Anaesthesia for ECT. Session 1. Dr Richard Cree Consultant in Anaesthesia & ICU. Roseberry Park Hospital and The James Cook Hospital, Middlesbrough
|
|
- Gwen Jennings
- 6 years ago
- Views:
Transcription
1 Anaesthesia for ECT Session 1 Dr Richard Cree Consultant in Anaesthesia & ICU Roseberry Park Hospital and The James Cook Hospital, Middlesbrough
2 Anaesthesia for ECT CHAPTERS 1. The principles of anaesthesia 2. Anaesthetic pharmacology Induction agents Muscle relaxants 3. The physiological effects of ECT 4. Anaesthetic assessment Contraindications for ECT Patient assessment Investigations
3 Chapter 1 The Principles of Anaesthesia
4 The Principles of Anaesthesia What is anaesthesia? without sensation Oliver Wendell Holmes, 1846 reversible lack of awareness General anaesthesia
5 The Principles of Anaesthesia History Alcohol Mesopotamia 3000BC Opium Sumeria 2000BC Mafeisan China 300BC Dwale UK Morphine Germany 1804 Nitrous Oxide UK 1844 Ether USA 1846 Chloroform UK 1847 Cocaine 1877 Thiopentone Curare 1940s Halothane 1950s
6 The Principles of Anaesthesia How do Anaesthetics Work? Biochemical mechanism unclear Myriad sites of action Anaesthesia triad 1. Anaesthesia 2. Analgesia 3. Muscle relaxation
7 The Principles of Anaesthesia Aim of ECT Anaethsesia Short period of unconsciousness to allow 1. The muscle relaxation 2. The ECT stimulus 3. The seizure Return to full consciousness Protection from the adverse physiological effects of the above
8 Chapter 2 Anaesthetic Pharmacology
9 The Principles of Anaesthesia Anaesthetic Drugs Induction agents 1. Propofol 2. Thiopentone 3. Etomidate 4. Methohexitone 5. Sevoflurane 6. Ketamine Muscle relaxants 1. Suxamethonium 2. Others
10 Anaesthetic Drugs Propofol PROS Rapid onset Short action Nice! - Less nausea Suppresses haemodynamic response CONS Raises seizure threshold Short seizures but no effect on efficacy Painful
11 Anaesthetic Drugs Thiopentone (Thiopental) PROS Longer seizures than Propofol CONS Raises seizure threshold Cardiac arrhythmias Less effect on haemodynamic stability
12 Anaesthetic Drugs Etomidate (Hypnomidate) PROS Lowers seizure threshold useful in refractory seizures Long seizures CONS No suppression of haemodynamic response Nausea Painful Abnormal movements Adrenal suppression?
13 Anaesthetic Drugs Methohexitone (Methohexital/Brevital) PROS Gold standard Rapid onset, rapid recovery No effect on seizure threshold or duration CONS Expensive Unlicensed since 2000 Difficult to obtain
14 Anaesthetic Drugs Sevoflurane Inhalational anaesthetic No effect on seizure Useful for difficult venous access Attenuates post-ect uterine contraction in 3 rd trimester of pregnancy Requires anaesthetic machine, vapouriser & scavenging
15 Anaesthetic Drugs Ketamine PROS Longer seizures Less memory deficit? CONS Slow onset Longer acting Emergence phenomena - hallucinations Less attenuation of haemodynamic response
16 Anaesthetic Drugs Opioids PROS Attenuate haemodynamic response Alfentanil & remifentanil prolong seizures Single agent in refractory seizures? CONS Fentanyl shortens seizure duration Prolong recovery time
17 Anaesthetic Drugs Muscle Relaxants Suxamethonium Depolarising muscle relaxant PROS Rapid onset Short acting CONS Fasciculation & muscle pain Suxamethonium apnoea Malignant hyperpyrexia Masseter spasm
18 Anaesthetic Drugs Muscle Relaxants - Atracurium, Rocuronium Non-depolarising muscle relaxant PROS CONS It isn t suxamethonium! Slow onset Long acting maintain anaesthesia & ventilation
19 Chapter 3 The Physiological Effects of ECT
20 The Physiological effects of ECT ECT stimulus results in. 1. Increased cerebral blood flow 2. Generalised tonic-clonic seizure 3. Cardiovascular effects Parasympathetic Sympathetic 4. Complex neuro-endocrine effects why it works!
21 Physiological effects of ECT Increased Cerebral Blood Flow Cerebral blood flow (CBF) increases by over 100% in ECT Munroe-Kelly doctrine Brain in a tight, rigid box the skull Brain 80% Blood 12% and CSF 8% Increasing CBF Increased intra-cranial pressure (ICP) Risks recent strokes or haemorrhages, aneurysms, AV malformations, brain tumours etc.
22 Physiological effects of ECT The Seizure Risks of the tonic-clonic convulsion: 1. Damage to teeth, tongue and mouth - Direct effect of the stimulus 2. Long bone fractures 3. Avulsion fractures 4. Cervical spine injury e.g. rheumatoid disease or ankylosing spondylitis
23 Physiological effects of ECT Cardiovascular Effects Autonomic nervous system effects 1. Parasympathetic nervous system During the stimulus Effects mediated by acetylcholine Bradycardia rarely asystole Salivation May be exacerbated by suxamethonium Can prevent with glycopyrrolate or atropine
24 Physiological effects of ECT Cardiovascular Effects 2. Sympathetic nervous system During the seizure Effects mediated by adrenaline Effects fade over mins Tachycardia Hypertension Effects attenuated by Anaesthetic agents - propofol Cardac drugs e.g. beta-blockers Short acting opiates
25 Physiological effects of ECT Cardiovascular Effects Ensure optimal treatment of underlying cardiovascular conditions
26 Chapter 4 Anaesthetic Assessment
27 Anaesthetic Assessment ASA Grade American Society of Anaesthesiologists (ASA) grading system Grade Description Example I II Healthy Mild systemic disease no functional limitation Well controlled hypertension, diabetes, asthma III Moderate systemic disease Definite functional limitation COPD with exercise limit. Diabetes with complications. Exertional angina IV V Severe systemic disease Constant threat to life Moribund Expected to die in 24hours Unstable angina. COPD-breathless at rest Critically ill ICU patient undergoing emergency surgery
28 Anaesthetic Assessment ASA Grade ASA grade Anaesthetic assessment for ECT ASA Grades 1 & 2 Can be seen by Anaesthetist immediately prior to ECT. Routine investigations & assessment only required. ASA Grade 3 ASA Grade 4 May need further assessment, investigations and specialist opinion prior to ECT. Consider conducting treatment in main operating theatre suite. Will require thorough assessment, investigation and specialist opinion prior to ECT. Treatment will need to be conducted in main operating theatre suite. Full consideration of risks vs. benefits.
29 Anaesthetic Assessment Contra-Indications to ECT Relative contra-indications: 1. Increased intra-cranial pressure Brain tumour Recent stroke Untreated cerebral aneurysm or AVM 2. Cardiovascular disease Recent acute coronary syndrome Unstable angina Untreated cardiac failure Aortic or thoracic aneurysm Severe valvular heart disease
30 Anaesthetic Assessment Contra-Indications to ECT 3. Musculo-skeletal disease Unstable cervical or lumbar spine - acute injury or chronic disease Severe osteoposis Unstabilised fractures 4. Phaechromocytoma 5. Deep venous thrombosis 6. Pregnancy 7. Cochlear implant?
31 Anaesthetic Assessment Investigations Local guidelines as agreed with your anaesthetist Results must be available for the anaesthetic assessment before first treatment Often do not need repeating during treatment period New tests may not be required if already performed within the previous three months
32 Anaesthetic Assessment Full blood count Rationale to check O 2 carrying capacity Perform in All patients over 60 yrs ASA grades III or IV Any cardiorespiratory disease Renal disease Diabetes Some antipsychotics e.g. Olanzapine
33 Anaesthetic Assessment Urea & Electrolytes Electrolyte disturbance arrhythmias affect seizure threshold Perform in All patients over 60 yrs ASA grades III or IV Any cardiorespiratory disease Renal disease Poor fluid intake / dehydration Diabetes Lithium
34 Anaesthetic Assessment Other Blood Tests Clotting & INR Detect over anti-coagulation in patients taking warfarin Sickle Cell Anaemia Screen Detect risk of sickle cell crisis in patients of African, Caribbean, Mediterranean or Asian ethnic origin
35 Anaesthetic Assessment Other Blood Tests Thyroid function Liver function Patients with known liver disease or alcohol excess and those taking drugs affecting liver function e.g. olanzipine, carbamazepine Pregnancy test Any woman of childbearing age Allows discussion of risks vs. benefits of ECT
36 Anaesthetic Assessment Electrocardiogram Rationale detect myocardial ischaemia & previous cardiac damage, risk of arrthymias Useful baseline Perform in All patients over 60 yrs ASA grades III or IV Cardiorespiratory disease Diabetes
37 Anaesthetic Assessment X-Rays Chest X-ray and / or pulmonary function tests only after discussion with anaesthetist Other imaging / tests only on specialist advice
38 Any Questions?
Physiological effects of ECT
Physiological effects of ECT This is where I work Not where ECT is done usually Broad Oak Hospital Liverpool (Mersey Care) Cottage hospital setting (no acute physicians or intensive care) At least 500
More informationECT Workshop. Rahul Bajekal Consultant Anaesthetist Newcastle upon Tyne 23 November 2017
ECT Workshop Rahul Bajekal Consultant Anaesthetist Newcastle upon Tyne 23 November 2017 My role To attenuate seizure appropriately Manage comorbidity Best place to treat? What we don t like Complex comorbidity
More informationGeneral Anesthesia. Mohamed A. Yaseen
General Anesthesia Mohamed A. Yaseen M.S,c Surgery Before Anesthesia General Anesthesia ( GA ) Drug induced absence of perception of all sensation allowing surgery or other painful procedure to be carried
More informationDr Ben Edwards Consultant Anaesthetist Sheffield Teaching Hospitals
Dr Ben Edwards Consultant Anaesthetist Sheffield Teaching Hospitals 70-75,000 #NOF per annum (costs 2 billion) 10% die within 1 month 33% die within 1 year Operative delays >48hs more than doubles risk
More informationCore Safety Profile. Pharmaceutical form(s)/strength: 5mg/ml and 25 mg/ml, Solution for injection, IM/IV FI/H/PSUR/0010/002 Date of FAR:
Core Safety Profile Active substance: Esketamine Pharmaceutical form(s)/strength: 5mg/ml and 25 mg/ml, Solution for injection, IM/IV P-RMS: FI/H/PSUR/0010/002 Date of FAR: 29.05.2012 4.3 Contraindications
More informationAnaesthesia for ECT. Session 2. Dr Richard Cree Consultant in Anaesthesia & ICU. Roseberry Park Hospital and The James Cook Hospital, Middlesbrough
Anaesthesia for ECT Session 2 Dr Richard Cree Consultant in Anaesthesia & ICU Roseberry Park Hospital and The James Cook Hospital, Middlesbrough Anaesthesia for ECT CHAPTERS 5. Monitoring 6. Patient care
More informationGeneral anesthesia. No single drug capable of achieving these effects both safely and effectively.
General anesthesia General anesthesia is essential to surgical practice, because it renders patients analgesic, amnesia, and unconscious reflexes, while causing muscle relaxation and suppression of undesirable
More informationANESTHETIZING DISEASED PATIENTS: URINARY; NEUROLOGICAL; TRAUMATIZED
ANESTHETIZING DISEASED PATIENTS: URINARY; NEUROLOGICAL; TRAUMATIZED Lyon Lee DVM PhD DACVA Patients with Urinary Tract Diseases General considerations Three main factors to consider in anesthetizing urinary
More informationSedation For Cardiac Procedures A Review of
Sedation For Cardiac Procedures A Review of Sedative Agents Dr Simon Chan Consultant Anaesthesiologist Department of Anaesthesia and Intensive Care Prince of Wales Hospital Hong Kong 21 February 2009 Aims
More informationSedation in children and young people. Appendix J. Sedation for diagnostic and therapeutic procedures in children and young people
SEDATION IN CHILDREN AND YOUNG PEOPLE 1 Sedation in children and young people Sedation for diagnostic and therapeutic procedures in children and young people Appendix J 2 SEDATION IN CHILDREN AND YOUNG
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acetaminophen, for geriatric surgical patients, 569 570 Acute kidney injury, critical care issues in geriatric patients with, 555 556
More informationANESTHESIA EXAM (four week rotation)
SPARROW HEALTH SYSTEM ANESTHESIA SERVICES ANESTHESIA EXAM (four week rotation) Circle the best answer 1. During spontaneous breathing, volatile anesthetics A. Increase tidal volume and decrease respiratory
More informationChapter 25. General Anesthetics
Chapter 25 1. Introduction General anesthetics: 1. Analgesia 2. Amnesia 3. Loss of consciousness 4. Inhibition of sensory and autonomic reflexes 5. Skeletal muscle relaxation An ideal anesthetic: 1. A
More informationOptimal sedation and management of anxiety in patients undergoing endobronchial ultrasound (EBUS)
Optimal sedation and management of anxiety in patients undergoing endobronchial ultrasound (EBUS) Georgios Dadoudis Anesthesiologist ICU DIRECTOR INTERBALKAN MEDICAL CENTER Optimal performance requires:
More informationINHALATION AGENTS 2013/05/28 1
INHALATION AGENTS 2013/05/28 1 2013/05/28 Isn t it romantic? 2 Administration 3 Physics Critical temperature Vapour vs. Gas Vapour pressure Blood Gas Partition Coefficient BGPC MAC 2013/05/28 4 Critical
More informationKurt Baker-Watson, MD Associate Professor
Kurt Baker-Watson, MD Associate Professor Anesthetics Previous types, complications, satisfaction, familial history of complications, acute and chronic pain issues Airway Dentition/dental appliances, temporomandibular
More informationDrugs used in obstetrics
Drugs used in obstetrics Drugs used in obstetrics Drugs may be used to modify uterine contractions. These include oxytocic drugs used to stimulate uterine contractions both in induction of labour and to
More informationNeurostorm: Modern understanding and nomenclature. Mitch Stanek RN, CBIS Charge Nurse/Infection Preventionist On With Life
Neurostorm: Modern understanding and nomenclature Mitch Stanek RN, CBIS Charge Nurse/Infection Preventionist On With Life Despite its significant clinical impact, the scientific literature on this syndrome
More informationAnalgesic-Sedatives Drug Dose Onset
Table 4. Commonly used medications in procedural sedation and analgesia Analgesic-Sedatives Fentanyl Morphine IV: 1-2 mcg/kg Titrate 1 mcg/kg q3-5 minutes prn IN: 2 mcg/kg Nebulized: 3 mcg/kg IV: 0.05-0.15
More informationGeneral Anesthesia. My goal in general anesthesia is to stop all of these in the picture above (motor reflexes, pain and autonomic reflexes).
General Anesthesia General anesthesia is essential to surgical practice, because it renders patients analgesic, amnesia and unconscious reflexes, while causing muscle relaxation and suppression of undesirable
More informationVO- PMHP Treatment Guideline 102: Electroconvulsive Therapy (ECT)
VO- PMHP Treatment Guideline 102: Electroconvulsive Therapy (ECT) Diagnostic Guidelines: Introduction: Electroconvulsive Therapy has been in continuous use for more than 60 years. The clinical literature
More informationAngina Pectoris Dr. Shariq Syed
Angina Pectoris Dr. Syed 1 What is Angina Pectoris (AP)? Commonly known as angina is chest pain often due to ischemia of the heart muscle, Because of obstruction or spasm of the coronary arteries 2 What
More informationCardiac Pathophysiology
Cardiac Pathophysiology Evaluation Components Medical history Physical examination Routine laboratory tests Optional tests Medical History Duration and classification of hypertension. Patient history of
More informationPain: 1-2µg/kg q30-60min prn. effects in 10 minutes. Contraindications: Morphine is preferred in. Duration of Action: minutes. renal failure.
Procedural Sedation / Analgesia / Anaesthesia Chart - Page 1 Diazepam (Valium) Anxiolytic / Sedative Etomidate (Amidate) Hypnotic / Anesthetic Fentanyl Citrate (Sublimaze) Narcotic Analgesic Dose Pediatric:
More informationASSESSMENT OF THE PAEDIATRIC NEEDS ANAESTHESIOLOGY DISCLAIMER
European Medicines Agency Evaluation of Medicines for Human Use ASSESSMENT OF THE PAEDIATRIC NEEDS ANAESTHESIOLOGY London, October 2006 Doc. Ref: EMEA/405166/2006 DISCLAIMER The Paediatric Working Party
More information(PP XI) Dr. Samir Matloob
DRUGS ACTING ON THE CHOLINERGIC SYSTEM AND THE NEUROMUSCULAR BLOCKING DRUGS IV (NICOTINIC ANTAGONISTS) (PP XI) Dr. Samir Matloob Dept. of Pharmacology Baghdad College of Medicine Drugs acting on the cholinergic
More informationFundamental Knowledge: List of topics relevant to PIC that will have been covered in membership examinations. They will not be repeated here.
Disclaimer: The Great Ormond Street Paediatric Intensive Care Training Programme was developed in 2004 by the clinicians of that Institution, primarily for use within Great Ormond Street Hospital and the
More informationNERVOUS SYSTEM NERVOUS SYSTEM. Somatic nervous system. Brain Spinal Cord Autonomic nervous system. Sympathetic nervous system
SYNAPTIC NERVOUS SYSTEM NERVOUS SYSTEM CENTRAL NERVOUS SYSTEM PERIPHERAL NERVOUS SYSTEM Brain Spinal Cord Autonomic nervous system Somatic nervous system Sympathetic nervous system Parasympathetic nervous
More informationAsthma Management in ICU. by DrGary Au From KWH
Asthma Management in ICU by DrGary Au From KWH Overview of Asthma Pathophysiology Therapeutic options Medical treatment NPPV Mechanical ventilation Salvage therapy ~ 235 million people worldwide were affected
More informationAirway management problem during anaesthesia. Airway management problem in ICU / HDU. Airway management problem occurring in the Emergency Department
4th National Audit Project of the Royal College of Anaesthetists: Major Complications of Airway Management in the UK Please select one form from the list below Airway management problem during anaesthesia
More informationCardiac arrhythmias. Janusz Witowski. Department of Pathophysiology Poznan University of Medical Sciences. J. Witowski
Cardiac arrhythmias Janusz Witowski Department of Pathophysiology Poznan University of Medical Sciences A 68-year old man presents to the emergency department late one evening complaining of increasing
More informationPostpartum Period. Dr Ann Roberts Consultant Psychiatrist
ECT in Pregnancy and the Postpartum Period Dr Ann Roberts Consultant Psychiatrist Thumbswood MBU Hertfordshire ECT searches/overview of evidence e Medline, Embase, Psychinfo, Pubmed No prospective randomised
More informationInhalational Anesthesia. Munir Gharaibeh, MD, PhD, MHPE School of Medicine The University of Jordan February, 2018
Inhalational Anesthesia School of Medicine The University of Jordan February, 2018 mgharaib@ju.edu.jo Inhalational Anesthesia n Gases or volatile liquids n Administration and Elimination is by the lungs
More informationPRE Operative Care of the High Risk Surgical Patient. Dr A T Dewhurst Consultant Anaesthetist St George s Hospital London
PRE Operative Care of the High Risk Surgical Patient Dr A T Dewhurst Consultant Anaesthetist St George s Hospital London Perioperative Optimization Shoemaker oxygen delivery goal directed therapy ITS NOT
More informationMental Health Commission Rules
Mental Health Commission Rules Reference Number: R-S59(2)/01/2006 RULES GOVERNING THE USE OF ELECTRO-CONVULSIVE THERAPY 1 st November 2006 PREAMBLE Section 59 of the Mental Health Act 2001 obliges the
More informationHypertension The normal radial artery blood pressures in adults are: Systolic arterial pressure: 100 to 140 mmhg. Diastolic arterial pressure: 60 to
Hypertension The normal radial artery blood pressures in adults are: Systolic arterial pressure: 100 to 140 mmhg. Diastolic arterial pressure: 60 to 90 mmhg. These pressures are called Normal blood pressure
More informationGALA GENERAL ANAESTHESIA vs LOCAL ANAESTHESIA FOR CAROTID SURGERY HOSPITAL DISCHARGE OR 7 DAY POST-SURGERY FOLLOW-UP FORM
GALA GENERAL ANAESTHESIA vs LOCAL ANAESTHESIA FOR CAROTID SURGERY HOSPITAL DISCHARGE OR 7 DAY POST-SURGERY FOLLOW-UP FORM To the surgeon and anesthetist: Please complete questions 1-29 (pages 1, 2 & 3)
More informationCurriculum Vitae. Dr.SAHIL BANSAL. To obtain a position of Consultant Anaesthesiologist(Cardiac or general) in an institute.
Curriculum Vitae Of Dr.SAHIL BANSAL PERSONAL DETAILS Date of Birth: 26 Feb 1986 Sex : Male Address : Dr. Sahil Bansal c/o Ghanshyam Bansal, Aggarwal Niwas, Kamal Chowk Nagpur- 440017 Nationality : INDIAN
More informationAnaesthesia. Update in. An Introduction to Cardiovascular Physiology. James Rogers Correspondence
Update in Anaesthesia Originally published in Update in Anaesthesia, edition 10 (1999) An Introduction to Cardiovascular Physiology Correspondence Email: James.Rogers@nbt.nhs.uk INTRODUCTION The cardiovascular
More informationANAESTHESIA EDY SUWARSO
ANAESTHESIA EDY SUWARSO GENERAL REGIONAL LOCAL ANAESTHESIA WHAT DOES ANESTHESIA MEAN? The word anaesthesia is derived from the Greek: meaning insensible or without feeling. The adjective will be ANAESTHETIC.
More informationWASHINGTON UNIVERSITY SCHOOL OF MEDICINE. Cranial Health History Form
WASHINGTON UNIVERSITY SCHOOL OF MEDICINE Cranial Health History Form Welcome to the Neurosurgery Department at Washington University. To help us treat you, please fill this form out completely. Your Name:
More informationResults of Ischemic Heart Disease
Ischemic Heart Disease: Angina and Myocardial Infarction Ischemic heart disease; syndromes causing an imbalance between myocardial oxygen demand and supply (inadequate myocardial blood flow) related to
More informationCHAPTER 11. General and Local Anesthetics. Anesthetics. Anesthesia. Eliza Rivera-Mitu, RN, MSN NDEG 26 A
CHAPTER 11 General and Local Anesthetics Eliza Rivera-Mitu, RN, MSN NDEG 26 A Anesthetics Agents that depress the central nervous system (CNS) Depression of consciousness Loss of responsiveness to sensory
More informationGENERAL ANAESTHESIA. Jozef Firment, MD PhD. Department of Anaesthesiology & Intensive Care Medicine Šafárik University Faculty of Medicine, Košice
GENERAL ANAESTHESIA Jozef Firment, MD PhD Department of Anaesthesiology & Intensive Care Medicine Šafárik University Faculty of Medicine, Košice DEFINITION (an) aisthetos = (un) perception general anaesthesia
More informationChapter 13. Learning Objectives. Learning Objectives 9/11/2012. Poisonings, Overdoses, and Intoxications
Chapter 13 Poisonings, Overdoses, and Intoxications Learning Objectives Discuss use of activated charcoal in treatment of poisonings List treatment options for acetaminophen overdose List clinical manifestations
More informationShared Care Agreement for Donepezil, Galantamine, Rivastigmine and Memantine
Clinical SECONDARY CARE SECTION TO BE COMPLETED BY INITIATING DOCTOR Patient s Name: Date of Birth: NHS Number: Date Treatment Started: Name of drug: (Add Date) One copy of information leaflet given to
More informationStudent Outline. Improving Transportation Safety: Commercial Driver Medical Examiner Training CHAPTER 1. General FMCSA Information
Student Outline CHAPTER 1 General FMCSA Information FMCSA Mission Statement / Dedicated to Safety / NRCME Important Definitions Regulations Vs. Medical Guidelines Privacy and the Medical Examination 13
More informationNEW ZEALAND DATA SHEET. Injection solution 2.5 mg/ml: a clear, colourless, particle-free solution containing 2.5 mg/ml Neostigmine methylsulphate.
NEW ZEALAND DATA SHEET NAME OF MEDICINE NEOSTIGMINE METHYLSULPHATE INJECTION B.P. Solution for injection 2.5 mg/ml. PRESENTATIONS Injection solution 2.5 mg/ml: a clear, colourless, particle-free solution
More informationAddendum D. Procedural Sedation Test MERCY MEDICAL CENTER- SIOUX CITY. Procedural Sedation Questions
Addendum D. Procedural Sedation Test MERCY MEDICAL CENTER- SIOUX CITY Procedural Sedation Questions Individuals applying for moderate sedation privileges must achieve a score of 80%. PRACTITIONER NAME
More informationInterface Prescribing Subgroup DRUGS FOR DEMENTIA: INFORMATION FOR PRIMARY CARE
Cholinesterase inhibitors and Memantine are now classified as green (following specialist initiation) drugs by the Greater Manchester Medicines Management Group. Who will diagnose and decide who is suitable
More information10. Severe traumatic brain injury also see flow chart Appendix 5
10. Severe traumatic brain injury also see flow chart Appendix 5 Introduction Severe traumatic brain injury (TBI) is the leading cause of death in children in the UK, accounting for 15% of deaths in 1-15
More informationCare of the Deteriorating Patient in Recovery NADIA TICEHURST : CLINICAL NURSE EDUCATOR PERI ANAESTHETICS BENDIGO HEALTH
Care of the Deteriorating Patient in Recovery NADIA TICEHURST : CLINICAL NURSE EDUCATOR PERI ANAESTHETICS BENDIGO HEALTH Intended learning outcomes Describe the components of a comprehensive clinician
More informationMUSCLE RELAXANTS. Mr. D.Raju, M.pharm, Lecturer
MUSCLE RELAXANTS Mr. D.Raju, M.pharm, Lecturer Muscle Relaxants are classified as: I)Peripherally acting A.Neuromuscular blocking agents:- 1) Depolarizing muscle relaxants. 2) Non-depolarizing muscle relaxants
More informationAUSTRALIAN PRODUCT INFORMATION REMIFENTANIL APOTEX (REMIFENTANIL HYDROCHLORIDE) POWDER FOR INJECTION
AUSTRALIAN PRODUCT INFORMATION REMIFENTANIL APOTEX (REMIFENTANIL HYDROCHLORIDE) POWDER FOR INJECTION 1 NAME OF THE MEDICINE Remifentanil (as hydrochloride) 2 QUALITATIVE AND QUANTITATIVE COMPOSITION Each
More informationNausicalm solution for injection is a clear colourless solution, presented in 1 ml ampoules.
Nausicalm Cyclizine lactate 50 mg/ml solution for injection Presentation Nausicalm solution for injection is a clear colourless solution, presented in 1 ml ampoules. Uses Actions Cyclizine is a piperazine
More informationGENERAL ANAESTHESIA AND FAILED INTUBATION
GENERAL ANAESTHESIA AND FAILED INTUBATION INTRODUCTION The majority of caesarean sections in the UK are performed under regional anaesthesia. However, there are situations where general anaesthesia (GA)
More informationAgonists: morphine, fentanyl Agonists-Antagonists: nalbuphine Antagonists: naloxone
Opioid Definition All drugs, natural or synthetic, that bind to opiate receptors Agonists: morphine, fentanyl Agonists-Antagonists: nalbuphine Antagonists: naloxone Opioid agonists increase pain threshold
More informationAnaesthetic Plan And The Practical Conduct Of Anaesthesia. Dr.S.Vashisht Hillingdon Hospital
Anaesthetic Plan And The Practical Conduct Of Anaesthesia Dr.S.Vashisht Hillingdon Hospital Anaesthetic Plan Is based on Age / physiological status of the patient (ASA) Co-morbid conditions that may be
More informationKelowna June 2011 Airway Assessment and Management. Golden, BC
Kelowna June 2011 Airway Assessment and Management Dr. Bruce Starke Golden, BC Not really... I am unable to identify any potential conflict of interest and I am unable to identify any potential conflict
More informationNeurocardiogenic syncope
Neurocardiogenic syncope Syncope Definition Collapse,Blackout A sudden, transient loss of consciousness and postural tone, with spontaneous recovery Very common Syncope Prevalence All age groups (particularly
More informationGeneral anesthetics. Dr. Shamil AL-Noaimy Lecturer of Pharmacology Dept. of Pharmacology College of Medicine
General anesthetics Dr. Shamil AL-Noaimy Lecturer of Pharmacology Dept. of Pharmacology College of Medicine Rationale General anesthesia is essential to surgical practice, because it renders patients analgesic,
More informationCore Safety Profile. Pharmaceutical form(s)/strength: Sterile eye drops 1%, 2% Date of FAR:
Core Safety Profile Active substance: Carteolol Pharmaceutical form(s)/strength: Sterile eye drops 1%, 2% P - RMS: SK/H/PSUR/0002/002 Date of FAR: 16.03.2012 4.1 THERAPEUTIC INDICATIONS Ocular hypertension
More information13.01 INHALATIONAL & IV ANAESTHETICS
13 ANAESTHETICS 13.01 INHALATIONAL & IV ANAESTHETICS Halothane (Fluothane) 250ml Isoflurane (Forane) 250ml *Ketamine (as HCl) Inj 50mg/ml, 10ml (Ketalar) *Nitrous Oxide Inhalation Gas [Cylinder neck: colour
More informationP-RMS: NO/H/PSUR/0009/001
Core Safety Profile Active substance: Propofol Pharmaceutical form(s)/strength: Emulsion for injection, infusion, 10mg/ml Emulsion for infusion, 20mg/ml P-RMS: NO/H/PSUR/0009/001 Date of FAR: 30.06.2011
More informationJMSCR Vol 04 Issue 01 Page January 2016
www.jmscr.igmpublication.org Impact Factor 3.79 Index Copernicus Value: 5.88 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: http://dx.doi.org/10.18535/jmscr/v4i1.04 Haemodynamic Effects during Induction in
More informationCalvertHealth Medical Center s Moderate Sedation Competency Examination
Medical Staff Office Use Only: Congratulations! You passed the Moderate Sedation Competency Examination. Enclosed is the test for your follow-up review. Test Results: % ( of 35 correct) Your test result
More informationCore Safety Profile. Pharmaceutical form(s)/strength: Film-coated tablets 1.25 mg, 2.5 mg, 3.75 mg, 5 mg, 7.5 mg and 10 mg. Date of FAR:
Core Safety Profile Active substance: Bisoprolol Pharmaceutical form(s)/strength: Film-coated tablets 1.25 mg, 2.5 mg, 3.75 mg, 5 mg, 7.5 mg and 10 mg P - RMS: FI/H/PSUR/0002/002 Date of FAR: 13.12.2011
More informationTranscatheter Aortic Valve Implantation Anaesthetic Prespectives
Transcatheter Aortic Valve Implantation Anaesthetic Prespectives Dr Simon Chan Consultant Department of Anaesthesia and Intensive Care Prince of Wales Hospital Hong Kong 11 Oct 2014 Aortic Stenosis Prevalence
More informationMilestone Guide. CBD Anesthesia
Table of Contents Department of Anesthesiology Foundations 1 Airway 1 Pharmacology 1 Physiology 1 Common Uncomplicated Anesthetics Practice 2 Obstetrics 2 Pain 2 Core 3 Perioperative Medicine 3 Complex
More informationOriginal Date of issue: 01/11/2005 Last Reviewed: 01/05/2011 Version:4 Page 1 of 7
Original Date of issue: 01/11/2005 Last eviewed: 01/05/2011 Version:4 Page 1 of 7 15: Anaesthesia 15.1 General anaesthesia 15.1.1 Intravenous anaesthesia Etomidate Injection (20mg/10ml) Ketamine Injection
More informationPERIPARTUM CARDIOMYOPATHY
PERIPARTUM CARDIOMYOPATHY Dr.T.Venkatachalam. Professor of Anaesthesiology Madras Medical College, Chennai Peripartum cardiomyopathy is defined as the onset of acute heart failure without demonstrable
More informationMalignant Hyperthermia PHUONG PHAM
Malignant Hyperthermia PHUONG PHAM Objectives Pathophysiology Diagnosis Management Clinical roles Aftermath Epidemiology 1: 62 000 1: 4500 M > F non-triggering agents triggering agents used 52% MH reactions
More informationChapter 18. Skeletal Muscle Relaxants (Neuromuscular Blocking Agents)
Chapter 18 Skeletal Muscle Relaxants (Neuromuscular Blocking Agents) Uses of Neuromuscular Blocking Facilitate intubation Surgery Agents Enhance ventilator synchrony Reduce intracranial pressure (ICP)
More informationPCTH General Anaesthetics Nov 5 th 2013 (9:30-10:50) Location Woodward 6
PCTH 325 - General Anaesthetics Nov 5 th 2013 (9:30-10:50) Location Woodward 6 M Walker (rsdaa@mail.ubc.ca) Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, UBC Slides adapted from, and
More informationPain & Sedation Management in PICU. Marut Chantra, M.D.
Pain & Sedation Management in PICU Marut Chantra, M.D. Pain Diseases Trauma Procedures Rogers Textbook of Pediatric Intensive Care, 5 th ed, 2015 Emotional Distress Separation from parents Unfamiliar
More informationStudy No.: Title: Rationale: Phase: Study Period: Study Design: Centres: Indication: Treatment: Objectives: Primary Outcome/Efficacy Variable:
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More informationChapter 11. The Cardiovascular System. Clicker Questions Pearson Education, Inc.
Chapter 11 The Cardiovascular System Clicker Questions Oxygen-poor blood is pumped through the venae cavae to the right side of the heart, and then through the pulmonary arteries to the lungs and back
More informationStatus Epilepticus And Prolonged Seizures: Guideline For Management In Adults. Contents
Status Epilepticus And Prolonged Seizures: Guideline For Management In Adults Classification: Clinical guideline Lead Author: Rajiv Mohanraj, Consultant Neurologist Additional author(s): Matt Jones, Consultant
More informationPreoperative tests (update)
National Institute for Health and Care Excellence. Preoperative tests (update) Routine preoperative tests for elective surgery NICE guideline NG45 Appendix C: April 2016 Developed by the National Guideline
More informationSPECIAL PATHOPHYSIOLOGY SHOCK
SPECIAL PATHOPHYSIOLOGY SHOCK 1. How do we call blood pressure values below the reference range? 1.Hypovolemia. 2. Hypothermia. 3. Hypooncia. 4. Hypoosmia. 5. Hypotension. 2. What is acute circulatory
More informationPreoperative Assessment. Block Prof JLA Rantloane Department of Anaesthesiology
Preoperative Assessment Block 18 2013 Prof JLA Rantloane Department of Anaesthesiology!1 Principles All patients scheduled to undergo surgery should have a preoperative evaluation to assist in planning
More informationSub-arachnoid haemorrhage
Sub-arachnoid haemorrhage Dr Mary Newton Consultant Anaesthetist The National Hospital for Neurology and Neurosurgery UCL Hospitals NHS Trust mary.newton@uclh.nhs.uk Kiev, Ukraine September 17 th 2009
More informationANESTHESIA DRUG REVIEW
ANESTHESIA REVIEW CAPA S 39 TH ANNUAL CONFERENCE PALM SPRINGS OCTOBER 10, 2015 ROBERT F. KOPEL, MD, FACP, FCCP HOAG HOSPITAL CARDIAC ANESTHESIOLOGIST ASSISTANT CLINICAL PROFESSOR UCLA SCHOOL OF MEDICINE
More informationResuscitation Fluids
Resuscitation Fluids Acceptable Fluids (also known as): Sodium Chloride Hartmann s Solution (Ringer-Lactate Solution, Compound Sodium Lactate) 4.5% Albumin Solution (PPS) Gelofusine 20ml/kg Bolus Can be
More informationGeneral Anesthetics Pharmacology
General Anesthetics Pharmacology Hiwa K. Saaed, PhD Department of Pharmacology & Toxicology College of Pharmacy, University of Sulaimani 2018-19 CLASSIFICATION General anesthetics Intravenous Inhalational
More informationInduction Agents 2013/05/28 1
Induction Agents 2013/05/28 1 Basic concepts One arm-brain circulation time Compartments Protein binding Redistribution vs. Metabolism Receptor binding 2013/05/28 2 One arm-brain circulation time From
More informationproblems with, 29, 98 psychiatric patients, 96 rheumatic conditions, 97
180 ACE inhibitors, 26 acetaminophen, see paracetamol acupressure, anti-emetic effect, 143 acute drugs, 64 5 adenoidectomy, 161 adrenaline, 64 α-2-chloroprocaine, 74, 81 age impact on patient selection,
More informationSummary of risk management plan for Dzuveo (Sufentanil (as citrate))
Part VI: Summary of the risk management plan Summary of risk management plan for Dzuveo (Sufentanil (as citrate)) This is a summary of the risk management plan (RMP) for Dzuveo. The RMP details important
More informationGanglion blocking agents
Ganglion blocking agents -out of date -Specifically act on the nicotinic receptors of both parasymphatetic and sympathetic ganglia - no selectivity toward PG or SG -These drugs are non-depolarizing, competitive
More informationSedation in Children
CHILDREN S SERVICES Sedation in Children See text for full explanation and drug doses Patient for Sedation Appropriate staffing Resuscitation equipment available Monitoring equipment Patient suitability
More informationYounger adults with a family history of premature artherosclerotic disease should have their cardiovascular risk factors measured.
Appendix 2A - Guidance on Management of Hypertension Measurement of blood pressure All adults from 40 years should have blood pressure measured as part of opportunistic cardiovascular risk assessment.
More informationOPEN ACCESS TEXTBOOK OF GENERAL SURGERY
OPEN ACCESS TEXTBOOK OF GENERAL SURGERY PRE-OPERATIVE ASSESSMENT AND POST-OPERATIVE CARE L Mitchell INTRODUCTION All but the most trivial surgical procedures result in a systemic response that may affect
More informationAnaesthesia pearls and pitfalls in periodic paralysis
Biannual Meeting of the PPA Orlando, FL, 2013 Anaesthesia pearls and pitfalls in periodic paralysis Department of Neurology Military Hospital Ulm Germany Frank Weber Frank Lehmann Horn, Senior Research
More informationPharmaceutical form(s)/strength: Solution: 5 mg/ml Suspensions: 2.5 and 5 mg/ml P-RMS:
0BCore Safety Profile Active substance: Betaxolol eyedrops Pharmaceutical form(s)/strength: Solution: 5 mg/ml Suspensions: 2.5 and 5 mg/ml P-RMS: HU/H/PSUR/0010/002 Date of FAR: 20.03.2013 4.2 Posology
More informationANAESTHESIA QUESTIONNAIRE: (TO BE COMPLETED BY THE PATIENT (POSSIBLY TOGETHER WITH THE GP))
Version No. 1.0 Valid from dec 2016 Document number DC 491 Unit Anaesthesia ANAESTHESIA QUESTIONNAIRE: (TO BE COMPLETED BY THE PATIENT (POSSIBLY TOGETHER WITH THE GP)) Together with your treating physician,
More informationChair Dental Anaesthesia
Dental Anaesthesia Dr E Rawlings Anaesthetic Directorate Chair Dental Anaesthesia Day Stay Surgery! Dental chair! Isolated site! Brief duration! Shared airway! Young children/nervous adults! Rapid recovery
More informationGuideline scope Hypertension in adults (update)
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Guideline scope Hypertension in adults (update) This guideline will update the NICE guideline on hypertension in adults (CG127). The guideline will be
More informationBIOP211 Pharmacology Tutorial Session 10 Drugs affecting the PNS
BIOP211 Pharmacology Tutorial Session 10 Drugs affecting the PNS Students problem-solve case studies of given drug scenarios affecting the peripheral nervous system Students continue to work on the Drug
More informationLESSON ASSIGNMENT Given the trade and/or generic name of an adrenergic blocking agent, classify that agent as either an alpha or beta blocker.
LESSON ASSIGNMENT LESSON 8 Adrenergic Blocking Agents. TEXT ASSIGNMENT Paragraphs 8-1 through 8-5. LESSON OBJECTIVES 8-1. Given a group of statements, select the statement that best describes one of the
More informationList of Qualifying Conditions
List of Qualifying Conditions Cancer Conditions 1) Adrenal cancer 2) Bladder cancer 3) Bone cancer all forms 4) Brain cancer 5) Breast cancer 6) Cervical cancer 7) Colon cancer 8) Colorectal cancer 9)
More information