ANESTHESIA OVERVIEW - PowerPoint PPT Presentation

1 / 96

About This Presentation

Title:

ANESTHESIA OVERVIEW

Description:

A a myelinated motor. A alpha myelinated touch-pressure. A beta myelinated touch-pressure ... Dorsal horn to thalamic. Third Neuron Pain. Thalamus to cortex ... – PowerPoint PPT presentation

Number of Views:308

Avg rating:3.0/5.0

Slides: 97

Provided by: classe5

Category:

more less

Transcript and Presenter's Notes

Title: ANESTHESIA OVERVIEW

1

BASICANESTHESIA PRACTICE
2
ANESTHESIA DEFINITION

TRADITIONAL
LOSS OF SENSATION WITH OR WITHOUT LOSS OF
CONSCIOUSNESS

3
MECHANISMS OF ACTION

Interaction at cellular receptor site
Action Intracellular
Cortical depression

4
PAIN

Pain is always subjective. Each individual
learns the application of the word through
experiences related in early life.

5
I.A.S.P.

International Association for Study of Pain

6
Pain

An unpleasant sensory and emotional experience
associated with actual or potential tissue damage
or injury, or described in terms of such damage
or injury.

7
ETIOLGY OF PAIN

HEAT
COLD
CHEMICAL
MECHANICAL
TORSION STRETCH CUT PINCH PRICK
COMPRESS CRUSH

8
TYPOLOGY OF PAIN

Acute
Chronic benign
Chronic cancer

9
Chronic Pain vs Acute Pain

Acute A Symptom of Injury or Disease
Chronic Benign Pain itself is the disease
Chronic Cancer Actual Tissue destruction

10
Acute Pain

A complex constellation of unpleasant sensory,
perceptive and emotional experiences and certain
associated autonomic psychological, emotional
behavioral responses provoked by noxious
stimulation.

11
CHRONIC PAIN

PAIN THAT PERSIST BEYOND
USUAL COURSE OF HEALING
(3 - 6 MONTHS)

12
Adverse Effects of Pain

Cardiovascular
Pulmonary
Gastrointestinal
Renal

Extremities
Endocrine
CNS
Immunologic

13
Adverse Effects of Pain

Cardiovascular Tachycardia, hypertension,
increased SVR, increased cardiac work, increased
myocardial O2 demand.
Pulmonary Hypoxia, hypercarbia, atelectasis,
decreased cough, decreased vital capacity and
function residual capacity, V/Q mismatch.
Gastrointestinal Nausea, vomiting, ileus,
intolerance for oral intake.
Renal Oliguria, urinary retention.

14
Adverse Effects of Pain

Extremities Skeletal muscle spasm, limited
mobility, thromboembolism.
Endocrine Excessive adrenergic activity, vagal
inhibition, catabolic metabolism, increased O2
consumption.
CNS Sedation, fatigue, anxiety, and fear cause
central sympathetic stimulation.
Immunologic Inhibited cellular immunity,
increased risk of infection, ?? impaired wound
healing ??

15
FREE NERVE ENDINGS ARE PRESENT IN ESSENTIALLY ALL
BODY TISSUES IN VARYING AMOUNTS
16
IN RESPONSE TO A PAINFUL STIMULUS, SUBSTANCES ARE
EXCRETED.
17
ALGOGENIC(substances released by pain)

SEROTONIN POTASSIUM
HISTAMINE ACETLYCHOLINE
BRADYKININS LEUKOTRIENES
PROSTAGLANDINS SUBSTANCE P29
NOREPINEPHRINE

18
THE RECEPTORS IN THE FREE NERVE ENDINGS RESPOND
TO THE SUBSTANCES BY BECOMING CHARGED
ELECTROCHEMICALY
19
RECEPTORS THEN PROPAGATE AN ELECTROCHEMICAL
STIMULUS TO DIFFERING NERVE FIBERS
20
NOCICEPTION

This electrochemical event that occurs
between the site of tissue damage or injury sets
off a series of neural transmissions that
eventually results in the perception of
painCollectively this known as nociception

21
NERVE FIBERPAIN CLASSIFICATION

A FIBER..SHARP-STABBING-LOCAL
FIRST PAIN
B FIBER....PHYSIOLOGIAL REACTION
C FIBER....DULL-ACHE-BURN-THROB
NONLOCALIZED-RADIATE
SECOND PAIN

22
NERVE FIBER CLASSIFCATION

TYPE FUNCTION
A a myelinated motor
A alpha myelinated touch-pressure
A beta myelinated touch-pressure
A delta myelinated pain-temperature
A gamma myelinated proprioception

23
A Delta

1 - 4 micrometers diameter
Myelinated, Rapid conduction
Sharp, localized
Heat, cold
First pain

24
NERVE FIBER CLASSIFCATION

TYPE FUNCTION
B myelinated preganglionic autonomic
C non-myelinated pain-temperature

25
C Fibers

Small
Slow Conduction
Unmyelinated
Postganglionic autonomic

26
C Fibers

Dull pain, burning, Aching throbbing
Nonlocalized - radiating - diffused
Temperature,Touch,Mechanical
Second pain

27
Gate Theory

Balance between A delta and C fibers to dorsal
horn determines the intensity of the stimulus
that is passed to higher brain center

28
Area of High Nociceptor Concentration

Mucosal membranes
Periosteum
Deep fascia
Ligaments
Joint capsules
Cornea
Subcutaneous tissue

29
Areas of Moderate Nociceptor Concentration

Skeletal muscle
Cardiac muscle
Smooth muscle

30
Areas of Minimal Nociceptor Concentration

Bone
Cartilage
Marrow

31
Physiologic Processes of Nociception

Detection
Transduction
Transmission
Modulation
Perception

32
Detection

First pain
Second pain

33
TRANSDUCTION

NOXIOUS STIMULI TRANSLATED INTO ELECTRICAL FIRING
AT THE SENSORY NERVE ENDINGS

34
TRANSMISSION

PROPAGATION OF IMPULSE TRAVELS VIA NEURAL
PATHWAYS.
SENSORY AFFERENT NEURONS PROJECT INTO THE
SPINAL CORD
ASCENDING NEURONS RELAY TO BRAINSTEM AND THALAMUS
THALAMUS RELAYS TO CEREBRAL CORTEX

35
MODULATION

INTRINIC PAIN MODIFICATION
1.DIFFERENT IN INDIVIDUALS
2.DEPENDS ON.....
PAST EXPERIENCES
CULTURE
PSYCHIC

36
MODULATION-CONT

STIMULUS PRODUCED ANALGESIA
NEUROENDOCRINE ANALGESIA
CNS/PNS ANALGESIA
OPIOID ANALGESIA
SITUATION
PATHOLOGY
PHYSIOLOGY

37
Modulation Excitatory Substances

Peripheral
Prostaglandins, bradykinins, histamine, K,
substance P, serotonin (5HT2)
Spinal
Glutamate, aspartate, amino acids, substance P,
norepinephrine (alpha 1)

38
Modulation - Inhibitory

Supraspinal
Endorphins, enkephalins, dynorphins,
norepinephrine (alpha 2), GABA, somatostatin
(5HT1), neurotensin

39
First Neuron Pain

Peripheral afferent fibers to dorsal horn
Second Neuron Pain
Dorsal horn to thalamic
Third Neuron Pain
Thalamus to cortex

40
IDEAL ANESTHETIC

1. SEDATION - HYPNOSIS
2. AMNESIA
3. ANALGESIA
4. MUSCLE RELAXATION
5. OBTUND REFLEXES
6. PHYSIOLOGICAL STABILITY
7. REVERSIBLE
8. ANTIEMETIC

41
IDEAL COMPONENTS

Block SENSORY feeling
Immobilize MOTOR responses
Obtund REFLEXES
wipe out MEMORY
Control VC and CTZ
Not permanent
Cause sense of well-being

42
DELIVERY METHODS

1. REGIONAL ( conduction)
2. INTRAVENOUS (systemic)
3. INHALATION (ventilatory)

43
REGIONAL ANESTHESIA

SEGMENTAL LOSS OF SENSATION
BY BLOCKING NERVE CONDUCTION

44
REGIONAL

1. SPINAL
2. EPIDURAL
4. INTRAVENOUS ( BIER )
5. AXILLARY (INFILTRATION)
6. RETROBULBAR

45
REGIONAL

PAIN RELIEF
DIAGNOSTIC
THERAPEUTIC

46
LOCAL ANESTHETICS

AMIDES MAX / DOSE
BUPIVACAINE 2 MG/KG
LIDOCAINE 7 MG/KG
ROPIVACAINE 4 MG/KG
MEPIVACAINE 7 MG/KG
PRILOCAINE 6MG/KG

47
LOCAL ANESTHETICS

ESTERS MAX /DOSE
CHLOROPROCAINE 20 MG/KG
COCAINE 3 MG/KG
NOVOCAINE 12 MG/KG
TETRACAINE 3 MG/KG

48
REGIONAL ADDITIVES

MUSCLE RELAXANTS
NARCOTICS
NON-STEROIDAL ANALGESICS

49
GENERAL ANESTHESIA INDUCTION AGENTS

INHALATION GASES
INTRAVENOUS AGENTS BARBITURATES
OPIOIDS
BENZODIAZEPINES
DIISOPROPYLPHENOL
IMIDAZOLE

50
INHALATION AGENTS

NITROUS OXIDE
HALOTHANE
ETHRANE
FORANE
SUPRANE
ULTANE

51
MAC

MINIMUM ALVELOAR CONCENTREATION
50 of the population will be
anesthetized...and wont move upon skin
incision...or wont jump with a clamp on their
tail!!!!!!!!!!!

52
MAC