This document provides an overview of local anesthesia and general anesthesia. It discusses types of local anesthesia including infiltration, field block, nerve block, and surface anesthesia. It describes the drugs, equipment, and techniques used in local anesthesia as well as the advantages and disadvantages. It also covers general anesthesia, including the drugs, stages of anesthesia, and muscle relaxants used during surgery.
During graduate school I was asked to give this lecture for pharmacy students. Describes aspects of local and general anesthetics including intravenous and inhaled forms of the latter.
During graduate school I was asked to give this lecture for pharmacy students. Describes aspects of local and general anesthetics including intravenous and inhaled forms of the latter.
A tourniquet can be defined as a constricting or compressing device used to control arterial and venous blood flow to a portion of an extremity for a period of time. ... In emergency settings, a tourniquet is used stop traumatic bleeding such that medical care can be provided in time before the injured person bleeds out.
The pneumatic tourniquet system consists of a pressure regulated control unit, hose assembly and an inflatable tourniquet cuff. The cuff inflates with air to a preset pressure to compress the patient's blood vessels during surgical procedures, thus ensuring a bloodless operative field
Surgery – Anaesthesia -- By Prof.Dr.R.R.Deshpande
• This PPT includes most useful Information of Anaesthesia ,which is syllabus Topic from Shalya tantra syllabus of 4th BAMS . Paper 1 Part A Point 4 --- Local anaesthesia ,Paper 1 Part A Point 4 --- Regional and General anaesthesia .This PPT includes Types of Local Anesthesia ,Drugs used in Local Anaesthesia ,General Anesthesia & drugs for GA ,Muscle Relaxants ,Stages of GA,Spinal Anesthesia ,Comparision of LA & GA
Visit – www.ayurvedicfriend.com
Phone – 9226810630
A tourniquet can be defined as a constricting or compressing device used to control arterial and venous blood flow to a portion of an extremity for a period of time. ... In emergency settings, a tourniquet is used stop traumatic bleeding such that medical care can be provided in time before the injured person bleeds out.
The pneumatic tourniquet system consists of a pressure regulated control unit, hose assembly and an inflatable tourniquet cuff. The cuff inflates with air to a preset pressure to compress the patient's blood vessels during surgical procedures, thus ensuring a bloodless operative field
Surgery – Anaesthesia -- By Prof.Dr.R.R.Deshpande
• This PPT includes most useful Information of Anaesthesia ,which is syllabus Topic from Shalya tantra syllabus of 4th BAMS . Paper 1 Part A Point 4 --- Local anaesthesia ,Paper 1 Part A Point 4 --- Regional and General anaesthesia .This PPT includes Types of Local Anesthesia ,Drugs used in Local Anaesthesia ,General Anesthesia & drugs for GA ,Muscle Relaxants ,Stages of GA,Spinal Anesthesia ,Comparision of LA & GA
Visit – www.ayurvedicfriend.com
Phone – 9226810630
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. 2
Learning objectives’
• Types of Local Anesthesia
• Drugs used in Local Anaesthesia
• General Anesthesia & drugs for
GA
• Muscle Relaxants
• Stages of GA
• Spinal Anesthesia
• Comparision of LA & GA
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3
• Local Anesthesia –
• Reversible depression of nerve impulse
conduction
• So temporary loss of sensation & relief of pain
4. 4
Equipments for Anesthesia
• 1) Laryngoscope 2) Endo Tracheal Tube (ETT)
• 3) Ambubag 4) Boyle’s apparatus
• 5) Pulse oximeter 6) Cardiac monitor
• 7) B. P. Instrument 8) Stethoscope
• 9) Spinal Needle 10) Tray of Emergency drug
• 11) Suction catheter 12) O2 cylinder
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Prof.Dr.Y.R.Lamture 6
Pre Anesthesia
• Physical fitness must
• Control of DM & BP
• Oral hygiene ( there should not be Pyorrhoea
like septic focus , loose or artificial denture )
• Nutritional & hydration should be normal
• Base line Lab reports should be normal like Hb,
Bl sugar ,KFT,LFT, & ECG
• Systemic Examination findings – Normal
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Prof.Dr.Y.R.Lamture 7
Grades of Patient by ASA
• ASA = Americal Society of Anesthesiologist
• Grade 1=No abnormality
• Grade 2= Mild systemic disorders
• Grade 3 = Severe systemic disease
• Grade 4 = Life threatening severe systemic
disease
• Grade 5 = Highest risk
• Grade 6 = Dead
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Prof.Dr.Y.R.Lamture 8
Anesthesia - Premedication
• Tab Calmpose – 1 hs ,previous night of
operation ( As a Tranquiliser)
• Inj Calmpose – at the time of surgery
• Inj Atropine – 0.6 mg IM ( reduces secretions)
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Prof.Dr.Y.R.Lamture 10
1) Infiltration Anaesthesia
• Local anesthetic drug is injected into the area
which is to be incised in a circular manner
• Used in - Excision of lipoma, polyp, dermal
cyst, etc.
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Prof.Dr.Y.R.Lamture 11
1) Infiltration Anaesthesia
• Anesthetic is infiltrated into the tissues to be
operated upon
•
• Suitable for small skin lesions ,for suturing
small lacerations
• Xylocaine with adrenaline is used .But if
longer duration of action is required
Bupivacaine is used
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Prof.Dr.Y.R.Lamture 12
1) Infiltration Anaesthesia
• In case of lacerated wound ,the injection may
be given from inside the margin of wound
• In palms ,soles ,nose ,infiltration is difficult (
because skin is tightly bound down)
• For infiltrating dome of an abscess ,a small
quantity is given by insulin syringe ,very
superficially
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Prof.Dr.Y.R.Lamture 13
2) Field Block
• Zone of analgesia is created around the
operative field by injecting local Anesthetic
• Used in Minor surgery ( when unconsciousness
with GA can be fatal )
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Prof.Dr.Y.R.Lamture 14
3)Nerve Block
• Local anesthetic drug is injected near the
nerve ,which is supplying operated area
• Used as Brachial block, Finger (ring) block,
Intercostal nerve block etc.
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Prof.Dr.Y.R.Lamture 15
Regional Anesthesia
• Particular area is anesthetized by a field or
nerve block
• For removal of a sebaceous cyst on the back
,field block can be used ( Local aneasthetic is
infiltrated on the skin of back in the area
,encircling the cyst )
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Prof.Dr.Y.R.Lamture 16
Regional Anesthesia
• In Nerve block ,the anaestheic drug is
deposited near the nerve
• Flooding technique – As there are anatomical
variations in localization of nerves ,large
volume of Anaesthetic drug is given in wider
area
• Injection should never be given in nerves (
recognized by the occurance of paraesthesia
during infiltration )
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Prof.Dr.Y.R.Lamture 17
Examples of Nerve blocks
• 1) Supraorbital Nerve block – To anesthetize skin of
forehead
• 2) Digital Nerve block – without adrenaline.By
blocking dorsal digital nerve ,whole finger can be
anaesthetized
• 3) Median Nerve block – This nerve lies behind
palmaris longus tendon at the wrist .This will
anaesthetize thumb,index,middle & half of ring finger
& corresponding of area of palm –dorsal & palmer
aspect
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Prof.Dr.Y.R.Lamture 19
Examples of Nerve blocks
• 4) Ulnar nerve block -- This will block little
finger & medial half of ring finger .A combined
median & ulnar block will anaesthetise the
whole hand
• 5) Posterior Tibial nerve block – Xylocaine is
injected ,just anterior to Achilles tendon at the
level of medial malleolus .Used in cases of
injuries on plantar aspect of foot
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Prof.Dr.Y.R.Lamture 20
Examples of Nerve blocks
• 6) Calcaneal Nerve block – 5 ml Xylocaine is
injected as a band into the skin below the level
of medial malleolus .Skin of heel is
anaesthetized .
• Useful for removal of corn ,For suturing
laceration in Plantar skin .Useful for giving
steroid injection to a patient of Plantar fasciitis
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Prof.Dr.Y.R.Lamture 21
Examples of Nerve blocks
• 7) Ankle block – This will anesthetize whole
foot .Rarely used
• 8) Penile block – Never use Xylocaine with
adrenaline .Use plain Xylocaine .Complete ring
block is not required ,because nerve enters
only along dorsal aspect .Useful for
circumcision & for correcting paraphimosis
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Prof.Dr.Y.R.Lamture 22
4) Surface Anaesthesia
• Local anesthetic agents is used in the form of
spray, ointment, cream & jelly, lotion to
anesthetized surface skin
• Used in Catheterization, Cystoscopy,
Insertion of Ryle’s tube, etc.
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Prof.Dr.Y.R.Lamture 23
4) Surface Anaesthesia
• Anesthesia is obtained by application of local
anaestheic drug to the surface of skin or
mucous membrane
• EMLA skin cream ( Lignocaine + prilocaine)
• With this cream anaethesia is produced after 1
hour ,after thick application
• Mucous membrane can easily anaesthetised
by eye or ear drops ,throat lozenges,rectal
jelly
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Prof.Dr.Y.R.Lamture 25
Advantages of LA
• 1) Simple & easy to administer
• 2) Body metabolism is not disturbed .So
special attention is not required
• 3) Less bleeding
• 4) Cheap
• Note – In spite of these advantages some
patients prefer GA ,due to fear of remain
conscious during operation
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Prof.Dr.Y.R.Lamture 26
Examples of Medicines for LA
Sr.No Specialty of Drug Drug
1 Low potency + short acting Procaine
2 Moderate Potency +
moderate duration
Lignocaine
( Xylocaine)
3 High Potency + Long
duration
Bupivacaine,
Marcaine
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Prof.Dr.Y.R.Lamture 27
Local Anesthetic drugs
• Commonly used drugs – Lignocaine –either
plain or with adrenaline ,Bupivaine ,
Procaine, Amethocaine
• Procaine ( Novocaine ) & Amethocaine (
Tetracaine) – Less potent & give frequently
Hypersensitive reactions
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Prof.Dr.Y.R.Lamture 28
Lignocaine ( Xylocaine)
• Most commonly used
• Stable & can be stored at room temperature
• Onset of action is rapid & duration of action ranges
from 30 to 60 min ( depending on local vascularity &
site)
• Addition of Adrenaline ( 1 in 2 Lakhs) – prolongs
action up to 2 hours
• Available as 2 % solution with or with out adrenaline
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Prof.Dr.Y.R.Lamture 29
Adrenaline
• Usually combined with Lignocaine
.Adavantages are –
• Adrenaline is local vasoconstrictor .So less
amount of Lignocaine is absorbed by which it
remains in tissue longer & we get prolonged
local anaesthetic effect
• Combination is useful in highly vascular areas
like face & scalp .It gives dry operative field
within 10 min
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Prof.Dr.Y.R.Lamture 30
Adrenaline
• Although there are advantages ,there is risk as well –
• Due to effect of local vaso constriction ,if it is used
around end arteries ( around digit or penis) ,it will
cause gangrene
• So Lignocaine with adrenaline should be avoided at
digits,tip of nose,pinna of ear,shaft of penis
• Plain & lignocaine with adrenaline are available in
different colour bottles
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Prof.Dr.Y.R.Lamture 31
Reaction to Lignocaine
• Anaphylactic is possible but rare
• Reactions occur due to use of large doses or large
amount enters into systemic circulation
• Aspirate ,before injecting locally .Needle should be
kept constantly moving forward & backward ( so
even if needle enters into blood vessel ,small amount
enters in circulation)
• Lignocaine poisoning – Hypotension, Bradycardia,
Heart block
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Prof.Dr.Y.R.Lamture 32
Bupivacaine ( Marcaine)
• More prolonged action
• 4 times more potent than Xylocaine
• So popular for spinal anaesthesia & painless
labour
• No benefit in minor surgeries of GP level
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Prof.Dr.Y.R.Lamture 33
For LA
• Enquire about history of allergy to anaesthetic
drug
• Do not exceed Toxic dose
• Be carful in patients with heart & liver disease
• Select proper site for nerve block
• Avoid accidental IV injection
• Keep watch on bradycardia & twitching on
face ( These are early signs of Toxicity)
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Prof.Dr.Y.R.Lamture 35
Lignocaine – Caution
• Lignocaine with adrenaline should never used
,where end arteries are present
• Tip of fingers
• Lips & Ear
• Penis
• Otherwise – Vasoconstriction effect – Necrosis
• Lignocaine with adrenaline is contraindicated in
MI & HT
• Dose of Lignocaine with adrenaline –
• 5 to 7 mg /kg --- Max 300 mg
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Prof.Dr.Y.R.Lamture 37
LA – Disadvantages
• Allergic reaction – From minor to serious like
Anaphylactic shock
• Nerve or vessel injury
• Lignocaine can not act in the acidic condition
of pus
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Prof.Dr.Y.R.Lamture 38
GA
• Reversible loss of sensations & consciousness
• Clinical features – Loss of sensations ,muscle
relaxation, diminished reflexes,
unconsciousness
• Types – 1) Inhalation of Nitrous oxide ,Ether 2)
Intravenous – Thiopentone sodium ,ketamine
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Prof.Dr.Y.R.Lamture 39
GA
• Techniques – Open drop method or Nitrous
oxide through Boyle’s apparatus
• Complications – Hypotension, Respiratory
depression, Nausea & vomiting, Hepato or
renal Toxicity
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Prof.Dr.Y.R.Lamture 40
Drugs for GA – Nitrous oxide
• Laughing gas ,Non irritating ,better smelling
,safest, administered with oxygen ,Post OP
complications less
• Disadvantages are BP may increase ,
Teratogenic effect
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Prof.Dr.Y.R.Lamture 41
Drugs for GA – Ether
• Colourless volatile liquid
• Muscle relaxation is good so used in all
abdominal surgeries ,safe
• Disadvantages are as vapours are highly
irritative to URT,causes Nausea & vomiting
,increases secretions of all glands
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Prof.Dr.Y.R.Lamture 42
Drugs for GA – Thiopentone sodium
• Ultra short acting for minor surgeries
• Non irritant to lungs .Less nausea & vomiting
,Muscle relaxation is rapid
• Disadvantages are shock may occur due to fall
in BP ,respiratory depression,recovery period
is long
• Dose – 5mg/kg ,IV
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Prof.Dr.Y.R.Lamture 43
Drugs for GA – Ketamine
• Called as ‘Dissociative Anesthesia’
• Good for repeated use
• Respiration not depressed
• Used while dressings of burn ,Incision &
Drainage
• Contraindicated in IHD (HR,BP –Elevated)
• 2mg/kg IV & 10mg/kg IM
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Prof.Dr.Y.R.Lamture 44
Muscle relaxants
• During abdominal surgeries or in fracture
reduction process ,in addition to Anesthetic
drugs muscle relaxants are also used
• Scoline – 50 to 70 mg –action for 5 min
• Flaxedil – 80 to 120 mg – action for 30 min
• Curare – 15 to 18 mg IV –action for 45 min
• Pavulon – 6 mg – action for 60 min
• Neostigmine – Antidote for Curare
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Prof.Dr.Y.R.Lamture 46
Stages of Anesthesia
• I) Stage of Analgesia ---
• Stage is from giving of Anesthetic drugs up to
loss of consciousness
• In this stage pain is diminished
• Respiration & reflexes are normal
• Used for minor operations like labour & for
Incision & Drainage
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Prof.Dr.Y.R.Lamture 47
Stages of Anesthesia
• II) Stage of Excitement
• This stage is from loss of consciousness to
regular respiration
• Patient gets excited , involuntary movements
occur , pupils are dilated, blood pressure and
heart rate increases
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Prof.Dr.Y.R.Lamture 48
Stages of Anesthesia
• III) Stage Of Surgical Anesthesia
• In this stage there will be shift of respiration
from regular to irregular
• BP goes down ,Muscle tone decreases
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Prof.Dr.Y.R.Lamture 49
3 – Stage of Surgical Anesthesia
• This stage is divided into 4 planes
• 1) Roving eye balls
• 2) Loss of Corneal & laryngeal reflexes
• 3) Pupils starts dilating & light reflex loss
• 4) Intercostal paralysis, shallow abdominal
respiration
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Prof.Dr.Y.R.Lamture 50
Stages of Anesthesia
• IV) Stage Of Respiratory Paralysis
• Irregular respiration
• BP drops down
• Pupils fully dilate
• Finally patient may die if situation is not
treated properly
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Prof.Dr.Y.R.Lamture 52
Epidural Anesthesia
• Type of local anesthesia
• Direct block of spinal nerve roots in epidural
space leading to centrifugal spread ,which
affects the nerve in block
• It can be done with the patient in the lateral
decubitus position.
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Prof.Dr.Y.R.Lamture 53
Epidural Anesthesia
• Epidural needle does not have sharp tip, so chance of
puncture in dura matter is very rare.
• In epidural anesthesia 16 to 18 number touhy
needle is used
• Needle is passed through the midline or para median
• Needle passes structure as similar to spinal
anesthesia except penetration into sub-arachnoid
space
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Prof.Dr.Y.R.Lamture 54
Spinal Anesthesia
• Also called as saddle block or saddle
anesthesia
• Local anesthetic drugs is injected around
spinal cord to block transmission of neural
impulses
• When drugs are injected in sub arachnoid
space it is called as Spinal Anesthesia.
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Prof.Dr.Y.R.Lamture 55
Spinal Anesthesia
• After injecting anesthetic drug in subarachnoid space
patient is given sitting position on table for 10 min.
Then it is known as Saddle Block or Saddle
Anesthesia.
• In sitting position CSF has more than 375 mm of Hg
pressure & in supine position CSF has 180 mm of Hg
pressure.
• So that drug does not go upward but spreads mostly
in lower limb .Hence more effect of drug can be seen
in lower abdomen
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Prof.Dr.Y.R.Lamture 56
Spinal Anesthesia
• Types –
• 1) Low spinal Anesthesia
• 2) Mid spinal Anesthesia
• 3) High Spinal Anesthesia
• Advantages
• Adequate relaxation with retention of
consciousness + No irritation of lungs
• Operative haemorrhage is less due to fall of Blood
pressure
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Prof.Dr.Y.R.Lamture 60
Drugs for Spinal Anesthesia
• 1) Lignocaine
• Dose - 15 to 100 mg Duration – 1 to one &
half hour
• 2) Bupivacaine
• Dose - 25 to 50 mg Duration – up to 3 hours
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Prof.Dr.Y.R.Lamture 61
Drugs for Spinal Anesthesia
• 3) Tetracaine
• Dose - 5 to 25 mg , Duration – up to 2 & half
hour
• 4) Cinchocaine (Nupercaine) / Dibucaine
• Dose - 2.5 to 10 mg , Duration – Up to 3 hours
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Prof.Dr.Y.R.Lamture 62
Spinal Anesthesia Procedure
• In sitting position or in left lateral position.
• In lying position ,back is kept parallel to edge
of table.
• In sitting position Leg should be flexed with
back bent forward & advised to rest his arm
on his shoulder.
• The back is cleaned with savlon, iodine &
spirit, under strict aseptic precautions.
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Prof.Dr.Y.R.Lamture 63
Spinal Anesthesia Procedure
• L3, L4 intervertebral space or L4 & L5 space is
commonly used.
• Lumbar puncture needle 25 to 27 G is inserted
in midline between intervertebral space
perpendicular to skin.
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Prof.Dr.Y.R.Lamture 68
Difference in LA & GA
• 1) Site of action in LA is peripheral nerve but
in in GA it is CNS
• 2)LA gives anesthesia to restricted area & GA
gives to whole body
• 3) Patient remains conscious in LA but not in
GA
• 4) LA is for minor procedures but GA is for
major operations
69. References.
1. Bailey & Love’s Short Practise of surgery 25th edition.
2. ACS Surgery: Principles & Practice, 2007 Edition
3. Heffner, Hess.Clinics in Chest Medicine 22 , 2001.
4. Cummings: Otolaryngology: Head & Neck Surgery, 4th ed.2005
5. SCHWARTZ'S PRINCIPLES OF SURGERY 2-volume set 11th edi.19
May 2019
21 October 202069