Anesthesiology Lecture 1

Controlled, reversible state of: amnesia (with LOC) analgesia akinesia (skeletal muscle relaxation) autonomic and sensory reflex blockade

State of reversible come intentionally induced by drugs in which the pt is not arousable, even w/ painful stimuli: intervention often required to support the airway spontaneous ventilation often inadequate CV fxn may be impaired

General anesthesia w/ several agents, possibly a mixture of inhalational and IV meds

Local anesthetics that numb a particular part of the body and can be supplemented w/ sedation

Use of regional anesthesia and general anesthesia at the same time often allows used of lower dose of general anesthetic (good for pt w/ many comorbidities) and useful for procedures that cannot logistically be done w/ just regional but have significant post-op pain amenable to a regional (ie thoracotomy)

Pt remains arousable when given an IV agent that induces analgesia, anxiolysisk, and often amnesia but consciousness is maintained

Normal response to verbal stimuli unaffected unaffected unaffected

Purposeful response to verbal or tactile stimuli no intervention necessary adequate usually maintained

Purposeful response w/ repeated or painful stimuli intervention may be required may be inadequate usually maintained

Unarouseable even w/ painful stimulus intervention often required frequently inadequate may be impaired

I: no medical problems other than localized indication for sx that can be cured w/ sx II: one or more systemic diseases under good control which do not limit function III: one or more systemic diseases which are not in perfect control or limit fxn to some extent (cancer, dialysis, most PVD pts) IV: systemic condition which is a constant threat to life V: expected to die w/in a day, sx is a desperation measure (80 yr old w/ ischemic bowel; sx even w/ 75% mortality b/c w/o sx mortality ~100%) VI-E: brain-dead pt for organ harvesting E: emergency, add to any status

Pre-op eval, consent,counseling IV premed (usually BDZ) to OR IV induction neuromuscular blocking agent intubation maintenance emergence extubation recovery

- crosses BBB rapidly and is short acting even though elimination half life is several hours b/c redistribution half life is very short; the slow release from tissues is not enough to reanesthetize the pt but enough to work for synergism w/ other drugs - dose dependent decr in SVR, MAP, CO - potent resp depressant (apnea) - reduces CMRO2 and CBF

Potential adrenocortical depression myoclonic movements N&V

Useful as a sedation/induction agent w/ amnestic and anti-emitic properties and least residual sedation/faster and more complete awakening