is the significance of Stage II during intravenous induction of anesthesia?
What is the significance of Stage II during intravenous induction of anesthesia?
Which criterion is essential for 'Awake Extubation'?
Which criterion is essential for 'Awake Extubation'?
What is the primary goal during the emergence phase from general anesthesia?
What is the primary goal during the emergence phase from general anesthesia?
What is a key characteristic of Stage III Plane 2 in general anesthesia?
What is a key characteristic of Stage III Plane 2 in general anesthesia?
Which method should be employed to minimize diffusion hypoxia after the use of N2O?
Which method should be employed to minimize diffusion hypoxia after the use of N2O?
What denotes the end of Stage IV in general anesthesia?
What denotes the end of Stage IV in general anesthesia?
What should be prioritized when evaluating a patient for deep extubation?
What should be prioritized when evaluating a patient for deep extubation?
What is the essential responsibility during the maintenance monitoring phase of anesthesia?
What is the essential responsibility during the maintenance monitoring phase of anesthesia?
Which of the following is NOT a sign of Stage III during the emergence phase?
Which of the following is NOT a sign of Stage III during the emergence phase?
In Monitored Anesthesia Care (MAC), what indicates that the anesthesia approach has transitioned to general anesthesia?
In Monitored Anesthesia Care (MAC), what indicates that the anesthesia approach has transitioned to general anesthesia?
What is the primary reason for performing pre-oxygenation before induction of anesthesia?
What is the primary reason for performing pre-oxygenation before induction of anesthesia?
Which statement accurately describes the characteristics of ideal intravenous induction agents?
Which statement accurately describes the characteristics of ideal intravenous induction agents?
What is a unique aspect of Rapid Sequence Induction (RSI) compared to standard induction?
What is a unique aspect of Rapid Sequence Induction (RSI) compared to standard induction?
Which monitor is considered a standard for all anesthetic techniques according to the established guidelines?
Which monitor is considered a standard for all anesthetic techniques according to the established guidelines?
What component is critical during the setup procedure for RSI to prevent aspiration?
What component is critical during the setup procedure for RSI to prevent aspiration?
Which anesthetic agent is commonly utilized for inducing anesthesia due to its minimal effect on seizure threshold?
Which anesthetic agent is commonly utilized for inducing anesthesia due to its minimal effect on seizure threshold?
Which component is typically NOT included in the standard induction sequence checklist?
Which component is typically NOT included in the standard induction sequence checklist?
What does the AANA and ASA standard require regarding monitoring during anesthesia?
What does the AANA and ASA standard require regarding monitoring during anesthesia?
Which volatile anesthetic is known for being non-pungent and non-irritating?
Which volatile anesthetic is known for being non-pungent and non-irritating?
What is primarily assessed in the post-induction phase to determine ventilation effectiveness?
What is primarily assessed in the post-induction phase to determine ventilation effectiveness?
During inhalation induction, which component is essential for achieving a sufficient onset of anesthesia?
During inhalation induction, which component is essential for achieving a sufficient onset of anesthesia?
At which spinal level is local anesthetic solution typically injected for spinal neuraxial anesthesia?
At which spinal level is local anesthetic solution typically injected for spinal neuraxial anesthesia?
What does 'maintenance of physiological homeostasis' during anesthesia require?
What does 'maintenance of physiological homeostasis' during anesthesia require?
Which of the following is NOT a goal of the maintenance phase in anesthesia?
Which of the following is NOT a goal of the maintenance phase in anesthesia?
Which structure must be penetrated to reach the subarachnoid space during a spinal block?
Which structure must be penetrated to reach the subarachnoid space during a spinal block?
In inhalation induction, what is the primary role of priming the circuit?
In inhalation induction, what is the primary role of priming the circuit?
What is the primary blood supply to the lower two-thirds of the spinal cord?
What is the primary blood supply to the lower two-thirds of the spinal cord?
What is a common feature of the 'valley of anesthesia' following induction?
What is a common feature of the 'valley of anesthesia' following induction?
Which of the following statements best describes the mechanism of action of spinal anesthesia?
Which of the following statements best describes the mechanism of action of spinal anesthesia?
What is one potential complication of delayed gastric emptying when considering anesthesia?
What is one potential complication of delayed gastric emptying when considering anesthesia?
What potential complication is associated with spinal blocks that result in sympathetic blockade?
What potential complication is associated with spinal blocks that result in sympathetic blockade?
What is indicated by a positive pressure ventilation technique in the post-standard induction phase?
What is indicated by a positive pressure ventilation technique in the post-standard induction phase?
Which airway device can be utilized without the administration of paralytics?
Which airway device can be utilized without the administration of paralytics?
What is the primary purpose of neuroaxial anesthesia?
What is the primary purpose of neuroaxial anesthesia?
Which of the following statements about ETCO2 monitoring is correct?
Which of the following statements about ETCO2 monitoring is correct?
What does the original application of modern local anesthesia involve?
What does the original application of modern local anesthesia involve?
Which of the following is NOT a known application of regional anesthesia techniques?
Which of the following is NOT a known application of regional anesthesia techniques?
How do local anesthetics primarily function on nerve fibers?
How do local anesthetics primarily function on nerve fibers?
Which of the following is a characteristic of spinal anesthesia?
Which of the following is a characteristic of spinal anesthesia?
Which surgeries are typically contraindicated for neuroaxial anesthesia?
Which surgeries are typically contraindicated for neuroaxial anesthesia?
Which of these is true about cardiovascular function during neuroaxial anesthesia?
Which of these is true about cardiovascular function during neuroaxial anesthesia?
Who is credited with the development of spinal anesthesia?
Who is credited with the development of spinal anesthesia?
Which stage of general anesthesia begins with the onset of regular breathing and ends with the loss of spontaneous respirations?
Which stage of general anesthesia begins with the onset of regular breathing and ends with the loss of spontaneous respirations?
During which stage of general anesthesia is there a critical risk for laryngospasms, especially if the endotracheal tube is pulled?
During which stage of general anesthesia is there a critical risk for laryngospasms, especially if the endotracheal tube is pulled?
What is necessary for adequate spontaneous ventilation during awake extubation?
What is necessary for adequate spontaneous ventilation during awake extubation?
What does the presence of dilated pupils and tachycardia indicate during the stages of general anesthesia?
What does the presence of dilated pupils and tachycardia indicate during the stages of general anesthesia?
Which criterion is essential for deep extubation immediately prior to extubation?
Which criterion is essential for deep extubation immediately prior to extubation?
What must be monitored during maintenance anesthesia in addition to vital signs?
What must be monitored during maintenance anesthesia in addition to vital signs?
What indicates that diffusion hypoxia may have occurred after the use of nitrous oxide?
What indicates that diffusion hypoxia may have occurred after the use of nitrous oxide?
When preparing for emergence from general anesthesia, what should be assessed specifically?
When preparing for emergence from general anesthesia, what should be assessed specifically?
Which breathing irregularity during Stage II could indicate a patient's readiness for extubation?
Which breathing irregularity during Stage II could indicate a patient's readiness for extubation?
What should a patient demonstrate before being considered safe for awake extubation?
What should a patient demonstrate before being considered safe for awake extubation?
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Study Notes
Preoperative Evaluation
- Preanesthetic evaluation aims to assess a patient's medical history and intraoperative risk.
- Identifying and mitigating risks is crucial for optimizing patient conditions and minimizing complications.
- Inadequate planning may lead to increased anesthetic complications and surgical delays.
Goals of Preoperative Evaluation
- Optimize patient care, satisfaction, and comfort.
- Minimize perioperative morbidity and mortality.
- Ensure effective communication among care providers about patient management issues.
- Educate patients regarding surgical and anesthetic expectations to reduce anxiety.
Components of the Preanesthetic Evaluation
- Chart review includes current medical records, previous anesthetic experiences, and patient medications.
- A directed physical examination assesses vital signs, airway, cardiac, and pulmonary systems.
- Preoperative tests and consultations based on patient needs.
- ASA classification determines patients' health status and anesthesia risk.
Medication Management
- Certain medications should be continued, including antihypertensives, antidepressants, and anticonvulsants.
- Medications to discontinue include:
- Short-acting insulin (day of surgery)
- Non-insulin antidiabetic meds (day of surgery)
- Warfarin (5 days before surgery)
- Herbal medications may require specific discontinuation times to avoid adverse effects.
Fasting Guidelines
- Applicable ASA fasting guidelines ensure patient safety prior to anesthesia delivery.
- Preoperative fasting is essential to reduce the risk of aspiration pneumonitis.
Aspiration Pneumonitis
- Aspiration pneumonitis occurs when foreign substances enter the lungs, causing inflammation.
- Prevention strategies focus on identifying at-risk populations and implementing appropriate fasting guidelines.
- Treatment options vary based on the severity of the aspiration.
Airway Evaluation
- Airway assessment utilizes the LEMON criteria, which includes examining the length of incisors, conditions of teeth, and visibility of the uvula.
- Factors such as neck circumference and range of motion are critical for determining anesthetic management.
Co-morbidities Impacting Anesthesia
- Obesity is defined in relation to ideal body weight and can complicate anesthesia due to increased risk and altered pharmacokinetics.
Social History Considerations
- Substance abuse, including tobacco and alcohol, affects anesthetic care and requires careful assessment.
- The impact of electronic cigarette use and its constituents on physiological function needs evaluation.
Summary of Preoperative Interview Objectives
- Streamline patient education on surgery and anesthesia.
- Confirm comprehensive medication history, including over-the-counter and herbal supplements.
- Gather information on patient's prior surgery and anesthetic experiences, including any adverse reactions.
Overview of Anesthesia
- Categories of anesthesia include obstetric, pediatric, cardiothoracic, neuro, outpatient surgery, ketamine clinic, office-based, pain management, and critical care.
- Key historical figures include 1864's Morton, known for the first ether anesthetic, and Alice Magaw, recognized as the first nurse anesthetist.
Considerations Influencing Anesthetic Technique
- Patient safety is paramount in anesthetic decisions.
- Patient comfort and provider preference also significantly influence techniques.
- Coexisting diseases, surgical site, patient positioning, and age are critical factors.
- Duration of surgery and recovery time vary based on procedure type and facility criteria.
Ideal Anesthetic Technique
- Prioritizes optimal patient safety, satisfaction, and low costs.
- Ensures excellent operating conditions and allows for rapid recovery while minimizing postoperative side effects.
Types of Anesthesia
- General Anesthesia: Induces a drug-induced depression of the CNS leading to loss of response to external stimuli.
- Types include inhalation-only, intravenous-only (TIVA), and a combination of both.
- Components of anesthetic state: unconsciousness, amnesia (often achieved via benzodiazepines), analgesia, immobility, and attenuation of autonomic responses.
Phases of General Anesthesia
- Induction: Administers anesthetic drugs to achieve unconsciousness and requires monitoring (EKG, NIBP, pulse-ox, etc.).
- Pre-Induction: Involves pre-oxygenation to replace nitrogen in lung capacity, preventing apnea.
- Intravenous Induction: Common induction agents include Propofol (most used), Thiopental, and Ketamine, each with specific pharmacological characteristics.
Standard Induction Sequence
- Room setup includes machine checks and patient monitoring.
- Pre-oxygenation and administration of induction agents are crucial.
- Neuromuscular blockers are given if an airway device is needed, followed by airway instrumentation.
Rapid Sequence Induction (RSI)
- Administers anesthetic followed by neuromuscular blocking agents, critical for patients at risk of aspiration.
- Requires careful monitoring and cricoid pressure to reduce aspiration risk during induction.
Inhalation Induction
- Common practice for pediatric cases; involves mask induction using oxygen and volatile agents.
- Volatile anesthetics such as Sevoflurane are preferred for their non-irritating properties.
Maintenance of Anesthesia
- Focuses on maintaining unconsciousness, analgesia, and muscle relaxation.
- Monitoring is essential for ensuring patient stability and preventing complications during procedures.
Stages of General Anesthesia
- Stage I (Analgesia): Begins with induction agent administration and ends with loss of consciousness.
- Stage II (Delirium): Characterized by involuntary movements; to be avoided during extubation.
- Stage III (Surgical Anesthesia): Four planes with varying levels of respiratory response; deep anesthesia where most surgeries occur.
- Stage IV (Overdose): Respiratory paralysis; demands immediate intervention.
Emergence from Anesthesia
- Transition from general anesthesia includes regaining consciousness and airway reflexes.
- Recovery involves careful monitoring, adequate reversal of neuromuscular blockers, and management of postoperative nausea and pain.
Monitored Anesthesia Care (MAC)
- MAC allows the anesthesiologist to administer varying sedation levels during procedures.
- Requires preparedness to convert to general anesthesia if necessary; patient comfort and vitals are maintained throughout.
Sedation Levels
- Different levels of sedation range from minimal (anxiolytics) to deep sedation:
- Minimal Sedation: Patients respond to verbal commands, maintaining airway reflexes.
- Moderate Sedation: Patients respond purposefully, spontaneous ventilation is adequate.
- Deep Sedation: Patients require significant stimulation for response; airway and ventilation must be closely monitored.
Safety Protocols
- Vigilance in monitoring and equipment readiness is essential to prevent complications during all sedation levels and anesthesia.
General Anesthesia Overview
- Immobility implies a lack of response to stimuli, not paralysis.
- Autonomic responses to noxious stimuli are attenuated during anesthesia.
Phases of General Anesthesia
- Induction: The process of administering anesthetic drugs (IV or inhaled) to induce unconsciousness.
- Pre-Induction Monitoring: Includes EKG, NIBP, pulse oximetry, CO2 levels, and temperature. These are minimum standards regardless of hospital location.
Pre-Induction Procedures
- Pre-Oxygenation: Patients inhale 100% oxygen for 3-5 minutes to replace nitrogen in functional residual capacity, facilitating airway security and reducing apnea risks.
- Intravenous Induction: No single ideal drug exists; characteristics of a desirable agent include rapid onset, analgesia, minimal depression of cardiac/respiratory functions, and lack of toxicity.
- Common IV Induction Agents: Propofol (most used), Thiopental, Brevital, Etomidate, Ketamine, Opioids, Benzodiazepines.
Standard Induction Sequence
- Ensure room setup, check machines, apply monitors, position the patient, establish baseline vitals, pre-oxygenate, administer induction agents, perform mask ventilation, and use neuromuscular blockers as needed.
Rapid Sequence Induction (RSI)
- Involves immediate administration of a neuromuscular blocking agent following an IV anesthetic, particularly crucial for patients with high aspiration risk.
- Cricoid pressure is employed to reduce aspiration risk until CO2 detection is confirmed.
Inhalation Induction
- Common in children and involves administering oxygen with a volatile agent.
- Volatile anesthetics include Sevoflurane (most common), Desflurane, and Isoflurane (slow onset).
Post-Induction Monitoring
- Assess loss of consciousness, eyelid reflex, and provide ventilation support as required. Ventilation quality must be maintained and monitored.
Maintenance of Anesthesia
- Surgical anesthesia characterized by sustained unconsciousness, amnesia, analgesia, immobility, and NS control over the sympathetic response to pain.
- Vigilance is essential for monitoring vital signs and drug administration.
Stages of General Anesthesia
- Stage I (Analgesia): Begins with induction agent administration.
- Stage II (Delirium): Involuntary movement, skipped in IV induction.
- Stage III (Surgical Anesthesia): Divided into four planes; most surgeries occur in planes 1 and 2.
- Stage IV (Overdose): Respiratory paralysis leading to circulatory collapse; requires urgent lightening of anesthesia.
Emergence from Anesthesia
- Transition from general anesthesia to consciousness, with attention on neuromuscular recovery and airway protection.
- Awake extubation is considered when the patient meets specific criteria for safety.
Monitored Anesthesia Care (MAC)
- Anesthesia service participation in procedures, which may require general anesthesia if the patient becomes unconscious.
History of Regional Anesthesia
- Carl Koller, in 1884, introduced cocaine for topical anesthesia, followed by William Halstead for nerve blocks.
Neuroaxial Anesthesia
- Involves local anesthetic adjacent to the spinal cord, disrupting nerve signal conduction.
- Can be performed as single injections or continuous infusions.
- Spinal anesthesia requires injection below L1 and results in neural conduction blockade.
Anatomy for Neuroaxial Anesthesia
- Needle traverses several layers including skin, ligaments, and eventually into the epidural or subarachnoid space.
Mechanism of Action
- Local anesthetics disrupt nerve conduction primarily at nerve roots.
- Spinal anesthesia leads to immediate action; heavy blocks (above T4) potentially cause cardiac complications.
Spinal Anesthesia Techniques
- Single injections in the subarachnoid space allow rapid onset and effective surgical anesthesia.
- Needle types: Pencil point tips (less traumatic) vs Cutting point tips (more traumatic).
Needles for Spinal Blocks
- Pencil point needles (Sprotte, Whitacre) are less traumatic than cutting-tip needles (Quincke, Atraucan).
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