Download File

ANAESTHESIA
DR. SHAH SUDHIRCHANDRA
M.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 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
Cervical
7
Thoracic
12
Lumber
5
Sacral
5
Coccygeal
4
Total
33
4 spinal curves
ANATOMY
SPINAL CORD
Spinal cord is covered
by 3 membranes
1. Pia
2. Arachnoid
3. Dura
PERIPHERAL BLOCKS
1. Surface anaesthsia – EMLA 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, 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 complications
Consent
PREMEDICATION
Premedication
Pethidine 1 mg/kg I.M.
Maxalon 0.2 mg/kg I.M.
Syrup vellargan 3 mg/kg orally
Ranitidine ( Zantac) 150 mg orally
Diazepam 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/kg
Propofol 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 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
MAINTENANCE
O2 (40%) + N2O (60%) + Isoflurane (1%)
Spontaneous breathing or controlled
ventilation
Tracrium 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 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
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
Maxalon, Zofran
4. Respiratory depression
Spinal analgesia
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 patinet
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
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 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 q???
THANK YOU