Anesthesia

• July 16, 2020
• Tony Guo
• no comments

Anesthesia

• Anesthetic technique and agents are selected by the ACP that consider
  • Physical and mental status
  • Age
  • Allergy and pain history
  • Expertise of the ACP
  • Factors related to operative procedure
• Classification of anesthesia
  • General anesthesia
    • Rarely use only one agent
      • Adjuncts
    • Dissociative anesthesia
      • Ketamine (Ketalar)
  • Adjuncts to general anesthesia
    • Opioids
      • Sedation and analgesia
      • Induction and maintenance intraoperatively
      • Pain management postoperatively
      • Respiratory depression
        • Assess respiratory rate and rhythm, monitor pulse oximetry, protect airway in anticipation of vomiting.
        • Use standing orders for antipruritics and antiemetics.
        • Reverse opioid-induced respiratory depression with naloxone (Narcan). If used, reversal of analgesic effects also occurs.
    • Benzodiazepines
      • Premedication for amnesia
      • Induction of anesthesia
      • Monitored anesthesia care
        • Monitor level of consciousness. Assess for respiratory depression, hypotension, and tachycardia.
        • Reverse severe benzodiazepine-induced respiratory depression with lumazenil (Romazicon).
    • Neuromuscular agents
      • Promote skeletal muscle relaxation (paralysis)
        • If intubated, monitor return of muscle strength, level of consciousness, and ventilation.
        • Maintain patent airway. Monitor respiratory rate and rhythm until patient able to cough and return to previous levels of muscle strength. Ensure availability of nondepolarizing reversal agents (e.g., neostigmine [Prostigmin]) and emergency respiratory support equipment.
        • Monitor temperature and levels of muscle strength with temperature changes.
    • Antiemetics
      • Prevent nausea and vomiting associated with anesthesia
        • Monitor heart rhythm, cardiopulmonary status, level of central nervous system excitation or sedation, ability to move limbs, presence of nausea or vomiting
  • Local anesthesia
    • Loss of sensation without loss of consciousness
    • Types
      • Topical
      • Ophthalmic
      • Nebulized
      • Injectable
  • Regional anesthesia
    • Loss of sensation in body region without loss of consciousness when specific nerve or group of nerves is blocked by administration of local anesthetic
    • Always injected