MAC, General, Hazards – Flashcards
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ANESTHETIC GAS EXPOSURE N20 used alone
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< 25ppm
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ANESTHETIC GAS EXPOSURE Agent used alone
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2 ppm
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Agent used with N20
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0.5 ppm
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PPM = parts per million
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10,000 ppm = 1%
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Benefits of Spinal
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decrease resp depression
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Types of anesthesia
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General Regional MAC with or without local
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Types of Regional
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Spinal Epidural CSE Peripheral Nerve Blocks
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General anesthesia techniques
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ETT, LMA, Mask, TIVA
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LMA, gas or IV
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use with gases only
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TIVA, gas or IV
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IV drugs only
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MS. MADE
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Monitor Suction Machine Airway Drugs Equipment
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Indications for ETT
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risk for aspiration, airway maintenance if masking difficult, Prolonged controlled ventilation (long cases), Specific surgical procedures (ENT, crantiotomy, etc), traumas, if LMA doesn't seal well
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LMA
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Seals glottic opening, Comes in multiple sizes (pediatrics and adults) and types,Can be used with positive pressure ventilation, May be used as a guide for placing ETT in difficult intubation situation (Fastrac)Does NOT protect against regurgitation and pulmonary aspiration
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NO muscle relaxants
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LMA/Mask/TIVA
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factors will influence the ability of the anesthetic to achieve its result
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Solubility of the anesthetic agent, Cardiac output, Alveolar ventilation Severe lung dz=doesn't absorb as easily, need more anesthetic and time
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General AnesthesiaInhalation Anesthetics produces
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Skeletal muscle relaxation (not nitrous), Amnesia Analgesia=NO
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Inhaled anesthetics used for General Anesthesia
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Nitrous oxide, Sevoflurane, Isoflurane, Desflurane, Halothane (not common)
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Stages of AnesthesiaStage 1
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Begins w/ induction of anesthesia and continues to loss of consciousness Dizziness, a sense of unreality, and a lessening sensitivity to touch and pain Sense of hearing increased &responses to noises are intensified
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Stages of AnesthesiaStage 2
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Excitement phase: Variety of reactions involving muscular activity & delirium, Vital signs show evidence of physiological stimulation, May respond violently to very little stimulation,Vomiting, laryngospasm, hypertension, tachycardia and uncontrolled movements,Gaze may be divergent, pupils are dilated, Breath holding
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Stages of AnesthesiaStage 3
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Surgical or operative stage 4 planes to this stage Plane 1 - Return of regular respirations to end of random eye movement Plane 2 - End of random eye movement to the onset of relaxation of intercostals. When surgical incision starts. Plane 3 - Onset to total relaxation of intercostals (apnea) Plane 4 - Apnea - relaxation of diaphragm, CV depression
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Stages of AnesthesiaStage 4
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Impending death/overdose Medullary depression, complete muscle relaxation (apnea), dilated/nonreactive pupils, severe hypotension then complete circulatory/cardiac failure
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Spinal Anesthesia
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Consists of injecting local anesthesia into the cerebral spinal fluid (CSF) within subarachnoid (intrathecal) space of spinal canal AKA SAB (Subarachnoid block) Limited to lumbar regions below termination of spinal cord
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Where does the spinal cord end in a normal adult?
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L1-L2
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7 Areas you have to penatitrate to given a spinal
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Skin, SQ Supraspinous ligament Interspinous ligament Ligamentum flavum Dura Arachnoid
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Spinal AnesthesiaSide Effects/Complications
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Neurologic complications Trauma Hematoma Hypotension,1/3 of patients Sympathetic nervous system block, decreases venous return to heart, Decrease in SVR Preload with fluid
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Spinal AnesthesiaSide Effects/Complications
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Bradycardia and asystole 10-15% Blocked cardiac accelerators (T1-T4) Decreased venous return Post-Dural Puncture Headache Puncture hole in dura Loss of CSF causes downward displacement of brain and stretch on supporting structures High spinal=can't breathe or can't feel arms, might have to intubate
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Epidural Anesthesia
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Injection of local anesthetic into space that lies within the vertebral canal but outside or superficial to the dural sac. Outside of dura, potential space
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Epidural AnesthesiaSide Effects & Complications
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Epidural hematoma Emergent surgery may be necessary Dural puncture PDPH Hypotension Intravascular injection Toxicity ranging from mild CNS symptoms to loss of consciousness and cardiac collapse
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Epidural AnesthesiaSide Effects & Complications
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Subarachnoid injection Total spinal anesthesia Subdural injection Neural injury Rare
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Spinal Vs. Epidural.....benefits of Spinal
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Less time to perform Less discomfort during placement (smaller gauge) More intense sensory and motor block Correct placement clearly confirmed with CSF
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Spinal Vs. Epidural.....benefits of Epidural
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Decreased risk PDPH (post dural puncture headache) Lower incidence hypotension Ability to produce segmental block Can titrate with catheter Control of post-op pain
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Contraindications of Epidural/Spinal
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Patient refusal Infection at site of needle puncture Elevated ICP Coagulopathy
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MAC (Monitored Anesthesia care)
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Administration of medications for which normal loss of protective reflexes and consciousness likely. Need an anesthesia provider.
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MAC Specific drugs include
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Propofol, Benzodiazepines, Opioids, Ketamine, Dexmedatomidine (Precedex)
