behind closed doors - memberclicks
TRANSCRIPT
“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.
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“Behind Closed Doors – What Happens in the OR?”
James T. Arscott, DO
POMA District 4 3rd Annual Mid-Winter Symposium
February 23, 2019
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“Behind Closed Doors – What Happens in the OR?”
James T. Arscott, DO
POMA District 4 3rd Annual Mid-Winter Symposium
February 23, 2019
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“Behind Closed Doors – What Happens in the OR?”
James T. Arscott, DO
POMA District 4 3rd Annual Mid-Winter Symposium
February 23, 2019
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“Behind Closed Doors – What Happens in the OR?”
James T. Arscott, DO
POMA District 4 3rd Annual Mid-Winter Symposium
February 23, 2019
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“Behind Closed Doors – What Happens in the OR?”
James T. Arscott, DO
POMA District 4 3rd Annual Mid-Winter Symposium
February 23, 2019
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“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
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“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
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“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
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“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
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“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
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“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
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“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
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“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…
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