Patient-controlled-anesthesia

Patients recovering from surgery can request that meperidine be administered through a system known as patient controlled anesthesia (PCA). This system allows a patient to administer his or her own medication in small doses. The machine has an electronic control... 

Medications Patient controlled anesthesia pump (PCA pump, separate order sheet)... 

Maurer K, Bonvini JM, Ekatodramis G, et al. Continuous spinal anesthesia/analgesia vs. single-shot spinal anesthesia with patient-controlled analgesia for elective hip arthroplasty. Acta Anaesthesiol Scand. 2003 47 878-883. 

Forty anxious day-case patients undergoing extraction of third molar teeth under local anesthesia with sedation, were studied in a randomized, double-blind, controlled trial (38). A target-controlled infusion of propofol was compared with patient-controlled propofol for sedation, combined with a small dose of intravenous midazolam (0.03 mg/kg) to improve amnesia. Five patients became over-sedated in the target-controlled group compared with none in the patient-controlled group. 

The client who has had an abdominal surgery has returned from the post-anesthesia care unit (PACU) with a patient-controlled analgesia (PCA) pump. Which intervention should the nurse implement ... 

Epidural anesthesia has been demonstrated to be an effective and acceptable alternative to opioid patient-controlled analgesia in many patients. However, the increased risks of hematoma in patients receiving anticoagulants have limited its use beyond the recovery period in these patients. 

Pain and hyperthermia at the injection site can be reduced by pre-administration neural blockade, and administration during general anesthesia. Ideally, Adlea may he applied to patients receiving anesthesia and post-operative analgesia with epidural and peripheral neural blockade catheters. Residual pain may be controlled with local application of ice packs, local anesthetic infiltration, and oral acetaminophen. 

Vicente KJ, Kada-Bekhaled K, Hillel G, Cassano A, Orser BA. (2003). Programming error contribute to death from patient-controlled analgesia Case report and estimate probability. Canadian Journal of Anesthesia 2003 50 328-32... 

A 27-year-old pregnant woman underwent cesarean section under epidural anesthesia and was given patient-controlled epidural analgesia, resulting in a total dose of 180 mg of pethidine over 9 hours she had a tonic-clonic seizure, thought to be secondary to a high CSF concentration of norpethidine [156 ]. 

Propofol (Diprivan) is used for induction and maintenance of anesthesia. It also may be used for sedation during diagnostic procedures and procedures that use a local anestiietic. This drug also is used for continuous sedation of intubated or respiratory-controlled patients in intensive care units. 

Promethazine Promethazine also is indicated for preoperative, postoperative, or obstetric sedation prevention and control of nausea and vomiting associated with certain types of anesthesia and surgery an adjunct to analgesics for control of postoperative pain sedation and relief of apprehension, and to produce light sleep antiemetic effect in postoperative patients active and prophylactic treatment of motion sickness (oral and rectal only). 

IV Relief of severe pain pain of Ml used preoperatively to sedate the patient and allay apprehension, facilitate anesthesia induction, and reduce anesthetic dosage control postoperative pain relieve anxiety and reduce left ventricular work by reducing preload pressure treatment of dyspnea associated with acute left ventricular failure and pulmonary edema produce anesthesia for open-heart surgery. 

Parenteral Immediately before induction of anesthesia, or postoperatively if the patient experiences nausea or vomiting shortly after surgery, administer 4 mg undiluted IV in not less than 30 seconds, preferably over 2 to 5 minutes. Alternatively, 4 mg undiluted may be administered IM as a single injection in adults. In patients who do not achieve adequate control, administration of a second IV dose of 4 mg ondansetron postoperatively does not provide additional control of nausea and vomiting. 

The most serious disadvantage to the use of ketamine is its propensity to evoke excitatory and hallucinatory phenomena as the patient emerges from anesthesia. Patients in the recovery period may be agitated, scream and cry, hallucinate, or experience vivid dreams. These episodes may be controlled to some extent by maintaining a quiet reassuring atmosphere in which the patient can awaken or if necessary by administering tran-quilizing doses of diazepam. 

The use of inhalational anesthetics is generally reserved for maintenance of anesthesia. The development of an anesthetic concentration in the brain occurs more slowly with inhalational anesthetics than with IV drugs. Once an anesthetic level has been achieved, however, it is easily adjusted by controlling the rate or concentration of gas delivery from the anesthesia machine. The rate of recovery from a lengthy procedure in which inhalational agents are used is reasonably rapid, since inhalational anesthetics are eliminated by the lungs and do not depend on a slow rate of metabolism for their tissue clearance. Thus, inhalational drugs meet the requirement for a relatively prompt return of the patient s psychomotor competence. 

Halothane (Fluothane) depresses respiratory function, leading to decreased tidal volume and an increased rate of ventilation. Since the increased rate does not adequately compensate for the decrease in tidal volume, minute ventilation will be reduced plasma PaCOz rises, and hypoxic drive is depressed. With surgical anesthesia, spontaneous ventilation is inadequate, and the patient s ventilation must be controlled. 

Fukusaki M et al Effects of controlled hypotension with sevoflurane anesthesia on hepatic function of surgical patients. Eur J Anaesthesiol 1999 16 111. [PMID 10101627]... 

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