Anesthesia specific.pdf

Anesthesia-Specific Issues Health Assessment Anesthesia-Specific Pseudocholinesterase deficiency Malignant hyperthermia Post-op nausea and vomiting Difficult airway Anesthesia specific à not seen unless exposed Pseudocholinesterase Deficiency Succinylcholine is only depolarizing agent used Metaboliz...

Anesthesia-Specific Issues Health Assessment Anesthesia-Specific Pseudocholinesterase deficiency Malignant hyperthermia Post-op nausea and vomiting Difficult airway Anesthesia specific à not seen unless exposed Pseudocholinesterase Deficiency Succinylcholine is only depolarizing agent used Metabolized by plasma cholinesterase (pseudocholinesterase) Butyryl cholinesterase and liver Cell-bound (acetylcholinesterase) plays no role in metabolism Prolonged paralysis and apnea is seen Pseudocholinesterase Deficiency Permanent or temporary Genetic component Three distinct allele phenotypes Disease states Hepatic failure, malnutrition, acute infection, carcinoma Drug therapy Neostigmine, oral contraceptives Alternations in enzyme activity 3rd trimester of pregnancy Newborns and infants Dibucaine number Dibucaine inhibits metabolism of a choline substrate by plasma cholinesterase Percentage of inhibition of plasma cholinesterase by dibucaine is the dibucaine number Dibucaine, a local anesthetic, inhibits normal PSE activity by 80%, atypical is only inhibited by 20% Suspect? Dibucaine number Genetic testing Dibucaine Number Values Malignant Hyperthermia Hypermetabolic state Tachycardia Hyperthermia Hypercarbia Hypoxemia Acidosis (metabolic) Muscle rigidity DIC Asymptomatic until triggered Pathogenesis of MH Associated conditions Strabismus Scoliosis Burkitt lymphoma Neuroleptic malignant syndrome Myelomeningocele Congenital hip dislocations Malignant hyperthermia 3 times greater incidence in kids than adults Exposure to succinylcholine and volatile agents Susceptible individuals have higher levels of sarcoplasmic calcium à excessive when triggered Genetic component of the ryanodine receptor (RYR1 gene) Gold standard for testing à Caffeine-halothane contracture test PONV Strong association with motion sickness At risk: Female Young Laparoscopic, ear, breast, colon, eye surgery Non-smoker Use of volatile agents Use of nitrous oxide Neostigmine, opioid use PONV Risk Assessment Factors Increasing Risk of PONV PONV 30% of all patients undergoing GA 70% of all at-risk patients undergoing GA Leading cause of delayed PACU discharge 2nd leading cause of hospital re-admission within 24 hours History and risk stratification are the key