Course Content
ANESTHESIA NOTES – ONLINE
No. Topic Key Focus Key Points 1 Analgesia, Sedation, and Paralysis ICU sedation and muscle relaxation Midazolam, propofol; muscle relaxants for ventilation; sedation monitoring 2 General Anesthesia Techniques for various surgical cases Pediatric, obstetric, dental anesthesia; neonatal considerations 3 NORA (Non-OR Anesthesia) Anesthesia outside the OR, e.g., MRI, RT Monitoring, sedation, emergency readiness 4 Tracheostomy Airway management in ICU Percutaneous vs. surgical tracheostomy; complications like bleeding and infection 5 ARDS and Ventilator Management Lung-protective ventilation strategies for ARDS Low tidal volume, PEEP, ECMO, prone positioning 6 VAP (Ventilator-Associated Pneumonia) ICU-acquired infection in ventilated patients Prevention bundle: head elevation, subglottic secretion drainage 7 Nosocomial Infections ICU infections like VAP, CAUTI, CLABSI Hand hygiene, device minimization, aseptic technique 8 Nutrition and Metabolomics Enteral and parenteral nutrition for critically ill TPN, electrolyte monitoring, refeeding syndrome 9 Fluid and Electrolyte Management Resuscitation and balance in ICU Hypovolemia, electrolyte balance, pediatric considerations 10 POCD (Postoperative Cognitive Dysfunction) Cognitive changes post-surgery Common in elderly; intraoperative depth monitoring and pre-op screening 11 PONV (Postoperative Nausea and Vomiting) Prevention and management of nausea/vomiting post-op Antiemetics, reduced opioids, TIVA, PONV risk factors 12 POVL (Postoperative Visual Loss) Vision loss risk in surgeries with prone position Intraoperative positioning, BP monitoring 13 Shock and Sepsis Systemic hypoperfusion and infection-induced shock Fluid resuscitation, vasopressors, early sepsis treatment 14 OP Poisoning Organophosphorus poisoning management Atropine, pralidoxime, respiratory support 15 Burns and Trauma Burn resuscitation and trauma management Parkland formula, airway management, wound care 16 Congenital Conditions (TOF, CDH, etc.) Pediatric surgical considerations Special monitoring, oxygenation, fluid balance 17 Fetal and Pediatric Anesthesia Anesthesia for neonates and fetal surgery Fetal circulation, caudal epidurals, airway management 18 Radiology Anesthesia Anesthesia for MRI, RT Sedation, MRI-compatible equipment, respiratory safety 19 Environmental Safety OT and ICU safety protocols Anesthetic gas control, cross-contamination prevention 20 Sterilization and Disinfection Hygiene in ICU and OR Equipment disinfection, reusable device handling 21 CPR, BLS, and ACLS Emergency response training CPR, rhythm recognition, medication in cardiac arrest 22 Temperature Regulation Managing hypothermia and hyperthermia Warming devices, monitoring intraoperative temperature 23 Tracheostomy Emergency airway access for long-term ventilation Percutaneous/surgical techniques, complications, infection control 24 Fluid Management Pediatric and adult resuscitation techniques 4-2-1 rule, electrolyte balance, hypovolemia management 25 Foreign Body Removal Anesthesia for pediatric foreign body removal Spontaneous ventilation, oxygenation, airway management 26 Gastroschisis Neonatal abdominal defect surgery Temperature control, fluid resuscitation, intra-abdominal pressure monitoring 27 Hydrocephalus Shunt procedure anesthesia in children ICP management, head size considerations, rapid sequence induction 28 IPPV (Intermittent Positive Pressure Ventilation) Mechanical ventilation strategy Alveolar ventilation, PEEP, ventilation-perfusion balance 29 Non-Invasive Ventilation (NIV) Respiratory support without intubation CPAP/BiPAP, reduced infection risk, monitoring for air leaks 30 Extracorporeal Support Therapies Hemodialysis, CRRT for renal support Electrolyte management, hemodynamic stability in ICU 31 Dental Anesthesia Sedation in complex dental cases Airway management, sedation protocols 32 Environment Extremes High-altitude, hypothermia management Hypoxia adaptation, hydration, hypothermia risk 33 CO Poisoning Carbon monoxide toxicity treatment 100% oxygen, hyperbaric therapy, neurological assessment 34 Complications in Long-Term Ventilation Risks from prolonged ICU mechanical ventilation Ventilator-associated pneumonia, respiratory muscle atrophy 35 NORA (Non-Operating Room Anesthesia) Safety and protocol for anesthesia outside the OR Preparedness, monitoring, emergency protocol 36 PACU (Post-Anesthesia Care Unit) Recovery and monitoring post-anesthesia Pain management, extubation readiness, respiratory monitoring 37 Sterilization and Disinfection OR and ICU infection prevention protocols Equipment sterilization, hygiene practices 38 Temperature Control Preventing perioperative hypothermia Warming devices, ambient temperature regulation 39 POCD Postoperative cognitive decline prevention and management Cognitive screening, anesthesia depth control 40 Inguinal Hernia Pediatric anesthesia for hernia repair Lower dose anesthesia, pain management 41 VAP Bundle ICU protocol for ventilator-associated pneumonia prevention Head elevation, subglottic secretion, chlorhexidine oral care 42 Environmental Hazards Operating theater safety Gas scavenging, hygiene, infection control 43 Cardiac Resuscitation Cardiac life support and emergency care CPR, defibrillation, airway management 44 ICU Nutrition Metabolic and nutritional support TPN, enteral feeding, metabolic monitoring 45 Obstetric Anesthesia Anesthesia management for cesarean and labor Fetal monitoring, uterine relaxation 46 Paracetamol Toxicity Toxicity management in overdose cases Liver protection, NAC administration, glucose monitoring 47 Temperature Extremes Control in extreme hot/cold environments Hypothermia/hyperthermia prevention, warming/cooling devices 48 Sedation in RT Imaging anesthesia and sedation for radiology procedures MRI-safe monitoring, sedation levels, airway management 49 Respiratory Distress Pediatric and adult respiratory distress protocols Oxygenation, airway support, mechanical ventilation 50 Fetal Anesthesia Anesthesia considerations for fetal surgery Uterine relaxation, fetal monitoring 51 Blood and Transfusion Therapy Blood products in ICU management Transfusion protocols, blood monitoring 52 Pediatric Emergency Pediatric life support and emergency protocols Age-specific resuscitation, airway support
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Analgesia, Sedation, and Paralysis (Free Read)
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General Anesthesia (Free Read)
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NORA (Non-OR Anesthesia) (Free Read)
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Tracheostomy
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ARDS and Ventilator Management
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VAP (Ventilator-Associated Pneumonia)
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Nosocomial Infections
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Nutrition and Metabolomics
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Fluid and Electrolyte Management
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POCD (Postoperative Cognitive Dysfunction)
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PONV (Postoperative Nausea and Vomiting)
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POVL (Postoperative Visual Loss)
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Shock and Sepsis
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OP Poisoning
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Burns and Trauma
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TOF
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Fetal and Pediatric Anesthesia
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Radiology Anesthesia (RD & RT)
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Environmental Safety
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Sterilization and Disinfection
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CPR, BLS, and ACLS
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Temperature Regulation
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Tracheostomy
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Fluid Management
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Foreign Body Removal
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Gastroschisis
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Hydrocephalus
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IPPV (Intermittent Positive Pressure Ventilation)
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Non-Invasive Ventilation (NIV)
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Extracorporeal Support Therapies
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Dental Anesthesia
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Environment Extremes
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CO Poisoning
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Complications in Long-Term Ventilation
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NORA (Non-Operating Room Anesthesia)
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PACU (Post-Anesthesia Care Unit)
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Sterilization and Disinfection
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POCD
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Paracetamol Poisoning
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Inguinal Hernia
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Respiratory Care
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Fetal Anesthesia
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ANESTHESIA NOTES

Analgesia, Sedation, and Paralysis

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Analgesia, Sedation, and Paralysis in Critical Care

  1. Purpose and Overview

    • In critically ill and ventilated patients, managing pain (analgesia), ensuring comfort (sedation), and controlling muscle activity (paralysis) are essential to maintain stability and improve outcomes.
    • These interventions reduce oxygen consumption, prevent patient-ventilator asynchrony, control agitation, and facilitate therapeutic and procedural needs, such as mechanical ventilation.

  2. Analgesia

    • Common Agents: Opioids like fentanyl and morphine are primary analgesics used due to their fast onset and potency.
    • Non-Opioid Alternatives: Include acetaminophen, ketamine (for multimodal analgesia), and non-steroidal anti-inflammatory drugs (NSAIDs), which may help reduce opioid requirements.
    • Monitoring: Pain levels are regularly assessed using tools such as the Behavioral Pain Scale (BPS) or the Critical-Care Pain Observation Tool (CPOT) to avoid both under- and over-sedation.

  3. Sedation

    • Primary Agents: Propofol, dexmedetomidine, and benzodiazepines like midazolam are commonly used for sedation in the ICU.
    • Sedation Goals: The goal is often light to moderate sedation to balance patient comfort with the ability to respond to commands. The Richmond Agitation-Sedation Scale (RASS) or Sedation-Agitation Scale (SAS) is used to target and monitor sedation depth.
    • Daily Interruption: Sedation is often paused daily (sedation vacations) to assess neurological function, reduce the duration of mechanical ventilation, and prevent long-term cognitive effects.

  4. Paralysis (Neuromuscular Blockade)

    • Indications: Neuromuscular blocking agents (NMBAs) like cisatracurium and rocuronium are used for short-term muscle relaxation during intubation, to reduce oxygen consumption, and to prevent movement in severely hypoxemic patients.
    • Continuous Infusion vs. Bolus: Continuous infusions of NMBAs may be used for longer periods, though regular monitoring is essential to minimize complications like muscle weakness.
    • Monitoring: Train-of-Four (TOF) monitoring ensures appropriate blockade levels, avoiding excessive paralysis.

  5. Complications and Monitoring

    • Risk of Over-Sedation: Can lead to prolonged mechanical ventilation, increased ICU stay, and delayed recovery. Careful titration and regular assessment are essential.
    • Delirium and Cognitive Dysfunction: Benzodiazepines have been associated with delirium; dexmedetomidine and propofol may be preferred for their shorter duration of action and lower risk.
    • Long-Term Effects: Overuse of sedation and muscle relaxants can lead to ICU-acquired weakness and long-term cognitive dysfunction.

  6. Weaning and Post-ICU Care

    • Patients are gradually weaned off sedatives and NMBAs as they stabilize. Effective weaning involves assessing respiratory and neurological function, ensuring pain and anxiety are controlled with lighter sedation or non-opioid analgesia.
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