These medications supplement local anesthetic injections, which are often given by your surgeon. Monitored anesthesia (MAC)Consists of medications to make you drowsy and to relieve pain. Medications can be given that will make the pt comfortable. Regional anesthetic techniques include spinal blocks, epidural blocks and arm and leg blocks. Regional anesthesiaInvolves the injection of a local anesthetic to provide numbness, loss of pain or loss of sensation to a large region of the body.General anesthesiaProvides loss of consciousness and loss of sensation.There are four main types of anesthesia from which to choose:.Sexually active, time of last menstrual period. Bleeding disorder hx., Anticoagulant meds, Hepatic ds. Lab Test CBC Coagulation testing Pregnancy testing Clinical Indications Hematologic disorder, bleeding, malignancy, Chemo/radiation tx, renal ds., highly invasive or trauma sx. Lab test LFT Renal fxn testing Clinical Indications Hx of Hepatitis, Cirrhosis, portal HTN, GB or biliary tract disease, Jaundice HTN, increased fluid overload, diabetes, urinary problems, dialysis pt’s HTN,cardiomegaly, Advanced COPD with blebs, PE Hx of CAD,Age > 50, HTN, chest pain, CHF, diabetes, PVD, SOB, DOE,palpitations, murmurs Lab Test CXR ECG Clinical indications Pneumonia, pulmonary edema, Atelectasis,mediastinal or pulmonary masses,pulm. Surgical patients require preop lab and diagnostic studies that are consistent with their medical histories, the proposed operative procedures, and the potential for blood loss.Tonsillar pillars and base of uvula hidden by base of tongue.Soft palate,anterior and posterior tonsillar pillars and uvula visible.This is the basis for the Mallampati Classification. The size of the tongue versus the oral cavity can be visually graded by assessing how much the pharynx is obscured by the tongue.Physical Exam: CNS Level of Consciousness Evidence of peripheral, sensory or skeletal muscle dysfxn CV Auscultation of heart Systemic blood pressure Peripheral pulses Veins Peripheral edema Lungs Auscultation of Lungs Pattern of breathing tract infection Liver Alcohol Consumption Hepatitis Kidneys Nocturia Pyuria Skeletal and Muscular Systems Arthritis Osteoporosis WeaknessĮndocrine System Diabetes mellitus Thyroid gland dysfunction Adrenal gland dysfunction Coagulation Bleeding tendency Easy bruising Hereditary coagulopathies Reproductive System Menstrual History STD’s Dentition Dentures Caps Lungs Exercise Tolerance Dyspnea and Orthopnea Cough and Sputum Production Cigarette consumption Pneumonia Recent upper resp. Previous adverse responses related to anesthesia Allergic Reactions Sleep apnea Prolonged skeletal muscle paralysis Delayed awakening Nausea and vomiting Adverse responses in relatives Central Nervous System Cerebrovascular insufficiency Seizures Cardiovascular System Exercise Tolerance Angina Prior MI HTN Claudication Preoperative management Presently, one gas (nitrous oxide) and the vapors of three volatile liquids (sevoflurane, desflurane & isoflurane) represent the commonly used inhaled anesthetics.Īreas to investigate in preop history.Fluorinated inhaled anesthetics were used in the 1950’s because of minimal depression of cardiovascular function, less organ toxicity and low blood solubility.Cyclopropane, because of its low blood solubility and support of the circulation, became the most important new inhaled anesthetic in the 1930’s. ![]() No significant new inhaled anesthetics were introduced during the next 80 years.The first successful anesthetic took place at Massachusetts General Hospital in 1846 by a dentist, Dr. ![]() Discuss the scope of anesthesia including preoperative assessment, intraoperative care and postoperative care.Discuss briefly the History of Anesthesia. ![]() Section III covers anesthesia management topics from preoperative preparation, monitoring, and anesthesia techniques ( e.g., airway management, regional anesthesia, transfusion medicine). The remainder of the text is devoted to topics in clinical anesthesia and allied areas. It also includes chapters about drug delivery systems, complementary and alternative therapies, and statistics. The basic science section of the book, section II, covers basic pharmacology principles, individual drug classes, and physiology. The introduction is comprised of a single chapter chronicling the history of anesthesia from ancient times to modern (with brief biographies of major historical figures in the specialty), which serves as an excellent springboard for the rest of the text. As with previous editions, the text is organized into sections that reflect the theory and practice of modern anesthesia. In view of the text's staying power, Miller's Anesthesia is likely to continue to enjoy its position as the standard by which competitors, both old and new, are judged.
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