3&4 conduct of general and regional anaesthesia

CONDUCT OF GENERAL AND REGIONAL

ANAESTHESIADR.GAYATRI MISHRA

ASSISTANT PROFESSOR

ANAESTHESIOLOGY AND CRITICAL CARE

• CONTENTS• DEFINiTION OF ANAESTHESIA• COMPONENTS-GA AND REGIONAL• STAGES OF ANESTHESIA• STEPS IN GA –Preoxygenation• premedication• induction intravenous and inhalational• MASK VENTILATION AND PARALYSE THE PATIENT • intubation using muscle DEPOLARISING AND NONDEPOLARISING• maintaienance• Reversal

PREOXYGENATION 100PERCENT OXYGEN CIRCLE, BAINS, JACKSONS REES MODIFICATION OF MAPLESON F

PREMEDICATION

• GOAL-to reduce anxiety,smothen induction nd intubation,prevents laryngoscopic response to intubation• Reduce secretion• Maintain stable hemodynamics,

PREMEDICANT DRUGS

OPOIDS FENTANYL ,MORPHINE,PETHIDINE, TRAMADOL,FORTWINBENZODIAZEPINE-DIAZEPAM,MIDAZOLAM,LORAZEPAMANTICHOLINERGICS-ATROPINE AND GLYCOPYROLATEALPHA2ADRENERGIC AGONIST-CLONIDINE AND DEXMEDITOMEDINEBETABLOCKER ESMOLOL,METOPROLOL,ATENOLOL

INDUCTION INTRAVENOUS AND INHALATIONAL

• Thiopentone 5 to 7mg/kg iv• Propofol 1 to 2 mg/kg iv• Ketamine 1 to 2 mg/kg iv• Etomidate 1 to 2 mg/kg iv

MUSCLE RELAXANT,-ONCE THE PATIENT IS UNDER

• DEPOLARISING SHORT ACTING-SUCCINYL CHOLINE ,ROCURONIUM• NONDEPOLARISING

ATRACURIUM,VECURONIUM,PANCURONIUM ,MIVACURIUM

MAINTENANCE USING OPIDS,RELAXANT, N2O,AIR,

• Adjunct epidural top up or nerve block catheter top up

INTUBATION USING DIRECT LARYNGOSCOPY,ENDOTRACHEAL TUBEADVANCE AIRWAY SUPRAGLOTTIC DEVICE,AIRWAY EQUIPMENT- FIBEROPTIC,FOR DIFFICULT AIRWAY

• PVC TUBE ,FLEXOMETALLIC TUBE, RAE TUBE,DLT,SPECIAL TUBE {laser surgeries}

REVERSAL AND RECOVERY

• Neostigmine and glycopyrolate• Protude tongue hand grip,• Able to swallow eye opening and respond to command• Able to cough out• Regular breathing,spo2,room air 100 percent• Monitor use neuro muscular monitor using tof > 0.7

correspond to complete recovery

REGIONAL ANESTHESIA

• Patient conscious but not felt sensation and unable to move [sensory as well as motor blockade]• Spinal ,epidural ,regional block • UPPER AND LOWER LIMB BLOCK,OPTHAL,COELIAC,LUMBAR

AND HYPOGATRIC brachialplexus,interscalene,femoral.sciatic,popliteal,saphenous,ankle

SPINAL AND EPIDURAL• USING SPINAL AND EPIDURAL NEEDLE

• BACK PAINTING AND DRAPING

• LOCAL ANAESTHETIC INJECTION WITH 25GAUGE SPINAL NEEDLE L3 –L4 INTERSPACE ,L2-L3

• ENTER THE SA SPACE AFTER PIERCING DURA –LAYERS (SKIN,SUBCUTANEOUS SPACE,SUPRASPINOUS LIGAMENT,INTERSPINOUS LIGAMENT,LIGAMENTUM FLAVUM,DURA)

• SUDDEN LOSS OF RESISTANCE ND CSF LA INJECTED INTO THE SPACE 0.5% HEAVY BUPIVACAINE

• HYPERBARIC USUALLY 3 TO 3.5 ML

• IN PREGNANCY 1.8 ML

• SYMPATHETIC BLOCKADE ,SENSORY, AUTONOMIC

• IMMEDIATE EFFECT IN SPINAL

• HYPOTENSON AND BRADYCARDIA COMMON

• LA USE• LIGNOCAINE,[WITH OR WITHOUT ADRENALINE 1:200000]• BUPIVACAINE(HYPERBARIC 0.5% AMPULE AND PLAIN 0.5% VIAL)• ROPIVACAINE,(.2%)• LEVOBUPIVACAINE(.2%)

• LA TOXICITY IF INTRAVASCULAR –SO TAKE CARE AVOID INJECTING INTO VESSEL DURING ADMINISTRATION . …..

• ASPIRATE THE SYRINGE ALWAYS

• EPIDURAL SPACE IDENTIFICATION BY LOSS OF RESISTANCE TECHNIQUE

• TEST DOSE WITH LIGNOCAINE AND ADRENALINE 3ML 1:200000 FOR INTRAVASCULAR PLACEMENT