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General anesthesia

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for newbies anaesthesia assistance

for newbies anaesthesia assistance

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  • 1. BASIC of GENERAL ANESTHESIA PRESENTER SITI ROHAYU ARSAT SITI ROHAYU ARSAT
  • 2. 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 and area of the body affected.
    SITI ROHAYU ARSAT
  • 3. TYPES SITI ROHAYU ARSAT
  • 4. GENERAL ANESTHESIA SITI ROHAYU ARSAT
  • 5. GENERAL ANESTHESIA ?? SITI ROHAYU ARSAT
  • 6. RESPIRATORY SYSTEM SITI ROHAYU ARSAT
  • 7. SITI ROHAYU ARSAT
  • 8. EQUIPMENT SITI ROHAYU ARSAT
  • 9. ANESTHESIA MACHINE SITI ROHAYU ARSAT
  • 10. M.A.L.E.S Cannulation Tray SITI ROHAYU ARSAT
  • 11. LARNGOSCOPE SITI ROHAYU ARSAT
  • 12. HUMIDIFICATION SITI ROHAYU ARSAT
  • 13.
    • 1. Analgesia - opiod
    • -I/v Fentanyl 50-100 mcg
    • Anesthetic Agents
    • Inhalation – Sevoflurane , isoflurane, Desflurane
    • Intravenous – propofol, etomidate, ketamine, thiopentone, midazolam
    DRUGS IN USE SITI ROHAYU ARSAT
  • 14. 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.
    SITI ROHAYU ARSAT
  • 15. cont
    • 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
    SITI ROHAYU ARSAT
  • 16. Cont
    • 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
    SITI ROHAYU ARSAT
  • 17. AIRWAY MANAGEMENT
    • To enable mechanical ventilation, an artificial airway is used
    • endotracheal tube
    • laryngeal mask airways
    SITI ROHAYU ARSAT
  • 18. ENDOTRACHEAL TUBE SITI ROHAYU ARSAT
  • 19. LARYNGEAL MASK AIRWAY SITI ROHAYU ARSAT
  • 20. SITI ROHAYU ARSAT
  • 21. 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
    SITI ROHAYU ARSAT
  • 22. CRICOID PRESSURE SITI ROHAYU ARSAT
  • 23. MONITORING SITI ROHAYU ARSAT
  • 24. 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
    SITI ROHAYU ARSAT
  • 25. COMPLICATIONS
    • Haemodynamicly instability
    • Awareness During Surgery -awake and aware.
    • Post operative nausea and vomiting (PONV)
    • Anesthetic Toxicity
    • Hypothermia
    • Malignant Hyperthermia
    • Bronchospasm
    • Larnygospasm
    • Stridor
    SITI ROHAYU ARSAT
  • 26. POSTOPERATIVE CARE
    • A – airway
    • B – breathing
    • C – circulation, color, consciousness
    • D – drainage ( fluid and drain tube)
    • E – elimination ( urine output)
    • F - fluid therapy
    • Pain management
    • PCAM
    • Epidural
    • Analgesia drug
    SITI ROHAYU ARSAT
  • 27. SITI ROHAYU ARSAT
  • 28. NURSE RESPONSIBILITIES 1.pre operative SITI ROHAYU ARSAT
  • 29. Cont 2. Intra operative SITI ROHAYU ARSAT
  • 30. Cont 3. Post operative SITI ROHAYU ARSAT
  • 31.
    • HANDLE WITH CARE……
    • FRAGILE!!!
    SITI ROHAYU ARSAT
  • 32. CRISIS AND MANAGEMENT
    • WHAT WOULD U DO????
    • DIFFICULT INTUBATION
    • - Fibre optic
    • - DIT trolley
    • - bougie
    • - cookairway
    • - LMA proseal
    • Em drugs – atropine, adrenaline, amiodarone, magnesium sulphate
    • Surgical approach – tracheostomy
    SITI ROHAYU ARSAT
  • 33.
    • DISSATURATION
    • Check probe
    • Call for help
    • BVM
    • Secretion – endotrachial suctioning
    • Bronchospasm – aerosol therapy – MDI salbutamol
    • ABG
    • Stop operation
    SITI ROHAYU ARSAT
  • 34. 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
    SITI ROHAYU ARSAT
  • 35. Disarrythmias - collapes SITI ROHAYU ARSAT
  • 36. MANAGEMENT
    • Call for help
    • Emergency trolley
    • Em drugs – atropine , adrenaline, amiodarone, magnesium sulphate
    • Treat causes - 6H 5T
    • ABG
    • BVM
    • CPR
    • Stop Op
    SITI ROHAYU ARSAT
  • 37. The Hs and Ts
    • Hs
    • Hypovolemia
    • Hypoxia
    • Hydrogen ion – acidosis
    • Hyperkalaemia / hypokalaemia
    • Hypothermia
    • Hypoglycemia / hyperglycemia
  • 38.
    • Ts
    • Toxins
    • Cardiac temponade
    • Tension pneumothorax
    • Thrombosis – heart attack’
    • Thromboembolism ( pulmonary embolism
    • Trauma
  • 39. SITI ROHAYU ARSAT
  • 40. 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
    SITI ROHAYU ARSAT
  • 41. 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
    SITI ROHAYU ARSAT
  • 42. SITI ROHAYU ARSAT
  • 43. SITI ROHAYU ARSAT