Upload
others
View
3
Download
0
Embed Size (px)
Citation preview
“Behind Closed Doors – What Happens in the OR?”
James T. Arscott, DO
POMA District 4 3rd Annual Mid-Winter Symposium
February 23, 2019
BEHIND CLOSED DOORSWhat happens in the O.R.?
James T. Arscott, DO
Disclosures
No financial conflicts to disclose.
1
2
3
“Behind Closed Doors – What Happens in the OR?”
James T. Arscott, DO
POMA District 4 3rd Annual Mid-Winter Symposium
February 23, 2019
4
5
6
“Behind Closed Doors – What Happens in the OR?”
James T. Arscott, DO
POMA District 4 3rd Annual Mid-Winter Symposium
February 23, 2019
7
8
9
“Behind Closed Doors – What Happens in the OR?”
James T. Arscott, DO
POMA District 4 3rd Annual Mid-Winter Symposium
February 23, 2019
10
11
12
“Behind Closed Doors – What Happens in the OR?”
James T. Arscott, DO
POMA District 4 3rd Annual Mid-Winter Symposium
February 23, 2019
13
14
15
“Behind Closed Doors – What Happens in the OR?”
James T. Arscott, DO
POMA District 4 3rd Annual Mid-Winter Symposium
February 23, 2019
16
17
18
“Behind Closed Doors – What Happens in the OR?”
James T. Arscott, DO
POMA District 4 3rd Annual Mid-Winter Symposium
February 23, 2019
BALANCED GENERAL ANESTHETIC
• Most common anesthetic
• Components:
– Induction agent
– Maintenance agent
• Inhaled anesthetics
• Opiod agents
– Neuromusclular blocking agent
– Reversal agents
BALANCED GENERAL ANESTHETIC
• Oxygenation and Ventilation
– spontaneous
– controlled
• Airway Management
– Endotracheal intubation
– Laryngeal mask airway
– Mask ventilation
BALANCED GENERAL ANESTHETIC
19
20
21
“Behind Closed Doors – What Happens in the OR?”
James T. Arscott, DO
POMA District 4 3rd Annual Mid-Winter Symposium
February 23, 2019
BALANCED GENERAL ANESTHETIC
BALANCED GENERAL ANESTHETIC
BALANCED GENERAL ANESTHETIC
22
23
24
“Behind Closed Doors – What Happens in the OR?”
James T. Arscott, DO
POMA District 4 3rd Annual Mid-Winter Symposium
February 23, 2019
TOTAL INTRAVENOUS ANESTHETIC
• TIVA
– Induction agent
– Maintenance agent
• Continuous propofol
• Continuous remifentanil
• Neurophysiologic Monitoring
• Strong History of PONV
• Office Anesthesia
NEURAXIAL ANESTHESIA
NEURAXIAL ANESTHESIA
25
26
27
“Behind Closed Doors – What Happens in the OR?”
James T. Arscott, DO
POMA District 4 3rd Annual Mid-Winter Symposium
February 23, 2019
ERAS
• Enhanced Recovery After Surgery
– Shortens hospital stay
– Reduces post-op complication rate
– Started with colo-rectal surgery cases
• Orthopedics
• Ob/Gyn
• Neurosurgery
• The fryer station at MacDonalds
ACUTE PAIN CONTROL
• Preoperative or Postoperative Regional Blocks
– Reduce opiate consumption
– Better quality pain relief
– Extended duration of pain relief
ACUTE PAIN CONTROL
• Common Blocks
– Interscalene block
– Supraclavicular block
– Axillary block
– Femoral n and fascia iliaca blocks
– Adductor canal (saphenous nerve) block
– Popliteal sciatic nerve block
– TAP and Rectus Sheath blocks
28
29
30
“Behind Closed Doors – What Happens in the OR?”
James T. Arscott, DO
POMA District 4 3rd Annual Mid-Winter Symposium
February 23, 2019
ULTRASOUND GUIDED BLOCKS
INTERSCALENE BLOCK
INTERSCALENE BLOCK
31
32
33
“Behind Closed Doors – What Happens in the OR?”
James T. Arscott, DO
POMA District 4 3rd Annual Mid-Winter Symposium
February 23, 2019
ADDUCTOR CANAL ANATOMY
ADDUCTOR CANAL BLOCK
LATERAL POPLITEAL SCIATIC BLOCK
34
35
36
“Behind Closed Doors – What Happens in the OR?”
James T. Arscott, DO
POMA District 4 3rd Annual Mid-Winter Symposium
February 23, 2019
TAP BLOCK
RECTUS SHEATH BLOCK
SPECIAL POPULATIONS
Patients with Chronic Painopiate debtmultimode treatment approachshort-acting rescue opiate
Patients with Substance Use Disorderagonist/partial agonist/antagonistDO NOT STOP SUBOXONEmultimode treatment approachRescue with short-acting opiate
37
38
39
“Behind Closed Doors – What Happens in the OR?”
James T. Arscott, DO
POMA District 4 3rd Annual Mid-Winter Symposium
February 23, 2019
THE END
Or is it…
40