anesthesia finalsurgical anestheisa

7/28/2019 Anesthesia Finalsurgical anestheisa

1/66

ANESTHESIA

1


2/66

2

ANESTHESIA SUPPRESSION OF

PAIN OF A SURGICAL PROCEDURE

ANALGESIA LOSS OF PAIN

SENSATION FROM OTHER CAUSES


3/66

3

GENERAL ANESTHESIA

- W/ LOSS OF CONSCIOUSNESS


4/66

LOCAL ANESTHESIA

- PATIENT IS AWAKE

4


5/66

5

GENERAL ANESTHESIA

1. INHALATION ANESTH


6/66

2. PARENTERAL ANESTHESIA

- IM- IV

6


7/66

7


8/66

8

STAGES OF GEN ANESTH

1. ANALGESIA

2. DELIRIUM / EXCITEMENT

3. SURGICAL

4. MEDULLARY PARALYSIS


9/66

9

PHARMACO KINETICS OF GEN

ANESTH1. FLOW ANESTHESIA MACHINE,

LUNGS, BLOOD, BRAIN, METABOLISM

ELIMINATION


10/66

10

PHARMACO KINETICS

2. FACTOR

- TENSION DIFFERENCE OR

PARTIAL PRESSURE BETWEEN

ALVEOLI AND BLOOD

- FROM HIGHER TO LOWER CONC


11/66

11

PHARMACO KINETICS

3. UPTAKE AND DISTRIBUTION

4. SOLUBILITY

5. CONC IN INSPIRED AIR

6. PULM VENTILATION

7. PULM BLOOD FLOW8. ARTERIOVENOUS CONC

9. ELIMINATION


12/66

12


13/66

13

PHARMACO DYNAMICS

MECHANISM OF ACTION OF

GEN ANESTH

1. DEPRESSES THE ACTIVITY OF THE

NEURONS

2. INTERACTS W/ LIPID MATRIX OFNERVE MEMBRANE W/C LEADS TO

CHANGES IN ION FLUX


14/66

14

- RESULTS TO MEMBRANE HYPER

POLARIZATION ( AN INHIBITORYACTION ), VIA ACTIVATION OF LIGAND

GATED K+ CHANNEL LINKED TO

NEUROTRANSMITTERS ( ACH,

DOPAMINE, NOREPINEPHRINE,

SEROTONIN


15/66

15

- TARGET - TO ACTIVATE

GABA RECEPTOR CHLORIDECHANNEL (THE MEDIATOR OF

INHIBITORY SYNAPTIC TRANSMISSION)


16/66

16

- RESULT

DECREASE ACTIVITY OF NEURONSDECREASE SENSORY TRANSMISSION


17/66

Ideal Characteristics of InhalationalAnesthetics:

Rapid & pleasant induction & recovery

Rapid changes in depth of anesthesia

Adequate relaxation of smooth muscle Absence of toxic effect

Wide margin of safety


18/66

18

ORGAN EFFECTS

CVS

ARTL PRESSURE

1. HALOTHANE

2. DESFLURANE

3. ENFLURANE

4. SEVOFLURANE5. ISOFLURANE


19/66

19

BRADYCARDIA

1. HALOTHANE

TACHYCARDIA

1. ISOFLURANE

2. DESFLURANE

NO EFFECT ON RATE

1. METHOXYFLURANE

2. SEVOFLURANE


20/66

20

MYOCARDIAL DEPRESSION

1. ALL INHALED ANESTH2. GREATEST DEPRESSION

a. ENFLURANE

b. HALOTHANE

3. LEAST DEPRESSION

a. NITROUS OXIDE ARRYTHMIA

1. HALOTHANE


21/66

RESPIRATORY

MOST DEPRESSANT

ISOFLURANE ENFLURANE

21


22/66

RESPIRATORY

DEPRESS MUCOCILIARY FXN

POOLING OF MUCUS

ATELECTASIS, PNEUMONIA BRONCHODILATATION

HALOTHANE, ENFLURANE

IRRITATION & COUGHING DESFLURANE

DIFFICULT INDUCTION

22


23/66

BRAIN

CEREBRAL BLOOD FLOW

UNDESIRABLE IN ICP

ENFLURANE POTENTIAL SEIZURE NITROUS OXIDE

W/ LEAST IN CEREBRAL BLOOD FLOW

23


24/66

TOXICITY

HEPATOTOXIC

HALOTHANE

FATAL HEPATITIS NEPHROTOXIC

METHOXYFLURANE

24


25/66

MALIGNANT HYPERTHERMIA

HALOTHANE

SYNDROME

HYPERTHERMIA, TACHYCARDIA, RIGIDITY,HYPERTENSION, HYPERKALEMIA, ACIDOSIS

DUE TO FREE CALCIUM IN MUSCLE

TREATMENT DANTROLENE PREVENTS RELEASE OF Ca

25


26/66

CHRONIC TOXICITY

MUTAGENECITY - NO EVIDENCE

FLUROXENE & ETHER NO LONGER USED

CARCINOGENECITY NO EVIDENCE

REPRODUCTIVE

MISCARRIAGE

TERATOGENIC

HEMATOTOXIC

NITROUS OXIDE MEGALOBLASTIC ANEMIA

26


27/66

CLINICAL USE

RARELY USED ALONE

COMBINED W/ IV ANESTHETICS

COMMONLLY USED NITROUS OXIDE

DESFLURANE

SEVOFLURANE

ISOFLURANE

HALOTHANE

27


28/66

NOT USED ANYMORE

METHOXYFLURANE

NEPHROTOXIC

CHLOROFORM

HEPATOTOXIC

CYCLOPROPANE & ETHER

EXPLOSIVE

FLAMMABLE

28


29/66

CLASSIFICATION

GAS NITROUS OXIDE, CYCLOPROPANE

VOLATILE LIQUID

HALOGENATED HALOTHANE, ISOFLURANE, SEVOLURANE,

METHOXYFLURANE, ENFLURANE,

DESFLURANE

NON HALOGENATED

ETHER, CHLOROFORM

29


30/66

HALOTHANE

CHOICE IN ASTHMA DUE TO

BRONCHODILATATION EFFECT

TOXICITY

ARRYTHMIA

HEPATITIS

MALIGNANT HYPERTHERMIA

30


31/66

ENFLURANE

CNS IRRITABILITY SEIZURE

NEPHROTOXIC DUE TO FLUORIDE BY PRODUCT

CARDIAC DEPRESSION

SALIVATION & TRACHEOBRONCHIAL

SECRETION

NON HEPATOTOXIC

31


32/66

ISOFLURANE

NON HEPATOTOXIC

NON NEPHROTOXIC

NON CARDIOTOXIC

CHOICE IN CARDIAC SURGERY

32


33/66

METHOXYFLURANE

MOST TOXIC DESFLURANE

BP & CARDIAC OUTPUT

NO HEPATO RENAL TOXICITY

AIRWAY IRRITANT

SEVOFLURANE

NON IRRITANT TO AIRWAY33


34/66

ETHER

FIRST ANESTHETICNO LONGER USED

EXPLOSIVE & FLAMMABLE

CHLOROFORM

NO LONGER USED

EXPLOSIVE & FLAMMABLE

34


35/66

NITOUS OXIDE

THE ONLY INORGANIC GAS W/ ANESTHETICPROPERTY

NON EXPLOSIVE

POTENT ANALGESIC, BUT WEAK

ANESTHETIC NO MUSCLE RELAXATION, NO CVS EFFECT

ANESTH OF CHOICE, COMBINED W/HALOTHANE

CYCLOPROPANE

NO LONGER USED, EXPLOSIVE, FLAMMABLE

35


36/66

INTRAVENOUS ANESTHETIC

BARBITURATE

BENZODIAZEPINE

KETAMINE

PROFOPOL

ETOMIDATE OPIATE

36


37/66

IV ANESTH

USUALLY USED AS ADJUNCT TO

INHALED ANESTH

SOMETIMES USED ALONEDO NOT REQUIRE ANESTH

MACHINE

37


38/66

SHORT ACTING IV ANESTH

RAPID ONSET

FOR OUT PATIENT USE

BARBITURATE THIOPENTAL

KETAMINE

PROFOPOL OPIATE

38


39/66

LONG ACTING IV ANESTH SLOW ONSET

CANT BE USED FOR INDUCTION

FOR MAINTENANCE IF USED W/ INHALATION

ANESTH AS PRE OP MEDS TO RELAX PX & REDUCE

ANXIETY

BENZODIAZEPINE DIAZEPAM, MIDAZOLAM,LORAZEPAM

W/ RETROGRADE AMNESIA PX DO NOT

REMEMBER THE UNPLEASANT SURGERY39


40/66

ULTRA SHORT ACTING BARBITURATES

THIOPENTAL

ONSET IN 10 -20 SEC

LAST FOR 20 30 MIN

FOR SHORT PROCEDURES

40


41/66

LOCAL ANESTHETICS

BLOCKS NERVE CONDUCTION LOCALLY,THUS BLOCKS PAIN SENSATION THRU Na

CHANNEL BLOCKADE

HISTORYCOCAINE 1 ST AGENT USED 1860

PROCAINE 1905

LIDOCAINE 1943

41


42/66

LOCAL ANESTH 2

CHEMISTRY

ESTER

COCAINE, PROCAINE, TETRACAINE,

BENZOCAINE

AMIDE

LIDOCAINE, MEPIVACAINE, BUPIVACAINE,ETIDOCAINE, PRILOCAINE, ROPIVACAINE

42


43/66

PHARMACOKINETICS

ABSORPTION

LOCAL ANESTH HAS TO STAY WHEREINJECTED TO SUSTAIN ITS EFFECT

ONCE ABSORBED, IT LOSSES ITS EFFECT AS

A LOCAL ANESTH, AND SYSTEMIC EFFECTOR TOXICITY MAY POTENTIALLY HAPPEN

MORE VASCULAR TISSUE ABSORBS THE

DRUG FASTER, THUS DURATION IS SHORTER VASOCONSTRICTOR EPINEPHRINE DELAYS

ABSORPTION & PROLONGS LOCAL EFFECT

43


44/66

PHARMACO DYNAMICS

MECHANISM OF ACTION

BINDING W/ SODIUM CHANNEL

RECEPTOR OF NERVE MEMBRANEBLOCKADE OF THE EXCITABLE

MEMBRANE OF AXON, THUS

BLOCKING THE NERVE IMPULSE

44


45/66

45


46/66

ACTION OF LOCAL ANESTH ON NERVE

BOTH SENSORY & MOTOR BLOCKADE MOTOR PARALYSIS

MAYBE UNDESIRABLE IN NORMAL

DELIVERY W/C REQUIRE ABDOMINALMUSCLE CONTRACTION

BUT DESIRABLE IN ABDOMINAL

OPERATIONS LIKE CS, W/C REQUIRE

ABDOMINAL MUSCLE RELAXATION

46


47/66

ACTIONS ON NERVE 2

AUTONOMIC PARASYMPATHETIC

BLOCKADE

VASODILATATION, HYPOTENSION SEQUENCE OF BLOCKADE

AUTONOMIC, TEMP, PAIN, TOUCH,DEEP PRESSURE, MOTOR

47


48/66

ACTIONS ON NERVE 5

IN EXTREMITY

PROXIMAL SENSORY FIBERS ARE

LOCATED IN THE OUTER LAYER,THUS ARE BLOCKED FIRST, BEFORE

THE DISTAL FIBERS

48


49/66

CARDIAC MUSCLE EFFECTS

ANTI ARRYTHMIC IN LOW CONC,

THUS IS USED AS TREATMENT

BUT CAN CAUSE ARRYTHMIA INHIGH DOSES, W/C IS THE TOXICITY

TO WATCH OUT FOR DURING

SURGERY UNDER LOCAL ANESTH

49


50/66

CLINICAL PHARMA

SHORT ACTING - PROCAINE,CHLORPROCAINE

INTERMEDIATE ACTING LIDOCAINE,

MEPIVACAINE, PRILOCAINE

LONG ACTING TETRACAINE,

BUPIVACAINE, ETIDOCAINE,ROPIVACAINE

50


51/66

ONSET

FASTER IF MIXED W/ Na

BICARBONATE SINCE THE CO2

PENETRATION OF ANESTH INTOMEMBRANE

SLOW IN INFECTION DUE TO ACIDIC

INFLAMMATION

51


52/66

ROUTES

TOPICAL

LOCAL INFILTRATION

NERVE BLOCK

SPINAL INTRA THECAL

EPIDURAL CAUDAL

52


53/66

TOPICAL

53


54/66

LOCAL INFILTRATION

54


55/66

NERVE BLOCK

55


56/66

SPINAL

56


57/66

EPIDURAL

57


58/66

CAUDAL

58


59/66

TOXICITY

TOXICITY OCCURS ONLY WHEN THE

ANESTH IS ABSORBED IN

CIRCULATION

59


60/66

CNS TOXICITY

LOW DOSESLEEPINESS

LIGHTHEADEDNESS

VISUAL / AUDITORY DISTURBANCE

RESTLESSNESS

CIRCUMORAL / TONGUE

NUMBNESS

60


61/66

CNS TOXICITY 2

HIGH DOSE

NYSTAGMUS, MUSCLE TWITCHING

CONVULSION, CNS DEPRESSION

DEATH

PREVENTION / TX DIAZEPAM,BARBITURATES, OXYGEN

61


62/66

NERVE TOXICITY

PROLONGED MOTOR / SENSORY W/

CHLORPROCAINE OR LIDOCAINE IF

USED AS SPINAL ANESTH

62


63/66

CVS TOXICITY

BLOCKS Na CHANNEL IN HEART -PACEMAKER, EXCITABILITY,

CONDUCTION

BLOCKS Ca CHANNEL DEPRESS

CONTRACTION - HYPOTENSION

(BUPIVACAINE)

63


64/66

CVS TOXICITY 2

EXCEPT COCAINE W/C CAUSES

VASOCONSTRICTION &

HYPERTENSION DUE TO BLOCKADEOF NOREPINEPHRINE REUPTAKE

CAUSE ISCHEMIA & ULCERATION IF

USED IN NASOPHARYNGEAL

MUCOSA

64


65/66

BLOOD TOXICITY

METHHEMOGLOBINEMIA DUE TOPRILOCAINE

65


66/66

ALLERGY

COMMON W/ ESTERS W/C ARE

METABOLIZED TO P-AMINOBENZOIC

ACID W/C CAUSE THE ALLERGY

anesthesia finalsurgical anestheisa

Documents