Barry-Definitions and Classifications
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| Relative contraindications of regional | Coagulopathies, severe hypovolemia or shock, increased ICP, aortic stenosis, sepsis, infection at puncture site, preexisting neuro muscular d/o
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| Regional definition | The production of insensibility by interrupting the sensory nerve conductivity from that region of the body
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| Geudel’s Signs (Stages) | I=Amnesia-beginning to LOC, II=Delerium/excitement-LOC to onset of Sx anesthesia, III= Surgical Plane-target depth, IV-Too Deep-overshot, profound CV/Resp Depression
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| 3 classes of anesthesia | MAC, General and Regional
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| An important distinguishing feature of conscious sedation | Pt’s ability to independently maintain a patent airway
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| Benefits of MAC anesthesia | less physiologic disturbance, more rapid recovery than GA
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| Deep Sedation characteristics | patient may not be easily aroused and may not purposefully respond to verbal commands or physical stimulation, patient may experience partial or complete loss the ability to independently and continuously maintain a patent airway.
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| General Anesthesia | Characterized by the achievement of amnesia, analgesia, unconsciousness and lack of movement
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| Preoxygenation | pt’s self ventilation with 100% O2 with sealed face mask for 3-5min or 8 vital capacity breaths in 1 min
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| A preoxygenated healthy adult has ____ minutes before desaturation | 6-10 minutes
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| Routine induction steps | preoxygen, IV induction agents (with LOC), verify ability to ventilate, establish an airway
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| RSI induction steps | preoxygen, defasciculation med, cricoid, IV induction agents(with LOC), neuromuscular blocking agent, ETT placement
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| High risk aspiration patients (use RSI) | Full stomach (emergent, unknown, ICU), Trauma,Obese, Pregnant(14-16wks), Acute abdomen(NG), Hiatal hernia/GERD/PUD,Diabetics(suspected gastroparesis)N/V
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| Succinylcholine Induction dose | (1-2 mg/kg IV)
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| Rocuronium Induction dose | (1.2 mg/kg)
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| Rocuronium defasciculation/curarization dose | 0.03mg/kg IV, 2-3minutes prior to depolarizing neuro muscular blocker
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| Emergence s/s | shivering, agitation, hypothermia, autonomic lability, laryngospasm
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| Stage II-delerium /excitement | laryngeal irritability, disconjugate pupils, increased BP, HR, RR (want to move through this stage quickly) NO stimulation!
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| Stage III-Surgical Plane | target depth, fixed gaze slightly constricted pupils, deep regular breathing, no response to stimuli
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| Stage IV- Too Deep | Profound CV and Resp Depression, absent/shallow resp
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