The document provides information on general anesthesia including:
- Levels of sedation ranging from minimal to general anesthesia
- The goals of sedation including sedation, anxiolysis, and analgesia
- Common anesthetic equipment such as laryngoscopes, endotracheal tubes, and monitoring equipment
- Pharmacology of anesthetic agents including inhalational gases and intravenous medications
- Stages of anesthesia including induction, maintenance, and reversal
- Potential complications and their management
properties, classification and principle of action of intravenous induction agent.
pharmacokinetics
comparison between properties of various agent
summary of ketamine, propofol, thiopenton etomidate , bzd and opioids.
Inhalational Anesthetics; Isoflurane and Sevoflurane.pptxMahmood Hasan Taha
Isoflurane (Furane) 1979, Sevoflurane (Ultane) 1990s
general description ,physical properties and anesthetic properties .
Effects on organ system, contraindications, drug interaction.
properties, classification and principle of action of intravenous induction agent.
pharmacokinetics
comparison between properties of various agent
summary of ketamine, propofol, thiopenton etomidate , bzd and opioids.
Inhalational Anesthetics; Isoflurane and Sevoflurane.pptxMahmood Hasan Taha
Isoflurane (Furane) 1979, Sevoflurane (Ultane) 1990s
general description ,physical properties and anesthetic properties .
Effects on organ system, contraindications, drug interaction.
This slide comprise the idea of General anesthesia, The intravenous and Inhalation Anesthetics- their mechanism and uses and effects on the organ system. Also the drug distribution and redistribution, MAC and pre-anesthetic medication with proper pictorial demonstration.
Summary:
Regional anesthetic techniques are increasing in popularity because of the improved recovery profiles
Intravenous adjuvants can provide patient comfort
Titrated infusion of rapid and short acting sedative drugs should enhance patient safety
Vigilant monitoring, supplemental oxygen, and the availability ressucitation equipment are strongly recommended
Rapid sequence intubation (RSI) is a technique that is used when rapid control of the airway is needed as a precaution for patients that may have a 'full stomach' or other risks of pulmonary aspiration. A short description about RSI procedure according to IQARUS guideline.
Dr. Ummay Sumaiya
ICU DOCTOR
| IQARUS | Medical Treatment Facility / IQARUS - Cox’s Bazar - Bangladesh |
Mail: Ummay.Sumaiya@iqarus.com
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.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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.