PRACTICAL CONDUCT OF ANAESTHESIA

DR ANIRBAN PAL Assistant professor

Dept of Anaesthesia CNMC, Kolkata, India

 PRE OPERATIVE CONSIDERATIONS INTRA OPERATIVE CONSIDERATIONS

Conduct of anaesthesia

POST OPERATIVE CONSIDERATIONS

PRE OPERATIVE CONSIDERATIONS

Pre anaesthetic assessment a) History b) Physical examination airway assessment examination of spine c) Investigations ASA grading Pre operative preparation
Optimization of co-morbid conditions

Consent

PRE ANAESTHETIC ASSESSMENT

SPECIFIC OBJECTIVES 1. To establish a doctor-patient relationship 2. To allay patient anxiety 3. To become familiar with co-existing medical condition 4. To formulate anaesthetic plan 5. To obtain informed consent Overall goal is to reduce peri-operative morbidity and mortality

HISTORY
Review Surgical illness Co existing medical illness Medications Allergies and drug reaction Previous anaesthetic history Relevant family history Addiction

PHYSICAL EXAMINATION
Vital signs Cardiovascular system Respiratory system Other systems ( CNS, abdomen, extremities)

Assessment of airway Examination of spine ASA physical status

INVESTIGATIONS
ROUTINE
Complete haemogram Sugar, urea, creatinine ECG Chest Xray Serum electrolytes Coagulation studies LFT Thyroid profile Miscellaneous

SPECIAL

PREOPERATIVE PREPARATION
Optimization of co-morbid conditions
Cardiovascular diseases Respiratory disease Endocrine diseases

Aspiration prophylaxis

Sedative and analgesic

Anti-cholinergics

INTRA OPERATIVE CONSIDERATIONS

Checking of anaesthesia machine and equipments Securing IV lines Attach the monitors Selection of anaesthetic technique Induction Intubation Positioning Monitoring Intravenous fluids & transfusion therapy Reversal

CHECKING OF MACHINE
Check pipeline and cylinder supplies Test flowmeter Perform leak check of machine and breathing system Check scavenging system Vaporiser

CHECKING OF EQUIPMENT
Functioning laryngoscopes Proper size endotracheal tubes Others

SEQURE IV LINE
Life line of the patient

SELECTION OF ANAESTHETC TECHNIQUE

GENERAL ANAESTHESIA REGIONAL ANAESTHESIA TIVA MONITORED ANAESTHESIA CARE (MAC) HYPOTENSIVE ANAESTHESIA

CONNECTING THE MONITORS

INDUCTION OF ANAESTHESIA (GA)

INTRAVENOUS INHALATIONAL

Intravenous Anaesthesia
Suitable for most routine purposes

RAPID SEQUENCE INDUCTION ( used in patients at high risk for aspiration)

COMPLICATIONS
Regurgitation and vomiting Intra arterial injection of Thiopentone Perivenous injection and tissue necrosis CVS, respiratory depression Anaphylaxis Aggravation of porphyria Others

Inhalation Anaesthesia
Done in paediatric age group Patients with airway obstruction

COMPLICATIONS
Slower induction Problem in stage 2 of anaesthesia Laryngospasm & bronchospasm Raises intracranial pressure Environmental pollution

LARYNGOSCOPY & INTUBATION

Prior use of muscle relaxants Conduct of laryngoscopy Conduct of intubation
Oral Nasal
LMA insertion

DIFFICULT INTUBATION ???

POSITIONING OF THE PATIENT

SUPINE LATERAL PRONE LITHOTOMY TRENDELENBURG SITTING

MAINTAINENCE OF ANAESTHESIA
Nitrous oxide or Medical air Inhalational agents Muscle relaxants

MONITORING OF THE PATIENT

Pulse oximetry Non invasive blood pressure ECG monitoring Capnography Temperature Urine output

IV FLUIDS & TRANSFUSION THERAPY

Ringer lactate ; most physiological Normal saline ; in neuro-anaesthesia

Transfusion therapy required when blood loss is more than 20% of the total blood volume

REVERSAL & EXTUBATION

Must be smooth When patient fully awake or in deep plane

COMPLICATIONS
Laryngeal spasm Regurgitation

POST OPERATIVE CONSIDERATIONS

Management Complications

Management
Oxygen therapy Analgesia IV fluids to continue Continue monitoring

In critically ill patients, shift to ICU and provision for mechanical ventilation

COMPLICATIONS
Post operative nausea and vomiting Pain Ventilatory depression Haemodynamic instability Acute renal failure Surgical complications