Total Intravenous Anesthesia And Spine / Neurosurgery

Anesthesiologists give patients anesthetics in a variety of ways, such as “orally, intravenously, by gas or direct injection to render patients insensible to pain Anesthesiologists typically maintain the same daily schedule a surgeon follows, participating in both scheduled and unscheduled operations. Anesthesiologists are responsible for determining the proper anesthetic and dosage level for each patient. They monitor the patients progress prior to, during, and after surgery.”(“Anesthesiologist” 31)

Use of daily spontaneous breathing trials to assess the patient’s ability to sustain ventilation, oxygenation, and breathing.

This Anaesthetic case study would describes and discussed the scenario of a patient through the anaesthetic role of their surgical procedure. It will include and discuss the anaesthetic safety procedures equipment and drug interventions used to ensure this particular patients maximum safety and comfort before and during the procedure. The case study will include pre and peri-operative assessment in order to describe the involvement contribution of various specialties in the holistic care of the critical care patient. This assignment will focus only on the anaesthetics side of the procedure but will also highlight the importance of the triad of anaesthesia and discuss the administration, maintenance and reversal of

(History of Nurse Anesthesia Practice. 2010, May), (Koch, E., Downey, P., Kelly, J. W., & Wilson, W. 2001).

The investigation of how anesthesia effects cognitive functioning has had a long history. Overtime, it has been suggested that there is an association between anesthesia, surgery, delirium, dementia and postoperative cognitive dysfunction (Inan & Ozkose Satirlar, 2015). The theory of anesthesia’s impact on cognitive functioning was derived in 1887, by Savage, who began to observe the “insanity” that follows the use of anesthesia. He suggested that “Any cause which will give rise to delirium may set up a more chronic form of mental disorder quite apart from any febrile disturbance” (Savage, 1887, p. 1199). Delirium can be defined as an altered level of consciousness that may cause a sudden decline in attention and focus perception (Isik, 2015). Postoperative delirium was reevaluated in 1955 when Bedford used a series of case studies collected over a 50 year span to describe a connection between anesthesia and dementia. The results suggest that 10% of the patients had postoperative cognitive dysfunction (Bedford, 1955). Since these initial studies, research has persisted using a variety of methods, in an attempt to determine: both long- and short-term effects of anesthesia on cognitive functioning and memory; whether the anesthesia administration technique will change the outcome of postoperative cognitive dysfunction; and other risk factors that may be associated to AD.

Patients can become hypertensive during induction, positioning, or tumor resection (12). Chronic catecholamine excess causes volume contraction and patients can become severely hypotensive, as in this case, if adequate volume resuscitation is not performed (12). It is prudent to evaluate for adverse events following hypertensive and hypotensive episodes. Serial neurological evaluations, CT brain, electrocardiograms, or serial cardiac enzymes may be warranted. Complications of surgery are primarily due to severe preoperative hypertension, high secretion tumors, or repeat intervention for recurrence (13). In one study, adverse perioperative events occurred in 32 percent of cases (14). The most common adverse event was sustained hypertension in 25 percent of the patients. There were no perioperative deaths, myocardial infarctions, or cerebrovascular events. Despite premedication of most patients with phenoxybenzamine and a beta-blocker, varying degrees of intraoperative hemodynamic lability occurred

Could you imagine going through a surgery without anesthetics? You know, an anesthesiologist isn't the only one who gives anesthesia—it's a team effort. Nurse anesthetists have been the primary administers of anesthesia since World War II. Many health care facilities do not have anesthesiologists on staff, but they have a CRNA, or a Certified Registered Nursing Anesthetist. They are the nurses that put IVs (intravenous sedatives) into patients before surgery, as well as a combination of other medicines to relax the patient ("Nurse Anesthetist" Career Articles). The anesthesia promotes a controlled state of unconsciousness, muscular relaxation, and insensitivity to pain. So when you go to the operating room, you will most likely have a nurse

This vastly effects the patient’s decision to have surgery performed, because the procedure could affect their normal way of living. This can cause a tremendous amount of anxiety in patients that prevents them from wanting to have surgery. If someone is close to dying and has a chance of being saved from surgery, they should have the surgery performed regardless of the possible side effects. To establish a faction of satisfied patients, neurosurgeons should start putting the impact of the treatment on the patient’s quality of life before the actual surgical procedure.

Anesthesia was developed in order to block or prevent pain during medical procedures. Anesthesia has been the backbone of the medical world for around 100 years now. Early anesthetics were primitive and many patients simply did not trust anesthetics. Anesthesia is still a risky process even in todays advanced medical world. Anesthesia is not used to treat or diagnose any specific disease; the sole purpose is to aid both the patient and surgeon through procedures. However, anesthesia is used in different ways based on the magnitude of the procedure. There are three levels of anesthesia which include; local, regional, and general anesthesia. An anesthesiologist determines which type of anesthesia will be needed.

Numerous studies have been conducted on the use of local anesthetic agents with adjuvants such as clonidine (a partial α2-adrenoreceptor agonist) and tramadol3, 4 for a brachial plexus block to improve the quality and duration of anesthesia, and these studies have shown that the adjuvants may prolong anesthesia and analgesia. Moreover, dexmedetomidine is a α2-receptor agonist that has more selectivity than clonidine and has analgesic and sedative properties.5, 6 Although several studies have described the effects of dexmedetomidine on neuroaxial and peripheral nerve blocks,7, 8, 9 to date, there is only 1 study available, performed by Esmaoglu et al,10 on the effect of adding dexmedetomidine to levobupivacaine for an axillary brachial plexus block. In view of the idea that decreasing the dose of dexmedetomidine may help to reduce side effects such as bradycardia and hypotension, we wanted to evaluate the effect of dexmedetomidine at a lower dose than that used in their study and the results. We think that more studies on this issue are needed.

The patient wakes up after few minutes of the procedure with some dizziness (anesthetic effects) and becomes alert after few hours and can resume normal activities.

[Introduction:] There is a lot of confusion among the general public on what goes on behind the closed doors of an operating room. Many people don 't even know who or what a Nurse Anesthetist is. Even if you are the patient, all you really know is there are people in scrubs and masks standing around you before you fall asleep. When patients start asking questions about what it is that is putting them to sleep during these procedures, they told either a Nurse Anesthetist(CRNA) or a Medical Doctor Anesthesiologist(MDA) had administered some type of drug and monitored their vitals throughout the procedure. Many are told a CRNA had administered these drugs, to which many people look shocked and shout "A Nurse!?" in fear as they could have just been killed by the "less educated" of the two choices. People are afraid of the unknown, and not many people know much about CRNAs or MDAs, so they resort to the only information available: Nurse vs Doctor. Many People do not understand that advanced practice Nurses, such as CRNAs, are just as capable as, and more common than a MDA. The articles I will be referencing in this literature review try to shed some light on CRNAs for the public by showcasing the long history of Anesthesia and how Nurses are, and will remain, a vital role in its function so future patients won 't not fear them as much. What I am attempting to do in this

Learning about the potential complications of epidural reinforced my knowledge in being able to choose the right anaesthetic monitoring equipment. Knowing that Spinal and epidural anaesthesia can cause unpredictable and profound arterial hypotension necessitate the use of adequate monitoring like the; Pulse oximetry, ECG and Blood pressure cuff. This knowledge will help me to be able to select appropriate monitoring devices during epidural catheter insertion. Also it goes without saying that an epidural must be performed in a work area that is equipped for airway management and resuscitation.

With an incidence once as high as 40%, spinal cord paralysis in thoracoabominal procedures has declined, however, still remains a devastating threat post-surgery (Roman, Grewal, Taylor, & Grigore, 2014). Modern techniques for repair of thoracic aneurysms and dissections include an open incision with extracorporeal bypass and aortic clamping. This surgical procedure puts patients at great risk for spinal cord paralysis. Open procedures required meticulous reimplantation of intercostal blood vessels, deep hypothermic cardiac arrest, epidural cooling, and various pharmacologic interventions. As surgical technique has advanced to percutaneous endograft repair, most of these techniques are no longer needed. However, the incidence of paralysis is still prevalent in patients having a TEVAR procedure. Naloxone, an opioid antagonist, has been studied as an additional pharmacologic adjunct in the prevention of spinal cord paralysis (Roman, Grewal, Taylor, & Grigore, 2014). Spinal cord injury can be multifactorial and a review of the literature indicates for patients undergoing endovascular repair of thoracic aneurysms, the use of multiple spinal cord protection strategies collectively reduce spinal cord injury compared to the use of naloxone as a primary measure.

Anesthesia is the loss of feeling or sensation. It may be accomplished without the loss of consciousness, or with partial or total loss of consciousness. Anesthesia has not been around forever, but there is a background history of its creation and the primitive anesthetics used before anesthesia was discovered. Today there are many different anesthetics and delivery methods dependent to the type of procedure. Anesthesiologists and nurse anesthetists are a crucial part of the surgical team. Without anesthesia where would we be today?