3. INTRODUCTION
Many advancements in pharmacology has been a great
help to the perfect conduction of anesthesia. When the
surgery is completed patient is-
-Comfortable
-cooperative and
-hemodynamically stable
This also provides the patient with following benefits.
-Sedation
-anxiolysis and
-analgesia
The goal has been to establish an environment
in which equipment and techniques are safe
and surgeon is less worried about the stability
of the patient pre and post operatively.
4. They did it for a better tomorrow
HISTORY
(Just to see)
5. -Anesthetic Equipments
-Pharmacology of anaesthetics
-Muscle relaxants
-Stages of anaesthesia
-Post operative care
-Complications of GA.
-Conclusion
CONTENT’s of
the Lecture
7. Minimal Sedation
LEVELS OF SEDATION
At minimal level of sedation, patient is
------Breathing himself and maintains his
airway without any assistance.
------He responds normally to tactile
stimulation and to
------Responds to verbal command
His cardiovascular remain normal and are
unaffected
(Anxiolysis
)
8. Moderate Sedation
LEVELS OF SEDATION
-A drug induced sedation of a patient reflects that
he would respond to
-Purposeful verbal commands either alone or
accompanied by
-Light tactile stimulation, this will work well
and
no intervention would be required to
maintain a patent airway.
- His cardiovascular function will comfortably be
maintained.
conscious
sedation
9. -A drug-induced depression of a conscious
patient during which he cannot be easily
aroused, but respond to purposefully
repeated painful stimulations.
-The patient’s ability to independently
maintain
ventilator function may be impaired, and
the patient may require assistance in
maintaining airway control
cardiovascular function will be
maintained during deep sedation
LEVELS OF SEDATION
Deep Sedation
10. General
Anesthesia
LEVELS OF SEDATION
-A drug-induced loss of consciousness
during which patient is not arousable
even by painful stimulation. The
ability
to maintain ventilatory function is
impaired. Patients often require
assistance in maintaining a patent
airway, and a positive pressure
ventilation may be required because
of a depressed spontaneous
ventilation
or drug-induced depression of
neuromuscular function.
Cardiovascular function may be
impaired.
12. SEQUENCE OF DEPRESSION IN
CENTRAL NERVOUS SYSTEM
CEREBRAL
CORTEX
CEREBELLUM
SPINAL
CORD
MEDULLARY
CENTERS
13. The basic process of taking
- A detailed history and
-Performing a systematic clinical
examination
remains the foundation on which
preoperative assessment relies, backed up
ordering appropriate investigations is
additional help where ever required.
PRE-ANAESTHETIC
EVALUATION
15. Medical history Questionnaire
1- Current problems
2- Other known problems
3- Treatment/medicines for the problems: dose
duration and effectiveness
4-Current drugs use: reason, dose, duration
effectiveness and side effect
5- History of drug allergies
6- History ofuse of tobacco—smoking or
smokeless
tobacco or alcohol consumption, frequency
quantity and duration
7- Prior anesthetic exposure: type and any
adverse
effects
8- General health and review of organ systems
24. 2----Potentially difficult airway.
Limited neck extension.
Limited mouth opening.
Receding mandible.
Mallampati class III or IV
Short thyromental distance
Airway Evaluation
Categories of difficult
airway
26. Patient’s counselling or psychologicalpreparation
----Premedication
----Preoperative instructions
- Fasting instructions
- current or pre-existing drug therapy.
PRE OPERATIVE
PREPARATION
INCLUDE
S
27. For relief of apprehension or anxiety
For sedation
For analgesia
For amnesia of preoperative events
For prevention of nausea and
vomiting
For vagolytic actions
For facilitation of anaesthetic
induction
For prophylaxis against allergies.
PRE OPERATIVE
PREPARATION
PREMEDICATIONS
39. It is Non flammable,non explosive.
-Pleasant smell, non irritating.
-Induction with 2-4 %
-Maintenance with 1-2%.
-BP falls in proportion to the inhaled vapour
concentration
-Depression of respiratory center in high
concentrations.
-Initially respiratory rate increases and depth of
respiration decreases.
-Malignant Hyperthermia can occur in susceptible
individuals
INHALA
TIONAL
ANESTHETICS
HALOTHANE(Fluothan
e)
40. -Introduced into practice in 1984
-Cheap and widely used
-Non carcinogenic, nonflammable
-Less soluble than halothane.
-It can cause coronary artery vasodilatation
-Depresses respiratory drive patient
-Myocardial depression is less than
halothane
INHALA
TIONAL ANESTHETICS
ISOFLURANE(Fora
ne)
41. --it is non flameable derivative
of Isoflorane
--It has a lowest oil-gas coefficient (18.7)
-Very fast action (on and off) makes it
a great choice for outpatient
anesthesia.
--Induction by using 6 to 10 %
desflurane
in air or in oxygen, or by using 5 to
8 % desflurane in 65 % nitrous oxide
--Maintenance with 5 to 7 % desflurane
INHALA
TIONAL ANESTHETICS
DESFLURA
NE
-- Volatile
anesthetic
42. --Nonflammable
--Its properties are intermediate between
isoflurane
and desflurane.
--Induction and emergence from anesthesia are
fast.
--Absence of pungency makes it pleasant
and
administrable through face mask.
--It does not sensitize the heart to arrhythmias
or
cause coronary artery steal syndrome.
INHALA
TIONAL ANESTHETICS
SEVOFLURA
NE
43. -Used as an induction agent.
-It’s a poor analgesic and muscle relaxant.
-It suppresses excitatory neurotransmission and
enhance
inhibitory neurotransmission
-Its pH>10 and it is water soluble.
-It is unstable when kept longer and preferably
-Should be freshly prepared.
-It has very rapid onset of action "30-60"sec.
-It is contraindicated in porphyria and status
asthematicus
cases.
INTRAVENOUS ANESTHETICS
THIOPENT
AL
44. Produce sedation and amnesia
-Potentiate GABA inhibitory receptors.
-Onset of action is 30-60 secs.
-Duration of action 50-80mins.
-Dose- Premedication 2-to-10mg
-Induction- 0.1-0.3mg/kg IV.
INTRAVENOUS ANESTHETICS
BENZODIAZIPIN
ES
45. Short acting Opioid.(30-50mins)
-Very potent anlgesic.
-Minimal cardiac effects
-No myocardial depression
-Marked respiratory depression
-Tone of chest muscles may increase after
rapid
fentanyl injection muscle relaxant is
required.
INTRAVENOUS ANESTHETICS
FENTAN
YL
47. -Excitation of inhibitory neurotransmitters(GABA)
-Oily liquid employed as a 1% emulsion for IV
induction
-Available in 20 ml vials
-Very rapid onset and of short duration of action
-Induction dose: 1-2.5mg/kg
-Sedation dose: 0.2mg/kg
-Decreases systemic vascular resistance.
INTRAVENOUS ANESTHETICS
PROPOF
OL
48. -Direct CNS depressant Lipid soluble.
-Pain on injection.
-Dose- 0.2-0.3mg/kg
-Minimal cardiac and respiratory
effects.
-Anti epileptic
-Post operative nausea and vomiting
are
common side effects.
INTRAVENOUS ANESTHETICS
ETOMIDATE
50. INDUCTION
-Initially nitrous oxide 70% in oxygen is used
-Anesthesia is deepened by the gradual
increments of volatile anesthetic agent
i.e. Sevoflurane
-Maintenance concentrations of isoflurane
(1-2 %) or sevoflurane(2-3%).
-If spontaneous ventilation is to be maintained
through out the procedure, the mask is applied
firmly as consciousness is lost and airway
is supported manually
-Pre- oxygenation may be started with 100%
oxygen using face mask. At the rate of 8L-
10L/min
52. REVERSAL
from anesthesia
-Check equipment
-Check drugs
-Turn off agents
-Give 100% oxygen
-Suction
-Reverse relaxant
-Usually a combination of neostigmine
glycopyrrolate in
the ratio of 5:1, or neostigmine and atropine in
the
ratio of 5:2 is given.
-Wait for adequate breathing
-Wait until patient wakes up
-Extubate and give 100% oxygen by mask
53. POST OPERATIVE CARE
-Patient is shifted to recovery for Post- op care
-N.P.O in normal cases for 4-6 hrs.
-Vital sign monitoring should be done.
-Iv fluids and blood products if required
may be given
postoperatively.
-Analgesia- iv/im Ns aids or opioids if required
-may be supplemented
-Antiemetic's may be given if required
-"Antibiotics“ if required
-Continue medications for medical disorders
If patient is taking already.
54. ----ACTIVITY
2=Move all extremities voluntarily or on command
1= Move two extremities
0= Unable to move extremities
-----RESPIRATION
2 = Breathes deeply and coughs freely, shallow /limited
breathing
1 = Requires assistance
0 = Apnic
-----CIRCULATION
2 = BP+20mm Hg of preanesthetic level
1 = BP+20-50 mm Hg of preanesthetic
level 0 = BP+50 mm Hg of
preanesthetic
level
POST ANESTHESIA
RECOVERY SCORE
55. POST ANESTHESIA
RECOVERY SCORE
--CONCIOUSNESS
--2= Fully awake
--1= Arousable on
calling
--0= Not responding
--OXYGEN
SATURATION
--2 = > 92% on room air or more
--1 = supplemental oxygen
required
--To maintain SpO2 >90%
--0 = SpO2< 92% with oxygen
supplementation
56. Pre operative Period
During maintenance of GA
- Related to anesthetic drug used
- Anesthetic technique
- Equipment failure
- Medical condition
- Surgical pathology
Post operative period
-Related to anesthetic drug used
- Anesthetic technique
- Intubation technique
- Pain
- Infection
- Medical condition
COMPLICATIONS
OF GENERAL ANAESTHESIA
57. ----COUGHING
-Occurs during light plane of anesthesia
-Causes- Irritation of respiratory passages
due to artificial airways,blood, regurgitated
gastric contents.
----Management
- Deepening of anesthesia
-Giving muscle relaxant
-Keep working suction machine ready
COMPLICATIONS
OF GENERALANAESTHESIA
58. 1-Reflex stimulation under light
anesthesia
2-Tracheal / surgical stimulation.
3-Endotracheal tubes- kinking
overdistended inserted too far
4-Anaphylactic reaction
5-Aspiration
6-Pnemothorax.
COMPLICATIONS
OF GENERALANAESTHESIA
WHEEZIN
G
Cause
s
59. COMPLICATIONS
OF GENERALANAESTHESIA
MALIGNANT HYPERTHERMIA
-Hypermetabolic syndrome occurs in
genetically
susceptible patients when exposed to
anesthetic triggering agents.
-Triggering agents-Halothane, Isoflurane,
Desflurane,Sevoflurane,Succinylcholine.
-The syndrome is thought to be due to
reduction
of reuptake of calcium ions by
sarcoplasmic
reticulum leading to sustained muscle
contraction. This results in signs of
hypermetabolism like tachycardia,
60. -Discontinue all anesthetic agents.
-Administer Dantrolene 2.5mg/kg IV. and repeat
to a total of 10 mg/kg.
-Hyperkalemia to be corrected by Insulin and
glucose
--Cold sponging
-Monitor urinary output
COMPLICATIONS
OF GENERALANAESTHESIA
MALIGNANT
HYPERTHERMIA
Treatmen
t
61. -It is caused by irritative stimulus of the upper
airway during light plane of anesthesia.
-The common noxious stimuli to elicit reflex
are throat secretions, vomitus and
inhalation of
pungent volatile anesthetic agents.
-The reflex closure of vocal cords causing
Partial
or total Glottic Obstruction
--Hypoxia, Hypercarbia, and Acidosis are the
worst complications
COMPLICATIONS
OF GENERAL ANAESTHESIA
LARYNGOSPAS
M
63. -Of Underlying cause
-Lateral position
-Anti emetics, Promethazine,
Metoclopramide
-12.5-25mg IM/IV and Antihistamines
-Ranitidine(Antacids) 50 mg IV
-Sodium citrate 30-60 ml orally
COMPLICATIONS
OF GENERAL ANAESTHESIA
POST OPERATIVE NAUSEA AND
VOMITING
Treatment
64. CONCLUSION
IMP--Pre-operative anesthetic assessment,
decreases complications rates and mortality. The pre-
operative visit may relieve anxiety and answers
questions about both the anesthetic and surgical
processes
Effective communication and a team approach
are
vital in the pre-operative period.
