Christine Du 12/22/10 http://www.youtube.com/watch?

v=ZTbKNA0XGGI

 5231 Spring Ridge Dr E. Macungie 18062

Please do NOT Park in front of the mailboxes. Wear socks cause you wont be wearing shoes. Vomit on my nice carpet! Please DO Bring the family. Bring money for some texas hold em. Bring some liquid courage cause you WILL karoake! OVER THE HUMP CELEBRATION

 Sodium Thiopental Propofol- Amnesic, sedative but NOT analgesic Rapid induction Cleared by hepatic metabolism & plasma cholinesterase SE: Hypotension, respiratory depression Contra: egg allergy Ketamine- amnesia/analgesia Phencyclidine derivative Dissociation between thalamus and limbic systems No respiratory depression Visual/auditory hallucinations delirium (tx: benzos) Indirect sympathetic nervous system stimulatory effects

Increases myocardial oxygen consumption and ICP

Etomidate Continuous infusion can lead to adrenocortical suppression.

 Inhalation Agents (unconsciousness,

amnesia, some analgesia)

MAC Lipid soluble Potency Speed of induction

Generalized depressants
Sevoflurane Fast onset/offset; Less cardiac depress; Less laryngospasm

Nitrous Oxide Halothane Enflurane Isoflurane Myocardial depression/vasodilation

Cerebral function/ metabolic rate Fastest Slow; highest Seizures induction; degree cardiac Loss of autoreguation minim cardiac depress/arrhy; depression Hepatits; Loss of heat conservation Least pungent

 Amnesics Benzodiazepines Short-acting- Versed . Contra: pregnancy crosses placenta. Long acting- ativan/valium Flumazenil- competitive inhibitor seizure/arrhythmias, contra in elevated ICP or status epilepticus Analgesics Narcotics act on mu receptors. Respiratory depression. Blunting of sympathetic vascular tone Chest wall rigidity with high IV doses- muscle relaxant Naloxone- SE: acute pulmonary edema and myocardial ischemia Avoid w/ MAO-I= Serotonin syndrome

Depolarizing (noncompetitive inhibitor) agent

Succinylcholine Hydrolyzed in plasma by cholinesterase Malignant hyperthermia

Nondepolarzing Agents
Cisatracurium- Hoffman

Defect in calcium metabolism Muscle excitation-contraction syndrome First sign- increased end-tidal CO2. fever/tachycardia/ rigidity/acidosis/hyperkalemia Dantrolene 10mg/kg. inhigbits ca release and decouples excitation complex. Cooling balnkets, hco3, glc

degradation, histamine release Mivacurium- fast, short, plasma cholinesterases Rocuronium- fast, intermediate, liver Pancuronium- slow, long ,renal SE tachycardia Reversal
Neostigmine- blocks acetylcholinesterase Edrophonium Atropine or glycopyrrolate

Contra: burn pts, neurologic injury (increased ICP), neuromuscular d/o, SCI, massive trauma, ARF

 Temporarily block nerve conduction by binding to

neuronal sodium channels. Preventing Na influx.

Autonomic sensory motor nerve transmission

Acute CNS toxicity 2/2 excessive plasma

concentration Hemodynamic/respiratory consequences 2/2 excessive conduction block of sympathetic or motor nerves Allergic rxns

Esters vs amides (less allergy- if so, preservatives)

Spinal/epidural blocks Progressive blockade of sympathetic nervous system vasodilation/bradycardia LMWH

 HTN HoTN & MI intra-op higher in untreated HTN pts than those adequately treated if pre-op DBP >110 Inadequately tx HTN more neurologic deficits after CEA. h/o prior MI have increased incidence of reinfarction CAD Preop CHF, recent MI, unstable angina, age >70 DM, m>40yo, f>50yo need pre-op ECG All elective surgery is delayed 6mos after MI. Pulmonary Disease Restrictive- intrinsic (ARDS) vs. extrinisic (deformity/obesity) Obstructive- FEV1/FVC <50%. VC/FRC reduced (lowest in first 24hrs postop) Obesity DM

Preoperative Health Status

Comments, Examples

ASA 1

Normal healthy patient

ASA 2

Patients with mild systemic disease

No functional limitations; has a well-controlled disease of one body sy (ex. controlled hypertension or diabetes without systemic effects, cig smoking without chronic obstructive pulmonary disease (COPD); mild obesity, pregnancy)

ASA 3

Patients with severe systemic disease

Some functional limitation; has a controlled disease of more than one system or one major system; no immediate danger of death; (ex. controlled congestive heart failure (CHF), stable angina, old heart attack, poorly controlled hypertension, morbid obesity, chronic renal failure; bronchospastic disease with intermittent symptoms)

ASA 4

Has at least one severe disease that is poorly controlled or at end stag Patients with severe systemic disease that possible risk of death is a constant threat to life (ex. unstable angina, symptomatic COPD, symptomatic CHF, hepator failure)

ASA 5

Not expected to survive > 24 hours without surgery; imminent risk of Moribund patients who are not expected to (ex. multiorgan failure, sepsis syndrome with hemodynamic instabilit survive without the operation hypothermia, poorly controlled coagulopathy) A declared brain-dead patient who organs are being removed for donor purposes

ASA 6