Test Review: Anesthesia .


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Test Review: Anesthesia. Jenifer Sweet, B.A., S.R.S., L.A.T. MPI Research in coordination with The Academy of Surgical Research Testing Committee. Overview. General Anesthesia Definition Stages of Anesthesia Considerations Pharmacokinetics Method of action Modifying factors
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Test Review: Anesthesia Jenifer Sweet, B.A., S.R.S., L.A.T. MPI Research as a team with The Academy of Surgical Research Testing Committee

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Overview General Anesthesia Definition Stages of Anesthesia Considerations Pharmacokinetics Method of activity Modifying components Types of Anesthesia Pre-soporific Agents and Adjuncts Injectable Anesthetic Agents and Adjuncts Inhalation Anesthesia Local and Regional Anesthesia Physical Methods of Anesthesia Equipment Review

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General Anesthesia What is general anesthesia? Measurements in view of "normal" creature Biological varieties Metabolic rate % fat General wellbeing Sex Genetics Time of day Species Individualized affectability The ideal sedative specialist does not exist

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Stages of Anesthesia 4 Stages of Anesthesia Stage I: "The phase of deliberate development" Initial organization of soporific to the loss of cognizance Tachycardia and hypertension Irregular/expanded Breath holding Pupils enlarge Struggling as creature gets to be ataxic Some pain relieving impacts Stage II: "The phase of incoherence or automatic development" CNS gloom Loss of intentional control Exaggerated reflexes Struggling, breath holding, tachypnea, hyperventilation Cardiac arrhythmias may happen Eyelash and palpebral reflexes show Vocalization Salivation Laryngeal fit

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Stages of Anesthesia Stage III: "Phase of Surgical Anesthesia" Pulse rate comes back to ordinary Muscles unwind Swallowing and heaving reflexes lost 3-4 planes Plane I: Eyeball development stops Normal BP with solid heartbeat Decrease of respiratory rate and profundity Pupils less widened Eyeball may pivot Palpebral reflex present Slight response to surgical control Loses jaw tone Plane II: Surgical Anesthesia Bradycardia Hypotension Capillary refill moderates Palpebral reflex reduces and vanishes Eyeball turns ventrally Abdominal muscle tone lost Minimal jaw tone Pedal reflex truant Dysrhythmia plausibility low

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Stages of Anesthesia Stage III (cont): "Phase of Surgical Anesthesia" Plane III: Deep surgical anesthesia Intercostal and muscular strength tone least Weak corneal reflexes Diaphragmatic breathing Profound muscle unwinding Centered and enlarged students Bradycardia heightens Hypotension builds Respiratory rate and profundity diminish Plane IV: Deep/Overdose Dysrhythmia likelihood Respirations moderate and unpredictable Lowered HR Cyanosis Widely widened understudy and lethargic to light Flaccid muscle tone Jaw tone lost Sphincter control lost

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Pharmacokinetics Action of analgesic on CNS Partial weight angles Inhalants versus Injectables Distribution and leeway Modifying elements Concentration Plasma pH Protein restricting Hydration Multiple medications present

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Effects of Disease Cardiovascular brokenness Most soporifics cause CV misery Animals inclined to liquid over-burden & arrhythmias Pulmonary brokenness Most soporifics cause aspiratory melancholy Balancing between bringing down measurements and avoiding tension Intubation and ventilation are scratch Nitrous oxide contraindicated Neurologic malady Loss of ICF and CBF direction Watch for respiratory dejection Nitrous oxide contraindicated Renal ailment Stress and soporific operators diminish rate of filtration Reduction in disposal = increment in acridity and plasma focuses Lingering impacts K+ increments in serum

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Effects of Disease Hepatic infection Acepromazine, thiobarbiturates and α - 2-adrenergic specialists contraindicated Propofol, ketamine and inward breath the most secure Lowered end rate and coagulation Gastrointestinal ailment Damaged GI can discharge poisons Decrease in heart capacity and ventilation Endocrine issue Select anesthesia for least demanding reversibility

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Pre-analgesic Agents and Adjuncts Anticholinergics Tranquilizers Opioids Alpha2adrenergic agonists Alpha2adrenergic rivals Tranquilizer-opioid mixes Paralytic specialists

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Anticholinergics Block acetylcholine receptors Reduce emissions Prevent vagal restraint and GI incitement Reduce vagus nerve reaction (spewing and laryngospasm) Promote bronchodilation Dilate the student Treatment of decision for opioid, xylazine and vagal reflex movement instigated bradycardia

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Anticholinergics Atropine Sulfate Contraindicated with tachycardia, blockage and impediment May bring about thick bodily fluid emissions in felines Atropine esterase happens in felines, rats, and rabbits Minimally successful in sheep and goats Increased occurrence of bloat Prolongs thiopental anesthesia Overdose: dry mucous layers, thirst, widened understudies and tachycardia (mutts most vulnerable) Can be treated with physostigmine IV more than a few minutes Glycopyrrolate Reduces dissemination over blood mind or placental films Lasts longer than atropine Prevents ketamine/xylazine related bradycardia in rabbits Longer onset of activity in ruminants

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Tranquilizers NO ANALGESIC EFFECTS Relieve uneasiness Decrease soporific doses Reduce histamine discharge and regurgitating Make analgesic recuperation smoother Promote skeletal muscle unwinding and vasodilatation May prompt hypotension and intemperate warmth misfortune May raise seizure limits/go about as anticonvulsants

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Tranquilizers Acepromazine Maleate Phenothiazine May lessen or anticipate dangerous hypothermia in swine Droperidol Butyrophenone Alpha-adrenergic rival May forestall epinephrine actuated dysrhythmias Decreases barbiturate dosages Primarily utilized as a segment of InnovarVt in a blend with fentanyl Diazepam Benzodiazepine Prevents seizures Rapidly passes blood-cerebrum and placental obstructions Should be infused gradually to avert venous thrombosis and ought not be infused IA IM infusion not prescribed excruciating

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Tranquilizers Midazolam Benzodiazepine Shorter length of activity and freedom than diazepam May bring about behavioral changes in puppies and felines Suitable for IM infusion Can be blended with other preanesthetic specialists Flumazenil Reverses CNS activity of benzodiazepine without nervousness, tachycardia, or hypertension Rapid activity (24 minutes) Replaced aminophylline and physostigmine

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Opioids Depress CNS Lower the measure of analgesic operators required Do not bring about obviousness at helpful levels Addictive Most are controlled substances Best for constant dull agony

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Opioids Methadone hydrochloride (Methadone, Dolophine) Synthetic opioid irrelevant to morphine 2-6 hours of absense of pain Decreases barbiturate measurement by half Oxymorphone hydrochloride (Numorphan) Semi engineered 10 times more powerful than morphine Provided viable epidural absense of pain Morphine sulfate Stimulates heaving Decreases BMR and body temp Variable impacts Poor consequences for neuropathic torment Meperidine hydrochloride (Demerol, Pethidine) Analgesic impact 1/10 of morphine Rapidly discharged Does not bring about retching Slow organization suggested

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Opioids Fentanyl citrate 250 times more strong than morphine Rapid onset of activity Short span; crest at 30 minutes Depressed breath Exaggerated reaction to boisterous clamor Little cardiovascular yield or BP impacts Carfentanil citrate 10,000 times more intense than morphine Used fundamentally for catch of wild creatures Sufentanil 5 to 10 times as powerful as fentanyl Provided unusual anesthesia in pooches Provides neuroleptanalgesia when joined with sedatives and glycopyrrolate Alfentanil 1/5 th to 1/10 th as powerful as fentanyl 80-1000 times more powerful than morphine SC More fast onset than fentanyl or sufentanyl Used principally for the catch of wild creatures

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Opioids Pentazocine lactate (Talwin) 1/3 rd as viable as morphine Minimal CV impacts Buprenorphine (Buprenex) 25 to 30 times as powerful as morphine Max pain relieving impact not as much as morphine Slow onset of activity (20-30 minutes) Excreted in dung

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Alpha 2 Adrenergic Agonists Produce sedation, muscle unwinding and absense of pain Not strong respiratory depressant Non-addictive Anticonvulsants Wide scope of medication cooperations Barbiturate, inhalant and dissociative sedative measurements ought to be brought down utilized as a part of mix with alpha 2 adrenergic agonists

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Alpha 2 Adrenergic Agonists Xylazine hydrochloride (Rompun) Most regular narcotic/pain relieving in stallions and steers Short term surgical sedative when consolidated with ketamine Effects inside 10-15 minutes IM or 3-5 minutes IV bolus causes bradycardia, hypotension took after by diminished CO and BP Poor adequacy in swine Wide edge of wellbeing May bring about emesis in felines and canines Reduces insulin emission, affecting blood glucose levels Medetomidine More powerful than xylazine BP and RR diminishes dosage subordinate Detomidine Sedative with pain relieving properties Cardiac, respiratory and antidiuretic impacts Primarily utilized as a part of steeds Dexmedetomidine (Precedex) More strong than medetomidine Sedative, pain relieving, sympatholytic and anxiolytic impacts Sedation without respiratory wretchedness Shortens time to extubation Reduces sedative doses Clonidine Alpha-methyldopa

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Alpha 2 Adrenergic Antagonists Used as inversion operators for injectable sedatives Yohimbine Reverses xylazine Also turns around ketamine and pentobarbital mixes when joined with 4-aminopyridine. Tolazoline Reverses xylazine and some soporific medication blends with xylazine Atipamezole Selectivity proportion 200 to 300 times higher than yohimbine Rapid IV measurements may bring about death or extreme hypotension and tachycardia

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Tranquilizer-Opioid Combinations Provide neuroleptanalgesia Intense pain relieving activity with brief term Fentanyl citrate Droperidol (Innovarvet) Wide edge of security with simple recuperation Partially turned around with opioid foes

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Paralytics Provide better muscle unwinding as an extra than general anesthesia DO NOT PROVIDE ANALGESIA OR UNCONSCIOUSNESS Prohibited as a sole sedative by the Guide Mechanical ventilation required M

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