Topic 2: Anesthesia

surgical time out

before anesthesia induction, ask the patient to confirm name, bday, procedure, site, and consent. All surgical team members stop what they’re doing just before the procedure starts to verify patient identification, procedure, and surgical site

patient refusal

what is an absolute contraindication to any anesthetic technique or agent

monitored anesthesia care (MAC)

used for diagnostic or therapeutic procedures done in or outside of the OR; includes varying levels of sedation, analgesia, and axiolysis

general anesthesia

The technique of choice for patients who are having surgeries that are of significant duration, need skeletal muscle relaxation, require uncomfortable operative positions because of the location of the incision site, or need control of ventilation

general anesthesia

effects on the patient:

• loss of sensation with LOC

• combo of hypnosis, analgesia, and amnesia

• usually involves use of inhalation agents

• skeletal muscle relaxation

• eliminates coughing, gagging, vomiting, and SNS responsiveness

• requires advanced airway management

local anesthesia

effects on the patient:

• loss of sensation without LOC

• induced topically or via infiltration, intracutaneously, or subcutaneously

• topical applications may be aerosolized or nebulized

regional anesthesia

effects on the patient:

• loss of sensation to a region or body without LOC

• involves blocking a specific nerve or group of nerves by administering a local anesthetic

• includes spinal, caudal, and epidural anesthesia and IV and peripheral nerve blocks

local anesthesia

anesthesia that interrupts the generation of nerve impulses by changing to flow of sodium into nerve cells results in autonomic system blockage, anesthesia, and skeletal muscle flaccidity or paralysis; NO SEDATION OR LOC

regional anesthesia

a local anesthetic that involves a central nerve or group of nerves that innervate a site remote to the point of injection; used as preop anesthesia, during surgery to manage surgical pain, and after surgery to relieve pain

local anesthetic systemic toxicity (LAST)

inadvertent vascular injection leads to this; presents as confusion, metallic taste, oral numbness, and dizziness; if not treated seizures, coma, and dysrhythmias may occur; Tx: lipid emulsion infusion and resp and CV support

spinal anesthesia

a type of regional anesthesia that involves the injection of a local anesthetic into the CSF in the subarachnoid space, producing autonomic (can cause vasodilation and hypotension), sensory (blocks pain), and motor blocks (cannot move)

epidural block

a type of regional anesthetic that involves the injection of a local anesthetic into the epidural space via a thoracic or lumbar approach; if a low dose, sensory pathways are blocked, by motor fibers are still intact. If a high dose is used, both sensory and motor fibers are blocked.

hypotension, bradycardia, N/V, puncture headache, back pain, urinary retention, isolated nerve injury, meningitis, tingling in the arms and hands, inadequate breathing, apnea

what are the side effects of spinal and epidural anesthesia that can occur with blocking of the autonomic nervous system

Malignant Hyperthermia (MH)

a rare, autosomal dominant disorder characterized by hyperthermia with skeletal muscle rigidity that occurs in genetically susceptible people exposed to certain anesthetic agents

succinylcholine (Anectine)

what is the primary trigger of MH especially when given with volatile inhalation agents

muscle contracture, hyperthermia, hypoxemia, lactic acidosis, hemodynamic and cardiac problems, tachycardia, tachypnea, hypercarbia, ventricular dysrhythmias, cardiac arrest, death

what are the S/S of MH

dantrolene (Dantrium, Ryanodex)

what is the definitive treatment of MH

dantrolene (Dantrium, Ryanodex)

medication that slows metabolism, reducses muscle contraction, and mediates the catabolic processes associated with MH