ANAESTHESIA · •1. General and regional anaesthesia •2. Selection of patient for anesthesia is...
Transcript of ANAESTHESIA · •1. General and regional anaesthesia •2. Selection of patient for anesthesia is...
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ANAESTHESIA
DR.RAHUL M. KONDEKAR
ASSOCIATE PROF.
DEPT. OF SHALYATANTRA
SRIGANGANAGAR AYURVEDIC
COLLEGE & HOSPITAL
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ANAESTHESIA
1. General Anaesthesia (G.A.)
2. Regional Anaesthesia (R.A.)
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GENERAL ANAESTHESIA
Defination :
Reversible loss of consciousness accompanied by
analgesia, hypnosis and loss of reflexes with or
without muscle relaxation
Subtypes :
1. Spontaneous breathing
2. Controlled ventilation
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REGIONAL ANAESTHESIA
Only a part of the body is anaesthetised
Types
1. Central blocks
2. Peripheral blocks
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CENTRAL BLOCK
1. Spinal Analgesia
2. Epidural Analgesia
3. Caudal Analgesia
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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
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PERIPHERAL BLOCKS
1. Surface anaesthsia – LA cream
2. Infiltration block – subcut. tissue
3. Nerve blocks
4. Field block - Inguinal field block
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NERVE BLOCKS
1. Upper extremity blocks
A Supraclavicular block
B Axillary block
C Elbow block
D Wrist block
E Digital block
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NERVE BLOCKS
2. Lower extremity blocks
A. Sciatic nerve block
B. Femoral nerve block
C. Popliteal block
D. Ankle block
E. Digital nerve block
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NERVE BLOCKS
3. Peribulbar block – eye operations
Cataract surgery
4. Penile block – circumcision
5. Dental block – tooth extraction
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PREOPERATIVE CHECKUP
History
• Previous operation
• Diseases
Hypertension, diabetes, asthma and heart
diseases
• Medications
• Allergy
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PREOPERATIVE CHECKUP
General examination
Pulse, B/P and temp.
Systemic exam
CVS and Resp. system exam.
Investigations
CBC, electrolytes, ECG and x ray chest,HIV,HbsAg,2D-Echo,Sr.Creatnine
Patient information about type of anaesthesia and its complications
Consent…..Most important
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PREMEDICATION
Premedication ??????
1) To reduce the stress
2) For good outcome of surgery
3) Less anaesthetic drug requirement
4) Lesser intra-op complications
5) Post-op complications are reduced
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GENERAL ANAESTHESIA
Cannulation
22 to 24 G cannula in children
20 to 18 G cannula for adult
I/V fluids
5% D/DNS/RL.
Haemacel soln.(Volume Expander)
Blood
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GENERAL ANAESTHESIA
• Preoxygenation for 3 min.
Induction
• Fentanyl 1 mcg/kg
• Propofol 2 to 3 mg/kg
Intubation
• Tracrium 0.5 mg/kg muscle relaxant
or
• Scoline 2 mg/kg for emergency cases as rapid onset of action
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GENERAL ANAESTHSIA
• Intubation with endotracheal tube
orLMA(laryngeal mask) 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
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INTUBATION
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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
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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 anaesthesia
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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
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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
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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 stable
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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
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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
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SPINAL ANALGESIA
Complications
• 1. Hypotension
Fluids, ephedrine 6 mg
• 2. Shivering
Warming blanket, Pethidine 25 mg, O2
• 3. Nausea, vomiting
Inj.Ondem
4. Respiratory depression – O2 inhalation
5. Headache – C.S.F. loss
6. Backache
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ANATOMY OF EPIDURAL SPACE
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EPIDURAL ANALGESIA
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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 patient.
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EPIDURAL- CATHETER
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EPIDURAL ANALGESIA
Complications
• 1. Total spinal
• 2. Hypotension
• 3. Nausea and
vomiting
• 4. Patchy analgesia
• 5. Headache
• 6. Epidural abcess
• 7. Backache
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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
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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
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EMERGENCY DRUGS
• 5. Hydrallazine
High blood pressure
• 6. Avil10 mg
Allergy
• 7. Dopamine, dobutamine
To increase blood pressure and cardiac
output
8. Hydrocortisone
Allergy
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EMERGENCY DRUGS
• 9. Narcan
To reverse overdose of narcotics
• 10. Maxalon 10 mg
Nausea and vomiting
• 11. Zofran
Nausea and vomiting
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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
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ANY QUESTIONS???
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• THANK YOU