anaesthesia dr. shah sudhirchandra m.d., d.a.(anaesthesia)

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