Transcript: Kaitlyn Almquist Anesthesia General Anesthesia https://www.medicalnewstoday.com/articles/265592.php https://www.qmul.ac.uk/media/news/2017/smd/major-grant-awarded-to-resolve-debate-on-treatment-after-major-surgery.html C12H18O Propofol https://en.m.wikipedia.org/wiki/Propofol John B. Glen Origin http://www.laskerfoundation.org/awards/show/discovery-and-development-propofol-widely-used-anesthetic/ https://www.dentistrytoday.com/news/industrynews/item/1589-patients-prefer-propofol-for-sedation Uses https://spectrum.ieee.org/the-human-os/biomedical/diagnostics/in-hospital-intensive-care-units-ai-could-predict-which-patients-are-likely-to-die https://blog.radiology.virginia.edu/mri-definition-kids-imaging/ https://www.vetpet.com/veterinary-services/veterinary-surgery.html Physical and Chemical Properties https:/www.pfizerinjectables.com/products/Propofol http://www.healthyblackwoman.com/nurses-doctors-abusing-the-drug-that-ended-michael-jacksons-life/ Reaction https://webbook.nist.gov/cgi/cbook.cgi?ID=C2934078&Mask=8 Phenol, 2,4,6-tris(1-methylethyl)- Phenol, 2-(1-methylethyl)- Propofol Phenol, 2,4-bis(1-methylethyl)- Interesting Facts https://www.tmz.com/2012/05/24/propofol-conrad-murray-missouri-michael-jackson/ https://www.theodysseyonline.com/dorys-short-term-memory-loss https://www.asahq.org/whensecondscount/anesthesia-101/types-of-anesthesia/general-anesthesia/ https://en.m.wikipedia.org/wiki/Propofol https://pubchem.ncbi.nlm.nih.gov/compound/propofol#section=Boiling-Point https://webbook.nist.gov/cgi/cbook.cgi?ID=C2934078&Mask=8 Sources
Transcript: Anesthesia Anesthesia is a sedative and pain killer that is commonly used in surgery now. Anesthesia was discovered separately by many people. Crawford Long is credited for first using Anesthesia is surgery. On March 30, 1842, he removed a tumor painlessly with the use of nitrous oxide or what was commonly known as ether.However Crawford di d not pulish hiw sucsess so it stayed unknow. William Tomes Green Morten, a scientist, and Charles T Jackson, a professor, attempted a successful painless surgery using Ether. After publishing their finds Morton became known as the Father of Anesthesia, not Jackson. Anesthesia was mostly commonly used by surgeons and dentists. Drug addicts also were a frequent used of ether. Anesthesia impacted society because people were less afraid to go to the doctor so more people were sick and less people died in surgery. Anesthesia affected land because less people dies in surgery, birth, or from disease so the population grew and land became more crowded. It impacted culture because less people were afraid of doctors and scientists. Anesthesia affected people financially because when less people died more could work and earn money. Anesthesia impacted where people lived and worked because more doctors due to that it was becoming such a well profiting job. Society would be different without Anesthesia because the population would be decreased and doctors and surgery would still feared. The End
Transcript: WHO? A few different people were involved in the important discovery of anesthesia between the years of 1938 and1945: Crawford Williamson Long, Alfred Velpeau, Horace Wells, and William Morton. Anesthesiologists are doctors of medicine that concentrate on the care of surgical patients and pain relief. What? General, regional, or local insensibility, as to pain and other sensation, induced by certain interventions or drugs to permit the performance of surgery or other painful procedures. General Anesthesia Affects the brain as well as the rest of your body so that you are unconscious and have no awareness or other sensations. Regional Anesthesia The anesthesiologist makes an injection near a cluster of nerves to numb a larger area of your body that requires surgery. Local Anesthesia The anesthetic drug is usually injected into the tissue to numb just the specific location of your body requiring minor surgery. Anesthesiologists An anesthsiologits is a physician who specializes in anesthesiology. Where? Anesthesia was first used in a dentist’s office by Dr. Horace Wells when he administered nitrous oxide (also known as laughing gas), which allowed him to pull teeth from unconscious patients. Crawford Williamson Long, a physician, used a chemical called ether as an anesthesia several times in a doctor’s office and during surgery. Why? Anesthesia was created to temporarily numb a specific or general area the body, or just to paralyze the whole body completely during surgery. How? Local anesthesia usually involves the injection of local anesthetic drug with a needle. Regional anesthesia involves the injection of local anesthetic drugs in such a way that a large number of nerves are blocked. anesthetic drugs can be given to the patient either as an inhaled gas or injected into the intravascular line (directly into the patient's bloodstream). Benefits When using epideral anesthesia, it makes the process of birth less painful by injecting the anesthetic into the patients spinal cord. The anesthesia medicine may be given in your IV, through a face mask, or through a tube in your nose or throat. Anyway it is given to you, it eases pain during any minor or severe surgery. Negatives Anesthesia, when given in large doses, isnt completely filtered from your blood stream until 6 months after the surgery. This doesn’t mean that you should’nt use anesthesia all together. It is suggested that the dose of the aneshetic is decreased so that the outcome isnt affected as severely. Side Effects -throwing up -so tired you can hardly get up -not feeling hungry for up to two weeks -headaches -aching throat and chest, NOT stabbing pains! -general aches and exhaustion, like after you exercise a lot in one day Cited Sources http://answers.ask.com/Health/Medicine/who_invented_anesthesia http://dictionary.reference.com/browse/anesthesia http://answers.reference.com/wellness/remedies/who_invented_anesthesia http://www.mshealthcareers.com/careers/anesthesiologist.htm http://www.lifelinetomodernmedicine.com/Types-Of-Anesthesia.aspx http://www.webmd.com/pain-management/tc/anesthesia-topic-overview http://anesthesiologyinfo.com/articles/01062002.php http://dictionary.reference.com/browse/anesthesiologist ANESTHESIA Local Anesthesia The anesthetic drug is usually injected into the tissue to numb just the specific location of your body requiring minor surgery WHO? Local Anesthesia Anesthesia is: general, local, or regional insensibility, as to pain and other sensation, induced by certain interventions or drugs, to permit the performance of surgery or other painful procedures. Anesthesia was fist used by in a dentist’s office by Dr. Horace Wells when he administered nitrous oxide (also known as laughing gas), which allowed him to pull teeth from unconscious patients. Crawford Williamson Long, a physician, used a chemical called ether as an anesthesia several times in a doctor’s office and during surgery. WHAT? Your anesthesiologist makes an injection near a cluster of nerves to numb a larger area of your body that requires surgery WHERE? It affects the brain as well as the rest of the body so that you are unconscious and have no awareness or other sensations. General Anesthesia Regional Anesthesia
Transcript: Economy Connections What if a soldier gets injured by accident, say he shoots himself while playing around with his friends. He will have to get the bullet out of his body to avoid infection. Without anesthesia, he would be getting a knife dug into him while he's throwing up because of alcohol he was given to help numb the pain. And soon, he would go into shock from the pain and die. Therefore we now have to draft another innocent civilian to replace him. Along with this new soldier is the military's responsibility to house, feed and clothe him. A farmer could have a malfunction with fixing or using this innovation, and be injured. If they need their leg amputated, they either need to bare the pain or die. Many would rather die. How would you like getting a body part amputated while you were wide awake. We needed farmers growing our food or we wouldn't be where we are today. They would die and not be replaced. Basically could help fix almost any wound caused by an innovation. Horace Wells Dentist Tried public demonstration with nitrous oxide and failed Anesthesia Money is spent Money is earned Contributors Humphry Davy Chemist Created laughing gas on accident First used as a narcotic James Young Simpson Found an safer alternative to ether. Chloroform Specifically for medical use Colt Revolver Mechanical Reaper Patients were given alcohol, marijuana, opium, mandrake or jimsonweed. They could also be knocked out by a blow to the jaw. Although this eliminated minor, everyday pain, it did not lower the pain of a leg getting sawed off. Patients would often wake up to this incredible pain and go into shock and soon die. It was also common for the patient to overdose and die. Keep in mind that these methods were also commonly used on childbirth. In fact, 15% of women between 20 and 40 died from childbirth and 100 out of 1000 infants died before age 1 commonly caused by the unsafe use of chloroform and/or ether. Soon there would be solution to this problem. William Morton Experimented with ether Dental demonstration succeeded Surgery before the miracle drug (Early) Anesthesia Jobs are created Anesthesia is the most important innovation from the 1800s because without it, we would have a little less than 50% chance to live during most surgeries. And a little bit of smelly gas isn't as bad as getting punched in the jaw or be wide awake while getting a limb amputated. People More jobs=more money Less people are dying of injuries on the job, so they are able to go back to work and earn money Conclusion Hospital Bills are rising with the increase use of anesthesia so the hospital can continue to run these life-saving buildings and use this life-saving drug. Crawford Long First to use diethyl ether Nurses, Doctors and Surgeons are trained to handle the drug. Anesthesiologists weren't required until the early 20th century The middle class would use home remedies and perform surgery at their own house instead of going to the hospital. They couldn't get anesthesia as easy as the did before it was used as a medical supply. This caused hospital's patients to rise Nitrous oxide Laughing Gas Used to relieve a patient of pain during a surgical operation
Transcript: Epidural anesthesia decreases pulmonary function during labor. Lung function is decreased during the procedure due to the motor blockade. Women that have severe asthma or chronic pulmonary disease need to put this information into consideration. An epidural anesthesia is the best method of anesthesia for postoperative outcome and has the lowest chance of postoperative pulmonary complications (Groeben 290). The purpose of this analysis is to provide an overview for anesthesiologists, obstetrics professionals, and women considering an epidural anesthesia (Merrill 1). Anesthesia and analgesia are interchangeable terms, analgesia is just one general aspect of anesthesia. Works Cited Thesis Statement Epidural Anesthesia and Health Risks Neurological Deficits Following Epidural or Spinal Anesthesia (Halpern et al.) Effects of Epidural vs Paternal Opioid Analgesia on the Progression of Labor Epidural anesthesia provides numerous benefits for women in labor. It prevents both, the adverse biochemical changes and stress during labor. The procedure also prepares women for the possibility of forceps, cesarean section, or the delivery of a second twin without the need for general anesthesia. This method is also beneficial for women with pre-eclampsia; this method suppresses noradrenaline contractions, instead producing beneficial haemodynamic changes ( Reynolds 751). Epidural Analgesia in Obstetrics Paralysis can occur after an epidural anesthesia procedure. The paralysis occurs in three out of fifty thousand women that have an epidural anesthesia during labor. The paralysis has lasted from seventy two hours up to four months after the procedure (Kane 150).The paralysis could have been caused by being administered a toxic chemical or by a chemical contamination of the anesthesia (Kane 159). " Epidural anesthesia for women in labor may be beneficial at the time of labor, but it is not always beneficial for women in the long run" (Merrill 1). Epidural Anesthesia and Pulmonary Function Women that experience labor at night have to deal with the increased risk of an unintentional dural puncture in the lower back. The unintentional dural puncture is caused from the anesthesiologist being fatigued, motor skills not as sharp, and less focused. A dural puncture can occur at any time of day this causes backaches and headaches for an unspecified duration after the epidural anesthesia procedure (Aya 666). Increased Risk of Unintentional Dural Puncture in Night-time Obstetric Epidural Anesthesia Epidural Analgesia Compared With Combined Spinal-Epidural Analgesia During Labor in Nulliparous Women Epidural anesthesia prevents walking during labor, for the procedure causes a motor blockade. A combined spinal-epidural anesthesia injection is a one time injection that allows for movement. This procedure is a one time injection, unlike an epidural anesthesia which remains in during labor. Since this method does not cause a motor blockade their is no chance of paralysis (Nageotte et al.). Images found on google images
Transcript: Anesthesia Day Patient History • NPO 34 y.o. F NKA 5'7'' 190 lb.s • Pre-op Meds: • Ranitidine 150 mg • Ancef 2g • Pre-op Labs: • Type & Screen #1 2018 36.9°C 36.8°C 18.0°C
Transcript: Anesthesia Sources for prezi: www.asahq.org/For-the-Public-and-media/Press-Room/Anesthesia-fast-Facts/aspx www.livestrong.com/article/161817-examples-of-anesthesia google images Sources for report: www.funtrivia.com/en/subtopics/Anesthesia-308338.html *It could have helped Gage after his injury. *Gage's doctor wouldn't have to be so worried about Gage. *Anesthesia can have side effects such as being light headed. *Helps take pain away. FACTS! *If having anesthesia during an operation patient will not remember anything during the operation. *Anesthesia was created when Phineas Gage had his injury. *Anesthesia is mainly used in hospitals or medical care centers, an ambulatory and surgical centers or doctor offices. *Regional anesthetics- act on a group of nerves, blocking out pain. *40 million anesthetics are administrated in a year in the U.S Examples Vocab *Today there is less complications with anesthesia then 50 years ago. Sources *Gage also could have been in less pain. What i found more useful was the internet because the internet gave me more information on the words that I didn't know the meaning of. *Gage could have been in less pain. Why Anesthesia? Insightful Analysis How I organized my research by using the note taking sheet, that helped keeping me on task. *To numb a hurting part of the body. *It connected to Gage's story. *Anesthesia is a medicine that can take pain away. Connections to Phineas Gage. *Anesthetic gases- a gas that makes a patient "fall asleep." *Gage also could have had less issues later on in life. *Anesthesia can help recovery. *General anesthesia- to be "put asleep" without pain. *Anesthesiologist are in charge of getting the patient ready with the anesthesia. Phineas Gage By: John Fleischman *Anesthesia is used to relieve pain. *Anesthesia can take some of the pain away. *Anesthesia can numb a part of the body for a while. *During operations patients area given anesthesia. *Internet *Gage book
Transcript: REVIEW OF SYSTEMS Standard PACU monitoring (EKG, sO2, NIBP, temp) Pain can be treated with Hydromorphone in 0.2mg doses PONV can be treated with additional doses of Zofran 4mg q4h to maximum of 16mg Maintain normal hemodynamics (BP and HR within 20% of baseline) QUESTION 1 PATIENT AND PROCEDURE ANALYSIS: ASA 3 PLAN Induction & Airway ALL at age 6 treated with Anthracycline chemotherapy HTN (Controlled on metoprolol (baseline 142/75)) N/V and motion sickness (No treatment) Diagnosed OSA (patient snores loudly and wakes up at night) - does not tolerate his nasal CPAP BPH CVA (without deficit) preceding heart transplant Gout (Takes prenisone, recent flare up s/p prednisone dose increase) HLD Works out every other day (heavy weight lifting and cardio) Discussion with surgeon regarding positioning prone position may require ETT intubation, which will require relaxation and subsequent reversal. Research shows that ProSeal LMA can be inserted and used in the prone position, and provides a seal up to 30cm H2O, reducing induction-incision time and increasing intraoperative hemodynamic stability (Brimacombe, et al, 2007) (Wekseler, et al, 2007) ultimately decided on a lateral position with the ProSeal LMA H&P reviewed Review tests as indicated from H&P TTE, Dobutamine Stress Echo, EKG, Right Heart Catheterization, Cardiac Consult (heart transplant, HTN) BUN, SCr, Renal Consult (kidney transplant) CBC (rectal bleeding) Plan discussed with patient. Consent signed and confirmed. Renal Positioning: left lateral position with right arm free draped T&S verified at blood bank Standard ASA Monitors 16-20g x 1 IV required Fluids at 5-8mL/kg/hr Ancef 1g Disposition planning: to PACU, then home thorough report to PACU nurse, verifying understanding of patient considerations Emergence Anthracycline induced cardiomyopathy s/p Orthotopic Heart Transplant in 2000 GETA with no complications noted Echo showed moderate LVH, with normal LV function (EF 55-60%) Right Heart Cath showed RV systolic pressure of 24-38 mmHg, PAP of 24/11 mmHg and Cardiac Index of 2.4 L/min/m2 Dobutamine Stress Echo from 6/2014 showed no evidence of ischemia EKG was NSR at 90 BPM CXR showed no evidence of cardiomegaly Cardiac consult: stable cardiac function with normal LV function and no evidence of vasculopathy Maintenance Cardiac Transplanted Heart transplanted heart has no sympathetic, parasympathetic, or sensory innervation, and the loss of vagal tone results in a higher than normal resting heart rate no sympathetic response to surgical stimulation, intubation, or hypovolemia is "Preload Dependent" because the heart cannot increase its rate to increase cardiac output (severed connection to carotid baroreceptors) When hepatic and renal function are normal, there is no contraindication to the use of any anesthetic drug. (Akhtar, 2012) Case reports show refractory bradycardia leading to asystole after administration of anticholinesterase neostigmine (unresponsive to anticholinergic treatment because of denervation of the heart) Indirect acting sympathomimetics are ineffective at increasing heart rate - must use epinephrine or isoproterenol EF 55-60%, negative stress echo with excellent exercise tolerance, and the patient will continue his beta blocker perioperatively. With an understanding of transplanted cardiac physiology, there is no contraindication to the planned procedure. QUESTION 2 Other PAST MEDICAL HISTORY Cancer QUESTIONS At conclusion of surgery, LMA should be removed deep to prevent coughing/bucking and potential dehiscence at surgical site adequate Vt (at least 5mL/kg) and RR (10-20/min) should be used as guides RR can guide fentanyl during emergence Treat hypotension with phenylephrine, Hypertension with Labetalol or fentanyl If plan B must be used, treat refractory bradycardia during reversal with epinephrine Transfer patient to PACU with 3L O2 via NC, give detailed report to PACU nurse, including recommendations QUESTION 4 How is the innervation of the transplanted heart different from the native heart? Akhtar, S. (2012). Ischemic Heart Disease. In Hines, R. L. & Marschall, K.E. (Eds), Stoelting's anesthesia and co-existing disease (pp. 1-30). Philadelphia: Elsevier Saunders. Brimacombe J. R., Wenzel V., Keller C. (2007) The proseal laryngeal mask airway in prone patients: A retrospective audit of 245 patients. Anaesthesia Intensive Care, 35(2):222-5. Jaffe, R. A. (2014). Anesthesiologist's manual of surgical procedures. Philadelphia: Walters Kluwer Health. Morgan, G.E., Mikhail, M. S., Murray, M. J. (2006). Clinical anesthesiology. McGraw Hill. Weksler N., Klein M., Rozentsveig V., Weksler D., Sidelnik C., Lottan M., Gurman G.M. (2007). Laryngeal mask in prone position: Pure exhibitionism or a valid technique. Minerva Anestesiology 73(1-2):33-7. Which special considerations do we take for the kidney transplant recipient? Prednisone (recently increased to 40mg) (will take DOS) Lopressor 25mg (will take DOS) ASA 81mg (continued in
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