Anaesthesia Outside O.R.
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Anaesthesia Outside O.R.

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Anesthesia challenges outside the Or suites

Anesthesia challenges outside the Or suites

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  • Yea its a nice presentation. But this can be doe also in lithotripsy room for children.
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Anaesthesia Outside O.R. Anaesthesia Outside O.R. Presentation Transcript

  • Anaesthesia outside Operating room
    • Dr.Shailendra.V.L.
    • Specialist in Anaesthesia,
    • Al-Bukariya general hospital.
  • Introduction
    • “ Modern Anaesthesia is quite safe ”
      • Well trained anaesthesiologists
      • Well trained anaesthesia technician
      • Fail-proof anaesthesia machine
      • Monitoring aids
      • Newer and versatile drugs
  • Introduction
    • Handicap for anaesthesia outside Operating Room:
      • Geographical
      • Logistics
      • Material
      • Manpower
  • Problems faced by the Anaesthesiologists
    • Lack of adequate space
    • Unfamiliar surroundings & equipment
    • Central pipeline will be missing & cylinders have to be used
    • Un-physiological postures needed for some procedures
    • Out-patients for investigations are inadequetely prepared/ investigated/ have associated medical illness
    • Adverse reactions to contrast media
    • Lack of post-anaesthetic care
  • Areas of need outside the O.R.
    • Cardiology: Cardiac Cathetherisation Lab (Cath Lab):
      • Coronary angiogram
      • Percutaneous Transluminal Coronary Angioplasty (PTCA)
    • Radiology:
      • C.T.Scan
      • MRI
      • Radio-therapy
  • Areas of need outside the OR
    • Psychiatry :
      • Electro-convulsive therapy (ECT)
    • Plastic Surgery:
      • Burn’s dressing
  • Anaesthetic Plan
    • Good Anaesthetic machine
    • Minimum monitoring standards
    • Resuscitation equipment / drugs
    • Manpower (anaesthetic / technical)
    • Simple & safe anaesthetic technique
  • Anaesthesia machine
    • O2 supply failure alarm
    • Automatic N 2 o cut-off system
    • Back-lit fluorescent back for the flowmeters
    • Bain’s circuit with long tubings
    • Well serviced anaesthesia machine
    • Anaesthesia ventilator
  • Monitoring standards
    • ECG – electro cardiogram
    • NIBP- non-invasive blood pressure
    • SpO2 – pulse-oximetry
    • FI02 – inspired oxygen fraction
    • ETCO2- end-tidal carbon-di-oxide
    • Ventilator disconnect alarm
  • Special procedures in Cardiology department
    • Coronary Angiogram
    • Per-cutaneous Trans-luminal Angioplasty
      • Done under local anaesthesia
      • Painless procedure
      • Only minimal sedation needed
    • Problems:
      • Severe coronary artery disease
      • Injury to coronary vessels needs emergency CABG
  • Special procedures in Psychiatry department
    • Electro-convulsive therapy :
      • Non-pharmacological mode of treatment
      • Commonly used for depression
      • 70-130 volts current is passed for 1 second through two cerebral hemispheres
      • Shock produces muscular contraction
      • Causes initial parasympathetic discharge followed by sympathetic surge
      • Causes retrograde amnesia
  • Anaesthesia for E.C.T.
    • Pre-anaesthetic assessment difficult in un-communicative patients
    • MAO inhibitors & tricyclic anti-depressants have drug interaction with pethidine and barbiturates
    • No pre-medication is given
    • Plan: Induction: Thiopentone – 4mg/kg
    • Relaxant: Suxamethonium 1mg/Kg
    • Patient is manually ventilated with the bite-block in place
    • ECT given
    • Patient is ventilated till he recovers from the relaxant effect
  • Plastic surgery-Burn’s dressing
    • Problems posed by a burn’s patient:
    • Pre-existing psychological trauma
    • Problems in positioning & transfer
    • Difficulty in vascular access
    • Repeated anaesthetics
    • Altered pharmacological response
  • Anaesthetic plan for burn’s dressing
    • Preoperative evaluation :
      • Check airway
      • Check vascular access
      • Check volume status
    • Routine monitoring
    • O 2 by face mask
    • Total Intravenous Anaesthesia (TIVA)
      • Ketamine 1.5mg/Kg IV
      • Diazepam 0.1mg/Kg IV
      • Atropine 0.01mg/Kg IV
  • Anaesthesia for burn’s dressing
    • Halothane avoided as repeated anaesthetics is necessary
    • Suxamethonium is avoided
      • Development of extra-junctional receptors on the muscle surface which will lead to hyperkalemic response
      • (develops 1 week following burns & lasts till 6 months post- burns)
  • Anaesthesia in Radiology department
    • C.T. scan
    • M.R.I. scan
    • Radio-therapy
  • Anaesthesia for C.T. scan
    • Procedure lasts for 10 minutes
    • Non-invasive procedure
    • Patient to lie motionless only
    • Contrast injected to do studies
      • Acute anaphylaxis to contrast media can be disastrous
  • Anaesthesia for C.T.Scan
    • Sedation with Chloral Hydrate 50mg/kg orally half an hour prior to the procedure
    • TIVA: Ketamine 1mg/kg with diazepam 0.1mg/kg & Atropine 0.01mg/Kg
    • TIVA: Propofol 1mg/Kg with Atropine 0.01mg/Kg
    • (Tracheal intubation is a must when Oral radio opaque is used)
    • Head injury patients with low GCS needs intubation and control of ventilation
  • Monitoring for CT Scan
    • ECG
    • Spo2
    • NIBP
    • End-tidal CO2
    • Ventilator disconnect alarm
  • Problems in C. T. scan room
    • Dark / poorly lit room
    • Radiation exposure
    • Very cold environment
    • Limited access to the patient
    • Contrast medium anaphylaxis
  • Anaesthesia for MRI Scan
    • Painless procedure
    • Children only need anaesthesia services
    • Procedure lasts for 60 – 75 minutes
    • Scary feeling staying inside the tube
  • Anaesthesia for MRI Scan
    • Mandatory to intubate all patients and control ventilation using ventilator
    • Need for anaesthesia machine & monitors compatible with MRI environment-Expensive
    • Routine anaesthesia technique is done
    • Minimal Motoring Standards is a must
  • Anaesthesia for Radio-therapy
    • Children need sedation to stay motionless
    • Repeated anaesthetics necessary
    • Painless procedure
    • Procedure lasts for 10 minutes
    • Plan:- TIVA using Ketamine/ Propofol
  • Thank you