ANESTHESIA  / SEDATION OUTSIDE OPERATING ROOM Dr.P.NARASIMHA REDDY NARAYANA MEDICAL COLLEGE.
<ul><li>INTRODUCTION </li></ul><ul><li>PROCEDURES DONE OUTSIDE O.R. </li></ul><ul><li>PLACES WHERE PROCEDURES ARE DONE. </...
<ul><li>WHAT ARE THE SAFETY STANDARDS? </li></ul><ul><li>MONITORING AIDS. </li></ul><ul><li>EQUIPMENT REQUIRED. </li></ul>...
<ul><li>INTRODUCTION : </li></ul><ul><ul><li>Ultra short acting potent drugs. </li></ul></ul><ul><ul><li>Portable monitori...
<ul><li>2. Ability -  does an anesthetist have to be present? </li></ul><ul><li>3. Affordability – is it cost effective? <...
<ul><li>6.accountability – are we responsible for the quality & outcome results? </li></ul><ul><li>7.Altruism – is it devo...
<ul><li>O.R – sterile,serene,peaceful. </li></ul><ul><li>Anesthetist--  comfortable,comprehensive,conducting procedures. <...
<ul><li>Outside O.R  - known & unknown problems . </li></ul><ul><li>Vulnerable to mishaps. </li></ul>
PROCEDURES OUTSIDE O.R <ul><li>Diagnostic,interventional& therapeutic radiology. </li></ul><ul><li>Cardiac catheterisation...
<ul><li>5.Bonemarrow aspiration & L.P. </li></ul><ul><li>6.Emergency airway management. </li></ul><ul><li>7.Transport of c...
PLACES WHERE PROCEDURES ARE DONE <ul><li>Radiology suit.. </li></ul><ul><li>Cath lab. </li></ul><ul><li>I.C.U. </li></ul><...
Contd.. <ul><li>6.Paediatric wards. </li></ul><ul><li>7.Field situations. </li></ul><ul><li>8.Ortho O.P’s. </li></ul><ul><...
PROBLEMS OF ANESTHETIST. <ul><li>GENERAL PROBLEMS : </li></ul><ul><li>- environment – new place,remote area,narrow lanes,l...
Contd.. <ul><li>May be old or not used for long time. </li></ul><ul><li>Cyllinders – less or empty. </li></ul><ul><li>Outl...
Contd.. <ul><li>Suction – present /not working. </li></ul><ul><li>Parking – narrow crowded places,difficult to transport t...
<ul><li>PATIENT PROBLEMS : </li></ul><ul><li>Not well prepared. </li></ul><ul><li>No fasting guidelines. </li></ul><ul><li...
<ul><li>SPECIFIC PROBLEMS : </li></ul><ul><li>- C.T SCAN  : </li></ul><ul><li>-Needs immobile patient for 20-40 mts. </li>...
Contd.. <ul><li>-  apnoea. </li></ul><ul><li>- cyanosis & cardiac arrest. </li></ul><ul><li>-radiation to anesthetist. </l...
<ul><li>M.R.I : </li></ul><ul><li>Narrow tunnel. </li></ul><ul><li>Access to the patient is difficult. </li></ul><ul><li>C...
Contd.. <ul><li>- Image degradation. </li></ul><ul><li>- Absolute immobility for long time. </li></ul><ul><li>- Cannot see...
<ul><li>Interventional radiology : </li></ul><ul><li>Laporotomies & craniotomies for accurate tumor resection. </li></ul><...
<ul><li>Neuro radiology : </li></ul><ul><li>-Embolisation : </li></ul><ul><li>- long procedures, embolic events. </li></ul...
<ul><li>Trigeminal neuralgia : </li></ul><ul><li>Local block induced </li></ul><ul><li>Neurolytic agent. </li></ul><ul><li...
<ul><li>Cyclotron therapy : </li></ul><ul><li>Proton beam radiation is used in the treatment of  A.V malformations,pituita...
<ul><li>Radiation therapy : </li></ul><ul><li>Children often require G.A. </li></ul><ul><li>3-4 times a week for 4 weeks. ...
<ul><li>E.C.T : </li></ul><ul><li>Used in patients with depression not controlled by the drugs. </li></ul><ul><li>Initial ...
Contd.. <ul><li>inc.intraocular & intra gastric pressures. </li></ul><ul><li>Absolute contraindication  : </li></ul><ul><l...
Contd.. <ul><li>Major bone fractures. </li></ul><ul><li>Thrombophlebitis. </li></ul><ul><li>Pregnancy. </li></ul><ul><li>R...
<ul><li>Cardioversion : </li></ul><ul><li>Painful procedure. </li></ul><ul><li>Must be unconscious. </li></ul><ul><li>Othe...
Contd.. <ul><li>Endoscopic suite : </li></ul><ul><li>Patient must be evaluated. </li></ul><ul><li>Ideal fasting guidelines...
ESSENTIAL REQUIREMENTS <ul><li>O2 Piped / cylinders. </li></ul><ul><li>Anesthesia machine. </li></ul><ul><li>Sufficient el...
Contd.. <ul><li>7.Adequate monitoring equipment. </li></ul><ul><li>8.Defibrillator. </li></ul><ul><li>9.2way communication...
MONITORING EQUIPMENT <ul><li>ECG. </li></ul><ul><li>Pulse oximeter. </li></ul><ul><li>Blood pressure. </li></ul><ul><li>ET...
OTHER EQUIPMENT <ul><li>Bag mask ventilation. </li></ul><ul><li>Airways – all sizes. </li></ul><ul><li>Laryngoscope with a...
TYPES OF ANESTHESIA <ul><li>INHALATIONAL  </li></ul><ul><li>I.V anesthetics </li></ul><ul><li>M.A.C  </li></ul><ul><li>Reg...
Contd.. <ul><li>Is the procedure painful? </li></ul><ul><li>What is the duration of procedure? </li></ul><ul><li>Patient n...
<ul><li>SEDATION : </li></ul><ul><li>Guidelines for sedation: </li></ul><ul><li>-  chloral hydrate  : </li></ul><ul><li>-n...
<ul><li>Rectal methohexital : </li></ul><ul><li>20-30 mg/kg  </li></ul><ul><li>Rapid onset 5-10 mts. </li></ul><ul><li>Pro...
<ul><li>Benzodiazepines : </li></ul><ul><li>Midazolam  -0.01mg/kg. </li></ul><ul><li>can be given by all routes. </li></ul...
<ul><li>I.V anesthetic agents : </li></ul><ul><li>Pentothol sodium : </li></ul><ul><li>5-7mg/kg. </li></ul><ul><li>careful...
Contd.. <ul><li>Broncho dilator. </li></ul><ul><li>Resp.activity maintained. </li></ul><ul><li>Raised i.c.t </li></ul><ul>...
<ul><li>Propofol : </li></ul><ul><li>1-2 mg/kg. </li></ul><ul><li>Shorter duration of action. </li></ul><ul><li>Complete r...
<ul><li>G.A : </li></ul><ul><li>Premed – atropine/ glyco. </li></ul><ul><li>Rapid sequence induction. </li></ul><ul><li>In...
<ul><li>REGIONAL : </li></ul><ul><li>EMLA  ( ligno+ prilo) </li></ul><ul><li>Occlusive dressing for 60mts. </li></ul><ul><...
DISCHARGE CRITERIA <ul><li>Stable C.V.S . </li></ul><ul><li>Satisfactory airway. </li></ul><ul><li>Patient easily arousabl...
THANK U.
Upcoming SlideShare
Loading in...5
×

Anaesthesia outside operating room

1,331

Published on

Published in: Health & Medicine, Business
0 Comments
5 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,331
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
78
Comments
0
Likes
5
Embeds 0
No embeds

No notes for slide

Anaesthesia outside operating room

  1. 1. ANESTHESIA / SEDATION OUTSIDE OPERATING ROOM Dr.P.NARASIMHA REDDY NARAYANA MEDICAL COLLEGE.
  2. 2. <ul><li>INTRODUCTION </li></ul><ul><li>PROCEDURES DONE OUTSIDE O.R. </li></ul><ul><li>PLACES WHERE PROCEDURES ARE DONE. </li></ul><ul><li>PROBLEMS OF ANESTHETIST </li></ul><ul><ul><li>GENERAL PROBLEMS. </li></ul></ul><ul><ul><li>SPECIFIC PROBLEMS. </li></ul></ul>
  3. 3. <ul><li>WHAT ARE THE SAFETY STANDARDS? </li></ul><ul><li>MONITORING AIDS. </li></ul><ul><li>EQUIPMENT REQUIRED. </li></ul><ul><li>TYPES OF ANESTHESIA ? SEDATION. </li></ul><ul><li>DISCHARGE CRITERIA. </li></ul>
  4. 4. <ul><li>INTRODUCTION : </li></ul><ul><ul><li>Ultra short acting potent drugs. </li></ul></ul><ul><ul><li>Portable monitoring aids. </li></ul></ul><ul><ul><li>PERIPATETIC : “who walks from place to place” </li></ul></ul><ul><ul><li>Essential criteria to anesthetist outside O.R. </li></ul></ul><ul><ul><li>1.Applicability – is it appropriate to provide service? </li></ul></ul>
  5. 5. <ul><li>2. Ability - does an anesthetist have to be present? </li></ul><ul><li>3. Affordability – is it cost effective? </li></ul><ul><li>4.Availability – can we provide the service outside? </li></ul><ul><li>5.Affability – is it the desire of the doctor to have anesthetist services? </li></ul>
  6. 6. <ul><li>6.accountability – are we responsible for the quality & outcome results? </li></ul><ul><li>7.Altruism – is it devotion to humanity or selfishness? </li></ul>
  7. 7. <ul><li>O.R – sterile,serene,peaceful. </li></ul><ul><li>Anesthetist-- comfortable,comprehensive,conducting procedures. </li></ul><ul><li>He is familiar with equipment,medical,paramedical persons,available drugs. </li></ul><ul><li>He can expect & delegate powers to suitable persons. </li></ul>
  8. 8. <ul><li>Outside O.R - known & unknown problems . </li></ul><ul><li>Vulnerable to mishaps. </li></ul>
  9. 9. PROCEDURES OUTSIDE O.R <ul><li>Diagnostic,interventional& therapeutic radiology. </li></ul><ul><li>Cardiac catheterisation,implantation of defibrillators,coronary angiography,stent replacements. </li></ul><ul><li>Cardioversions. </li></ul><ul><li>E.C.T. </li></ul>
  10. 10. <ul><li>5.Bonemarrow aspiration & L.P. </li></ul><ul><li>6.Emergency airway management. </li></ul><ul><li>7.Transport of critically ill patients. </li></ul><ul><li>8.Ortho procedures. </li></ul><ul><li>9.Removal of patients from rubble or accident vehicles. </li></ul>
  11. 11. PLACES WHERE PROCEDURES ARE DONE <ul><li>Radiology suit.. </li></ul><ul><li>Cath lab. </li></ul><ul><li>I.C.U. </li></ul><ul><li>Psychiatry O.P. </li></ul><ul><li>Cancer wards. </li></ul>
  12. 12. Contd.. <ul><li>6.Paediatric wards. </li></ul><ul><li>7.Field situations. </li></ul><ul><li>8.Ortho O.P’s. </li></ul><ul><li>9.Transport vehicles – road/air. </li></ul>
  13. 13. PROBLEMS OF ANESTHETIST. <ul><li>GENERAL PROBLEMS : </li></ul><ul><li>- environment – new place,remote area,narrow lanes,low lighting,no back-up facility. </li></ul><ul><li>- personnel – not trained & less number. </li></ul><ul><li>-equipment – anesthesia machine may be present or absent. </li></ul>
  14. 14. Contd.. <ul><li>May be old or not used for long time. </li></ul><ul><li>Cyllinders – less or empty. </li></ul><ul><li>Outlets for power – O2,N2O may not be present. </li></ul><ul><li>Laryngoscope may be present / absent, may not be working. </li></ul><ul><li>Proper size of tubes & airways – not available. </li></ul>
  15. 15. Contd.. <ul><li>Suction – present /not working. </li></ul><ul><li>Parking – narrow crowded places,difficult to transport the patient in case of emergency. </li></ul><ul><li>Communication system may not be good. </li></ul><ul><li>Resuscitation facilities – not adequate. </li></ul><ul><li>Post anesthetic care – not available. </li></ul>
  16. 16. <ul><li>PATIENT PROBLEMS : </li></ul><ul><li>Not well prepared. </li></ul><ul><li>No fasting guidelines. </li></ul><ul><li>PAC not done. </li></ul><ul><li>May be on some medications. </li></ul><ul><li>Comorbid conditions present </li></ul><ul><li>patient must be ASA 1 & 2. </li></ul>
  17. 17. <ul><li>SPECIFIC PROBLEMS : </li></ul><ul><li>- C.T SCAN : </li></ul><ul><li>-Needs immobile patient for 20-40 mts. </li></ul><ul><li>-children,unconscious,noncooperative,head injury,convulsions,communication problems – requires sedation / anesthesia. </li></ul><ul><li>-airway obstruction </li></ul><ul><li>-kinking of tube </li></ul>
  18. 18. Contd.. <ul><li>- apnoea. </li></ul><ul><li>- cyanosis & cardiac arrest. </li></ul><ul><li>-radiation to anesthetist. </li></ul><ul><li>- allergic reactions to contrast dyes . </li></ul>
  19. 19. <ul><li>M.R.I : </li></ul><ul><li>Narrow tunnel. </li></ul><ul><li>Access to the patient is difficult. </li></ul><ul><li>Claustrophobia. </li></ul><ul><li>Strong magnetic fields. </li></ul><ul><li>Ferromagnetic implants,monitoring aids. </li></ul><ul><li>Loud noise. </li></ul>
  20. 20. Contd.. <ul><li>- Image degradation. </li></ul><ul><li>- Absolute immobility for long time. </li></ul><ul><li>- Cannot see the airway & chest movements. </li></ul><ul><li>- Modified anesthesia machine & monitors. </li></ul><ul><li>- No coil cables. </li></ul><ul><li>- Alluminium trolleys & alluminium cyllinders. </li></ul><ul><li>- Plastic laryngoscope with batteries which are wrapped with plastic covers. </li></ul>
  21. 21. <ul><li>Interventional radiology : </li></ul><ul><li>Laporotomies & craniotomies for accurate tumor resection. </li></ul><ul><li>Intermittent imaging. </li></ul><ul><li>Scanning time may be significantly longer. </li></ul><ul><li>Patient access limited. </li></ul><ul><li>Contrast dyes produce diuresis. </li></ul><ul><li>Hypo-hypertensive. </li></ul>
  22. 22. <ul><li>Neuro radiology : </li></ul><ul><li>-Embolisation : </li></ul><ul><li>- long procedures, embolic events. </li></ul><ul><li>- airway management urgent. </li></ul><ul><li>- G.A ideal. </li></ul><ul><li>- hemorrhage ,hemodynamic disturbances & aspiration can occur. </li></ul>
  23. 23. <ul><li>Trigeminal neuralgia : </li></ul><ul><li>Local block induced </li></ul><ul><li>Neurolytic agent. </li></ul><ul><li>Brief period of loss of consciousness is induced. </li></ul><ul><li>Neurologic examination on awake patient. </li></ul><ul><li>Airway support may be difficult when block needle is in place. </li></ul>
  24. 24. <ul><li>Cyclotron therapy : </li></ul><ul><li>Proton beam radiation is used in the treatment of A.V malformations,pituitary tumors & retinoblastomas. </li></ul><ul><li>Radiation is painless but positioning may take several hours. </li></ul><ul><li>Head fixation may be painful. </li></ul><ul><li>Standard T.V with CCTV. </li></ul>
  25. 25. <ul><li>Radiation therapy : </li></ul><ul><li>Children often require G.A. </li></ul><ul><li>3-4 times a week for 4 weeks. </li></ul><ul><li>Planning of radiation on first day takes long time. </li></ul><ul><li>Standard monitoring with CCTV. </li></ul>
  26. 26. <ul><li>E.C.T : </li></ul><ul><li>Used in patients with depression not controlled by the drugs. </li></ul><ul><li>Initial vagal discharge,later sympathetic discharge. </li></ul><ul><li>HTN for 5-10 mts. </li></ul><ul><li>E.C.G – prolonged PR & QT intervals, T wave inversion. </li></ul>
  27. 27. Contd.. <ul><li>inc.intraocular & intra gastric pressures. </li></ul><ul><li>Absolute contraindication : </li></ul><ul><li>- intracranial HTN. </li></ul><ul><li>Relative contraindications : </li></ul><ul><li>- intracranial mass with normal ICT </li></ul><ul><li>-aneurysms </li></ul><ul><li>- recent M.I,angina , CCF </li></ul><ul><li>- untreated glaucoma </li></ul>
  28. 28. Contd.. <ul><li>Major bone fractures. </li></ul><ul><li>Thrombophlebitis. </li></ul><ul><li>Pregnancy. </li></ul><ul><li>Retinal detatchment. </li></ul><ul><li>“ Be careful with drug interactions ” </li></ul>
  29. 29. <ul><li>Cardioversion : </li></ul><ul><li>Painful procedure. </li></ul><ul><li>Must be unconscious. </li></ul><ul><li>Others should not touch the patient during shock. </li></ul><ul><li>Patient is ventilated with 100% O2 till recovery. </li></ul>
  30. 30. Contd.. <ul><li>Endoscopic suite : </li></ul><ul><li>Patient must be evaluated. </li></ul><ul><li>Ideal fasting guidelines. </li></ul><ul><li>Glyco + topical L.A + benzo / propofol. </li></ul><ul><li>Contraindications : </li></ul><ul><li>- achalasia,esophageal stricture,corrosive esophagitis,intestinal obstruction,esophageal discoordination. </li></ul>
  31. 31. ESSENTIAL REQUIREMENTS <ul><li>O2 Piped / cylinders. </li></ul><ul><li>Anesthesia machine. </li></ul><ul><li>Sufficient electrical outlets. </li></ul><ul><li>Adequate space & access to the patient. </li></ul><ul><li>Adequate illumination. </li></ul><ul><li>Emergency resuscitation cart. </li></ul>
  32. 32. Contd.. <ul><li>7.Adequate monitoring equipment. </li></ul><ul><li>8.Defibrillator. </li></ul><ul><li>9.2way communication. </li></ul><ul><li>10.Qualified anesthesiologist. </li></ul><ul><li>11.Transportation facility. </li></ul>
  33. 33. MONITORING EQUIPMENT <ul><li>ECG. </li></ul><ul><li>Pulse oximeter. </li></ul><ul><li>Blood pressure. </li></ul><ul><li>ETCO2. </li></ul><ul><li>Oxygen analyser. </li></ul>
  34. 34. OTHER EQUIPMENT <ul><li>Bag mask ventilation. </li></ul><ul><li>Airways – all sizes. </li></ul><ul><li>Laryngoscope with all blades. </li></ul><ul><li>Correct size E.T tubes. </li></ul><ul><li>Drugs – anesthetic & resuscitation drugs. </li></ul>
  35. 35. TYPES OF ANESTHESIA <ul><li>INHALATIONAL </li></ul><ul><li>I.V anesthetics </li></ul><ul><li>M.A.C </li></ul><ul><li>Regional </li></ul><ul><li>Sedation </li></ul>
  36. 36. Contd.. <ul><li>Is the procedure painful? </li></ul><ul><li>What is the duration of procedure? </li></ul><ul><li>Patient needs to be motionless? </li></ul><ul><li>Many times procedures are done under sedation. </li></ul><ul><li>Rarely G.A with E.T tube with relaxant. </li></ul>
  37. 37. <ul><li>SEDATION : </li></ul><ul><li>Guidelines for sedation: </li></ul><ul><li>- chloral hydrate : </li></ul><ul><li>-non-narcotic. </li></ul><ul><li>- no resp.depression. </li></ul><ul><li>- no addiction. </li></ul><ul><li>-50-70 mg/kg orally 30-60 mts before the procedure. </li></ul><ul><li>- not analgesic. </li></ul><ul><li>-15% failure rate. </li></ul>
  38. 38. <ul><li>Rectal methohexital : </li></ul><ul><li>20-30 mg/kg </li></ul><ul><li>Rapid onset 5-10 mts. </li></ul><ul><li>Prolonged action 30-60 mts. </li></ul><ul><li>Unpredictable sedation. </li></ul>
  39. 39. <ul><li>Benzodiazepines : </li></ul><ul><li>Midazolam -0.01mg/kg. </li></ul><ul><li>can be given by all routes. </li></ul><ul><li>sedative ,anxiolytic,anticonvulsant. </li></ul><ul><li>amnesia . </li></ul><ul><li>minimal hemodynamic effects. </li></ul><ul><li>not an analgesic. </li></ul>
  40. 40. <ul><li>I.V anesthetic agents : </li></ul><ul><li>Pentothol sodium : </li></ul><ul><li>5-7mg/kg. </li></ul><ul><li>careful with full stomach & airway. </li></ul><ul><li>ketamine : </li></ul><ul><li>1-2 mg/kg i.v, 2-4 mg/kg i.m </li></ul><ul><li>perfect analgesia. </li></ul><ul><li>reflexes retained. </li></ul>
  41. 41. Contd.. <ul><li>Broncho dilator. </li></ul><ul><li>Resp.activity maintained. </li></ul><ul><li>Raised i.c.t </li></ul><ul><li>Ketatonia. </li></ul><ul><li>Emergency delirium. </li></ul>
  42. 42. <ul><li>Propofol : </li></ul><ul><li>1-2 mg/kg. </li></ul><ul><li>Shorter duration of action. </li></ul><ul><li>Complete recovery. </li></ul><ul><li>Early apnea & hypotension. </li></ul><ul><li>Pain during injection. </li></ul>
  43. 43. <ul><li>G.A : </li></ul><ul><li>Premed – atropine/ glyco. </li></ul><ul><li>Rapid sequence induction. </li></ul><ul><li>Induction agents – thio/propo/ketamine. </li></ul><ul><li>Muscle relaxants – succi/ vec/E.T tube. </li></ul><ul><li>Reversal – neo+ glyco. </li></ul>
  44. 44. <ul><li>REGIONAL : </li></ul><ul><li>EMLA ( ligno+ prilo) </li></ul><ul><li>Occlusive dressing for 60mts. </li></ul><ul><li>L.P ,bone marrow aspiration,ICD,i.v cannula. </li></ul><ul><li>Methemoglobinemia. </li></ul>
  45. 45. DISCHARGE CRITERIA <ul><li>Stable C.V.S . </li></ul><ul><li>Satisfactory airway. </li></ul><ul><li>Patient easily arousable. </li></ul><ul><li>Reflexes intact. </li></ul><ul><li>Patient can talk, can sit up. </li></ul><ul><li>Patient can void urine. </li></ul><ul><li>Young & handicapped – preanesthetic level. </li></ul><ul><li>Hydration must be adequate. </li></ul>
  46. 46. THANK U.
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×