Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Reference book
Clinical Anesthesiology, G. Edward Morgan, Jr., Maged S. Mikhail, Michael J. Murray Fourt Edition by the McGraw-Hill Companies 2006 a LANGE Medical Book
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www.katedraanest.cm-uj.krakow.pl
Prof. Janusz Andres (Head of the Chair and Department) email: msandres@cyf-kr.edu.pl Agnieszka Frczek (Secretary) email: agafrk@cm-uj.krakow.pl Katarzyna Lepszy-Muszyska (Coordinator, email:muszynscy.brzozowka@neostrada.pl
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Inhalation Anesthesia
1540 Paracelsus: oil of vitriol (prepared by
Valerius Cordus and named Aether by
Local anesthesia
Ancient Incas: coca leaf as a gift to the
Incas from the sun of God: destruction of Incas culture slaves payment
Anesthesia
analgesia reversible anesthetic effect amnesia areflexia sleep supression of the vegetative response
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Is anesthesia safe?
Like airplane? Anesthesia related deaths: 1940 1/1000 1970 1/10 000 1995 1/250 000 2005 ?
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Safety of anesthesia
1950 - 25 000 deaths during 108 hours of anesthesia
2000 - 500 deaths during 108 hours of anesthesia Airplane risk (very low) - 5 deaths during 108 hours of flight Risk of anaesthesia: 100 x higher
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Progress in anesthesia
New monitoring techniques and standards New anesthetics (iv and inhalation) New drugs (inotropic, NO) New ways of drug delivery New management techniques Cost - effective Fast truck
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Future of anesthesiology
CNS and transdermal stimulation Safe delivery of drugs More specific drugs (membrane function) Perfluorocarbons Genetically focus therapy Noninvasive monitoring Visible pre- and postsynaptic area Hibernation
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ASA scale
1 normal healthy patient 2 mild systemic disease (no limitation0 3 moderate to severe systemic disease with limitation of function 4 severe systemic disease (threat to life) 5 moribund patient E emergency case 6 brain death patient 22
An anaesthetic plan
Patients baseline condition with medical record and previous anaesthesia and surgery Planned procedure Drug sensitivities Psychological makeup
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Documentation
Informed consent Preoperative note Intraoperative anesthesia record
patient status review of anesthesia and surgery laboratory drugs dosage and time of administration
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Documentation 2
Patient monitoring (intraoperative monitor, future reference for the patient, tool for quality assurance) fluid administration procedures (catheters, caniulas, tubes) time of important events unusual complication end of procedures state of consciousness
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Ventilation management
Breathing systems
Open drop anesthesia Mapleson circuits Anesthesia machines
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Breathing Systems
Patient breathing system anaesthesia machine Mapleson systems: Beathing tubes, fresh gas inlets, adjustable pressure limiting (APL) or pop-off valves, reservoir bags Carbon Dioxide Absorbent: CO2 + H2O = H2CO3,
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Airway management
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Airway management
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Airway management
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Airway management
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Airway management
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Airway management
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Mask ventilation
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Mask ventilation
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Edotracheal intubation
Most common and safe protection of aiways during anaesthesia and intensive care But Need skills and permament training
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AIRWAY
Difficulty in managing the airway Difficult intubation Traumatic intubation Esophageal intubation Bronchial intubation Laryngospasm Bronchospasm
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Patient monitors
Arterial blood pressure ECG CVP, PAC Capnometry Pulsoxymetry EEG, BIS Temperature Nerve stimulation
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Intravenous anaesthesia
Changes in plasma concentration Absorption Distribution (Vd= Dose/Concentration) Biotransformation Excretion Compartment model of distribution and elimination
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Muscle relaxants
Neuromuscular transmission Depolarizing agents (Ach rec. agonists) Nondepolarizing agents (Ach rec. antagonists) Cholinesterase inhibitors (edrofonium, neostigmine, pyridostigmine)
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Anticholinergic drugs
Antimuscarinic effect
Atropine Scopolamine
Glycopyrrolate
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Anesthesia complications
Inadequate preoperative planning and errors in patient preparation are the most commom causes of anesthestic complications
Anesthesia and elective operations should not proceed until the patient is in optimal medical condition
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Anesthetic complications
Human error (technical problems, lack of communication, experience, fatigue,) Ventilation (breathing circuit, defect of monitoring equipment, anesthesia machine) Position (periferal nerve damage) Anaphylaxis Latex allergy
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