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BASIC of GENERAL ANESTHESIA PRESENTER SITI ROHAYU ARSAT SITI ROHAYU ARSAT
DEFINITIION <ul><li>Total or partial loss of sensation, especially tactile sensibility, induced by disease, injury, acupun...
TYPES SITI ROHAYU ARSAT
GENERAL ANESTHESIA SITI ROHAYU ARSAT
GENERAL ANESTHESIA ?? SITI ROHAYU ARSAT
RESPIRATORY SYSTEM SITI ROHAYU ARSAT
SITI ROHAYU ARSAT
EQUIPMENT SITI ROHAYU ARSAT
ANESTHESIA MACHINE SITI ROHAYU ARSAT
M.A.L.E.S Cannulation  Tray SITI ROHAYU ARSAT
LARNGOSCOPE SITI ROHAYU ARSAT
HUMIDIFICATION SITI ROHAYU ARSAT
<ul><li>1. Analgesia - opiod </li></ul><ul><li>-I/v Fentanyl 50-100 mcg </li></ul><ul><li>Anesthetic Agents </li></ul><ul>...
cont <ul><li>3. Maintenance  </li></ul><ul><li>IV induction agents is generally 5 to 10 minutes duration. </li></ul><ul><l...
cont <ul><li>4.   Muscle relaxation / Neuromuscular blockade </li></ul><ul><li>Acetylcholine, the natural neurotransmitter...
Cont <ul><li>5. Reversal </li></ul><ul><li>anti-cholinesterase  increasing both the level and duration of action of the ne...
AIRWAY MANAGEMENT  <ul><li>To enable mechanical ventilation, an artificial airway is used </li></ul><ul><li>endotracheal t...
ENDOTRACHEAL TUBE SITI ROHAYU ARSAT
LARYNGEAL MASK AIRWAY SITI ROHAYU ARSAT
SITI ROHAYU ARSAT
SELLICK MANEUVER <ul><li>WHAT  – cricoid pressure </li></ul><ul><li>WHY  - preventing regurgitation of stomach content to ...
CRICOID PRESSURE SITI ROHAYU ARSAT
MONITORING SITI ROHAYU ARSAT
MONITORING <ul><li>ECG – heart rate and rhythm </li></ul><ul><li>SpO2 – haemoglobin saturation with O2 </li></ul><ul><li>B...
COMPLICATIONS <ul><li>Haemodynamicly instability  </li></ul><ul><li>Awareness During Surgery -awake and aware. </li></ul><...
POSTOPERATIVE   CARE <ul><li>A – airway </li></ul><ul><li>B – breathing </li></ul><ul><li>C – circulation, color, consciou...
SITI ROHAYU ARSAT
NURSE RESPONSIBILITIES 1.pre operative SITI ROHAYU ARSAT
Cont  2.  Intra operative SITI ROHAYU ARSAT
Cont 3. Post  operative  SITI ROHAYU ARSAT
<ul><li>HANDLE  WITH  CARE…… </li></ul><ul><li>FRAGILE!!! </li></ul>SITI ROHAYU ARSAT
CRISIS AND MANAGEMENT <ul><li>WHAT WOULD U DO???? </li></ul><ul><li>DIFFICULT INTUBATION </li></ul><ul><li>-  Fibre optic ...
<ul><li>DISSATURATION </li></ul><ul><li>Check probe </li></ul><ul><li>Call for help </li></ul><ul><li>BVM </li></ul><ul><l...
MASSIVE BLOOD LOSS <ul><li>Check and record blood loss </li></ul><ul><li>ABG </li></ul><ul><li>GXM, DIVC regim </li></ul><...
Disarrythmias - collapes SITI ROHAYU ARSAT
MANAGEMENT <ul><li>Call for help </li></ul><ul><li>Emergency trolley </li></ul><ul><li>Em drugs – atropine , adrenaline, a...
The Hs and Ts <ul><li>Hs </li></ul><ul><li>Hypovolemia </li></ul><ul><li>Hypoxia </li></ul><ul><li>Hydrogen ion – acidosis...
<ul><li>Ts </li></ul><ul><li>Toxins </li></ul><ul><li>Cardiac temponade </li></ul><ul><li>Tension pneumothorax </li></ul><...
SITI ROHAYU ARSAT
POST OPERATIVELY 1. PAIN <ul><li>Recheck BP compare with base line data </li></ul><ul><li>Heart rate - tachycardia </li></...
2. PONV <ul><li>Causes ?? </li></ul><ul><li>Laparoscopic surgery, ENT, anaesthetic drugs- opiod , pain, Gynae/Obs ,increas...
SITI ROHAYU ARSAT
SITI ROHAYU ARSAT
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General anesthesia

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Transcript of "General anesthesia"

  1. 1. BASIC of GENERAL ANESTHESIA PRESENTER SITI ROHAYU ARSAT SITI ROHAYU ARSAT
  2. 2. DEFINITIION <ul><li>Total or partial loss of sensation, especially tactile sensibility, induced by disease, injury, acupuncture, or an anesthetic, such as chloroform or nitrous oxide. </li></ul><ul><li>Local or general insensibility to pain with or without the loss of consciousness, induced by an anesthetic. </li></ul><ul><li>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. </li></ul>SITI ROHAYU ARSAT
  3. 3. TYPES SITI ROHAYU ARSAT
  4. 4. GENERAL ANESTHESIA SITI ROHAYU ARSAT
  5. 5. GENERAL ANESTHESIA ?? SITI ROHAYU ARSAT
  6. 6. RESPIRATORY SYSTEM SITI ROHAYU ARSAT
  7. 7. SITI ROHAYU ARSAT
  8. 8. EQUIPMENT SITI ROHAYU ARSAT
  9. 9. ANESTHESIA MACHINE SITI ROHAYU ARSAT
  10. 10. M.A.L.E.S Cannulation Tray SITI ROHAYU ARSAT
  11. 11. LARNGOSCOPE SITI ROHAYU ARSAT
  12. 12. HUMIDIFICATION SITI ROHAYU ARSAT
  13. 13. <ul><li>1. Analgesia - opiod </li></ul><ul><li>-I/v Fentanyl 50-100 mcg </li></ul><ul><li>Anesthetic Agents </li></ul><ul><li>Inhalation – Sevoflurane , isoflurane, Desflurane </li></ul><ul><li>Intravenous – propofol, etomidate, ketamine, thiopentone, midazolam </li></ul>DRUGS IN USE SITI ROHAYU ARSAT
  14. 14. cont <ul><li>3. Maintenance </li></ul><ul><li>IV induction agents is generally 5 to 10 minutes duration. </li></ul><ul><li>To maintain - mixture of oxygen, nitrous oxide, and a volatile anesthetic agent </li></ul><ul><li>supplemented by intravenous anesthetics -opioids fentanyl, morphine and sedative hypnotics -propofol or midazolam. </li></ul>SITI ROHAYU ARSAT
  15. 15. cont <ul><li>4. Muscle relaxation / Neuromuscular blockade </li></ul><ul><li>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. </li></ul><ul><li>depolarising drug – suxamethonium. </li></ul><ul><li>Non depolarising (NDMR) - pancuronium, rocuronium, vecuronium, atracurium, mivacurium, and </li></ul>SITI ROHAYU ARSAT
  16. 16. Cont <ul><li>5. Reversal </li></ul><ul><li>anti-cholinesterase increasing both the level and duration of action of the neurotransmitter acetylcholine. </li></ul><ul><li>Neostigmine 0.05 mg plus </li></ul><ul><li>Atropine 0.04mg or </li></ul><ul><li>Glycopyrolate 0.2 mg </li></ul>SITI ROHAYU ARSAT
  17. 17. AIRWAY MANAGEMENT <ul><li>To enable mechanical ventilation, an artificial airway is used </li></ul><ul><li>endotracheal tube </li></ul><ul><li>laryngeal mask airways </li></ul>SITI ROHAYU ARSAT
  18. 18. ENDOTRACHEAL TUBE SITI ROHAYU ARSAT
  19. 19. LARYNGEAL MASK AIRWAY SITI ROHAYU ARSAT
  20. 20. SITI ROHAYU ARSAT
  21. 21. SELLICK MANEUVER <ul><li>WHAT – cricoid pressure </li></ul><ul><li>WHY - preventing regurgitation of stomach content to the lung </li></ul><ul><li>WHO – Pt ; RSI, full stomach </li></ul><ul><li>HOW - applying pressure 30-40N with thumb, index and middle finger </li></ul><ul><li>WHERE - to the cricoid cartilage to occlude esophagus. </li></ul><ul><li>WHEN – ETT in place confirmed by auscultation of air entry equal </li></ul>SITI ROHAYU ARSAT
  22. 22. CRICOID PRESSURE SITI ROHAYU ARSAT
  23. 23. MONITORING SITI ROHAYU ARSAT
  24. 24. MONITORING <ul><li>ECG – heart rate and rhythm </li></ul><ul><li>SpO2 – haemoglobin saturation with O2 </li></ul><ul><li>BP ( NIBP / IBP - art line) </li></ul><ul><li>CVP - measure volume status and fluid access. </li></ul><ul><li>Gas analyzer - Agent concentration measurement of inhalation agent (sevo,iso) </li></ul><ul><li>Capnography - measures the amount of carbon dioxide expired by the patient's lungs. </li></ul><ul><li>Temperature measurement - hypothermia or fever or malignant hyperthermia </li></ul>SITI ROHAYU ARSAT
  25. 25. COMPLICATIONS <ul><li>Haemodynamicly instability </li></ul><ul><li>Awareness During Surgery -awake and aware. </li></ul><ul><li>Post operative nausea and vomiting (PONV) </li></ul><ul><li>Anesthetic Toxicity </li></ul><ul><li>Hypothermia </li></ul><ul><li>Malignant Hyperthermia </li></ul><ul><li>Bronchospasm </li></ul><ul><li>Larnygospasm </li></ul><ul><li>Stridor </li></ul>SITI ROHAYU ARSAT
  26. 26. POSTOPERATIVE CARE <ul><li>A – airway </li></ul><ul><li>B – breathing </li></ul><ul><li>C – circulation, color, consciousness </li></ul><ul><li>D – drainage ( fluid and drain tube) </li></ul><ul><li>E – elimination ( urine output) </li></ul><ul><li>F - fluid therapy </li></ul><ul><li>Pain management </li></ul><ul><li>PCAM </li></ul><ul><li>Epidural </li></ul><ul><li>Analgesia drug </li></ul>SITI ROHAYU ARSAT
  27. 27. SITI ROHAYU ARSAT
  28. 28. NURSE RESPONSIBILITIES 1.pre operative SITI ROHAYU ARSAT
  29. 29. Cont 2. Intra operative SITI ROHAYU ARSAT
  30. 30. Cont 3. Post operative SITI ROHAYU ARSAT
  31. 31. <ul><li>HANDLE WITH CARE…… </li></ul><ul><li>FRAGILE!!! </li></ul>SITI ROHAYU ARSAT
  32. 32. CRISIS AND MANAGEMENT <ul><li>WHAT WOULD U DO???? </li></ul><ul><li>DIFFICULT INTUBATION </li></ul><ul><li>- Fibre optic </li></ul><ul><li>- DIT trolley </li></ul><ul><li>- bougie </li></ul><ul><li>- cookairway </li></ul><ul><li>- LMA proseal </li></ul><ul><li>Em drugs – atropine, adrenaline, amiodarone, magnesium sulphate </li></ul><ul><li>Surgical approach – tracheostomy </li></ul>SITI ROHAYU ARSAT
  33. 33. <ul><li>DISSATURATION </li></ul><ul><li>Check probe </li></ul><ul><li>Call for help </li></ul><ul><li>BVM </li></ul><ul><li>Secretion – endotrachial suctioning </li></ul><ul><li>Bronchospasm – aerosol therapy – MDI salbutamol </li></ul><ul><li>ABG </li></ul><ul><li>Stop operation </li></ul>SITI ROHAYU ARSAT
  34. 34. MASSIVE BLOOD LOSS <ul><li>Check and record blood loss </li></ul><ul><li>ABG </li></ul><ul><li>GXM, DIVC regim </li></ul><ul><li>DIVC screening – PTAPTT, INR </li></ul><ul><li>Fluid challange colloid – hartman, gelafusin, voluven </li></ul><ul><li>Urine output </li></ul><ul><li>Hypovolumic shock – seizure, increase temp., tacyhcardia, increace BP, hypoventilation, increase co2. </li></ul><ul><li>Hypothermia – warming pt. </li></ul><ul><li>Stop Op </li></ul>SITI ROHAYU ARSAT
  35. 35. Disarrythmias - collapes SITI ROHAYU ARSAT
  36. 36. MANAGEMENT <ul><li>Call for help </li></ul><ul><li>Emergency trolley </li></ul><ul><li>Em drugs – atropine , adrenaline, amiodarone, magnesium sulphate </li></ul><ul><li>Treat causes - 6H 5T </li></ul><ul><li>ABG </li></ul><ul><li>BVM </li></ul><ul><li>CPR </li></ul><ul><li>Stop Op </li></ul>SITI ROHAYU ARSAT
  37. 37. The Hs and Ts <ul><li>Hs </li></ul><ul><li>Hypovolemia </li></ul><ul><li>Hypoxia </li></ul><ul><li>Hydrogen ion – acidosis </li></ul><ul><li>Hyperkalaemia / hypokalaemia </li></ul><ul><li>Hypothermia </li></ul><ul><li>Hypoglycemia / hyperglycemia </li></ul>
  38. 38. <ul><li>Ts </li></ul><ul><li>Toxins </li></ul><ul><li>Cardiac temponade </li></ul><ul><li>Tension pneumothorax </li></ul><ul><li>Thrombosis – heart attack’ </li></ul><ul><li>Thromboembolism ( pulmonary embolism </li></ul><ul><li>Trauma </li></ul>
  39. 39. SITI ROHAYU ARSAT
  40. 40. POST OPERATIVELY 1. PAIN <ul><li>Recheck BP compare with base line data </li></ul><ul><li>Heart rate - tachycardia </li></ul><ul><li>Pain score – </li></ul><ul><li>0 – no pain, 3-5 - moderate, 6-8 – severe, 9- 10 – worst pain </li></ul><ul><li>Check operation site </li></ul><ul><li>Check for bladder distention </li></ul><ul><li>Pain managent </li></ul><ul><li>Analgesic as Dr. ordered </li></ul>SITI ROHAYU ARSAT
  41. 41. 2. PONV <ul><li>Causes ?? </li></ul><ul><li>Laparoscopic surgery, ENT, anaesthetic drugs- opiod , pain, Gynae/Obs ,increase ICP/IOP </li></ul><ul><li>Management?? </li></ul><ul><li>Suction </li></ul><ul><li>Prop up and head turn to lateral </li></ul><ul><li>Fluid </li></ul><ul><li>Antiametic – maxalon 10mg as ordered </li></ul><ul><li>Informed anesthetist - ? Increase ICP / IOP </li></ul>SITI ROHAYU ARSAT
  42. 42. SITI ROHAYU ARSAT
  43. 43. SITI ROHAYU ARSAT
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