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Objectives
define anesthesia and pain relief mention components of anesthesia define MAC mention proposed site of anesthetic action mention types of anesthetics in clinical use
Definition
Anesthesia- term first used by Greek philosopher Dioscorides to describe narcotics like effect- 1st century Defect of sensation- Baileys Dictionary 1721 Privation of Sensation- Encyclopedia Britannica- 1771 Sleep like state that makes possible painless surgery- Oliver Wendel Holmes 1846
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Definition contd
General or local insensibility to pain and other sensation, induced by certain drugs GA- Drug induced reversible depression of the CNS resulting in the loss of responses to and perception of all external stimuli Balanced anaesthesia Triad of anesthesia
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Definition contd
History of Anesthesia
Date from ancient time Ether synthesized by V Cordus in 1540, used by Crawford W Long in 1842, publicized by Morton in 1846 N2O synthesized by Priestley in 1772, experimented by Davy in 1800, used in anesthesia by Colton and Wells in 1844. Chloroform used as anesthetic by John Snow in 1853
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History contd
ET tube discovered- 1878 LA with cocaine 1885 Thiopentone first used in 1934 Curare first used in anesthesia in 1942 Age of Anesthesia started Halothane synthesized by Suckling in 1956
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Molecular Mechanism
Unsolved mystery
Minimum alveolar concentration (MAC) is the alveolar partial pressure of a gas at which 50% of humans do not respond to surgical incision Limitations
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Spinal cord- inhibition of excitatory synaptic transmission Reticular Activating System (RAS)Locus ceruleus (LC)- Ventrolateral preoptic nucleus (VLPO)Tuberomamillary nucleus (TMN)sedative actions of GABAergic anesthetics
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Cerebral cortex- depression of the excitability of the thalamic neurons, thus blocking thalamo-cortical communication potentially resulting in loss of consciousness.
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Depress neurons subserving pacemaking (pattern generation) Decrease neuronal excitability Inhibiting excitatory synaptic transmission or enhancing inhibitory synaptic transmission
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Voltage dependent channels Ligand gated Glutamate activated GABA activated channels Second messenger activated
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Meyer- Overton Rule- potencies of gases as anesthetics strongly correlated with their solubility in olive oil Limitations
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What Is Sedation?
It Is Really A Continuum
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Elements Of Sedation
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Types Of Anesthetics
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General Anesthesia
Spontaneous/controlled ventilation
Endotracheal intubation - ett Laryngeal mask airway lma Mask airway
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Regional Anesthesia
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Nerve Block
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Plexus Block
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Epidural Block
Can place catheters at different levels for differential blocks Can use infusions with local anesthetics and/or narcotics
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Spinal Anatomy
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Subarachnoid Block
Can use local anesthetics and/or narcotics Morphine lasts 1224 hours
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Combination
General Regional
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Epidural
Intermittent bolus Continuous infusion Pca patient controlled analgesia Intermittent/continuous/pcea Narcotics and/or local anesthetic Narcotic
Subarachnoid
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Pain Assessment
Pain scale Physical Emotional Cultural Age
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Relief of pain adequate for postoperative rehabilitation Around the clock medication Breakthrough pain relief Narcotics Non-steroidal anti-inflammatory Cox 2 receptor inhibitors
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Anesthesia service Critical care Acute and chronic pain management Resuscitation Teaching/training Research Administration
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Objectives
define anesthesia and pain relief mention components of anesthesia define MAC mention proposed site of anesthetic action mention types of anesthetics in clinical use
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Thank you
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