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ANAESTHESIA
DR. SHAH SUDHIRCHANDRAM.D., D.A.(ANAESTHESIA)
ANAESTHESIA
1. General Anaesthesia (G.A.)2. Regional Anaesthesia (R.A.)
GENERAL ANAESTHESIA
Reversible loss of consciousness accompanied by analgesia, hypnosis and loss of reflexes with or without muscle relaxation
1. Spontaneous breathing2. Controlled ventilation
REGIONAL ANAESTHESIA
Only a part of the body is anaesthetised
Types1. Central blocks2. Peripheral blocks
CENTRAL BLOCK
1. Spinal Analgesia2. Epidural Analgesia3. 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
ANATOMY SPINAL CORD
Spinal cord is covered by 3 membranes1. Pia2. Arachnoid3. Dura
PERIPHERAL BLOCKS
1. Surface anaesthsia – EMLA cream2. Infiltration block – subcut. tissue3. Nerve blocks4. 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 blocksA. Sciatic nerve blockB. Femoral nerve blockC. Popliteal blockD. Ankle blockE. Digital nerve block
NERVE BLOCKS
3. Peribulbar block – eye operations
Cataract surgery4. Penile block – circumcision5. Dental block – tooth extraction
PREOPERATIVE CHECKUP
HistoryPrevious operationDiseases
Hypertension, diabetes, asthma and heart diseasesMedicationsAllergy
PREOPERATIVE CHECKUP
General examination Pulse, B/P, colour and temp.
Systemic exam CVS and Resp. system exam.
Investigations Hb, electrolytes, ECG and x ray chest
American Society of Anaesthesiologist (ASA) grading of patient for risk of anaesthesia (1 to 6)Patient information about type of anaesthesia and its complicationsConsent
PREMEDICATION
PremedicationPethidine 1 mg/kg I.M.Maxalon 0.2 mg/kg I.M.Syrup vellargan 3 mg/kg orallyRanitidine ( Zantac) 150 mg orallyDiazepam 5 to 10 mg at night on previous day
General anaesthesia
Cannulation 22 to 24 G cannula in children 20 to 18 G cannula for adult
I/V fluids 5% D/S or hartman soln. Gelafusin soln. Blood
GENERAL ANAESTHESIA
Preoxygenation for 3 min. Induction
Fentanyl 1 mcg/kgPropofol 2 to 3 mg/kg
Soya bean and egg phosphide solvent Intubation
Tracrium 0.5 mg/kg muscle relaxant or
Scoline 2 mg/kg for emergency cases as rapid onset of action
GENRAL ANAESTHSIA
Intubation with endotracheal tube or L.M.A. inserted or holding face maskE.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 menL.M.A. size 3 for femaleL.M.A. size 1, 1.5, 2, 2.5 for
children Insertion technique
Advantages of lma
1. Supraglottic device - no irritation of larynx2. Easy to insert3. Laryngoscope is not necessary – blind intubation4. Awake insertion possible5. Life saving for difficult intubation6. E.T tube can be passed through LMA7. Tolerated at lighter plane of anaesthesia
MAINTENANCE
O2 (40%) + N2O (60%) + Isoflurane (1%)Spontaneous breathing or controlled ventilationTracrium and Fentanyl are repeated every 30 min.Continuous monitoring
monitoring
Continuous monitoring• 1. Electrocardiogram (E.C.G.)
2. SPO2 Saturation of Hb – normal 97%
3. End tidal CO24. Blood pressure
Systolic, diastolic and mean pressure every
5 min.5. Temperature - warming matress
reversal
Reversal of relaxant drug Tracrium at the end of operationN2O and Isoflurane are stoppedOnly O2 given to the patientNeostigmine 2.5 mg + atropine 1 mgOral suctionExtubation only when patient conscious and coughingO2 by face maskMonitoring of vital signsShifted to recovery room when vital signs are stable
RECOVERY
O2 by face maskMonitoring SPO2, B/P and ECGWarming blanketTreat any complicationsNausea/ vomiting – maxalon or zofranAdequate pain relief I/V Fentanyl or I/M PethidineAldrete scoring systemShifted to ward when vital signs are stable
SPINAL ANALGESIA
Local anaestheticsLignocaine 1% 2 ml for L.A. at L2-3 interspaceMarcaine (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 needleSpinal cord 45 cm long3 covering membranesDura, arachnoid and pia membranesCerebro spinal fluid (C.S.F.)
is in subarachnoid space
Spinal analgesia
Complications1. Hypotension
Fluids, ephedrine 6 mg2. Shivering
Warming blanket, Pethidine 25 mg, O23. Nausea, vomiting
Maxalon, Zofran4. Respiratory depression
Spinal analgesia
5. Headache – C.S.F. loss6. 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 operationCatheter is inserted thro’ the needle upto 8 to 9 cm at skin levelNeedle is removed and catheter is fixed to the back of the patinet
Epidural- Catheter
EPIDURAL ANALGESIA
Complications1. Total spinal2. Hypotension3. Nausea and vomiting4. Patchy analgesia5. Headache6. Epidural abcess7. Backache
CAUDAL BLOCK
21 G needle is inserted into thro’ sacral haitus15 TO 20 ml .25% marcaine injectedLower abdominal surgeryChildren 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. Piriton 10 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 anaesthesia2. Selection of patient for anesthesia is very important2. Monitoring and safe anesthesia are vital throughout
anesthesia 4. Adequate recovery of patient before sending to
ward
Any q???
THANK YOU