پاورپوینت کامل General Anesthesia 67 اسلاید در PowerPoint

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پاورپوینت کامل General Anesthesia 67 اسلاید در PowerPoint

اسلاید ۴: Minimal SedationAnalgesiaModerate Sedation (Conscious Sedation)Deep Sedation (Aپاورپوینت کامل General Anesthesia 67 اسلاید در PowerPointiolysis)پاورپوینت کامل General Anesthesia 67 اسلاید در PowerPoint / AnalgesiaResponsivenessNormal response to verbal stimulationPurposeful response to verbal or tactile stimulationPurposeful response following repeated or painful stimulationUnarousable even with painful stimulusAirwayUnaffectedNo intervention requiredIntervention may be requiredIntervention often requiredRespiratory FunctionUnaffectedAdequateMay be inadequateFrequently inadequateCardiovascular FunctionUnaffectedUsually maintainedUsually maintainedMay be impairedCONTINUUM OF DEPTH OF SEDATION: DEFINITION OF GENERAL ANESTHESIA AND LEVELS OF SEDATION/ANALGESIA* Approved by ASA House of Delegates on October 13, 1999, and amended on October 27, 2004

اسلاید ۵: Stages of پاورپوینت کامل General Anesthesia 67 اسلاید در PowerPointStage 1 (amnesia) From induction of anesthesia to loss of consciousness (loss of eyelid reflex)Pain perception threshold is not lowered. Stage 2 (delirium/excitement) Characterized with uninhibited excitation, agitation, delirium, irregular respiration and breath holdingPupils are dilated and eyes are divergentResponses to noxious stimuli: vomiting, laryngospasm, hypertension, tachycardia, and uncontrolled movements PRINCIPLES Morgan, et al. Clinical Anesthesiology, 4th ed. 2006Ezekiel. Handbook of Anesthesiology, 2005

اسلاید ۶: Stages of پاورپوینت کامل General Anesthesia 67 اسلاید در PowerPointStage 3 (surgical anesthesia) characterized by central gaze, constricted pupils, and regular respirationsPainful stimulation does not elicit somatic reflexes or deleterious autonomic responses. Stage 4 (impending death/overdose) characterized by onset of apnea, dilated and nonreactive pupils, and hypotensionmay progress to circulatory failure PRINCIPLES Morgan, et al. Clinical Anesthesiology, 4th ed. 2006Ezekiel. Handbook of Anesthesiology, 2005

اسلاید ۷: Principles of پاورپوینت کامل General Anesthesia 67 اسلاید در PowerPointMinimum Alveolar Concentration (MAC) the minimum concentration necessary to prevent movement in 50% of patients in response to a surgical skin incisionThe lower the MAC, the more potent the agent PRINCIPLES Morgan, et al. Clinical Anesthesiology, 4th ed. 2006Ezekiel. Handbook of Anesthesiology, 2005AnestSummary of physical properties of volatile anestheticsSummary of physical properties of volatile anestheticsSummary of physical properties of volatile anestheticsSummary of physical properties of volatile anestheticsSummary of physical properties of volatile anestheticsSummary of physical properties of volatile anestheticsHalothaneIsofluraneEnflurane DesfluraneSevofluraneMolecular weight197 184 184 168 200 Boiling point (°C)50.248.556.522.858.5 Saturated vapor pressure at 20°C243 238 175 669 157 MAC in 100% O20.751.151.86 2.05 % Biotransformation20 0.22<0.13 – 5Blood / gas 2.2 1.361.910.450.6 Oil / gas224 98 98.528 47

اسلاید ۸: Minimum Alveolar Concentration PRINCIPLES Morgan, et al. Clinical Anesthesiology, 4th ed. 2006Ezekiel. Handbook of Anesthesiology, 2005

اسلاید ۹: Minimum Alveolar ConcentrationFactor that increase/decrease PRINCIPLES

اسلاید ۱۰: Meyer-Overton HypothesisThe MAC of a volatile substance is inversely proportional to its lipid solubility (oil:gas coefficient)High MAC equals low lipid solubilityBacktrack: MAC is inversely related to potency (high MAC equals low potency) PRINCIPLES

اسلاید ۱۱: Meyer-Overton HypothesisCorrelation between lipid solubility with potency onset of anesthesia occurs when sufficient molecules of the agent have dissolved in the cells lipid membranesHigh lipid solubility equals high potency (and low MAC) PRINCIPLES Summary of physical properties of volatile anestheticsSummary of physical properties of volatile anestheticsSummary of physical properties of volatile anestheticsSummary of physical properties of volatile anestheticsSummary of physical properties of volatile anestheticsSummary of physical properties of volatile anestheticsHalothaneIsofluraneEnflurane DesfluraneSevofluraneMolecular weight197 184 184 168 200 Boiling point (°C)50.248.556.522.858.5 Sat’d vapor pressure 20°C243 238 175 669 157 MAC in 100% O20.751.151.86 2.05 MAC in 70% N2O0.290.560.572.50.66 % Biotransformation20 0.22<0.13 – 5Blood / gas 2.2 1.361.910.450.6 Oil / gas224 98 98.528 47

اسلاید ۱۲: Meyer-Overton HypothesisFactors Affecting the Meyer – Overton HypothesisConvulsant propertiesHalogenation results in decreased anesthetic potency and appearance of convulsant activitySpecific Receptors e.g. opioid receptorsthere is reduction of MAC by opioidsDexmedetomidinean alpha-2- agonist, results in marked reduction in MACHydrophilic site of actioncorrelation between ability to form clathrates and anesthetic potencyClathrates (of water) are postulized to alter membrane ion transport

اسلاید ۱۳: II. OVERVIEW OF PHARMACOLOGIC AGENTS USED IN GENERAL ANESTHESIA Inhaled AnestheticsIntravenous induction AgentsNeuromuscular Blocking AgentsOpioidsBenzodiazepinesAnticholinergic agents Anticholinesterases

اسلاید ۱۴: Inhalational AgentsUsed in the induction and maintenance of anesthesiaHalogenated alkane or ether-derived compoundsNitrous oxide (N2O; laughing gas) is the only inorganic anesthetic gas in clinical useProduce dose-dependent systemic effectsAssociated with Malignant Hyperthermia PHARMACOLOGIC AGENTSExamples:Ether HalothaneMethoxyfluraneEnfluraneIsofluraneSevofluraneDesfluraneNitrous OxideXenon

اسلاید ۱۵: Inhalational AgentsPHARMACOLOGIC AGENTSMorgan, et al. Clinical Anesthesiology, 4th ed. 2006Ezekiel. Handbook of Anesthesiology, 2005Townsend, et al. Sabiston, Textbook of Surgery, 17th ed. 2004

اسلاید ۱۶: Intravenous Induction AgentsUsed as premedications, sedatives, intravenous induction agents and in the maintenance of anesthesia.Total intravenous anesthesia (TIVA)PHARMACOLOGIC AGENTSMorgan, et al. Clinical Anesthesiology, 4th ed. 2006Ezekiel. Handbook of Anesthesiology, 2005Townsend, et al. Sabiston, Textbook of Surgery, 17th ed. 2004Examples:Barbiturates (Thiopental)Benzodiazepines (Midazolam)KetamineEtomidatePropofol

اسلاید ۱۷: Intravenous Induction AgentsThiopentalREVIEW: RedistributionHepatic eliminationCan cause hypotension, vasodilation and cardiac depression Can precipitate bronchospasm in patients with reactive airway diseaseDecreases CMRO2 in neuroanesthesiaPHARMACOLOGIC AGENTSMorgan, et al. Clinical Anesthesiology, 4th ed. 2006Townsend, et al. Sabiston’s Textbook of Surgery, 17th ed. 2004www

اسلاید ۱۸: wwwIntravenous Induction AgentsKetamineProduces dissociative state of anesthesiaOnly IV induction agent that increases blood pressure and heart rateDecreases bronchomotor toneMay be used as sole anesthetic for short proceduresProduces profound amnesia and analgesiaIncreases intracranial pressureProduces emergence delirium and bad dreamsPHARMACOLOGIC AGENTSMorgan, et al. Clinical Anesthesiology, 4th ed. 2006Townsend, et al. Sabiston’s Textbook of Surgery, 17th ed. 2004j>

اسلاید ۱۹: Intravenous Induction AgentsPropofol, (2,6-diisopropylphenol) Short-acting induction agentAvailable as oil-in-water emulsion containing soybean oil, glycerol, and egg lecithinIdeal for ambulatory surgeryCan decrease blood pressure in susceptible patientsProduces bronchodilatationAssociated injection painPHARMACOLOGIC AGENTSMorgan, et al. Clinical Anesthesiology, 4th ed. 2006Townsend, et al. Sabiston’s Textbook of Surgery, 17th ed. 2004jchemed.chem.wisc.edup>

اسلاید ۲۰: Intravenous Induction AgentsEtomidateImidazole compoundProduces minimal hemodynamic changes (ideal for patients with cardiovascular disease)Produces pain on injection, abnormal muscular movements and adrenal suppressionMidazolamA benzodiazepine (Other BZD: Diazepam, Lorazepam)Because of minimal cardiovascular effects, used for anesthesia inductionProduces aپاورپوینت کامل General Anesthesia 67 اسلاید در PowerPointiolysis and profound amnesiaAlso used as a premedicantPHARMACOLOGIC AGENTSMorgan, et al. Clinical Anesthesiology, 4th ed. 2006Townsend, et al. Sabiston’s Textbook of Surgery, 17th ed. 2004w.bedf

اسلاید ۲۱: OpioidsUsed as part of general anesthesia, and in patients receiving regional anesthesiaProduces profound analgesia and minimal cardiac depressionCause ventilatory depressionExamples: (REVIEW CLASSIFICATION OF OPIOIDS AND RECEPTORS)Agon