Download
james holding n.
Skip this Video
Loading SlideShow in 5 Seconds..
James Holding PowerPoint Presentation
Download Presentation
James Holding

James Holding

306 Vues Download Presentation
Télécharger la présentation

James Holding

- - - - - - - - - - - - - - - - - - - - - - - - - - - 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)