ANESTHESIA

• Anesthesia = no sensations
• General = Alters consciousness - Reduces pain - Minimizes awarness of surg env
• Nerve Block = Stops sensory impulse

ANESTHESIOLOGIST

ANESTHETIST

• Anesthesiologist = MD
• Anesthetist = CRNA

PRE-OP ASSESSMENT

• Conducted by anesthesia provider
• H (interview) & P (baseling vital, HR, BP, loose teeth, dentures
• Confirm disease, meds, allergies, physical status
• Questionnaire and interview
• Psychological assessment
• Airway elvaluation
• Tests - ECG, PULM, HEMO, HEMATO, COAGULATION, SERUM
• Classified by ASA rating system

ASA RATING SYSTEM

PHYSICAL STATUS

• I - Normal, healthy patient
• II - Mild systemic disease
• III - Severe systemic disease that limits activity but not incapacitating
• IV - Incapacitating systemic disease that is constant threat to life
• V - Morbid - not expected to survive 24hrs with our w/out operation
• E - In emergency situation, E is placed after roman numeral

RBC

• Red blood cell count
• Act as transporters, count must be normal
• EPO in kidneys initiate growth of more RBC

HEMATOCRIT

• Measures blood, buffy coat and plasma
• Buffy coat (WBC) - small unless infection present
• WBC = 4500-5000
• Albumin = 90% of plasma protein
• Fibrinogen = clotting

HEMOGLOBIN

• Bloods oxygen carrying copacity
• Reduction = hypoxemia = hypoxia=metabolic acidosis (cells shut down) - Would need blood transfussion

WBC

• Granules = have grains (enzymes) = neutrophils,eosinophils,basophils
• Non-Granule = lymphocytes,monocytes
• Test WBC and differential

ASA CLASSIFICATION OF PATIENT RISK ASSESSMENT

• Class I = Healthy
• Class II = Mild/moderate systemic disease - asthma, anemia, diabetes, controlled hypertension
• Class III = Sever systemic disturbance - Angina, post myocardial infarction,poorly controlled hypertension, resp disease
• Class IV = Severe systemic disease - life threatening disorders, unstable angina, CHF, severe resp disease, hepato-renal failure (LOCAL ANEST)
• Class V = Moribund - small chance of survival - cancer, malignant (LOCAL ANEST)
• Class VI = Brain dead, life support (organ procurement)
• Emergency modifier (E) = overrides all other classes

HISTORY

• Raw opium and alcohol once used
• Modern anesteshia began in 1776, discovery of N2O by Priestly
• Began using N2O in 1844

ETHER

• 1816 Morton demonstrated anesthetic properties of Ether
• One of the first volitile agents used

LISA

• 1905 Long Island Society of Anesthesiologist formed
• 1936 LISA renamed to (ASA)

CHLOROFORM

• Simpson was the first to use it
• 85% mortality rate - cardiac arrest

SEDATIVES

• Given to relieve anxiety, prevent vomitting, cause anmesia
• Most used pre-op = BENZODIAZEPINES - remain conscious but wont remember
• Diazepam (Valium), Lorazepam (ativan) Midazolam (versed) <--most common 

ANALGESICS

• Opioids = Pre-op for analgesia and reduce amt of anesthesia needed
• OPIOID = All drugs having morphine-like effects
• analgesia, mild sedation, slowing of resp, reduced intestinal motility
• Not usually first choice of agents
• CI = out patient surgery
• Morphine (astramorph) Meperidine (demerol) Fentanyl (sublimaze)
• Demerol and fentanyl most common

ANTICHOLINERGICS

• Pre-op - block vagus nerve receptors, inhibit mucus of resp and GI, increase HR
• Can also be used intra-op to block vagal response (bradycardia) for abdominal, peritoneum, bowl manipulation, cervical traction or retinal procedures
• Atropine (atropine) Glycopyrrolate (robinul) Scopolamine - prevent nausea and vomitting (transderm scop)

GASTRIC AGENTS

• Anxiety / fear can slow or stop GI
• Food and Acid in stomach are hazard - can cause aspiration
• Risk - GERD, diabetes, obesity
• Nonparticulate antacid = Sodium Citrate (bicitra)                            
• Acid secretion blockers= Crimetidine (tagamet) Famotidine (pepcid) Ranitidine (zantac)
• Antiemetic = Ondansetron (zofran)
• Metoclopramide (reglan) GI motility agent given pre-op