This document discusses non-operating room anesthesia (NORA). It begins by defining NORA as anesthesia provided outside the operating room, such as in radiology, endoscopy suites, MRI, and dental clinics. It then outlines a three step approach to NORA involving thorough patient assessment, appropriate monitoring and anesthesia care, and post-procedure management. Several ASA guidelines for equipment and facilities in NORA locations are also reviewed. Complications associated with NORA and special considerations for procedures like X-rays, MRIs, and IV contrast administration are discussed. The document emphasizes choosing anesthesia techniques based on patient factors and needs for each specific non-operating room procedure.
This document discusses anesthesia considerations for procedures performed outside the operating room. It notes that the number and complexity of such procedures has increased, bringing additional responsibilities for anesthesiologists. Special challenges include limited space, equipment, and support staff unfamiliar with patient management. Proper equipment, monitoring, and planning are important when providing anesthesia or sedation in remote locations. The document discusses various locations like radiology suites, specific procedures like ECT, and choices of anesthetic agents and techniques. Patient safety is the top priority for remote location anesthesia.
This document discusses different oxygen therapy techniques including conventional oxygen therapy and high flow nasal cannula (HFNC) oxygen therapy. It provides details on:
- How HFNC works by using an air/oxygen blender to deliver high flows of humidified oxygen at variable concentrations.
- The physiologic effects of HFNC including improved oxygen delivery to the alveoli and prevention of adverse effects from lack of humidification.
- Techniques called THRIVE and STRIVE-Hi that use HFNC to provide apneic oxygenation and tubeless anesthesia, extending the time available to secure an airway without risk of hypoxemia.
Anesthesia awareness occurs when a patient becomes conscious during a surgical procedure performed under general anesthesia and has recall of events. The incidence is 0.1-0.2% but higher for certain procedures like cardiac surgery. Patients at risk include women, those under 60, long surgeries, and prior awareness. Causes include light anesthesia, increased anesthetic requirements, and equipment errors. Patients commonly recall sounds and paralysis. Aftereffects may include PTSD. Prevention strategies include preoperative evaluation, proper equipment use, and intraoperative monitoring like BIS monitoring to maintain anesthesia levels.
The document discusses monitored anesthesia care (MAC), which involves administering drugs to provide anxiolytic, hypnotic, amnestic, and analgesic effects without depressing consciousness below a certain level. It provides guidelines on drug selection and dosing for MAC, including opioids like fentanyl and remifentanil, benzodiazepines like midazolam, propofol, ketamine, and dexmedetomidine. It also discusses factors that can lead to patient agitation during MAC and principles of drug administration via continuous infusion or patient-controlled methods.
This document discusses airway local blocks and awake intubation. It describes the indications for awake intubation including comorbidities, risk of aspiration, difficult airway assessment, and emergencies. It provides details on the pharmacological agents, equipment, personnel, and techniques used for airway local blocks and awake intubation. Specifically, it outlines common methods for anesthetizing different areas of the airway using lidocaine, including dosage calculations and risks of lidocaine toxicity. The goal is to safely anesthetize the airway to allow for awake intubation.
1. Tonsillectomy requires maintaining deep general anesthesia to prevent reflex responses during the procedure while allowing for rapid recovery of airway reflexes.
2. Intubation is usually done under deep inhalational or muscle relaxant anesthesia to prevent bucking, and the tube is secured to prevent aspiration of blood or secretions.
3. During the procedure, inhaled anesthetics with opioids or muscle relaxants are used to maintain adequate depth while monitoring for blood loss or airway issues.
This document discusses non-operating room anesthesia (NORA). It begins by defining NORA as anesthesia provided outside the operating room, such as in radiology, endoscopy suites, MRI, and dental clinics. It then outlines a three step approach to NORA involving thorough patient assessment, appropriate monitoring and anesthesia care, and post-procedure management. Several ASA guidelines for equipment and facilities in NORA locations are also reviewed. Complications associated with NORA and special considerations for procedures like X-rays, MRIs, and IV contrast administration are discussed. The document emphasizes choosing anesthesia techniques based on patient factors and needs for each specific non-operating room procedure.
This document discusses anesthesia considerations for procedures performed outside the operating room. It notes that the number and complexity of such procedures has increased, bringing additional responsibilities for anesthesiologists. Special challenges include limited space, equipment, and support staff unfamiliar with patient management. Proper equipment, monitoring, and planning are important when providing anesthesia or sedation in remote locations. The document discusses various locations like radiology suites, specific procedures like ECT, and choices of anesthetic agents and techniques. Patient safety is the top priority for remote location anesthesia.
This document discusses different oxygen therapy techniques including conventional oxygen therapy and high flow nasal cannula (HFNC) oxygen therapy. It provides details on:
- How HFNC works by using an air/oxygen blender to deliver high flows of humidified oxygen at variable concentrations.
- The physiologic effects of HFNC including improved oxygen delivery to the alveoli and prevention of adverse effects from lack of humidification.
- Techniques called THRIVE and STRIVE-Hi that use HFNC to provide apneic oxygenation and tubeless anesthesia, extending the time available to secure an airway without risk of hypoxemia.
Anesthesia awareness occurs when a patient becomes conscious during a surgical procedure performed under general anesthesia and has recall of events. The incidence is 0.1-0.2% but higher for certain procedures like cardiac surgery. Patients at risk include women, those under 60, long surgeries, and prior awareness. Causes include light anesthesia, increased anesthetic requirements, and equipment errors. Patients commonly recall sounds and paralysis. Aftereffects may include PTSD. Prevention strategies include preoperative evaluation, proper equipment use, and intraoperative monitoring like BIS monitoring to maintain anesthesia levels.
The document discusses monitored anesthesia care (MAC), which involves administering drugs to provide anxiolytic, hypnotic, amnestic, and analgesic effects without depressing consciousness below a certain level. It provides guidelines on drug selection and dosing for MAC, including opioids like fentanyl and remifentanil, benzodiazepines like midazolam, propofol, ketamine, and dexmedetomidine. It also discusses factors that can lead to patient agitation during MAC and principles of drug administration via continuous infusion or patient-controlled methods.
This document discusses airway local blocks and awake intubation. It describes the indications for awake intubation including comorbidities, risk of aspiration, difficult airway assessment, and emergencies. It provides details on the pharmacological agents, equipment, personnel, and techniques used for airway local blocks and awake intubation. Specifically, it outlines common methods for anesthetizing different areas of the airway using lidocaine, including dosage calculations and risks of lidocaine toxicity. The goal is to safely anesthetize the airway to allow for awake intubation.
1. Tonsillectomy requires maintaining deep general anesthesia to prevent reflex responses during the procedure while allowing for rapid recovery of airway reflexes.
2. Intubation is usually done under deep inhalational or muscle relaxant anesthesia to prevent bucking, and the tube is secured to prevent aspiration of blood or secretions.
3. During the procedure, inhaled anesthetics with opioids or muscle relaxants are used to maintain adequate depth while monitoring for blood loss or airway issues.
This document provides an overview of supraglottic airway devices. It discusses their history, classifications, indications, contraindications, complications and techniques. It describes some of the major devices including the Classic LMA, LMA Unique, Flexible LMA, LMA Fastrach, Air-Q, and LMA CTrach. Supraglottic devices are used to maintain airway patency and provide ventilation above the vocal cords. They have advantages over face masks and endotracheal tubes in certain situations but also have potential complications if not properly placed.
The document discusses the management of difficult airways. It defines difficult mask ventilation and difficult laryngoscopy/intubation. It describes various tests that can be used to assess a difficult airway, such as the Mallampati test, thyromental distance, sternomental distance, and neck mobility tests. Radiographic predictors of a difficult airway are also discussed, along with causes of difficult intubation related to patient anatomy and various medical conditions.
This document provides information on interscalene brachial plexus blocks, including indications, contraindications, anatomy, techniques, complications, and references. It describes Winnie's anterior approach using landmarks to identify the interscalene groove for injection, as well as a posterior approach. Areas of blockade, continuous techniques, and use of nerve stimulation are also summarized. Supraclavicular blockade as an alternative is outlined with similar details.
This document discusses strategies for optimizing preoxygenation prior to endotracheal intubation. It notes that conventional preoxygenation techniques provide safe intubation for most ED patients but that a subset may still desaturate. To safely intubate this higher risk group, the document recommends optimizing preoxygenation through techniques like non-invasive ventilation, apneic oxygenation through nasal cannula, positioning patients in a head-up position, and breaking the sequence of rapid sequence intubation administration. The goal is to prevent deoxygenation and extend the safe apneic period for patients undergoing endotracheal intubation.
Patient positioning and anaesthetic considerationIqraa Khanum
This document discusses various surgical body positions and their physiological effects. It describes positions like supine, lithotomy, lateral, and prone. For each position, it details how positioning impacts cardiovascular and pulmonary function, as well as nerves that may be at risk of injury. Complications from prolonged use of each position are also reviewed. The document emphasizes the importance of careful patient positioning to balance surgical access needs with physiological stability and risk of pressure injuries.
Caudal anesthesia involves injecting local anesthetic into the caudal canal of the sacrum to provide pain relief below the umbilicus. It can be used alone or with general anesthesia for surgeries involving the perineum, anus, rectum, or lower extremities. The technique involves identifying the sacral hiatus and inserting a needle, with ultrasound or fluoroscopy guidance available. Potential complications include dural puncture, nerve injury, and local anesthetic toxicity. The level of pain relief varies significantly among patients.
Neuromuscular monitoring, also known as train of four monitoring, is a technique used during recovery from the application of general anesthesia to objectively determine how well a patient's muscles are able to function. It involves the application of electrical stimulation to nerves and recording of muscle response using, for example, an acceleromyograph. Neuromuscular monitoring is typically used when neuromuscular-blocking drugs have been part of the general anesthesia and the doctor wishes to avoid postoperative residual curarization (PORC) in the patient, that is, the residual paralysis of muscles stemming from these drugs.
1) The document discusses the history and techniques of fiberoptic intubation. It began with the first rigid bronchoscopy in 1897 and the development of the flexible fiberoptic bronchoscope in 1966.
2) There are different modes of fiberoptic intubation including anesthetized oral, anesthetized nasal, awake oral, and awake nasal. Proper airway anesthesia and sedation techniques are important to prepare for awake fiberoptic intubation.
3) The document reviews techniques for fiberoptic intubation including how to open the airway, use various airway devices, handle the bronchoscope, advance the scope, and pass the endotracheal tube. It emphasizes the importance of proper setup
Total intravenous anesthesia (TIVA) involves maintaining general anesthesia without inhaled anesthetics. TIVA is vital for safely anesthetizing patients at risk of malignant hyperthermia. Propofol and remifentanil are preferred agents due to their fast onset, offset, and context-sensitive half-times. Target-controlled infusion systems aim to achieve and maintain target plasma drug concentrations by using a bolus/elimination/transfer model to account for drug distribution and elimination from three compartments. While effective for anesthesia, propofol requires careful monitoring due to risks of propofol infusion syndrome with high doses or prolonged use.
This document discusses the history, techniques, and physiology of controlled hypotensive anesthesia. It began in 1917 to provide a bloodless surgical field for neurosurgery. Various techniques were developed over time using drugs like nitroprusside and anesthetics to safely lower blood pressure. Key aspects include carefully monitoring vital organ perfusion and using positioning, ventilation, and fluids to potentiate the effects while avoiding dangerous drops in blood flow to the brain, heart, kidneys and other organs.
This document provides an overview of anesthesia considerations for laparoscopic surgeries. It discusses the history of laparoscopy, physiological effects of pneumoperitoneum including on the cardiovascular, respiratory, central nervous and renal systems. It also outlines respiratory complications like subcutaneous emphysema, pneumothorax, gas embolism and their treatment. The effects of patient positioning and conduct of anesthesia are summarized.
The document discusses awake intubation, including indications, patient preparation, pharmacological considerations like using lidocaine to anesthetize the airway via various methods to block different nerves, equipment needs, and personnel requirements to safely perform an awake intubation. It also reviews closed claims analyses related to airway management and difficult intubation, and the ASA's difficult airway algorithm.
Anaesthetic management of tracheoesophageal fistula and congenital diaphragmaticIqraa Khanum
The document discusses the anesthetic management of tracheoesophageal fistula (TEF) and congenital diaphragmatic hernia (CDH) in neonates. It covers the embryology, clinical presentation, diagnosis, and preoperative, intraoperative and postoperative anesthetic considerations for repair of each condition. TEF results from imperfect division of the foregut during development, while CDH occurs due to failure of the diaphragm to fully form, allowing abdominal organs to herniate into the chest cavity. Proper management requires careful attention to the neonate's respiratory status and minimizing risks of aspiration or overdistention.
as the life expectancy has increased. more and more elderly patients are undergoing surgery. the burden of postoperative dysfunction has to be increased in future. There should be attempt to identify the risk factors and measures to prevent POCD.
This document provides an overview of obstructive sleep apnea (OSA) and its implications for anesthesia. It defines OSA and discusses its causes, diagnosis, and physiological effects. It outlines risks of anesthesia for those with OSA, including difficult intubation and postoperative respiratory depression. It recommends preoperative screening and treatment with CPAP or weight loss. Intraoperatively, it advises securing the airway and avoiding sedatives that could cause collapse. Postoperatively, supplemental oxygen is important due to risk of apnea and respiratory depression upon waking.
Anticoagulants, antiplatelet drugs and anesthesiaRajesh Munigial
It is a presentation on anticoagulants and antiplatelets in anesthesia , starting from basis of coagulation , its tests and dugs and anesthetic implications
Based on latest ASRA (AMERICAN SOCIETY OF REGIONAL ANESTHESIA GUIDELINES)
1) Day case anesthesia, also known as ambulatory surgery or same-day surgery, allows patients to be admitted for a surgical procedure and investigation but return home the same day without an overnight hospital stay.
2) There has been a rapid expansion in the use of day case surgery over the last 30 years, with approximately 65% of surgeries in the United States now performed on an outpatient basis.
3) Day case anesthesia provides advantages like reduced costs, increased bed availability, and less risk of hospital-acquired infections compared to traditional inpatient surgery.
Dr. Kumar presented on extubation problems and their management. Some key points:
1. Tracheal extubation requires careful planning and preparation to prevent complications like laryngospasm, laryngeal edema, and pulmonary aspiration.
2. Patients should generally be extubated awake to allow for airway protection, but deep extubation may be considered to reduce cardiovascular stimulation.
3. Potential problems include mechanical issues removing the tube, cardiovascular changes, respiratory complications, and airway obstruction. Management depends on the specific issue but may include medications, positioning, or alternative extubation techniques.
4. Careful evaluation of each patient's risk factors and planning is necessary to safely perform extubation and prevent
Anaesthetic management in a patient of burns injurykshama_db
This document provides an overview of the anaesthetic management of a burn patient. It begins with definitions and classifications of burns. It then discusses the pathophysiology of burns which involves inflammatory and circulatory changes, injury to the airway and lungs, immune system response, and effects on other organ systems. The document outlines assessment of burn wounds including total body surface area involved and depth of burns. It discusses the role of the anaesthesiologist in airway management, vascular access, fluid resuscitation, and surgical procedures for burn patients. The goal of management is to maintain intravascular volume following a burn to provide sufficient circulation to preserve organ function.
This document provides information about total intravenous anesthesia (TIVA). It begins with a definition of TIVA as a technique of general anesthesia that uses intravenous agents exclusively without inhalational gases.
It then discusses the history of TIVA, types of TIVA, indications, advantages, disadvantages, common drugs used and their properties, drug combinations, and methods of administration including single syringe, manually controlled infusion, target controlled infusion, and closed loop systems. Specific TIVA protocols, dosages, and drug mixtures are also outlined. The document aims to provide an overview of TIVA for educational purposes.
QUALITY AND SAFETY IMPROVEMENT EFFORTS OUTSIDE OPERATING ROOMPallavi Ahluwalia
This document discusses quality and safety improvement efforts for anesthesia provided outside the operating room (NORA). It outlines common NORA locations like radiology, endoscopy, intensive care, and lists challenges faced including unfamiliar surroundings, patient positioning issues, and lack of monitoring and recovery resources. Guidelines are presented for ensuring adequate space, equipment, monitoring and personnel to safely conduct NORA. Complications associated with NORA are reviewed along with tools like checklists and protocols to improve reliability and safety. Specific considerations for different NORA locations like radiology, MRI, and interventions are highlighted. The importance of adherence to standards, continuous quality improvement, and interdisciplinary communication are emphasized for enhancing NORA safety.
This document provides an overview of supraglottic airway devices. It discusses their history, classifications, indications, contraindications, complications and techniques. It describes some of the major devices including the Classic LMA, LMA Unique, Flexible LMA, LMA Fastrach, Air-Q, and LMA CTrach. Supraglottic devices are used to maintain airway patency and provide ventilation above the vocal cords. They have advantages over face masks and endotracheal tubes in certain situations but also have potential complications if not properly placed.
The document discusses the management of difficult airways. It defines difficult mask ventilation and difficult laryngoscopy/intubation. It describes various tests that can be used to assess a difficult airway, such as the Mallampati test, thyromental distance, sternomental distance, and neck mobility tests. Radiographic predictors of a difficult airway are also discussed, along with causes of difficult intubation related to patient anatomy and various medical conditions.
This document provides information on interscalene brachial plexus blocks, including indications, contraindications, anatomy, techniques, complications, and references. It describes Winnie's anterior approach using landmarks to identify the interscalene groove for injection, as well as a posterior approach. Areas of blockade, continuous techniques, and use of nerve stimulation are also summarized. Supraclavicular blockade as an alternative is outlined with similar details.
This document discusses strategies for optimizing preoxygenation prior to endotracheal intubation. It notes that conventional preoxygenation techniques provide safe intubation for most ED patients but that a subset may still desaturate. To safely intubate this higher risk group, the document recommends optimizing preoxygenation through techniques like non-invasive ventilation, apneic oxygenation through nasal cannula, positioning patients in a head-up position, and breaking the sequence of rapid sequence intubation administration. The goal is to prevent deoxygenation and extend the safe apneic period for patients undergoing endotracheal intubation.
Patient positioning and anaesthetic considerationIqraa Khanum
This document discusses various surgical body positions and their physiological effects. It describes positions like supine, lithotomy, lateral, and prone. For each position, it details how positioning impacts cardiovascular and pulmonary function, as well as nerves that may be at risk of injury. Complications from prolonged use of each position are also reviewed. The document emphasizes the importance of careful patient positioning to balance surgical access needs with physiological stability and risk of pressure injuries.
Caudal anesthesia involves injecting local anesthetic into the caudal canal of the sacrum to provide pain relief below the umbilicus. It can be used alone or with general anesthesia for surgeries involving the perineum, anus, rectum, or lower extremities. The technique involves identifying the sacral hiatus and inserting a needle, with ultrasound or fluoroscopy guidance available. Potential complications include dural puncture, nerve injury, and local anesthetic toxicity. The level of pain relief varies significantly among patients.
Neuromuscular monitoring, also known as train of four monitoring, is a technique used during recovery from the application of general anesthesia to objectively determine how well a patient's muscles are able to function. It involves the application of electrical stimulation to nerves and recording of muscle response using, for example, an acceleromyograph. Neuromuscular monitoring is typically used when neuromuscular-blocking drugs have been part of the general anesthesia and the doctor wishes to avoid postoperative residual curarization (PORC) in the patient, that is, the residual paralysis of muscles stemming from these drugs.
1) The document discusses the history and techniques of fiberoptic intubation. It began with the first rigid bronchoscopy in 1897 and the development of the flexible fiberoptic bronchoscope in 1966.
2) There are different modes of fiberoptic intubation including anesthetized oral, anesthetized nasal, awake oral, and awake nasal. Proper airway anesthesia and sedation techniques are important to prepare for awake fiberoptic intubation.
3) The document reviews techniques for fiberoptic intubation including how to open the airway, use various airway devices, handle the bronchoscope, advance the scope, and pass the endotracheal tube. It emphasizes the importance of proper setup
Total intravenous anesthesia (TIVA) involves maintaining general anesthesia without inhaled anesthetics. TIVA is vital for safely anesthetizing patients at risk of malignant hyperthermia. Propofol and remifentanil are preferred agents due to their fast onset, offset, and context-sensitive half-times. Target-controlled infusion systems aim to achieve and maintain target plasma drug concentrations by using a bolus/elimination/transfer model to account for drug distribution and elimination from three compartments. While effective for anesthesia, propofol requires careful monitoring due to risks of propofol infusion syndrome with high doses or prolonged use.
This document discusses the history, techniques, and physiology of controlled hypotensive anesthesia. It began in 1917 to provide a bloodless surgical field for neurosurgery. Various techniques were developed over time using drugs like nitroprusside and anesthetics to safely lower blood pressure. Key aspects include carefully monitoring vital organ perfusion and using positioning, ventilation, and fluids to potentiate the effects while avoiding dangerous drops in blood flow to the brain, heart, kidneys and other organs.
This document provides an overview of anesthesia considerations for laparoscopic surgeries. It discusses the history of laparoscopy, physiological effects of pneumoperitoneum including on the cardiovascular, respiratory, central nervous and renal systems. It also outlines respiratory complications like subcutaneous emphysema, pneumothorax, gas embolism and their treatment. The effects of patient positioning and conduct of anesthesia are summarized.
The document discusses awake intubation, including indications, patient preparation, pharmacological considerations like using lidocaine to anesthetize the airway via various methods to block different nerves, equipment needs, and personnel requirements to safely perform an awake intubation. It also reviews closed claims analyses related to airway management and difficult intubation, and the ASA's difficult airway algorithm.
Anaesthetic management of tracheoesophageal fistula and congenital diaphragmaticIqraa Khanum
The document discusses the anesthetic management of tracheoesophageal fistula (TEF) and congenital diaphragmatic hernia (CDH) in neonates. It covers the embryology, clinical presentation, diagnosis, and preoperative, intraoperative and postoperative anesthetic considerations for repair of each condition. TEF results from imperfect division of the foregut during development, while CDH occurs due to failure of the diaphragm to fully form, allowing abdominal organs to herniate into the chest cavity. Proper management requires careful attention to the neonate's respiratory status and minimizing risks of aspiration or overdistention.
as the life expectancy has increased. more and more elderly patients are undergoing surgery. the burden of postoperative dysfunction has to be increased in future. There should be attempt to identify the risk factors and measures to prevent POCD.
This document provides an overview of obstructive sleep apnea (OSA) and its implications for anesthesia. It defines OSA and discusses its causes, diagnosis, and physiological effects. It outlines risks of anesthesia for those with OSA, including difficult intubation and postoperative respiratory depression. It recommends preoperative screening and treatment with CPAP or weight loss. Intraoperatively, it advises securing the airway and avoiding sedatives that could cause collapse. Postoperatively, supplemental oxygen is important due to risk of apnea and respiratory depression upon waking.
Anticoagulants, antiplatelet drugs and anesthesiaRajesh Munigial
It is a presentation on anticoagulants and antiplatelets in anesthesia , starting from basis of coagulation , its tests and dugs and anesthetic implications
Based on latest ASRA (AMERICAN SOCIETY OF REGIONAL ANESTHESIA GUIDELINES)
1) Day case anesthesia, also known as ambulatory surgery or same-day surgery, allows patients to be admitted for a surgical procedure and investigation but return home the same day without an overnight hospital stay.
2) There has been a rapid expansion in the use of day case surgery over the last 30 years, with approximately 65% of surgeries in the United States now performed on an outpatient basis.
3) Day case anesthesia provides advantages like reduced costs, increased bed availability, and less risk of hospital-acquired infections compared to traditional inpatient surgery.
Dr. Kumar presented on extubation problems and their management. Some key points:
1. Tracheal extubation requires careful planning and preparation to prevent complications like laryngospasm, laryngeal edema, and pulmonary aspiration.
2. Patients should generally be extubated awake to allow for airway protection, but deep extubation may be considered to reduce cardiovascular stimulation.
3. Potential problems include mechanical issues removing the tube, cardiovascular changes, respiratory complications, and airway obstruction. Management depends on the specific issue but may include medications, positioning, or alternative extubation techniques.
4. Careful evaluation of each patient's risk factors and planning is necessary to safely perform extubation and prevent
Anaesthetic management in a patient of burns injurykshama_db
This document provides an overview of the anaesthetic management of a burn patient. It begins with definitions and classifications of burns. It then discusses the pathophysiology of burns which involves inflammatory and circulatory changes, injury to the airway and lungs, immune system response, and effects on other organ systems. The document outlines assessment of burn wounds including total body surface area involved and depth of burns. It discusses the role of the anaesthesiologist in airway management, vascular access, fluid resuscitation, and surgical procedures for burn patients. The goal of management is to maintain intravascular volume following a burn to provide sufficient circulation to preserve organ function.
This document provides information about total intravenous anesthesia (TIVA). It begins with a definition of TIVA as a technique of general anesthesia that uses intravenous agents exclusively without inhalational gases.
It then discusses the history of TIVA, types of TIVA, indications, advantages, disadvantages, common drugs used and their properties, drug combinations, and methods of administration including single syringe, manually controlled infusion, target controlled infusion, and closed loop systems. Specific TIVA protocols, dosages, and drug mixtures are also outlined. The document aims to provide an overview of TIVA for educational purposes.
QUALITY AND SAFETY IMPROVEMENT EFFORTS OUTSIDE OPERATING ROOMPallavi Ahluwalia
This document discusses quality and safety improvement efforts for anesthesia provided outside the operating room (NORA). It outlines common NORA locations like radiology, endoscopy, intensive care, and lists challenges faced including unfamiliar surroundings, patient positioning issues, and lack of monitoring and recovery resources. Guidelines are presented for ensuring adequate space, equipment, monitoring and personnel to safely conduct NORA. Complications associated with NORA are reviewed along with tools like checklists and protocols to improve reliability and safety. Specific considerations for different NORA locations like radiology, MRI, and interventions are highlighted. The importance of adherence to standards, continuous quality improvement, and interdisciplinary communication are emphasized for enhancing NORA safety.
This document discusses anesthesia and sedation procedures performed outside the operating room. It outlines common procedures that require anesthesia outside OR settings like radiology suites and ICUs. It also describes the challenges anesthesiologists face in these settings like unfamiliar environments, limited equipment and monitoring, and patient issues. Guidelines are provided for sedation versus general anesthesia based on the procedure and safety standards for monitoring, equipment, and discharge criteria when anesthesia is provided outside the traditional operating room.
This document discusses anesthesia and sedation procedures performed outside the operating room. It outlines common procedures requiring anesthesia outside OR settings like radiology, cardiology, and the emergency department. Key challenges include unfamiliar environments, limited equipment and monitoring, and lack of backup. The document then discusses specific patient safety standards, recommended monitoring equipment, types of anesthesia that can be used, and discharge criteria for patients receiving sedation outside the OR.
This document discusses anesthesia considerations for MRI and CT scans. It notes that sedation or anesthesia is often required for infants, uncooperative children, patients with movement or psychological disorders, and critically ill patients. The main challenges include using MRI-compatible monitoring equipment, limited access to patients, and treating medical emergencies safely outside of the scanner. Commonly used sedative agents include oral chloral hydrate, midazolam, and propofol administered with monitoring of ventilation.
Anaesthesia for radiological procedures final Kalpesh Shah
This document discusses the unique constraints anesthesiologists face when providing care in radiology settings rather than traditional operating rooms. It notes that radiological procedures generate significant volume and revenue, and require the same attention to efficiency, planning, and consistency as major surgeries. The document outlines general constraints like equipment limitations, monitoring challenges, and communication barriers in radiology suites. It also provides anesthesia considerations and approaches for specific radiological procedures like CT, MRI, cath lab cases, and interventional radiology.
Anesthesia carries risks that can lead to patient death or injury. Several factors contribute to risks in the operating room including equipment issues, patient health factors, human performance errors, and system failures. Some key errors that can cause severe harm are airway issues, medication errors, and procedure mistakes. Maintaining vigilance, checklists, standards, training, and learning from adverse events can help improve safety. Thorough documentation and review of incidents is important for quality assurance.
This document discusses the challenges of performing thyroid surgery for patients with large thyroid swellings that extend into the chest (retrosternal goiters). Key risks include difficult intubation, blood loss, prolonged surgery, and cardiovascular or airway complications during or after surgery. Thorough preoperative evaluation and planning is required, including assessing airway accessibility and developing primary and backup airway management plans. Careful perioperative management is also needed to address issues like potential airway obstruction, tracheomalacia, nerve injury, hematoma, or edema. Postoperative monitoring and treatment may involve assessing for tracheomalacia, nerve palsies, or the need for tracheostomy or ventilation.
Daycare surgery involves operations where the patient is discharged on the same day. General anaesthesia is commonly used, while central neuraxial blocks are discouraged due to delayed discharge from motor block. Local and plexus blocks are good options. Anaesthetic goals include smooth onset, adequate intraoperative analgesia/amnesia, and rapid recovery. Common daycare surgeries include hernia repair, hemorrhoidectomy, laparoscopic procedures, otoplasty, and cystoscopy. Monitored anaesthesia care involves anaesthesiologist oversight during planned procedures. Non-operating room anaesthesia presents challenges due to unfamiliar environments but can be addressed through thorough patient evaluation, appropriate monitoring, and careful planning for procedures such as cardiac catheter
This document discusses guidelines and considerations for providing anaesthesia services in non-operating room areas (NORA) such as for MRI/CT scans. It notes special challenges in NORA including limited space, equipment issues, and unfamiliar environments. Key guidelines are outlined such as having proper patient monitoring, emergency equipment, and following pre-procedure evaluations. Specific anaesthetic drugs that can be used for moderate sedation are discussed, including propofol, benzodiazepines, dexmedetomidine, and ketamine. Hazards in the MRI environment like magnetic fields, acoustic noise, and restricted access are summarized. The document stresses the importance of patient safety, standards of care, and proper planning for NORA cases.
This document discusses the importance of preoperative assessment and premedication in anesthesia. It outlines the goals of the preoperative visit including assessing fitness for anesthesia and optimizing medical conditions. The document describes taking an anesthetic history and physical examination, with a focus on evaluating the cardiovascular, respiratory and airway systems. It discusses using tests like Mallampati scoring and thyromental distance to predict potential airway difficulties. The document also covers determining appropriate preoperative investigations and developing an anesthetic plan tailored to each patient's needs.
Handling the emergencies in radiology and first aid in the x ray departmentAnupam Niraula
1) Emergency departments are designed to treat acute medical issues without appointments and are staffed by trauma physicians. They classify patients into non-urgent, urgent, and acute categories to prioritize care.
2) For trauma patients, MDCT is often the preferred imaging method and should be located near the emergency room along with radiography. Interventional radiology may perform procedures like embolization to stop hemorrhaging.
3) In reaction emergencies, treatments vary based on symptoms but may include oxygen, antihistamines, epinephrine, saline, and moving the patient to stabilize their condition. Staff are trained to recognize and respond to different types and severities of reactions.
PRE-OPERATIVE AND INTRA-OPERATIVE CARE OF THE ANESTHESIA PATIENT group 8-2.pptxDakaneMaalim
1. The document discusses pre-operative and intra-operative care of anesthesia patients, outlining factors like history, physical exam, labs, and risk assessment that are important to evaluate patients.
2. Key parts of evaluation include assessing airway, cardiovascular and respiratory systems, medications, allergies, and relevant medical history.
3. The goals are to decrease risks and complications, make plans for anesthesia, and optimize patient condition and education prior to surgery.
Managing Upper airway problems in children for ENT / Paediatric / Anaesthetic...MTD Lakshan
Here I discuss approach to managing an obstructed upper airway of a child. Details about clinical assessment, investigations and management stratergies are outlined.
A 43 year old male patient was transferred with an ambulance in the emergency department of the hospital with bleeding from right thigh after a motorcycle accident. He had become a trapped under the motorcycle.
Discuss the medical, surgical and anesthetic management of this patient.
Emergency sonography in Pediatrics has evolved to become one of the most versatile
modalities for diagnosing and guiding
treatment of critically ill patients.
Case presentation of Orthopedic Cse Anaesthesia ManagementMr.Harshad Khade
A 43 year old male patient was transferred with an ambulance in the emergency department of the hospital with bleeding from right thigh after a motorcycle accident. He had become a trapped under the motorcycle.
Discuss the medical, surgical and anesthetic management of this patient.
This document provides guidance on various trauma and critical care topics. It discusses:
1. The benefits of early tourniquet use and ketamine for pain control in trauma patients.
2. Recommendations for use of TEG/Rotem, TXA, and fluid resuscitation in massive transfusion patients.
3. Tips for estimating burn severity and fluid resuscitation in burn patients.
name of person assisting with transfer
Background: brief history of present illness and injury
Assessment: vital signs, GCS, injuries identified, procedures performed
Recommendation: level of care required, pending procedures or tests,
anticipated problems during transport
This document discusses the management of various types of medicolegal emergencies from an intensivist's perspective. It outlines procedures for handling cases involving polytrauma, poisoning, drug overdoses, burns, assaults, gunshot wounds, drowning, hanging, and snake/animal bites. Priority is given to stabilizing the patient and addressing life-threatening injuries before legal formalities. Proper consent, confidentiality, evidence collection and medico-legal report preparation are also emphasized.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
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Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
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Anesthesia at Remote locations
1. Anaesthesia & sedation in offsite
locations:
How to maintain quality & avoid
complications
Dr Sandeep Kundra
Associate Professor,
Department of Anesthesia,
DMC & H, Ludhiana.
2. What’s there in the name
- Non operating room anesthesia.
(NORA)
- Anesthesia at remote location.
- Outpatient anesthesia.
- Office based anesthesia.
That which we call a Rose by any other name would smell as sweet.
- William Shakespeare
4. Anesthesia outside OR : Goals.
• Ensure safety.
• Minimize pain and discomfort.
• Control patient movement.
• Minimize psychological discomfort and anxiety.
• Careful monitoring and recording of vital signs.
• Develop efficient and cost effective system.
5. Anesthesia out of OR – A dangerous
proposition!!!
• Exact data – not available.
• Complication rate higher than OR.
• Adverse respiratory event – 44 %.
• 50 % cases were under MAC.
• Many were preventable.
MetznerJ, Posner KL, Domino KB. The risk and safety of anesthesia at remote locations:
the US closed claims analysis. Curr Opin Anaesthesiol 2009; 22:502–508.
6. Challenges of Anesthesia outside OR
Patient is desaturating…..Please give me mask, quickly.
Sure Sir. Here it is.
Patient
Procedure Environment
Anesthesiologist
7. Challenges - Patient
• Extremes of age.
• Sick patients offered procedures, otherwise unfit.
• Proceduralist unaware of general condition.
• Little time for cross consultation and optimization.
• Lack of patient awareness.
8. Challenges - Procedure
Sisterrrrrr…………. I asked for Laryngoscope,
not this endoscope!!!!!
• Staff not acquainted with anesthetic management.
• In case of any problem, additional help not available.
• Procedure details may not be known to anesthetist.
• Limited airway rescue devices.
9. Challenge - Environment
• Cramped for space.
• Limited access to patient.
• Poor Illumination.
• Often Old, unfamiliar equipment, not serviced.
• Emergency drugs and resuscitation equipment not
readily available.
14. MRI Challenges
MRI suite
MRI safe equipment
Ensure patient has
no ferromagnetic
implants
Anesthetist has no
metal objects
Absolute immobility
needed
Young children
Claustrophobic
Mentally challenged
Auditory protection
15. Ferromagnetic Objects
• ICD/ Pacemakers
• Vascular clips
• Ortho Implants
• Insulin pump
• Dentures
• Metallic Heart valve
• Pellets, bullets.
• Magnetic strips including credit cards and ID badges.
16. MRI zones
There is a yellow line
within the MRI room
which cannot be crossed
with any ferromagnetic
materials.
17. Interventional Radiology
• Liver biopsy, abscess drainage, TIPPS, embolization.
• Unfit for surgery are offered interventions so many
patients are high risk patients.
• Sclero-therapeutic agents:
- Ethanol - Bleomycin
- Polyvinyl alcohol - sodium tetradecyl sulfate
- Ethylene vinyl alcohal - cyanoacrylate glue
19. Nuclear medicine : PET
• Applications for diagnosis and response to treatment.
• Sedation required during warming phase, 30 min to 1
hour after radioisotope injection.
• High risk of exposure to anesthesia personnel, remote
monitoring can be set up.
• Commonly require long periods of sedation.
20. External beam radiation therapy
• Complete patient immobility.
• Daily treatments are common.
• Remote monitoring is necessary.
• Children commonly require monitored transport to a
radiation centre.
21. Cardiac Cath Lab
• PTCA for unstable patients.
• Minimize effects of anesthetic drugs on CVS.
• May need resuscitation during procedure.
• Multiple infusions.
• Device closure for ASD/VSD – GA.
22. Upper GI endoscopy
GI endoscopy
Shared airway
Risk of aspiration
Bleeding
Copious bowel
prep agents
Hemodynamic
instability esp in
elderly
Limited CVS
reserve &
Dehydration
Vagal response
from distended
bowel
Risk of Apnea, Laryngospasm, Bronchospasm and Airway
obstruction.
25. Dentistry
• Reserved for Complicated
or prolonged cases, uncooperative patients.
• Shared airway - Tracheal intubation, often nasally.
• Postoperative complications:
- Bleeding,
- Airway obstruction
- Laryngeal spasm.
26. Ensuring safety : Onus is on
Anesthesiologist
• Personnel for NORA.
• Equipments.
• Monitoring.
• Precautions.
• Post procedural care.
Patient
safety
Constraints
Patient
Comfort
Quality
Assurance
Proceduralist
requirements
27. Who can administer sedation.
• American Society of Anesthesiologists. (ASA)
• American Society for gastro-instestinal endoscopy.
(ASGE)
• Guidelines by American College of Chest Physicians.
• Guidelines by Interventional radiologists
28. Who can administer sedation
• Non-anesthetists – Well, Yes They can !!
• Person sedating - should not perform procedure.
• Skilled in resuscitation and airway management.
• Nurse administered propofol sedation. (NAPS)
• Adequate Monitoring is must.
• Deep sedation – anesthetist help should be sought.
30. Equipment checklist - SOAPME
S (Suction) Reliable with appropriate size catheters
O ( Oxygen) Reliable source
At least one spare E-type cylinder
A ( Airway) Appropriate sized airway equipment
- Face mask
- Oral and nasal airway
- ETT & Stylets
- Bag-valve-mask or equivalent device
P ( Pharmacy) Emergency Resuscitation drugs
M ( Monitors) As per ASA standards
E ( Equipment) - Defibrillator with pads
- Gas Scavenging if volatile being used
- Safe electrical Outlets (earthed)
- Adequate Lighting ( Torch/ Batteries)
- Means of Communication to main OT
31. Monitoring requirements
As per ASA minimum monitoring standards in OR
1. Pulse oxymeter
2. NIBP
3. ECG
4. End tidal CO2
5. Temperature
Easier said than done !!!
32. MRI – monitoring difficulties
• ECG - Voltage induced by blood flow in the aorta
produces T- and ST-wave abnormalities
ECG electrodes using carbon graphite and coaxialised
cables to avoid any coils.
• BLOOD PRESSURE – pneumatically operated no
interference.
Invasive BP – transducers need to be kept outside the
Gauss line
33. MRI – monitoring difficulties
• VENTILATION
– difficult to visualize pt.
– capnography (signal delay long tubing)
– spontaneously/controlled breathing bag movements.
• OXYGENATION – MR specific oxymeters with
fibreoptic cables which don’t heat and cant be looped.
• TEMPERATURE – Cold room predisposes to hypothermia
35. What to do if MRI safe workstation not
available.
36. Patient preparation
• Detailed PAC & relevant investigations.
• Review previous procedures and sedation.
• Ensure NPO status as per ASA guidelines.
• Airway examination is of utmost importance.
• Informed consent.
• Patient information and Education.
38. Ensuring safety despite constraints
• Acquaintance with the place.
• Check anesthesia machine and monitors.
• Ensure adequate drugs and resuscitation equipment.
• Enough Light and space.
• Have a trained assistant.
Always have a back up plan and have someone on
call.
39. Sedation - Contraindications
• Full stomach.
• Airway problems – actual/potential obstruction.
• Apneic spells.
• Respiratory distress- SpO₂ <94% with room air,
respiratory failure, inability to cough and cry.
• Raised ICT – drowsiness, headache & vomiting.
40. Special Conditions
• Burn ICU – difficult airway and IV access.
• Pediatric patients – More prone to obstruction.
• Screen for syndromes and typical facies.
• Obese patients : Difficult airway.
• H/O OSA – challenges.
41. Anesthetist called in the midst of
procedure
• Hazardous condition.
• No prior planning.
• Sub-optimal monitoring.
• Unsure of the drugs, already administered.
• If possible, postpone the procedure.
42. Post procedure care
• Ensure proper documentation.
• Transfer to an area where monitoring continues.
• Careful transfer and hand over.
• Clear instructions to the holding area.
• Must fulfill Discharge criteria before shifting back.