BASICof GENERAL ANESTHESIA

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DEFINITIION

Total or partial loss of sensation, especially tactile

sensibility, induced by disease, injury, acupuncture,

or an anesthetic, such as chloroform or nitrous

oxide.

Local or general insensibility to pain with or without

the loss of consciousness, induced by an anesthetic.

A drug, administered for medical or surgical

purposes, that induces partial or total loss of

sensation and may be topical, local, regional, or

general, depending on the method of administration

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TYPES

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GENERAL ANESTHESIA

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GENERAL ANESTHESIA ??

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RESPIRATORY SYSTEM

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EQUIPMENT

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ANESTHESIA MACHINE

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M.A.L.E.S

Cannulation Tray

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LARNGOSCOPE

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HUMIDIFICATION

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1. Analgesia - opiod

-I/v Fentanyl 50-100 mcg

2.Anesthetic Agents

Inhalation – Sevoflurane , isoflurane,

Desflurane

Intravenous – propofol, etomidate,

ketamine, thiopentone, midazolam

DRUGS IN USE

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cont

3. Maintenance

IV induction agents is generally 5 to 10

minutes duration.

To maintain - mixture of oxygen, nitrous

oxide, and a volatile anesthetic agent

supplemented by intravenous anesthetics

-opioids fentanyl, morphine and sedative

hypnotics -propofol or midazolam.

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4. Muscle relaxation / Neuromuscular blockade

Acetylcholine, the natural neurotransmitter

substance at the neuromuscular junction, causes

muscles to contract when it is released from nerve

endings. Muscle relaxants work by preventing

acetylcholine from attaching to its receptor.

depolarising drug – suxamethonium.

Non depolarising (NDMR) - pancuronium,

rocuronium, vecuronium, atracurium, mivacurium,

and

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5. Reversal

anti-cholinesterase increasing both the level and

duration of action of the neurotransmitter acetylcholine.

Neostigmine 0.05 mg plus

Atropine 0.04mg or

Glycopyrolate 0.2 mg

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AIRWAY MANAGEMENT

To enable mechanical ventilation, an

artificial airway is used

endotracheal tube

laryngeal mask airways

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ENDOTRACHEAL TUBE

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LARYNGEAL MASK AIRWAY

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SELLICK MANEUVER

WHAT – cricoid pressure WHY - preventing regurgitation of

stomach content to the lung WHO – Pt ; RSI, full stomach HOW - applying pressure 30-40N with

thumb, index and middle finger WHERE - to the cricoid cartilage to

occlude esophagus. WHEN – ETT in place confirmed by

auscultation of air entry equal

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CRICOID PRESSURE

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MONITORING

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MONITORING ECG – heart rate and rhythm

SpO2 – haemoglobin saturation with O2

BP ( NIBP / IBP - art line)

CVP - measure volume status and fluid access.

Gas analyzer - Agent concentration measurement

of inhalation agent (sevo,iso)

Capnography - measures the amount of carbon

dioxide expired by the patient's lungs.

Temperature measurement - hypothermia or fever

or malignant hyperthermia

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COMPLICATIONS

Haemodynamicly instability Awareness During Surgery -awake

and aware. Post operative nausea and vomiting

(PONV) Anesthetic Toxicity Hypothermia Malignant Hyperthermia Bronchospasm Larnygospasm Stridor

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POSTOPERATIVE CARE

A – airwayB – breathingC – circulation, color, consciousnessD – drainage ( fluid and drain tube)E – elimination ( urine output)F - fluid therapyPain management PCAM Epidural Analgesia drug

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NURSE RESPONSIBILITIES1.pre operative

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Cont 2. Intra operative

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Cont 3. Post operative

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HANDLE WITH CARE……

FRAGILE!!!

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CRISIS AND MANAGEMENTWHAT WOULD U DO????

1.DIFFICULT INTUBATION- Fibre optic - DIT trolley- bougie- cookairway- LMA proseal- Em drugs – atropine, adrenaline,

amiodarone, magnesium sulphate- Surgical approach – tracheostomy

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2.DISSATURATION- Check probe- Call for help- BVM- Secretion – endotrachial suctioning- Bronchospasm – aerosol therapy –

MDI salbutamol- ABG- Stop operation

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MASSIVE BLOOD LOSS Check and record blood loss ABG GXM, DIVC regim DIVC screening – PTAPTT, INR Fluid challange colloid – hartman, gelafusin,

voluven Urine output Hypovolumic shock – seizure, increase

temp., tacyhcardia, increace BP, hypoventilation, increase co2.

Hypothermia – warming pt. Stop Op

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Disarrythmias - collapes

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MANAGEMENT

Call for help Emergency trolley Em drugs – atropine , adrenaline,

amiodarone, magnesium sulphate Treat causes - 6H 5T ABG BVM CPR Stop Op

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The Hs and Ts

Hs- Hypovolemia- Hypoxia- Hydrogen ion – acidosis- Hyperkalaemia / hypokalaemia- Hypothermia- Hypoglycemia / hyperglycemia

Ts- Toxins- Cardiac temponade- Tension pneumothorax- Thrombosis – heart attack’- Thromboembolism ( pulmonary

embolism- Trauma

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POST OPERATIVELY

1. PAIN Recheck BP compare with base line data Heart rate - tachycardia Pain score – 0 – no pain, 3-5 - moderate, 6-8 –

severe, 9- 10 – worst pain Check operation site Check for bladder distention Pain managent Analgesic as Dr. ordered

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2. PONV

Causes ?? Laparoscopic surgery, ENT, anaesthetic

drugs- opiod , pain, Gynae/Obs ,increase ICP/IOP

Management?? Suction Prop up and head turn to lateral Fluid Antiametic – maxalon 10mg as ordered Informed anesthetist - ? Increase ICP / IOP

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