1 / 25

James Holding

James Holding. Green for Danger - Rank Films 1946. 2009 Anaesthesia. Intravenous induction Short acting opiate - e.g. fentanyl ‘anaesthetic’ - e.g. propofol Set up of anaesthetic maintenance - e.g. sevoflurane vapour in oxygen and air Specific muscle paralysis may be needed

bernad
Download Presentation

James Holding

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. James Holding

  2. Green for Danger - Rank Films 1946

  3. 2009 Anaesthesia • Intravenous induction • Short acting opiate - e.g. fentanyl • ‘anaesthetic’ - e.g. propofol • Set up of anaesthetic maintenance - e.g. sevoflurane vapour in oxygen and air • Specific muscle paralysis may be needed • Definitive analgesia • Anti-emetic

  4. Propofol

  5. Maintenance

  6. Maintenance Concepts of partial pressure and MAC • Isoflurane (ISO) – MAC = 1.1 • Desflurane (DES) – MAC = 6 • The most insoluble – so the fastest to equilibrate – but a respiratory irritant, so unsuitable for gaseous induction. • Sevoflurane (SEVO) – MAC = 2.2 • Used for gaseous induction. • Nitrous Oxide – a gas. MAC = 105 • Propofol and Remifentanil

  7. MAC = minimum alveolar concentration

  8. Muscle Paralysis

  9. Neuromuscular blockers • Depolarising • Suxamethonium • Non-depolarising • Atracurium • Vecuronium • Rocuronium

  10. Nicotinic ACh Receptor

  11. Reversal of Paralysis • Neostigmine • Blocks cholinesterase • Stimulates nicotinic and muscarinic • Given with an anticholinergic • Sugammadex

  12. Uppers • Anticholinergics • Atropine • Glycopyrulate • Symatheto-mimetics •  agonists • Phenylepherine • Metaraminol • Ephidrine • A mixed  and  adreno agonist

  13. Downers More anaesthetic or opiate Short acting -blockers (labetalol, esmolol) GTN Clonidine - 2 agonist clonidine

  14. Opiates Morphine Fentanyl Alfentanil Remifentanil

  15. Antiemetics

  16. Antiemetics • Cyclizine – an anti-histamine (SE – tachycardia and other anti-cholinergic effects) • Granisetron and ondansatron – 5-HT3 receptor antagonists (SE – constipation) • Prochlorperazine (stematil) – a dopamine and mACh receptor antagonist (SE – extrapyramidal) • Dexamethasone – a glucocorticoid (SE – deranged glucose control)

More Related