Often ,students of medicine,nurses,friends and acquintances ask me how an anesthetic procedure is selected for a particular surgery. Some cases we give sub arachnoid block ,in some an epidural , general anesthesia in some while we prefer local anesthesia in some.

WHY…?. There are certain guide lines which are

considered before deciding the type of anesthesia to administer.

1)The Patient 2)The Surgery 3)Available Facilities 4)The Surgeon 5)Self Assessment

The patient is the first and foremost to be considered before choosing the anesthetic procedure.

1)Age 2)Sex 3)Associated medical problems 4)Other considerations

Children under 5 years are never considered for local or regional blocks. General anesthesia is the ideal method.

Children between 5 to15 are not considered for regional blocks by many anesthetists as they are more apprehensive and do not coperate.Fear and anxiety are more .

In elderly people physiological changes like emphysema ,atherosclerosis and general debility are against choosing GA.At the same time s..a.b also has certain restraints like hypertension,IHD,calcifide ligaments etc.,An epidural bloc is preferred, even for upper abdominal surgery.

Though sex is not as important as the age, the female patient is more apprehensive and nervous. Indian female is more modest and shy. In such persons it is better to administer GA.

Cardio vascular diseases like HTN,IHD,CCF,Congenital heart problems etc., we have to weigh the individual cases .

DM,Hyper/Hypo Thyroidism and other endocrinal/metabolic disorders to be considered before deciding the plan of anesthesia .

Respiratory disorders like COPD,Emphysema are better done under regional blocs than GA.,

Renal disorders are also better done under GA., Spinal is contra indicated in shock

The type of surgery is of foremost importance before deciding the anesthetic procedure. In surgeries involving head,neck,thorax and upper abdomen there is no alternative but GA.

Upper limb surgeries can be managed under regional(Brachial)bloc provided the duration of surgery is under two hours. Lower limb/lower abdomen/perennial surgeries can be done under either sab or epidural bloc. Upper abdominal surgeries like epigastric hernia repair can be done under epidural .The advantage of epidural is we can top up ,if required to prolong the duration by keeping an epidural catheter –in-situ.

We always have to consider the available facilities, support and assisting staff while undertaking anesthesia and surgery.

a)whether a proper anesthesia machine in working condition available,

B)whether sufficient gases, nitrous and oxygen available,

Whether you are alone or working in a team, If trained technical staff available, What are the monitoring facilities available. Remember we cannot take up an abdominal

surgery in CT unit and vice versa.

Anesthetist should always consider the surgeon, fresh or experienced, is he fast or slow, irritable and grumbling or calm and cooperative. We choose an anesthetic depending on the attitude of the surgeon and it makes a lot of difference.

Before taking up a case for anesthesia ,one should always assess his/her competency to administer anesthesia and manage the complications, if required. Our experience and temperament should be assessed without inhibition or ego.