ANESTHETIC TECHNIQUE
Dr. Reza Aminnejad
Assistant Professor of Anesthesiology & Critical Care
Qom University of Medical Sciences
CHOICES FOR ANESTHESIA
General Anesthesia
Regional Anesthesia
Monitored Anesthesia Care (MAC)
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GENERAL ANESTHESIA
Immobility
Amnesia
Analgesia
Lack of Patient Harm
The American Society of Anesthesiologists (ASA) defines generalanesthesia as “a drug-induced loss of consciousness during whichpatients are not arousable, even by painful stimulation.”
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REGIONAL ANESTHESIA
Neuraxial (Spinal, Epidural, Caudal) Anesthesia
Peripheral Nerve Blocks
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MAC
Specific anesthesia service in which ananesthesiologist has been requested to participate inthe care of a patient undergoing a diagnostic ortherapeutic procedure
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CHOOSING AN APPROPRIATE ANESTHETIC TECHNIQUE
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DECISION MAKING PROCESS
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INHALED INDUCTION OF ANESTHESIA
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INDUCTION OF ANESTHESIA WITH SEVOFLURENE
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IV INDUCTION OF ANESTHESIA
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INDICATIONS OF RSI OF ANESTHESIAIncreased risk for aspiration of gastric contents
Clinically significant gastroesophageal reflux disease
Delayed gastric emptying
Unknown fasting state
Known full stomach
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SEQUENCE OF RSI
(1) preoxygenation
(2) intravenous administration of a hypnotic (e.g., propofol);
(3) immediate administration a of a rapid-onset neuromuscularblocking drug (e.g., succinylcholine 1.0-1.5 mg/kg orrocuronium 1.0-1.2 mg/kg);
(4) application of cricoid pressure (using force of 30 newtons,approximately 7 pounds);
(5) avoidance of ventilation via a mask or
(6) tracheal intubation; and
(7) release of cricoid pressure after confirmation of correctendotracheal tube placement
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MODIFIED RSI
Though ventilation via a mask is generally avoidedwith RSI, the use of positive pressure less than 20 cmH2O (called modified RSI)
should minimize the risk of gastric insufflation andmay be needed if the patient develops hypoxemiaprior to tracheal intubation.
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AIRWAY MANAGEMENT TECHNIQUES
Direct Laryngoscopy
Supraglottic Airway Placement
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MAINTENANCE OF ANESTHESIA
After induction of anesthesia and appropriate airwaymanagement, anesthesia is maintained typically byadministration of a combination of anesthetic drugs,each titrated to achieve the desired anesthetic goalwhile minimizing side effects.
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MAC
•The most dangerous anesthetic risk during MAC isrespiratory depression from excessive sedation.
•The manifestations of respiratory depression includeupper airway obstruction, hypoventilation, andhypoxemia.
•During MAC, end-tidal capnography can beaccomplished with a nasal cannula that has adedicated sampling line attached.
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ENVIRONMENTAL IMPACT
The environmental impact of inhaled anesthetics can be minimized
by use of
Total intravenous anesthesia
Low-flow anesthesia
Closed-circuit anesthesia
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ANY QUESTION?
THANKS FOR YOUR ATTENTION
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