PAIN MANAGEMENT
ACUTE PAIN MANAGEMENT Acute pain = pain that occurs as direct result of tissue damage, <3 mos in duration • Can occur as a result of trauma, surgical insult, labor,…
TECHNIQUES
ANESTHESIA TECHNIQUES: (GOALS) • Monitored anesthesia care (MAC): Anxiolysis, sedation, analgesia & monitoring by anesthesia personnel able to anticipate and react to changes in pt status & anesthetic state/requirements • …
ALGORITHMS
• Compressions and circulation • Check for a pulse • If a pulse is present, continue rescue breathing • Reassess pulse every 2 min • If a pulse is not…
FOR CARDIAC SURGERY
Cardiac Cycle: Definitions & Equations • Systole = isovolumic ventricular contraction & ejection • Diastole = isovolumic ventricular relaxation & filling • Cardiac output = stroke volume × heart rate…
ANALGESICS
Fentanyl (Sublimaze IV, Fentora Buccal, Actiq Lozenge, Duragesic Transdermal) Clearance: Liver by CYP-450 3A4; 10% unchanged in urine, metabolite norfentanyl detectable up to 48 hrs Comments: High lipid solubility causes…
FOR OTOLARYNGOLOGY SURGERY, NEURORADIOLOGY, AND ECT
Intracranial Pressure (ICP) ICP = cranial (closed space) pressure on brain, CSF, & blood components • Brain components: Brain mass/cells (80%); blood (10%); CSF (10%) • Normal range: 0–10 mm…
FOR OTOLARYNGOLOGY (ENT) AND OPHTHALMOLOGY
CSF Leak Repair Often performed via endoscopic sinus approach for spontaneous leak with rhinorrhea • Usually requires intrathecal injection of fluorescein (aids in localization under FESS) • May place lumbar…
ANESTHESIA
• Reduction of risk (Anesth Analg 2007;105:1615–1628) • Regional techniques (general anesthesia has 11-fold ↑ risk of PONV) • Propofol (19% ↓ PONV risk compared to inhalational agents) • Avoid…
MANAGEMENT
• Injury of SLN (external branch) → hoarseness • Injury of RLN → unilateral paralysis → paralysis of ipsilateral vocal cord → hoarse voice; bilateral paralysis → stridor & respiratory…
