icu anesthesiology intensive care operating room

1. Anesthesiology, Intensive Care
Medicine and Resuscitation
Roman Zahorec , MD, assoc. Prof.
Dpt. Anesthesiology and ICU
St. Elizabeths Cancer Institute

2. Dept. of Anesthesia and ICU
 Anesthesia in operating rooms and PACU
 Intensive Care Medicine – providing care
about critically ill patients in ICU
 Cardiopulmonary Resuscitation in-hospital
including BLS, ACLS.
 Analgesia – acute pain managment , consulting
invasive chronic pain managment
 www.fmed.uniba.sk

3. Anaesthesia
 Controlled and reversible maintainance of
unconsciousness , analgesia and muscle relaxation
induced by drugs for safe surgery
 Requires the administration of special drugs –
anesthetics , with beneficial effects on CNS –
analgesia, anaesthesia, while minimizing side
effects of surgery or toxicity.
 Anesthesia local - peripheral nerves anesthesia
 Anesthesia regional – spinal or epidural or perineur
 Anesthesia general – inhaled, i.ven, TIVA,
balanced an.

4. History of Modern Anaesthesia – 165 yrs anniv.
16. 10. 1846
Boston, MA
USA
William Thomas
Green Morton:
1. Successful
Anasesthesia
using Ether
„The hour of birth
of modern
Anaesthesia
Horace Wells
25. 1. 1845:
1. Anaethesia using
N2O
16. 10. 1846 Boston, MA, USA: William G. Morton

5. Mask of Schimmelbush – Inhaled Aether Anaesthesia

6. Old anaesthetic machine

7. Anesthesiologic
machine
Monitoring in
anaesthesia

8. Intensive Care medicine
 Is that section of health care specifically organized
for the managment of critically ill patients , who
have sustained or are at risk of an acute life-
threatening disorder (e.g. Acute failure of vital
functions, acute / sudden organ dysfunction ).
 It involves : specialized facilities, intensive care
units , trained staff providing appropriate care ,
intensive care specialist:
 Procedural skills, clinical skills, diagnostic skills.

9. ICU – specialized units
 A three level classification of ICU / pts
 ICU – surgical, medical, traumatic, burns, coronary
ICU, neonatal and pediatric ICU.
 DESIGN of ICU : large rooms, central station and
monitors, ICU beds, illumination and air-condition,
special equipments – infusion pumps, syringe
pumps, medicinal gases and ventilators.

10. Medical Education of Anaesthetist
 Knowledge - physiology, pathophysiology, clinical
pharmacology , clinical anesthesia
 Clinical experiences – years of practice
 Skills – clinical practice, procedures
 Communication – with patients, with relatives, with
colleagues , team work , together with attitudes,
ethical and legislative background.

11. ANAESTHESIA
Local anaesthesia
Regional anaesthesia – neuroaxial
(spinal , epidural, caudal) and
blocks of peripherals nerves plexus.
General anaesthesia: i.v., inhaled,
balanced anesthesia
Combined anesthesia: general +
regional anaesthesia.

12. General Anaesthesia
 Inhaled anaesthesia - vapour anaesthetics (Halotha,n,
Isofluran, Sevofluran, Defluran ) and gases ( N2O, Xe )
 Intravenous anaesthesia – intravenous drugs,
anaesthetics like opioids, propofol, thiopental, ketamine
 Balanced anaesthesia – clinical use of vapour /
inhaled and intravenous anaesthetics together.
 Combined anaesthesia – combination of
general and regional anaesthesia. Balanced
anaesthesia together with

13. Mechanism of general anaesthesia
 Decreased cerebral activity, decerebration –
lower activity of RAF.
 Inter- neuron synapses / blocking transmission –
general and/or inhaled anaesthetics.
Thalamocortical loops and thalamospinal
loops – central position of THALAMUS ..
 Receptor blocking – Blockade of specific brain
and spinal neuron receptors : nAch R , DOPA R,
GABA Receptors type A – benzodiazepins, IV anesth and
inhaled an., NMDA, AMPA , Opioid Rcp – μ-R , κ-R – potent
analgetics ( sufentanil, fentanyl, morphin ...)

14. Mechanism of local anesthetics
 Inhibition of spreading action potential in nervous
axons of spinal and peripheral neurons - blocking of
sodium current I/Na – blocking sodium channels - LOCAL
ANEST. and I/Ca2+ - blocking calcium channels
 Isomers of receptors and soluble proteins ... Stereoisomers
of anaestetics (thiopental, ketamin, ) , stereoisomers of
muscle relaxannts (atracurium, cis-atracurium)

15. Lumbal epidural anesthesia

16. Neuroaxial -Spinal anaesthesia

17. General / regional
Anaesthesia
 Loss of consciousness – controlled and reversible
state of unconsciousness and immobility.
 Loss of pain – analgesia
 Loss of muscle tone – immobility , muscle
relaxation
 Physiologic homeostasis – while maintaining
cardiovascular stability, stability of vegetative nervous
system and regulation, adequate exchange of blood gases,
aerobic metabolism, thermoregulation – and minimizing
effects of SURGICAL STRESS ... Perioperative
medicine !

18. Anesthesia – amnesia, hypnosis,
sedation, analgesia, immobility, muscle
relaxation, vegetative stability
(circulation, thermoregulation)
 Anesthetic consultation before surgery
 Anesthetic visit – evaluation of the clinical
status, anamnesis, comorbidity , clinical
examination – CHOICE of ANESTHESIA
 Pre-premedication, /day before surgery/
 Premedication (anxiolytics, hypnotics,
analgetics) before anesthesia for smooth
induction
 Diet , drug and fluid managment before G.A.

19. Anaesthesia – G.A. procedure
– 6 steps :
 1. Anestethetic consultation
 2. Premedication – 30- 45 - 60 minutes before G.A.
 3. INTRODUCTION to G.A, and to R.A.
 4. Maintenance of general Anaesthesia
 5. End of general anaesthesia – finishing
G.A. or weaning from G.A. - approx. 15-20
minutes before finishing surgery start to wean
 6. Post- anesthetic care - PACU (1- 6 hrs ) –
recovery from G.A. on Recovery rooms .

20. Advantages and disadvantages
of general anaesthesia