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  • Anesthesia Components Introduction

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    KrishnaBihariShukla
    33 visualizzazioni15 pagine
    Anesthesia, or anaesthesia (from Greek ἀν-, an-, "without"; and αἴσθησις, aisthēsis, "sensation"),[1] is a temporary state that causes unconsciousness, loss of memory, lack of pain and muscle relaxation. Anesthesia is a unique intervention, in that it does not offer any particular benefit, rather it allows others to do things that might be beneficial. The best anesthetic, therefore is the one with the lowest risk to the patient that still achieves the end points required to complete the procedure. A general anesthetic will cause a person to sleep but the body can still mount a fight-or-flight (stress) response to surgical stimulation leading to a harmful condition called shock. Muscles will also contract under anesthetic making surgical procedures impossible. Since the needs of anesthesia are multifaceted, so are the end points which are traditionally described as hypnosis (medically meaning unconsciousness and amnesia), analgesia and muscle relaxation. To reach multiple end points one or more drugs are commonly used (such as general anesthetics, hypnotics, sedatives, paralytics, narcotics and analgesics) each of which serves a specific purpose in creating a safe anesthetic. The types of anesthesia are broadly classified into general anesthesia, sedation and regional anesthesia. General anesthesia refers to the suppression of activity in the central nervous system, resulting in unconsciousness and total lack of sensation. Sedation (or dissociative anesthesia) uses agents that inhibit transmission of nerve impulses between higher and lower centers of the brain inhibiting anxiety and the creation of long-term memories. Regional anesthesia renders a larger area of the body insensate by blocking transmission of nerve impulses between a part of the body and the spinal cord. It is divided into peripheral and central blockades. Peripheral blockade inhibits sensory perception within a specific location on the body, such as when a tooth is "numbed" or when a nerve block is given to stop sensation from an entire limb. Central blockades place the local anesthetic around the spinal cord (such as with spinal and epidural anesthesia) removing sensation to any area below the level of the block. There are both major and minor risks of anesthesia. Examples of major risks include death, heart attack and pulmonary embolism whereas minor risks can include postoperative nausea and vomiting and readmission to hospital. The likelihood of a complication occurring is proportional to the relative risk of a variety of factors related to the patient's health, the complexity of the surgery being performed and the type of anesthetic. Of these factors, the person's health prior to surgery (stratified by the ASA physical status classification system) has the greatest bearing on the probability of a complication occurring. Patient's typically wake within minutes of an anesthetic being terminated and regain their senses within hours. An exception being a condition called long-term post-operative cognitive dysfunction. It is characterized by persistent confusion lasting weeks or months and is more common in those undergoing cardiac surgery and in the elderly. The first public demonstration of general anesthesia was in 1842 by a Boston dentist named William T.G. Morton at the Massachusetts General Hospital. Dr. Morton gave an ether anesthetic for the removal of a neck tumor by surgeon John Collins Warren (the first editor of the New England Journal of Medicine and dean of Harvard Medical School). About a decade later, cocaine was introduced as the first viable local anesthetic. It wasn't until the 1930s that Dr. Harvey Cushing tied the stress response to higher mortality rates and began using local anesthetic for hernia repairs in addition to general anesthesia.

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    Anesthesia, or anaesthesia (from Greek ἀν-, an-, "without"; and αἴσθησις, aisthēsis, "sensation"),[1] is a temporary state that causes unconsciousness, loss of memory, lack of pain and muscle relaxation. Anesthesia is a unique intervention, in that it does not offer any particular benefit, rather it allows others to do things that might be beneficial. The best anesthetic, therefore is the one with the lowest risk to the patient that still achieves the end points required to complete the procedure. A general anesthetic will cause a person to sleep but the body can still mount a fight-or-flight (stress) response to surgical stimulation leading to a harmful condition called shock. Muscles will also contract under anesthetic making surgical procedures impossible. Since the needs of anesthesia are multifaceted, so are the end points which are traditionally described as hypnosis (medically meaning unconsciousness and amnesia), analgesia and muscle relaxation. To reach multiple end points one or more drugs are commonly used (such as general anesthetics, hypnotics, sedatives, paralytics, narcotics and analgesics) each of which serves a specific purpose in creating a safe anesthetic. The types of anesthesia are broadly classified into general anesthesia, sedation and regional anesthesia. General anesthesia refers to the suppression of activity in the central nervous system, resulting in unconsciousness and total lack of sensation. Sedation (or dissociative anesthesia) uses agents that inhibit transmission of nerve impulses between higher and lower centers of the brain inhibiting anxiety and the creation of long-term memories. Regional anesthesia renders a larger area of the body insensate by blocking transmission of nerve impulses between a part of the body and the spinal cord. It is divided into peripheral and central blockades. Peripheral blockade inhibits sensory perception within a specific location on the body, such as when a tooth is "numbed" or when a nerve block is given to stop sensation from an entire limb. Central blockades place the local anesthetic around the spinal cord (such as with spinal and epidural anesthesia) removing sensation to any area below the level of the block. There are both major and minor risks of anesthesia. Examples of major risks include death, heart attack and pulmonary embolism whereas minor risks can include postoperative nausea and vomiting and readmission to hospital. The likelihood of a complication occurring is proportional to the relative risk of a variety of factors related to the patient's health, the complexity of the surgery being performed and the type of anesthetic. Of these factors, the person's health prior to surgery (stratified by the ASA physical status classification system) has the greatest bearing on the probability of a complication occurring. Patient's typically wake within minutes of an anesthetic being terminated and regain their senses within hours. An exception being a condition called long-term post-operative cognitive dysfunction. It is characterized by persistent confusion lasting weeks or months and is more common in those undergoing cardiac surgery and in the elderly. The first public demonstration of general anesthesia was in 1842 by a Boston dentist named William T.G. Morton at the Massachusetts General Hospital. Dr. Morton gave an ether anesthetic for the removal of a neck tumor by surgeon John Collins Warren (the first editor of the New England Journal of Medicine and dean of Harvard Medical School). About a decade later, cocaine was introduced as the first viable local anesthetic. It wasn't until the 1930s that Dr. Harvey Cushing tied the stress response to higher mortality rates and began using local anesthetic for hernia repairs in addition to general anesthesia.

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    33 visualizzazioni15 pagine

    Anesthesia Components Introduction

    Caricato da

    KrishnaBihariShukla
    Anesthesia, or anaesthesia (from Greek ἀν-, an-, "without"; and αἴσθησις, aisthēsis, "sensation"),[1] is a temporary state that causes unconsciousness, loss of memory, lack of pain and muscle relaxation. Anesthesia is a unique intervention, in that it does not offer any particular benefit, rather it allows others to do things that might be beneficial. The best anesthetic, therefore is the one with the lowest risk to the patient that still achieves the end points required to complete the procedure. A general anesthetic will cause a person to sleep but the body can still mount a fight-or-flight (stress) response to surgical stimulation leading to a harmful condition called shock. Muscles will also contract under anesthetic making surgical procedures impossible. Since the needs of anesthesia are multifaceted, so are the end points which are traditionally described as hypnosis (medically meaning unconsciousness and amnesia), analgesia and muscle relaxation. To reach multiple end points one or more drugs are commonly used (such as general anesthetics, hypnotics, sedatives, paralytics, narcotics and analgesics) each of which serves a specific purpose in creating a safe anesthetic. The types of anesthesia are broadly classified into general anesthesia, sedation and regional anesthesia. General anesthesia refers to the suppression of activity in the central nervous system, resulting in unconsciousness and total lack of sensation. Sedation (or dissociative anesthesia) uses agents that inhibit transmission of nerve impulses between higher and lower centers of the brain inhibiting anxiety and the creation of long-term memories. Regional anesthesia renders a larger area of the body insensate by blocking transmission of nerve impulses between a part of the body and the spinal cord. It is divided into peripheral and central blockades. Peripheral blockade inhibits sensory perception within a specific location on the body, such as when a tooth is "numbed" or when a nerve block is given to stop sensation from an entire limb. Central blockades place the local anesthetic around the spinal cord (such as with spinal and epidural anesthesia) removing sensation to any area below the level of the block. There are both major and minor risks of anesthesia. Examples of major risks include death, heart attack and pulmonary embolism whereas minor risks can include postoperative nausea and vomiting and readmission to hospital. The likelihood of a complication occurring is proportional to the relative risk of a variety of factors related to the patient's health, the complexity of the surgery being performed and the type of anesthetic. Of these factors, the person's health prior to surgery (stratified by the ASA physical status classification system) has the greatest bearing on the probability of a complication occurring. Patient's typically wake within minutes of an anesthetic being terminated and regain their senses within hours. An exception being a condition called long-term post-operative cognitive dysfunction. It is characterized by persistent confusion lasting weeks or months and is more common in those undergoing cardiac surgery and in the elderly. The first public demonstration of general anesthesia was in 1842 by a Boston dentist named William T.G. Morton at the Massachusetts General Hospital. Dr. Morton gave an ether anesthetic for the removal of a neck tumor by surgeon John Collins Warren (the first editor of the New England Journal of Medicine and dean of Harvard Medical School). About a decade later, cocaine was introduced as the first viable local anesthetic. It wasn't until the 1930s that Dr. Harvey Cushing tied the stress response to higher mortality rates and began using local anesthetic for hernia repairs in addition to general anesthesia.

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    Surgical Anesthesia

    A Components Introduction

    Jose D. Chinchilla, LVT, RLATG


    Training Coordinator Priority One Services

    Anesthesia Components
    Anesthesia Machine
    Frame Regulator Flowmeter Oxygen Flush Assembly Vaporizer Anesthetic Supply System Scavenging System

    Anesthesia Components
    Anesthesia Machine
    Frame
    Supports the components of the anesthetic machine Several styles available

    Anesthesia Components
    Anesthesia Machine
    Frame

    Regulator
    Placed on O2 tanks to decrease pressure from tank 2 types of tanks
    E Tanks 650L @ 1800PSI H Tanks 7100L @ 2200PSI

    Output pressure adjusted with knob

    Anesthesia Components
    Anesthesia Machine
    Frame Regulator

    Flowmeter
    Controls the amount of air released into the anesthetic circuit Calculation: (Tidal volume - mL) x (Breathes per minute) / (1000mL/Liter)= Liters Resp. per Minute

    Anesthesia Components
    Anesthesia Machine
    Frame Regulator Flowmeter

    Oxygen Flush Assembly


    High flow oxygen straight from O2 supply 45-50psi Do not use while connected to patient through tracheal tube Use to flush anesthetic gases from circuit and minimize exposure

    Anesthesia Components
    Anesthesia Machine
    Flowmeter Oxygen Flush Assembly

    Vaporizer
    Changes liquid agent to a vapor Delivers the vapor into the moving steam of oxygen in controlled amounts Must b e serviced to maintain accuracy of delivery and safety Caution with refurbished models

    Anesthesia Components
    Anesthesia Machine
    Oxygen Flush Assembly Vaporizer

    Anesthetic Supply System


    a.k.a Breathing circuits Rebreathing
    Exhaled air is cleaned and reused with the patient

    Non-rebreathing
    Exhaled air is taken by scavenging system

    Anesthetic Supply Systems


    Rebreathing Circuit

    Non-Rebreathing Circuit

    Modified from Nakae Y et al. Anesthesia and Analgesia 1996;83:488-492

    Anesthesia Components
    Anesthesia Machine
    Vaporizer Anesthetic Supply System

    Scavenging Systems
    Containing Anesthetic Gas Evacuating Gases Filtering Gases Passive vs. Active Evacuation In-facility Vacuum Fume Hoods & Down Draft Tables

    Scavenging Systems
    Scavenging Systems
    Containing Anesthetic Gas
    NIOSH
    National Institute for Occupational Safety and Health

    Permissible Exposure Limits (PEL's) 2 parts per million (PPM) Must make every attempt to limit leaks Where can leaks come from?

    Scavenging Systems
    Scavenging Systems
    Containing Anesthetic Gas

    Evacuating Gases
    Waste gas is contained until it can be released to the outside atmosphere Ensure connections are leak free No resistance of gas flow Evacuation lines checked to assure they are clear of obstructions Passive Systems Active Systems

    Scavenging Systems
    Scavenging Systems
    Containing Anesthetic Gas

    Evacuating Gases
    In-facility Vacuum Connects the in-house vacuum lines to the exhaust portion of the anesthetic machine Caution: Negative pressure in exhaust line possible Caution: Positive pressure build up in circuit possible

    Scavenging Systems
    Scavenging Systems
    Containing Anesthetic Gas Evacuating Gases

    Filtering Gases
    Fume Hoods & Down Draft Tables Applies negative pressure to procedure area not just exhaust. Less possibility of incorrect use Must keep patient and exhaust within cabinet or 30 from table

    Scavenging Systems
    Scavenging Systems
    Containing Anesthetic Gas Evacuating Gases

    Filtering Gases
    Activated Charcoal Adsorbent Material Management of Canisters 25% of Original Canister Weight Documentation

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