Conduct of general and regional anaesthesia

1. CONDUCT OF GENERAL AND
REGIONAL ANAESTHESIA
DR.GAYATRI MISHRA
ASSISTANT PROFESSOR
ANAESTHESIOLOGY AND CRITICAL CARE

5. • CONTENTS
• DEFINiTION OF ANAESTHESIA
• COMPONENTS-GA AND REGIONAL
• STAGES OF ANESTHESIA
• STEPS IN GA –Preoxygenation
• premedication
• induction intravenous and inhalational
• MASK VENTILATION AND PARALYSE THE PATIENT
• intubation using muscle DEPOLARISING AND NONDEPOLARISING
• maintaienance
• Reversal

6. PREOXYGENATION
100PERCENT OXYGEN
CIRCLE, BAINS, JACKSONS REES
MODIFICATION OF MAPLESON F

7. PREMEDICATION
• GOAL-to reduce anxiety,smothen induction nd
intubation,prevents laryngoscopic response to intubation
• Reduce secretion
• Maintain stable hemodynamics,

8. PREMEDICANT DRUGS
OPOIDS FENTANYL ,MORPHINE,PETHIDINE,
TRAMADOL,FORTWIN
BENZODIAZEPINE-DIAZEPAM,MIDAZOLAM,LORAZEPAM
ANTICHOLINERGICS-ATROPINE AND GLYCOPYROLATE
ALPHA2ADRENERGIC AGONIST-CLONIDINE AND
DEXMEDITOMEDINE
BETABLOCKER ESMOLOL,METOPROLOL,ATENOLOL

9. INDUCTION INTRAVENOUS AND INHALATIONAL
• Thiopentone 5 to 7mg/kg iv
• Propofol 1 to 2 mg/kg iv
• Ketamine 1 to 2 mg/kg iv
• Etomidate 1 to 2 mg/kg iv

12. MUSCLE RELAXANT,-ONCE THE PATIENT IS UNDER
• DEPOLARISING SHORT ACTING-SUCCINYL CHOLINE ,ROCURONIUM
• NONDEPOLARISING ATRACURIUM,VECURONIUM,PANCURONIUM
,MIVACURIUM

13. MAINTENANCE USING OPIDS,RELAXANT, N2O,AIR,
• Adjunct epidural top up or nerve block catheter top up

14. INTUBATION USING DIRECT LARYNGOSCOPY,ENDOTRACHEAL
TUBE
ADVANCE AIRWAY SUPRAGLOTTIC DEVICE,
AIRWAY EQUIPMENT- FIBEROPTIC,FOR DIFFICULT AIRWAY
• PVC TUBE ,FLEXOMETALLIC TUBE, RAE TUBE,DLT,SPECIAL
TUBE {laser surgeries}

15. REVERSAL AND RECOVERY
• Neostigmine and glycopyrolate
• Protude tongue hand grip,
• Able to swallow eye opening and respond to command
• Able to cough out
• Regular breathing,spo2,room air 100 percent
• Monitor use neuro muscular monitor using tof > 0.7
correspond to complete recovery

16. REGIONAL ANESTHESIA
• Patient conscious but not felt sensation and unable to
move [sensory as well as motor blockade]
• Spinal ,epidural ,regional block
• UPPER AND LOWER LIMB
BLOCK,OPTHAL,COELIAC,LUMBAR AND HYPOGATRIC
brachialplexus,interscalene,femoral.sciatic,popliteal,saphe
nous,ankle

19. SPINAL AND EPIDURAL
• USING SPINAL AND EPIDURAL NEEDLE
• BACK PAINTING AND DRAPING
• LOCAL ANAESTHETIC INJECTION WITH 25GAUGE SPINAL NEEDLE L3 –L4 INTERSPACE ,L2-L3
• ENTER THE SA SPACE AFTER PIERCING DURA –LAYERS (SKIN,SUBCUTANEOUS SPACE,SUPRASPINOUS
LIGAMENT,INTERSPINOUS LIGAMENT,LIGAMENTUM FLAVUM,DURA)
• SUDDEN LOSS OF RESISTANCE ND CSF LA INJECTED INTO THE SPACE 0.5% HEAVY BUPIVACAINE
• HYPERBARIC USUALLY 3 TO 3.5 ML
• IN PREGNANCY 1.8 ML
• SYMPATHETIC BLOCKADE ,SENSORY, AUTONOMIC
• IMMEDIATE EFFECT IN SPINAL
• HYPOTENSON AND BRADYCARDIA COMMON

20. • LA USE
• LIGNOCAINE,[WITH OR WITHOUT ADRENALINE 1:200000]
• BUPIVACAINE(HYPERBARIC 0.5% AMPULE AND PLAIN 0.5% VIAL)
• ROPIVACAINE,(.2%)
• LEVOBUPIVACAINE(.2%)

21. • LA TOXICITY IF INTRAVASCULAR –SO TAKE CARE AVOID INJECTING INTO VESSEL DURING
ADMINISTRATION . …..
• ASPIRATE THE SYRINGE ALWAYS
• EPIDURAL SPACE IDENTIFICATION BY LOSS OF RESISTANCE TECHNIQUE
• TEST DOSE WITH LIGNOCAINE AND ADRENALINE 3ML 1:200000 FOR INTRAVASCULAR PLACEMENT