Awareness during Anesthesia

Awareness during Anesthesia Groups at risk for awareness: Awareness is due to too light plane of anesthesia. It is more likely where muscle relaxants are used. They may be due to: 1-Inadequate anesthetic dose: -Emergency surgery -Hypotensive anesthesia -Cardiac surgery -Inability to monitor dose in TIVA -Obstetric surgery -Normal variability in MAC 2-Resistance: -Hypermetabolic...

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Angioneurotic Edema

Angioneurotic Edema -A general term applied to the development of acute edema in the subcutaneous or submucous tissues.-Anesthetic help may be sought during an attack, when edema of the lips, tongue, or larynx may cause respiratory problems. Causes: -Angioedema may be secondary to the release of histamine, or many other vasoactive substances such as bradykinins, prostaglandins,...

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Acquired C1 Esterase Inhibitor Deficiency

Acquired C1 Esterase Inhibitor Deficiency -This may be a familial or, more rarely, an acquired disorder involving the complement system.-The acquired form is mostly associated with a B-lymphocyte malignancy, and antibodies have been detected against abnormal immunoglobulins present on the malignant B-cells. The reaction between the two causes C1 activation, which in...

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Oculo-cardiac Reflex and Oculo-respiratory Reflex

Oculo-cardiac Reflex and Oculo-respiratory Reflex 1-Oculo-cardiac Reflex Definition: Bradycardia following traction on the extraocular muscles, especially the medial rectus. The reflex is particularly active in children. Bradycardia may be severe and may lead to asystole. Other arrhythmias may occur, e.g. ventricular ectopics or junctional rhythm. Bradycardia may also...

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Tachycardia during Anesthesia

Tachycardia during Anesthesia Definition: -Pulse rate greater than 100 beats/min. in adults Causes and Management: 1-Light anesthesia, Pain: -Hypertension, sweating, lacrimation, reactive pupils, movement  Treatment: Deepening the anesthesia, Analgesia  2-Drug induced: -Anticholinergic drugs, Catecholamines, Oxytocin  3-Hypovolemia: -Actual...

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Bradycardia during Anesthesia

Bradycardia during Anesthesia Definition:-Pulse rate less than 60 beats/min. in adults -Pulse rate less than 80 beats/min. in infants -Pulse rate less than 100 beats/min. in neonates Causes and Management: 1-Hypoxia:-Late response is bradycardia Treatment: -Of the cause, Oxygenation, Anticholinergics 2-Drug induced:-High-concentration volatile anesthetics, Opioids,...

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Fat Embolism Syndrome (FES)

Fat Embolism Syndrome (FES) ➧ Fat embolism can be difficult to diagnose. It most often follows a closed fracture of a long bone but there are many other causes. Epidemiology: ➧ Incidence of this complication ranges from 0.5 to 11% in different studies. It varies considerably according to the cause. Patients with fractures involving the middle and proximal parts of the...

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Bone Cement Implantation Syndrome (BCIS)

Bone Cement Implantation Syndrome (BCIS) Bone Cement constituents: -Bone cement is an acrylic polymer that is formed by mixing two sterile components:  a) Powder: 1-Polymer: Polymethyl methacrylate/co-polymer (PMMA)  2-Initiator: Benzoyl peroxide (BPO)  b) Liquid: 1-Monomer: Methyl methacrylate (MMA)  2-Accelerator: N, N-Dimethyl para-toluidine...

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Anesthetic Precautions for Bloody and Lengthy Surgery

Anesthetic Precautions for Bloody and Lengthy Surgery A) Precautions for Bloody Surgery 1-Decrease blood loss by: ➧ The surgical site elevation is 10-15° ➧ Use of tourniquet ➧ Local infiltration of epinephrine ➧ Use of topical hemostats  ➧ Application of hypotensive anesthesia ➧ Controlled mechanical ventilation (decrease venous return → decrease...

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Propofol Related Infusion Syndrome (PRIS)

Propofol Related Infusion Syndrome (PRIS)➧ It is a rare syndrome that affects patients undergoing long-term treatment with high doses of the anesthetic and sedative drug propofol.  ➧ It is associated with high doses and long-term use of propofol (>4 mg/kg/hr for more than 24 hours). It occurs more commonly in children, and critically ill patients receiving...

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