ANESTHESIA

INTRODUCTION DEFINITION: loss of sensation TYPES: General anesthesia

Retinol anesthesiaLocal anesthesia

Anesthesia may induce temporary loss of sensation or awareness

It may categorized as :- analgesia (relief from or prevention

of pain)  paralysis(muscle relaxation) amnesia (loss of memory)

or unconsciousness.

A patient under the effects of anesthetic drugs is referred to as being anesthetized.

General anesthesia suppresses central nervous system.

Regional anesthesia and local anesthesia, which block transmission of nerve impulses between a targeted part of the body.

MEDCINAL USESMAIN PURPOSE OF ANESTHESIA Hypnosis (temporary loss of

consciousness) Analgesia(lack of sensation) muscle relaxation

General anesthetics can affect all of the endpoints.

Whereas local/regional anesthetics affect  the endpoints differently.

OBJECTIVES OF ANESTHESIA Unconsciousness Amnesia Analgesia Oxygenation Ventilation Homeostatic Air management Reflex management Muscle relaxation monitoring

TREATMENT INTRAVENOUS DRUGS:- Thiopentone Propofol Others like:-

etomidate,benzodiazepines,ketamine.

INHALATIONAL DRUGS:- NITROUS OXIDE ISOFLURANE SEVOFLURANE DESFLURANE HALOTHANE

ANALGESIC CLASS:- Opiates Local anesthetics like:NSAIDS,

Paracetamol. Opiate analgesics

like:morphine,codeine. NSAIDS ANALGESIC:- Ibuprofen Diclofenac Cox-2 inhibitors

Muscle relaxant anesthesia drugs like:- Suxmethonium Tracurium LOCAL ANESTHESIA

ex:lignocaine,bupivacaine, prilocaine

ADVANTAGES OF LOCAL ANESTHESIA Effective alternative to general

anesthesia Avoids polypharmacy Allergic reactions Patient can remain awake

DISADVANTAGES OF LOCAL ANESTHESIA LIMITED SCOPE HIGHER FAILURE RATE RISK OF NEURAL INJURY

ANESTHESIA CODING In coding it classified as:- Spinal anesthesia Epidural anesthesia Nerve block anesthesia Time of anesthesia is calculated in units Each 15 minutes=I unit

TIME REPORT FOR ANESTHESIA Time starts from preparing the patient

for the induction of anesthesia in OP room and ends when the patient may be safely placed under postoperative supervision

Depending upon the type of services codes are listed in E/M services

special services are listed in medicine

Multiple procedures under single anesthetic administration code represents most complex procedure.

Range of anesthesia code 00100-01999 plus addition of physical state modifier.

The use of other optional modifiers may be appropriate

PHYSICAL STATUS MODIFIERS Based on (ASA) P1:a normal healthy patient P2 :a patient with mild systemic disease P3:a patient with severe systemic disease P4:a patient with severe systemic disease

that is a constant threat to life P5:a moribund(hospitalized)patient who is

not expected to survive without the operation

p6:a declared brain-dead patient whose organs are being removed for donor purposes

ANESTHESIA TERMINOLOGY AA: anesthesia given by anesthelogist. CRNA: certified registered nurse

anesthelogist SRNA:student registered nurse

anesthetist MAC:monitored anesthesia care AD:medical super vision by a physician

more than 4 concurrent anesthesia procedures

QK:medical direction of 2,3,or 4 concurrent anesthesia procedures.

QY:medical direction of 1 crna by anesthesiologist.

QX:crna service with medical direction by anesthesiologist

QZ:crna services without medical direction by anesthesiologist

QS:MAC services

G8: monitored anesthesia by deep complex, complicated(or)marketly invasive surgical procedure

G9:MAC for a patient who has the history of severe cardiopulmonary condition

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