Hershey - Anaesthesia

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The american society of anesthesiologists physical staus mesure for patients undergoing surger

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Class 1 - Normal and heathy - no known dieaes
class2 mild systemic disease i.e. presnce of essential hypertension or mild typ II diabetes
class 3 sever systemic dieases i.e. presnce of essential hypertension or mild type II diabetes,
class 4 - incapcitatin systemic diease that is a threat to life i.e. advanced cardiac, renal, pulmonary hepatic or endocrine insuffiency
class 5 moribund patient - who is not expected to live with or without surgery
EMERGENCY OPERATION - any patient in one of hte above classes who is operated ona s an emergency

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Stages of anesthesia

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Stage 1: analgesia (characterized by variable degrees)
Stage 2: delirium ( extends from loss of concisousness until the beginning of surgical anesthesai) - unocnsciousness, irregualr breathing pupils dialted
stage 3: surgical anesthesia - sleep, sensory loss, muscle tone loss
stage 4: medullary paralysis - reversible respiratory failure or irreversible cardiovascular collapse

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Wydase (hyaluronidase)

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used in local blocks
permits more rapid spread of solutions into tissues, increased indence of toxic reactions, reduces duration of action

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ankle block

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saphenous nerve, posterior tibial nerve, sural nerve, superficial peroneal nerve, deep peronela nerve

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indications for lumbar epidura nad caudal anestheisa

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when lower extremity surgery may be risky for hte patient to due ot a preexisting meidcla problem liek ashm or RA
patient who are not suitbale cnadadates for muscle realxnats ie myasthenia gravis

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contraindicatiosn for lumbar or caudal aneshtsia

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sever hemorrhage or shock, at proposed punctuer site, septicemai, neurologic disease , exteme sof age,

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adavantages of s;inal anesthesia over epedural aneshteisai

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less local anesthic drug is need
less tiem is need to achieve an adequat block
level fo aneshtesia is more predictabel
easier to perform

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advantages of epdiural naesthesai over spinal anesthesia

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allow segmental anesthesia
postoerative headache does not occcur
hypotension is lsess liekly
can be maintaitn 1-2 days into the postoperative period as use ful methot for relif of pain
don ont have to remain in baed as long as with spina

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what is succinylcholne used ofor

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muscle relaxant used to quicly establish an airway especially when reguritation and aspiration pneumonits are a risk
can cause masseter spasm

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symptosm of hypnatremia

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comfusion, anorexia, lehtargy, nausea, vomiting, coma, and seizures

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How do you trat hyponatremai if
hypovolemic-hypotonic?
hypervolemic-hypotonic

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hypovolemic-hypotonic: treat with isotonic salin
hypervolemic-hypotonic: trat with restricion of water and consider diureics

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sings and symptoms of hypokalemia

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disorders of muscle physioogy, rspiratory arrest, cardia arrhytmias

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signs and symptoms of hyperkalemia

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muscle weakness
paresthesia
cardiac conduction abnormalities (dangerous as K+ leves reach 7 mEq/L)

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signs and symptoms of PE

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dyspnea, pleuritc chest pain, hemptysis, tachypnea, cough, wheezig nad fever

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what anesthtics predispose pt. to nausea nd vomiting

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opioids,nitrous oxid, volatile anesthtic, barbituates.

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what local anesthetic has the longes tduration

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bupivicaine (marcaine)

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signs and symptoms of PE

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dyspnea, pleuritc chest pain, hemptysis, tachypnea, cough, wheezig nad fever

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what anesthic should not be used in children under the age of 12

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marcaine

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what anesthtics predispose pt. to nausea nd vomiting

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opioids,nitrous oxid, volatile anesthtic, barbituates.

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EKG for hyperkalemia

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peaked T waves, ST depression, prolonged PR intervals, loss of P wave,

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what local anesthetic has the longes tduration

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bupivicaine (marcaine)

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what anesthic should not be used in children under the age of 12

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marcaine

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EKG for hyperkalemia

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peaked T waves, ST depression, prolonged PR intervals, loss of P wave,

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treatment of hyperkalemia

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kayexalete, glucose and inulsin
dalyyis if necessary

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respiratory effect of hypothermia

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hypoxic ventilatory drive may be deprressed or absent i nprece of ypothermai.

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carovascualr efects of hypothermia

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hear rate and cariac out changes
prononged PR interva, widened QRS comples
dyrhymias

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what organ has the largest proportioante reduction in blood flwo with hypothermia

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kidneys, GFR decreased 60%

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most common potop upper extremiat complications

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brachial plexus injuris

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most common post op lower extremity injureis

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sciatic nerve injury
femora nerve injur due to ecessive angualtion fothe thig
common peroneal nerve injury (most commony damaged)
saphenous
obturatur nerve

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what drugs could you give to prevent post op nausea and vomiting

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metrocopramid
drperidol
cimetidine
ranitidine
scopolamin

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etilogy of malignant hyperthermai

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thoght to be due to reduction in the reputake of Ca by the sarcoplasmic reticulum

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most common potop upper extremiat complications

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brachial plexus injuris

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clinical features of malignant hyperthermai

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unexplained tachycardia
hypercarbia or tachypneaacidosis
muscle rigidy
hypxemia
ventricualr arrhymias
hyperkalemia
fever s a late sign

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most common post op lower extremity injureis

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sciatic nerve injury
femora nerve injur due to ecessive angualtion fothe thig
common peroneal nerve injury (most commony damaged)
saphenous
obturatur nerve

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what drugs could you give to prevent post op nausea and vomiting

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metrocopramid
drperidol
cimetidine
ranitidine
scopolamin

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etilogy of malignant hyperthermai

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thoght to be due to reduction in the reputake of Ca by the sarcoplasmic reticulum

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clinical features of malignant hyperthermai

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unexplained tachycardia
hypercarbia or tachypneaacidosis
muscle rigidy
hypxemia
ventricualr arrhymias
hyperkalemia
fever s a late sign

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treatment for malignat hyperthermia

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discontinue all anesthics
dantrolen
correct arrhythmia s with procainamide

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What are some anesthetics for people with a predisposition to malignant hyperthemia

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barbituates
propfol
benzodiazepines - narcotics
nitrous oxide

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use of diazepam

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prevent and treat convulsions
also sedative and amnesic effect

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side effects of halothane

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myocardial depressant may trigger malgnant hyperthemai, can produc arrhytmias, senstized myocardium to catechoalmines, psoterative shivering

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side effects of isoflurane

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depresse cardiovascualr system, shivering postoperatively