Induction, maintenance and emergence of anesthesia notes – Flashcards
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From awake state to level of surgical anesthesia
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Induction- phase of anesthesia Be aware
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From post induction to emergence
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Maintenance- phase of anesthesia
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From completion of surgery into PACU
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Emergence- phase of anesthesia
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Induction of anesthesia
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the administration of a drug or combination of drugs at the beginning of an anesthetic that results in a state of general anesthesia
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TIVA
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total IV anesthesia- no inhalation rarely do inhalation with adults
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Amnesia and analgesia
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Stage 1 of Anesthesia
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Delirium and excitement
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Stage 2 of Anesthesia normally seen in induction and emergence quickly move through this stage
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Surgical anesthesia
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Stage 3 of Anesthesia this is where u want to be for maintenance
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premortem- arrived at only in error cessation of respiration to failure of circulation High concentration of anesthesia in CNS
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Stage 4 of Anesthesia overdose of anesthesia (rare)
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Stage 3 Plane 1
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very light sedation still some eye movement
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Stage 3 Plane 2
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moderate sedation Pupils begin to dilate no eye movement Laryngospam unlikely
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Stage 3 Plane 3
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Moderate deep anesthesia- complete intercostal paralysis Unwise to maintain plane 3 very long
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Stage 3 Plane 4
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deep anesthesia paralysis of intercostals to cessation of spontaneous respirations pupils dilate and do not React to Light Little or no muscle tone PRECEDES TO STAGE 4
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Standard IV GA induction methods
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adults
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Standard inhalation GA induction methods
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children
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Rapid sequence (RSI) GA induction methods
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those at risk for vomiting and aspiration protect airway
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Modified RSI GA induction methods
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protect airway
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Denitrogenation/preoxygenation
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100 % O2 prior to induction intend to replace air/nitrogen in the Pt's FRC with oxygen
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Before NMBA is given what must be verified
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the ability to ventilate
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what does rocking boat sign indicate
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indicated we do not have the airway
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patent airway good seal no leaks aournd mask maintain airway pressure at <20 cm H2O
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requirements for mask ventilation
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IV induction
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Monitors in place Baseline VS Preoxygenation /denitrogenation Amnestics/ opioids IV induction agent Airway patency NMBA (if needed) Intubation/LMA
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inhalation induaction
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Generally pediatric patients only Alternative to IV induction Premedication is very helpful Opioid/ Benzodiazepine Antisialogogue Denitrogenation with 100% oxygen High flows of N2O/O2 Add inhalation agent (usually slowly) Halothane / Sevoflurane
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RSI
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Generally for full stomach or risk of aspiration situations Important points of RSI Reduce gastric acidity HOB elevated Suction at head of bed Cricoid pressure Do not ventilate before intubation
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P-1
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preparation 0- 20 min
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P-2
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Preoxygenation 0- 5 min
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P-3
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Pretreatment 0- 3min
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P-4
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Paralysis with induction 0
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P-5
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Protection and positioning 0+ 20-30 sec
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P-6
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Placement with proof 0+ 45 sec
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P-7
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Postintubation management 0 + 1 min
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cricoid pressure
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after loss of eyelash reflex hold pressure until ETT is verified
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Modified RSI
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Patients at risk for aspiration Patients at risk for rapid desaturation Important points of MRSI Reduce gastric acidity HOB elevated Suction at head of bed Cricoid pressure Gentle ventilation before intubation
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ETT verification
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Bilateral equal breath sounds (listen axillary) Capnographic evidence of CO2 Normal waveform 3-5 breaths Ventilation after ETT placed & cuff inflated
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Synergy
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The summing of the simultaneous effects of two or more drugs such that the combined effect is greater than the effect of either of the drugs when they are given alone
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Additive
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An effect in which two substances or actions used in combination produce a total effect the same as the sum of the individual effects
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stages of awareness -1
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concious awareness with explicit recall
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stages of awareness -2
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consious awareness with no explicit recall
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stages of awareness -3
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subconscious awareness with implicit recall may have with MAC
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stages of awareness -4
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no awareness or recall Goal for anesthesia
