A Neurosurgical Operation - UHNResearch

A Neurosurgical Operation - UHNResearch

A Neurosurgical Operation A neurosurgical operation has several stages Induction of Anesthesia Line Insertion Local anesthesia Induction General anesthesia

Maintenance of anesthesia Initiation of Neuromonitoring The Operation Termination of Anesthesia Line Insertion Local Anesthesia Insertion of an

arterial line for blood pressure monitoring Lidocaine HCL Local Anesthesia Erythroxylon coca, a shrub growing high in the Andes mountains appreciated for centuries by the Peruvian people.

The plant ash releases an alkaloid in a form that can be absorbed across mucous membranes. The pure alkaloid of cocaine was isolated in 1880. In 1884, cocaine was used clinically as a local anesthetic in ophthalmology, dentistry, and surgery. In 1905, the first synthetic local anesthetic, procaine, was developed.

Local Anesthesia There are currently 16 chemical agents used in local anesthesia; lidocaine, bupivacaine, and tetracaine are the most commonly used in clinical practice. Local anesthetics are used to decrease pain, temperature, touch proprioception, and skeletal

muscle tone. Used in a variety of clinical situations, from topical application to the skin or mucosa membranes to injectable agents used for peripheral, central, or spinal nerve block. Lidocaine a local

anesthetic All local anesthetics reversibly block nerve conduction by decreasing nerve membrane permeability to sodium.

This decreases the rate of membrane depolarization, thereby increasing the threshold for Lidocaine a local anesthetic

All nerve fibers are affected, albeit in a predictable sequence: autonomic, sensory, motor. These effects diminish in reverse

order. Why we have to learn about axons, ion channels & how they work 1. Local anesthetics: an everyday example used in a variety of medical disciplines 2. Axons are the prototypical nerve fiber. Knowing

how they work facilitates an understanding of much of neuroscience. 3. Axons are involved in a range of very common medical diseases that you will all see. 4. It will be on the exam. Well get back to the operation

Once we can get the arterial line into the patient without them jumping off the table. Anatomy of the axon Anatomy of the axon

Axons behave very differently from dendrites In Health (their physiological role) And in Disease (their pathological response) Axon

Anatomy Axons are cables composed of a tube surrounded by a cell membrane +/insulation (myelin). From:

Li S, Mealing GA, Morley P, Stys PK J Neurosci 1999 Jul 15;19(14):RC16 Axon Anatomy The tubes of large axons are wrapped with myelin

Axon Anatomy Myelin is produced by oligodendrocytes Axon Anatomy Myelination:

Axon Anatomy The tube contains A cytoskeleton used for - Transporting stuff (axoplasmic transport) - Maintaining structure - Trafficking and anchoring

cytoplasmic and cell membrane components. Organelles, and the stuff being transported (proteins, neurotransmitters, etc) Axoplasmic transport -Axonal transport controls the distribution of membranes and

secretory proteins in the neuron -Transport is anterograde and retrograde -Both anterograde and retrograde transport have fast and slow components.

Fast transport Fast anterograde transport depends on microtubules & MT-associated ATPases (kinesins) that move large components (e.g., organelles) at high rates > 100mm / day Other transport: Slow anterograde transport serves to

move smaller elements such as cytoskeletal and other proteins at 0.2-5 mm/day Fast retrograde transport moves at to 2/3 the rate of fast anterograde transport. Serves to recycle large elements back to the cell soma, and also to inform the body about whats happening at the other end (e.g., retrograde transport of hormones,

and other signaling molecules) Axon Anatomy- The Node Axon Anatomy >Physiology More About the tube: The tube & its membrane contain

- The Cytoskeleton - Organelles - Ion Channels - Ion Exchangers/Transporters - Neurotransmitter Exchangers/ Transporters - Enzymes

To Understand How the Axon Works, we need to understand: 1. Ion Channels 2. Concepts of Diffusion 3. Basic Concepts of Electicity 4. How to Put 1-3 Together

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