Conduct of Anaesthesia

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PRACTICAL CONDUCT OF ANAESTHESIA DR ANIRBAN PAL Assistant professor Dept of Anaesthesia CNMC, Kolkata, India

Transcript of Conduct of Anaesthesia

Page 1: Conduct of Anaesthesia

PRACTICAL CONDUCT OF ANAESTHESIA

DR ANIRBAN PAL Assistant professor

Dept of Anaesthesia CNMC, Kolkata, India

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• PRE OPERATIVE CONSIDERATIONS

• INTRA OPERATIVE CONSIDERATIONS

• POST OPERATIVE CONSIDERATIONS

Conduct of anaesthesia

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PRE OPERATIVE CONSIDERATIONS

• Pre anaesthetic assessment

a) History

b) Physical examination

airway assessment

examination of spine

c) Investigations

ASA grading• Pre operative preparation Optimization of co-morbid conditions

• Consent

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PRE ANAESTHETIC ASSESSMENT

• SPECIFIC OBJECTIVES1. To establish a doctor-patient relationship2. To allay patient anxiety3. To become familiar with co-existing

medical condition4. To formulate anaesthetic plan5. To obtain informed consent

• Overall goal is to reduce peri-operative morbidity and mortality

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HISTORY

• Review Surgical illness

• Co existing medical illness

• Medications

• Allergies and drug reaction

• Previous anaesthetic history

• Relevant family history

• Addiction

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PHYSICAL EXAMINATION

• Vital signs• Cardiovascular system• Respiratory system• Other systems ( CNS, abdomen, extremities)

• Assessment of airway• Examination of spine• ASA physical status

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INVESTIGATIONS

• ROUTINE– Complete haemogram– Sugar, urea, creatinine– ECG– Chest Xray

• SPECIAL– Serum electrolytes– Coagulation studies– LFT– Thyroid profile– Miscellaneous

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PREOPERATIVE PREPARATION

• Optimization of co-morbid conditions– Cardiovascular diseases– Respiratory disease– Endocrine diseases

• Aspiration prophylaxis

• Sedative and analgesic

• Anti-cholinergics

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INTRA OPERATIVE CONSIDERATIONS

• Checking of anaesthesia machine and equipments

• Securing IV lines• Attach the monitors• Selection of anaesthetic technique• Induction• Intubation • Positioning• Monitoring• Intravenous fluids & transfusion therapy• Reversal

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CHECKING OF MACHINE

• Check pipeline and cylinder supplies

• Test flowmeter

• Perform leak check of machine and breathing system

• Check scavenging system

• Vaporiser

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CHECKING OF EQUIPMENT

• Functioning laryngoscopes

• Proper size endotracheal tubes

• Others

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SEQURE IV LINE

• Life line of the patient

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SELECTION OF ANAESTHETC TECHNIQUE

• GENERAL ANAESTHESIA

• REGIONAL ANAESTHESIA

• TIVA

• MONITORED ANAESTHESIA CARE (MAC)

• HYPOTENSIVE ANAESTHESIA

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CONNECTING THE MONITORS

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INDUCTION OF ANAESTHESIA (GA)

• INTRAVENOUS

• INHALATIONAL

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Intravenous Anaesthesia

• Suitable for most routine purposes

RAPID SEQUENCE INDUCTION ( used in patients at high risk for aspiration)

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COMPLICATIONS

• Regurgitation and vomiting

• Intra arterial injection of Thiopentone

• Perivenous injection and tissue necrosis

• CVS, respiratory depression

• Anaphylaxis

• Aggravation of porphyria

• Others

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Inhalation Anaesthesia

• Done in paediatric age group

• Patients with airway obstruction

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COMPLICATIONS

• Slower induction

• Problem in stage 2 of anaesthesia

• Laryngospasm & bronchospasm

• Raises intracranial pressure

• Environmental pollution

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LARYNGOSCOPY & INTUBATION

• Prior use of muscle relaxants

• Conduct of laryngoscopy

• Conduct of intubation– Oral – Nasal

DIFFICULT INTUBATION ???

LMA insertion

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POSITIONING OF THE PATIENT

• SUPINE

• LATERAL

• PRONE

• LITHOTOMY

• TRENDELENBURG

• SITTING

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MAINTAINENCE OF ANAESTHESIA

• Nitrous oxide or Medical air

• Inhalational agents

• Muscle relaxants

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MONITORING OF THE PATIENT

• Pulse oximetry

• Non invasive blood pressure

• ECG monitoring

• Capnography

• Temperature

• Urine output

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IV FLUIDS & TRANSFUSION THERAPY

• Ringer lactate ; most physiological

• Normal saline ; in neuro-anaesthesia

Transfusion therapy required when blood loss is more than 20% of the total blood volume

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REVERSAL & EXTUBATION

• Must be smooth

• When patient fully awake or in deep plane

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COMPLICATIONS

• Laryngeal spasm

• Regurgitation

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POST OPERATIVE CONSIDERATIONS

• Management

• Complications

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Management

• Oxygen therapy

• Analgesia

• IV fluids to continue

• Continue monitoring

• In critically ill patients, shift to ICU and provision for mechanical ventilation

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COMPLICATIONS

• Post operative nausea and vomiting

• Pain

• Ventilatory depression

• Haemodynamic instability

• Acute renal failure

• Surgical complications

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