Just studying for Anesthesia (from handouts)

Anesthesia Care Provider

A professional licensed to administer anesthetic agents and medically manage the patient throughout the period of anesthesia

Malignant hyperthermia

A rare condition that occurs in conjuction with general anesthesia. The patient experiences extremely high body temperature, muscle rigidity, seizures, and cardiac arrhythmia. The condition is reversible with specific drugs and manage symptoms but can be fatal if left untreated. Patients with a history of muscular disease are particularly at risk for malignant hyperthermia. Most general anesthetic inhalation agents carry risk of producing malignant hyperthermia

Amnesia

Amnesiac agents provide a lack of recall of perioperative events for the patient, and permit the use of safer, less toxic aesthetic agents and techniques

Laryngeal Mask Airway (LMA)

An airway consisting of a tube and small mask that is fitted internally over the patient's larynx. It has advantage over an ET tube in that does not require the use of muscle relaxants to facilitate insertion and can be used in a patient whose anatomy makes an ET tube difficult to insert.

Bronchospasm

An involuntary smooth muscle spasm of the bronchi - patients with difficult airway, anatomical malformation, and bronchiole disease are prone to bronchospasm. Certain anesthetic agents cause bronchospasm.

4 WAYS TO DELIVER ANESTHESIA

Anesthesia - Freedom from pain is the major focus of anesthesia practice. Today OR practices deliver pain-free surgery in a variety of ways A. Topical B. Local C. Regional D. General

Regional block

Anesthesia an analgesia of a specific area of the body. Tegional blocks may be produced by interruption of impulses of one major nerve or group of nerves. Adjunct drugs usually are administered to sedate and provide anxiolysis

General Anesthesia (definition)

Anesthesia associated with a state of unconsciousness. General Anesthesia is not a fixed state of unconsciousness but ranges along a continuum from semi-responsive to profoundly unresponsive.

Apnea

Cessation of breathing

DEPTH OF GENERAL ANESTHESIA (4 stages) Stage #3:

Consist of the period between the onset of regular breathing and loss of eye-lid reflex to the cessation of breathing. This is known as the Surgical Anesthesia Stage. Patient is unresponsive to painful stimuli and sensation, with the sense of hearing being the last sense to be obtunded

DEPTH OF GENERAL ANESTHESIA (4 stages) Stage #2:

Consist of the period from loss of consciousness to the return of regular breathing and loss of the eyelid reflex. AKA Excitement or Delirium Stage due to the uninhibited movement of the patient demonstrated during the period

PHASES OF GENERAL ANESTHESIA (4 phases) Maintenance Phase

Different combination of narcotics and neuroleptic drugs and tranquilizers are administered whether they are used along or in combination with inhalation agents. Neuroleptics - Reduce motor activity and anxiety a detached apathetic state, and potentiate hypnotic and analgesic narcotic effects. The dosage can be regulated to produce the desired state. Surgical intervention takes place during the maintenance phase of anesthesia. Maintenance of hemostatic function of vital ordans with the provision of appropriate operating condition is critical to a successful anesthetic and good surgical outcome. Monitoring - Anesthesia personnel monitors the patient closely for changes throughout the surgical procedure. Bispectral - index BIS is a compact system for monitoring the effects of anesthesia on the brain. The BIS monitor allows the anesthesia provider to accurately track the patient's level of consciousness by using an electrode applied to the patient's forehead that sends electroencephalogram (EEG) like signals to a small monitor. The read out is a single number from 100 (wide awake) to 0 (absence of brain activity) - The purpose of the BIS number is to monitor the numbers so when surgery is done the patient can return to consciousness quicker.

Neuromuscular blocking agents

Drugs that block conduction of nerves that control striated muscle tissue. Muscle relaxation or paralysis may be needed to allow access to the operative site during general anesthesia.

General Anesthesia

Focus on altering the patient level of consciousness, minimizing pain and awareness of the surgical environment. Accomplished in 3 techniques; Agent inhalation, agent injection and agent instillation

3 Levels Of Sleep By Hypnotic Drugs

Hypnotic Drugs - classified as those that induce sleep. Pharmaceutical agents permit varying levels of hypnosis to be achieved. A. Light B. Natural Sleep of Sedation C. Full Unconsciousness of General Anesthesia

Aneterograde Amnesia

In anesthesia, the patient's inability to recall events that occur while under the effects of certain drugs. After the drug is metabolized in the body, normal recall returns

ASA Classification System Class #6:

Includes patient that have been declared brain dead, but whose organs will be removed for donor purposes. Mechanical ventilation life support systems are maintained until organs are procured

ASA Classification System Class #4:

Includes patient with in incapacitating disease that is a constant threat to life cardio vascular or renal disease (ex. Angina, congestive heart failure, debilitating respiratory disease, hepatic-renal failure

ASA Classification System Class #2:

Includes patient with mild systemic disease (ex diabetes controlled by oral hypoglycemic agents or diet, controlled hypertension, history of asthma, anemia, smoker, mild obesity, age less than 1 or greater than 70

ASA Classification System Class #3:

Includes patients with severe systemic disease that limits activity but is not totally incapacitated (ex. Chronic obstructive pulmonary disease or severe hypertension, angina, post myocardial infarction, massive obesity

Agent Instillation

Involves the administration of medication into an area such as the rectum, where the agent is absorbed via the mucous membranes, and transported to the CNS by the circulatory system.

Anesthesia

Literally, "without sensation". In medicine, anesthetic agents block nerve impulses that conduct sensation; these agents also may produce loss of consciousness

Amnesia

Loss of recall of events or sensations. In anesthesia, amnesia is a desirable component produced by a specific drugs such as the benzodiazepines. Patient recall of surgery is seen in about 0.2% of all cases performed under general anesthesia ---- Amnestic agents provide a lack of recall of perioperative events for the patient, and permit the use of safer, less toxic aesthetic agents and techniques

Anesthesia machines

Machines that are capable of delivering anesthetic gases or volatile liquids.

Ventilation

Movement of gases into and out of the lungs. Positive pressure ventilation is produced the ACP when deep general anesthesia an neuromuscal bloacking agents inhibit the patient's normal breathing mechanisms. The reservoir bag on the anesthesia machine allows the ACP to manually force o2 into the patient's lungs. Called "bagging" the patient.

PHASES OF GENERAL ANESTHESIA (4 phases) Recovery Phase

Recovery is the period that the patient returns to the optimum level of consciousness and well-being - it usually begins in the OR suite, carries through the patient stay in the PACU

Anxiolysis

Reduction in anxiety

DEPTH OF GENERAL ANESTHESIA (4 stages) Stage #1:

Referred to as Amnesia stage and begins with the initial administration of an anesthesia agent to loss of consciousness

Bier Block

Regional anesthesia by IV, used for surgiery performed on arm or below elbow or on leg below the knee. Performed in a bloodless field maintained by tourniquet - also prevents anesthetic from entering the systemic circulation

Hypnosis

Results from an aletered state of consciousness, related to the patient's perception of the surgical procedure and the surgical environment

Synergistic

Term used to describe 2 drugs that , when combined, produce an effect that is greater than the sum of effects produced by each drug individually.

Analgesia

The absence of pain, produced by specific drugs.

PHASES OF GENERAL ANESTHESIA (4 phases) Emergence Phase

The anesthesia provider attempts to have the patient as nearly awake as possible at the end of a surgical procedure. Pharyngeal and laryngeal reflexes must be recovered to prevent aspiration and respiratory obstruction. The degree of neuromuscular blockage must be determined and treated if necessary for respiratory adequacy. Extubation is delayed until spontaneous respiration is ensured. The end tracheal tube carefully is removed when this maneuver is deemed safe. Patient airway and adequate manual or mechanical ventilation are maintained until full recovery. Vomiting and restlessness may company emergence. Slight cyanosis, rigidity, shivering is not uncommon, as a result of temporary disturbance of body temperature Administering apin medicationand applying warm blankets help relieve these after effects 1. monitoring of adequate independent respiratory rate and function 2. restoration of the "gag reflex" 3. extubation if necessary will be accomplish during this phase

Gas Scavenging

The capture and safe removal of anesthetic gases that escape from the anesthesia machine and other devices such as a patient face mask. Repeated exposure to anesthetic gases is known to be a risk to personnel. OSHA and Joint commission require effective scavenger systems

Induction

The time from the beginning of administration of an anesthetic agent until the patient reaches the surgical level of loss of consciousness. Sensation is lost and the patient is unaware of the environment.

ASA Classification System Class #1:

Theoretical includes very healthy patients with localized pathological processes. An emergency surgical procedure designated "E" signifies additional risk. Ex. A hernia that becomes incarnated changes the patient's status to Class 1-E

Anesthetic

a drug that produces a lack of sensation. A General Anesthetic produces a state of unconsciousness, while a regional anesthetic blocks nerve conduction in a specific area of the body without producing loss of consciousness

Esmarch Bandage

a roller bandage made of rubber or latex. Occludes blood flow.

Emergence

a stage in general anesthesia in which delivery of the anesthetic agent is stopped. The patient emerges from a state of unconsciousness into a state of wakefulness. Emergence can be an unstable period that is similar to induction except that physiological and somatic events occur in reverse order.

Delirium

a state of confusion and disorientation. Delirium is a stage of anesthesia induction that produces struggling coughing gagging, and possible airway obstruction resulting from bronchospasm or laryngospasm. Delirium, on induction, is seldom observed with use of modern induction drugs that rapidly bypass this stage

DEPTH OF GENERAL ANESTHESIA (4 stages) Stage #4:

aka Over Dosage Stage. Dilated and non reactive pupils mark this stage, as do the cessation of respiration and marked hypotension leaving to circulatory failure. If uncorrected this stage leads to patient's death.

Hypnotic Drugs

are classified as those that induce sleep. Pharmaceutical agents permit varying levels of hypnosis

Controlled hypothermia

deliberate lowering of patient's core body temperature during general - this recudes the o2 requirements of tissues. Can be used in Cardiac procedures that require occlusion or blockage of large blood vessels, and organ transplant

Pulse oximeter

device that measures a patient's hemoglobin o2 saturation throught he use of spectrometry

Cricoid Pressure

direct manual pressure on the patient's cricoid cartilage, which compresses the trachea, helps to prevent aspiration, can facilitate intubation.

PHASES OF GENERAL ANESTHESIA (4 phases) Induction Phase

induction can be accomplished with a thiobarbituate derivative (thiopental - pentothal, methohexital (Brevital), Dazepan (valium), Midazolam (Versed) or other induction agent. O2 is administered in physiological quantities. Neuromuscular blockers permit control of ventilation while providing muscle relaxation during intubation Induction involves altering the patient's level of consciousness, from the conscious (alert) state to the unconscious (asleep), state with depressed reflexes. During induction, lost of consciousness occurs and may be associated with respiratory depressiong and an inadequate airway. Induction may be carried out in 2 ways IV Induction, Inhalation of gaseous vapors *patient hearing is the last to be obtunded

Induced Hypotension

intentional lowering of the patient's blood pressure during surgery to control hemorrhage, produce a more bloodless operative field, or control intracranial pressure.

Laryngospasm

involuntary spasm of the smooth muscles of the larynx. Some drugs cause laryngospasm, and some patients are prone to spasm because of a medical or anatomical condition. Severe laryngospasm can restrict or block the patient's airway. It can occur during intubation, during induction and emergence from deep sedation, or in periods of relatively light anesthesia.

Agent Injection

involves the administration of medication directly into the bloodstream intravenously. This is accomplishing by venous access device. A. Usually a peripheral intravenous catheter B. Or a central venous delivery system. Medication effect does not rely on adequate respiratory function, only on circulatory function.

Agent Inhalation

involves the delivery of gases across the alveolar membrane aof the vascular system, where the agent is able to cross the blood-brain barrier, affecting the CNS function. Medication delivery relies on an adequately functioning respiratory and circulatory system. Agents are delivered through a closed anesthesia circuit connected to a vaporizer

Nerve Conduction Blockade

involves the prevention of sensory nerve impulse transmission. Many of today's anesthetic administrations involve components of both methods. Choices of anesthesia agents are done on a case by case basis, to meet the goal of maximum patient safety and optimal results.

ASA Classification System Class #5:

moribund patients that are not expected to survive 24 hours with or without surgical procedure. They are operated on in an attempt to save their life. The surgical procedure is resuscitative measure as in a massive pulmonary embolus. The patient may or may not survive the surgical procedure.

Muscle relaxation

neuromuscular blocking agents in combination with inhalation agents are capable of producing profound muscle relaxation (to the point of paralysis)

Patent

open or unobstructed, in reference to a tubular or hollow structure. It is usually used to describe the patient's airway, a blood vessel, or a duct.

Hypnosis

results from an altered state of consciousness, related to the patient's perception of the surgical procedure and the surgical environment