INTRODUCTION TO ANESTHETIC AND ACUTE PAIN MANAGEMENT

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INTRODUCTION TO ANESTHETIC AND ACUTE PAIN
MANAGEMENT

• DEPARTMENT OF ANESTHESIOLOGY FACULTY

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AT THE END OF THE SESSION THE STUDENT WILL BE
ABLE TO

• NAME THREE METHODS OF ANESTHESIA
• PROPOSE ANESTHETIC CHOICES FOR SURGICAL
  PROCEDURES ON HEALTHY PATIENTS
• EVALUATE ACUTE PAIN
• NAME THREE METHODS OF PAIN MEDICATION
  ADMINISTRATION
• PROPOSE ACUTE PAIN MANAGEMENT TECHNIQUES FOR
  CERTAIN POSTOPERATIVE HEALTHY PATIENTS

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WHO HAS HAD SURGERY?

• WHAT KIND OF SURGERY?
• WHAT KIND OF ANESTHETIC?
• WHAT KIND OF ACUTE PAIN MANAGEMENT?
• WHAT WAS THE WORST PART?

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WHAT DOES ANESTHESIA MEAN?
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WHAT DOES ANESTHESIA MEAN?

• GENERAL OR LOCAL INSENSIBILITY TO PAIN AND OTHER
  SENSATION, INDUCED BY CERTAIN DRUGS

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WHAT ARE THE ELEMENTS OF GENERAL ANESTHESIA?
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WHAT DOES GENERAL ANESTHESIA GUARANTEE?

• HYPNOSIS
• ANALGESIA
• AMNESIA
• MUSCLE RELATION

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WHAT IS SEDATION?
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WHAT IS SEDATION? IT IS REALLY A CONTINUUM

• LEVEL I MINIMAL SEDATION
• LEVEL II MODERATE SEDATION
• LEVEL III DEEP SEDATION
• LEVEL IV GENERAL ANESTHESIA

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ELEMENTS OF SEDATION

• RESPONSIVENESS
• AIRWAY
• SPONTANEOUS VENTILATION
• CARDIOVASCULAR FUNCTION

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TYPES OF ANESTHETICS

• GENERAL
• REGIONAL
• COMBINATION
• MONITORED ANESTHETIC CARE (MAC)

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GENERAL ANESTHESIA

• SPONTANEOUS VENTILATION
• ENDOTRACHEAL INTUBATION - ETT
• LARYNGEAL MASK AIRWAY LMA
• MASK AIRWAY
• MECHANICAL VENTILATION

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REGIONAL ANESTHESIA

• FIELD BLOCK
• NERVE BLOCK
• PLEXUS BLOCK
• EPIDURAL
• SUBARACHNOID

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NERVE BLOCK
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PLEXUS BLOCK

• CAN USE A CATHETER FOR LONG TERM ANALGESIA

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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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MORE SPINAL ANATOMY
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SUBARACHNOID BLOCK

• CAN USE LOCAL ANESTHETICS AND/OR NARCOTICS
• MORPHINE LASTS 12-24 HOURS

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COMBINATION

• GENERAL
• REGIONAL

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MONITORED ANESTHETIC CARE

• PAIN MANAGEMENT
• SEDATION
• AIRWAY MANAGEMENT

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ANESTHETIC MANAGEMENT

• 25 YEAR OLD FEMALE FOR LIPOMA EXCISION 2X2 CM
• 25 YEAR OLD MALE FOR ID FINGER 4 POST SPIDER
  BITE
• 82 YEAR OLD MALE FOR IOL FOR LEFT EYE CATARACT
• 25 YEAR OLD MALE FOR ACL REPAIR AND PASSIVE
  MOTION MACHINE POST-OP
• 45 YEAR OLD FEMALE FOR RIGHT MODIFIED RADICAL
  MASTECTOMY AND LYMPH NODE DISSECTION
• 43 YEAR OLD FEMALE FOR LAPARASCOPIC
  CHOLECYSTECTOMY FOR CHOLELITHIASIS

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ANESTHETIC MANAGEMENT

• 25 YEAR OLD MALE FOR RIGHT INGUINAL HERNIA REPAIR
• 25 YEAR OLD MALE FOR INTRAMEDULLARY NAIL OF RIGHT
  FEMUR AFTER CAR ACCIDENT
• 45 YEAR OLD MALE FOR CABGX2
• 45 YEAR OLD FEMALE FOR RIGHT UPPER LOBECTOMY FOR
  VALLEY FEVER
• 55 YEAR OLD FEMALE FOR RIGHT HEMICOLECTOMY FOR
  MASS
• 65 YEAR OLD MALE FOR ABDOMINAL AORTIC ANEURYSM
  REPAIR
• 25 YEAR OLD MALE FOR RIGHT TEMPORAL SUBDURAL
  HEMATOMA EVACUATION AFTER CAR ACCIDENT

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ACUTE POSTOPERATIVE PAIN MANAGEMENT

• ORAL
• INTRAMUSCULAR
• INTRAVENOUS
• INTERMITTENT BOLUS
• CONTINUOUS INFUSION
• PCA PATIENT CONTROLLED ANALGESIA
• EPIDURAL
• INTERMITTENT/CONTINUOUS/PCEA
• NARCOTICS AND/OR LOCAL ANESTHETIC
• SUBARACHNOID
• NARCOTIC
• FIELD BLOCK
• NERVE BLOCK
• PLEXUS BLOCK/CATHETER

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PAIN ASSESSMENT

• PAIN SCALE
• PHYSICAL
• EMOTIONAL
• CULTURAL
• AGE

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WHAT DOES ONE HAVE TO DO POSTOPERATIVELY IN THE
HOSPITAL?

• COUGH
• DEEP BREATHE
• AMBULATE
• SANITARY NEEDS
• PHYSICAL THERAPY
• PASSIVE MOTION MACHINE

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WHAT DOES ONE HAVE TO DO AT HOME?

• WALK
• EAT
• DRESS
• USE THE BATHROOM
• BATHE
• TAKE CARE OF FAMILY MEMBERS

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PAIN MANAGEMENT GOALS

• 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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ACUTE PAIN MANAGEMENT

• 25 YEAR OLD FEMALE FOR LIPOMA EXCISION 2X2 CM
• 25 YEAR OLD MALE FOR ID FINGER 4 POST SPIDER
  BITE
• 82 YEAR OLD MALE FOR IOL FOR LEFT EYE CATARACT
• 25 YEAR OLD MALE FOR ACL REPAIR AND PASSIVE
  MOTION MACHINE POST-OP
• 45 YEAR OLD FEMALE FOR RIGHT MODIFIED RADICAL
  MASTECTOMY AND LYMPH NODE DISSECTION
• 43 YEAR OLD FEMALE FOR LAPARASCOPIC
  CHOLECYSTECTOMY FOR CHOLELITHIASIS

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ACUTE PAIN MANAGEMENT

• 25 YEAR OLD MALE FOR RIGHT INGUINAL HERNIA REPAIR
• 25 YEAR OLD MALE FOR INTRAMEDULLARY NAIL OF RIGHT
  FEMUR AFTER CAR ACCIDENT
• 45 YEAR OLD MALE FOR CABGX2
• 45 YEAR OLD FEMALE FOR RIGHT UPPER LOBECTOMY FOR
  VALLEY FEVER
• 55 YEAR OLD FEMALE FOR RIGHT HEMICOLECTOMY FOR
  MASS
• 65 YEAR OLD MALE FOR ABDOMINAL AORTIC ANEURYSM
  REPAIR
• 25 YEAR OLD MALE FOR RIGHT TEMPORAL SUBDURAL
  HEMATOMA EVACUATION AFTER CAR ACCIDENT

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AT THE END OF THE SESSION THE STUDENT WILL BE
ABLE TO

• NAME THREE METHODS OF ANESTHESIA
• PROPOSE ANESTHETIC CHOICES FOR SURGICAL
  PROCEDURES ON HEALTHY PATIENTS
• EVALUATE ACUTE PAIN
• NAME THREE METHODS OF PAIN MEDICATION
  ADMINISTRATION
• PROPOSE ACUTE PAIN MANAGEMENT TECHNIQUES FOR
  CERTAIN POSTOPERATIVE HEALTHY PATIENTS