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

v=ZTbKNA0XGGI

 Wear socks ‘cause you won’t be wearing shoes.  Bring money for some texas hold ‘em. Macungie 18062  Please do NOT  Park in front of the mailboxes.  Bring some liquid courage ‘cause you WILL karoake! OVER THE HUMP CELEBRATION .  Vomit on my nice carpet!  Please DO  Bring the family. 5231 Spring Ridge Dr E.

sedative but NOT analgesic  Rapid induction  Cleared by hepatic metabolism & plasma cholinesterase  SE: Hypotension. .Amnesic.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. respiratory depression  Contra: egg allergy  Ketamine. Sodium Thiopental  Propofol.

some analgesia) MAC Lipid soluble Potency Speed of induction  Generalized depressants Sevoflurane Fast onset/offset. degree cardiac  Loss of autoreguation minim cardiac depress/arrhy. Less laryngospasm Nitrous Oxide Halothane Enflurane Isoflurane  Myocardial depression/vasodilation  Cerebral function/ metabolic rate Fastest Slow.  Loss of heat conservation Least pungent . Less cardiac depress. depression Hepatits. highest Seizures induction. Inhalation Agents (unconsciousness. amnesia.

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

fast.Depolarizing (noncompetitive inhibitor) agent  Succinylcholine  Hydrolyzed in plasma by cholinesterase  Malignant hyperthermia   Nondepolarzing Agents  Cisatracurium. plasma cholinesterases Rocuronium.blocks acetylcholinesterase  Edrophonium  Atropine or glycopyrrolate   Contra: burn pts. neuromuscular d/o. glc degradation. Cooling balnkets. fever/tachycardia/ rigidity/acidosis/hyperkalemia Dantrolene 10mg/kg.renal SE tachycardia Reversal Neostigmine. short.slow. neurologic injury (increased ICP).fast. SCI.Hoffman       Defect in calcium metabolism Muscle excitation-contraction syndrome First sign. massive trauma. histamine release Mivacurium.increased end-tidal CO2. long . intermediate. ARF . liver Pancuronium. inhigbits ca release and decouples excitation complex. hco3.

 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. preservatives)  Spinal/epidural blocks  Progressive blockade of sympathetic nervous system vasodilation/bradycardia  LMWH .if so. Temporarily block nerve conduction by binding to neuronal sodium channels. Preventing Na influx.

extrinisic (deformity/obesity)  Obstructive. f>50yo need pre-op ECG  All elective surgery is delayed 6mos after MI. unstable angina. m>40yo. age >70  DM. 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.  VC/FRC reduced (lowest in first 24hrs postop)  Obesity  DM .  Pulmonary Disease  Restrictive. recent MI.intrinsic (ARDS) vs.FEV1/FVC <50%.  h/o prior MI have increased incidence of reinfarction  CAD  Preop CHF.

poorly controlled hypertension. stable angina.Preoperative Health Status Comments. imminent risk of Moribund patients who are not expected to (ex. Examples ASA 1 Normal healthy patient ASA 2 Patients with mild systemic disease No functional limitations. mild obesity. no immediate danger of death. chronic renal failure. symptomatic COPD. (ex. symptomatic CHF. old heart attack. unstable angina. controlled congestive heart failure (CHF). sepsis syndrome with hemodynamic instabilit survive without the operation hypothermia. has a controlled disease of more than one system or one major system. cig smoking without chronic obstructive pulmonary disease (COPD). morbid obesity. 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. has a well-controlled disease of one body sy (ex. multiorgan failure. pregnancy) ASA 3 Patients with severe systemic disease Some functional limitation. controlled hypertension or diabetes without systemic effects. hepator failure) ASA 5 Not expected to survive > 24 hours without surgery. poorly controlled coagulopathy) A declared brain-dead patient who organs are being removed for donor purposes ASA 6 .

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