ANAESTHESIA

DR.RAHUL M. KONDEKAR

ASSOCIATE PROF.

DEPT. OF SHALYATANTRA

SRIGANGANAGAR AYURVEDIC

COLLEGE & HOSPITAL

ANAESTHESIA

1. General Anaesthesia (G.A.)

2. Regional Anaesthesia (R.A.)

GENERAL ANAESTHESIA

Defination :

Reversible loss of consciousness accompanied by

analgesia, hypnosis and loss of reflexes with or

without muscle relaxation

Subtypes :

1. Spontaneous breathing

2. Controlled ventilation

REGIONAL ANAESTHESIA

Only a part of the body is anaesthetised

Types

1. Central blocks

2. Peripheral blocks

CENTRAL BLOCK

1. Spinal Analgesia

2. Epidural Analgesia

3. Caudal Analgesia

ANATOMY

VERTEBRAL COLUMN

Spinal cord is protected by

vertebral column 33 vertebrae

4 spinal curves

Cervical 7

Thoracic 12

Lumber 5

Sacral 5

Coccygeal 4

Total 33

PERIPHERAL BLOCKS

1. Surface anaesthsia – LA cream

2. Infiltration block – subcut. tissue

3. Nerve blocks

4. Field block - Inguinal field block

NERVE BLOCKS

1. Upper extremity blocks

A Supraclavicular block

B Axillary block

C Elbow block

D Wrist block

E Digital block

NERVE BLOCKS

2. Lower extremity blocks

A. Sciatic nerve block

B. Femoral nerve block

C. Popliteal block

D. Ankle block

E. Digital nerve block

NERVE BLOCKS

3. Peribulbar block – eye operations

Cataract surgery

4. Penile block – circumcision

5. Dental block – tooth extraction

PREOPERATIVE CHECKUP

History

• Previous operation

• Diseases

Hypertension, diabetes, asthma and heart

diseases

• Medications

• Allergy

PREOPERATIVE CHECKUP

General examination

Pulse, B/P and temp.

Systemic exam

CVS and Resp. system exam.

Investigations

CBC, electrolytes, ECG and x ray chest,HIV,HbsAg,2D-Echo,Sr.Creatnine

Patient information about type of anaesthesia and its complications

Consent…..Most important

PREMEDICATION

Premedication ??????

1) To reduce the stress

2) For good outcome of surgery

3) Less anaesthetic drug requirement

4) Lesser intra-op complications

5) Post-op complications are reduced

GENERAL ANAESTHESIA

Cannulation

22 to 24 G cannula in children

20 to 18 G cannula for adult

I/V fluids

5% D/DNS/RL.

Haemacel soln.(Volume Expander)

Blood

GENERAL ANAESTHESIA

• Preoxygenation for 3 min.

Induction

• Fentanyl 1 mcg/kg

• Propofol 2 to 3 mg/kg

Intubation

• Tracrium 0.5 mg/kg muscle relaxant

or

• Scoline 2 mg/kg for emergency cases as rapid onset of action

GENERAL ANAESTHSIA

• Intubation with endotracheal tube

orLMA(laryngeal mask) or holding face mask

• E.T tube

Size 8 to 8.5 mm for men

Size 7 to 7.5 mm for female

Children Age/4 + 4 mm

INTUBATION

LARYNGEAL MASK

• L.M.A. size 4 for men

• L.M.A. size 3 for female

• L.M.A. size 1, 1.5, 2, 2.5 for

children

Insertion technique

ADVANTAGES OF LMA

1. Supraglottic device - no irritation of larynx

2. Easy to insert

3. Laryngoscope is not necessary – blind

intubation

4. Awake insertion possible

5. Life saving for difficult intubation

6. E.T tube can be passed through LMA

7. Tolerated at lighter plane of anaesthesia

MONITORING

Continuous monitoring

• 1. Electrocardiogram (E.C.G.)

• 2. SPO2

Saturation of Hb – normal 97%

• 3. End tidal CO2

• 4. Blood pressure

Systolic, diastolic and mean pressure every

5 min.

5. Temperature - warming matress

REVERSAL

• Reversal of relaxant drug Tracrium at the end of operation

• N2O and Isoflurane are stopped

• Only O2 given to the patient

Neostigmine 2.5 mg + atropine 1 mg

Oral suction

Extubation only when patient conscious and coughing

O2 by face mask

Monitoring of vital signs

Shifted to recovery room when vital signs are stable

RECOVERY

• O2 by face mask

• Monitoring SPO2, B/P and ECG

• Warming blanket

• Treat any complications

• Nausea/ vomiting – maxalon or zofran

• Adequate pain relief

• I/V Fentanyl or I/M Pethidine

• Aldrete scoring system

• Shifted to ward when vital signs are stable

SPINAL ANALGESIA

• Local anaesthetics

• Lignocaine 1% 2 ml for L.A. at L2-3 interspace

• Marcaine (Bupivacaine) 0.5% 2to 2.5 ml with fentanyl 25 mcg

Autonomic, sensory and motor nerve block upto T6-8 level

Duration 3 to 4 hours

SPINAL ANALGESIA

• Spinal needle – 25 G

pencil point needle

• Spinal cord 45 cm long

• 3 covering membranes

• Dura, arachnoid and pia

membranes

• Cerebro spinal fluid

(C.S.F.) is in

subarachnoid space

SPINAL ANALGESIA

Complications

• 1. Hypotension

Fluids, ephedrine 6 mg

• 2. Shivering

Warming blanket, Pethidine 25 mg, O2

• 3. Nausea, vomiting

Inj.Ondem

4. Respiratory depression – O2 inhalation

5. Headache – C.S.F. loss

6. Backache

ANATOMY OF EPIDURAL SPACE

EPIDURAL ANALGESIA

EPIDURAL ANALGESIA

• 18-16 G Touhy needle

inserted into epidural

space at any level

depending on site or

operation

• Catheter is inserted thro’

the needle upto 8 to 9 cm

at skin level

• Needle is removed and

catheter is fixed to the

back of the patient.

EPIDURAL- CATHETER

EPIDURAL ANALGESIA

Complications

• 1. Total spinal

• 2. Hypotension

• 3. Nausea and

vomiting

• 4. Patchy analgesia

• 5. Headache

• 6. Epidural abcess

• 7. Backache

CAUDAL BLOCK

• 21 G needle is inserted into thro’ sacral

haitus

• 15 TO 20 ml .25% marcaine injected

• Lower abdominal surgery

• Children for postop pain relief

Herniotomy, circumcision

EMERGENCY DRUGS

• 1. Atropine

Bradycardia pulse less than 50/min

2. Adrenaline

Cardiac arrest, allergy

3. Ephedrine 6 to 9 mg

low blood pressure

4. Labetolol 3 to 5 mg

Low blood pressure

EMERGENCY DRUGS

• 5. Hydrallazine

High blood pressure

• 6. Avil10 mg

Allergy

• 7. Dopamine, dobutamine

To increase blood pressure and cardiac

output

8. Hydrocortisone

Allergy

EMERGENCY DRUGS

• 9. Narcan

To reverse overdose of narcotics

• 10. Maxalon 10 mg

Nausea and vomiting

• 11. Zofran

Nausea and vomiting

SUMMARY

• 1. General and regional anaesthesia

• 2. Selection of patient for anesthesia is very important

• 2. Monitoring and safe anesthesia are vital throughout

anesthesia

4. Adequate recovery of patient before sending to

ward

ANY QUESTIONS???

• THANK YOU