Conduction of general anesthesia
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General anesthesia involves inducing a state of unconsciousness during surgery through the use of drugs. The goals are amnesia, hypnosis, analgesia, and immobility. Preparation includes evaluations of the patient's airway, medical conditions, medications, and labs. Monitoring is established and intravenous access and fluids are given. Induction involves preoxygenation before administering intravenous or inhalational drugs to induce unconsciousness and allow intubation. Maintenance of anesthesia involves increasing the depth of unconsciousness through volatile gases, IV drugs, or combinations while monitoring vital signs and homeostasis. Emergence and extubation involve ensuring the patient meets criteria like being awake, responsive, with full strength before discharge from recovery. Transport is the
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2) Preoperative preparation such as evaluations, medications, and ensuring adequate hydration and intravenous access.
3) Induction of anesthesia through preoxygenation, intravenous or inhalational methods, and airway management including intubation.
4) Maintenance of anesthesia by maintaining homeostasis, monitoring depth to prevent awareness, and using various anesthetic methods and ventilation techniques.
5) Emergence from anesthesia and considerations for extubation such as ensuring the patient is awake, responsive, and has adequate pain
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1846-1900: Establishment of anesthesia
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This document provides a history of anesthesia from ancient times through the 19th century. It discusses early herbal remedies and intoxicants used for pain relief, including opium, mandrake, hemlock, and wine. It describes experiments with inhaled anesthetics in ancient Greece, China, the Arab world, and Renaissance Europe. Key events discussed include William Morton's 1846 public demonstration of ether anesthesia at the Massachusetts General Hospital, establishing it as the first non-toxic surgical anesthetic. The document also briefly mentions the discoveries of nitrous oxide and its anesthetic properties in the late 18th century.
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This document discusses spinal anatomy and physiology relevant to spinal anaesthesia. It describes the:
1. Vertebral anatomy including the 7 cervical, 12 thoracic, and 5 lumbar vertebrae. It outlines the parts of each vertebra including the body, pedicles, lamina, processes and foramina.
2. Ligaments that stabilize the vertebrae including the supraspinous, interspinous, and ligamentum flavum.
3. Meninges covering the spinal cord including the dura, arachnoid, and pia mater.
4. Spinal spaces such as the subarachnoid space containing cerebrospinal fluid, the epid
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- The causes, signs and symptoms, and compensation mechanisms for each condition.
- Specific types like acute vs chronic respiratory acidosis, and chloride responsive vs chloride resistant metabolic alkalosis.
- How the kidneys, lungs, and buffering systems work to regulate pH and compensate for acid-base imbalances.
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This document discusses preoperative airway assessment. It begins by defining the airway and why assessing it is important, as respiratory events are a leading cause of anesthesia-related injuries. It then defines what constitutes a difficult airway and lists various individual predictors and scoring systems that can be used for assessment, including measurements of neck and mouth structures. Overall, thorough preoperative airway examination involving multiple predictive tests can help identify patients that may present difficulties during ventilation or intubation.
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The document discusses various breathing systems used for anesthesia, including the Mapleson A-F systems. It provides details on the history, components, configurations, techniques of use, and functional analysis of each system. The Mapleson A system is described as the original system developed by Evan Magill, with fresh gas entering at the opposite end of the reservoir bag near the patient. Rebreathing occurs more readily with lower fresh gas flows. The Mapleson B and C systems have the fresh gas inlet and adjustable pressure limiting valve located near the patient end.
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Spinal anesthesia involves injecting local anesthetic into the subarachnoid space of the spinal canal. The summary discusses the key points of spinal anesthesia including:
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2. Complications include hypotension from sympathetic blockade and post-dural puncture headache from leakage of cerebrospinal fluid through the puncture site in the dura mater.
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Crystalloids are electrolyte solutions that can freely diffuse throughout the extracellular space. The principal crystalloid is isotonic saline (0.9% NaCl), which expands the interstitial space rather than plasma volume. Ringer's lactate is also commonly used as it more closely matches plasma composition. Dextrose 5% in water (D5W) is hypotonic and expands both intra and extracellular spaces, providing calories but not electrolytes. Each crystalloid has different indications and disadvantages to consider when selecting the appropriate fluid for treatment.
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Regional anesthesia is a technique that induces loss of sensation in part of the body using local anesthetics. It has benefits like lower costs, high patient satisfaction, and decreased risks of DVT and PE compared to general anesthesia. However, it requires skills and may cause issues like hypotension. The main types are topical, intravenous, peripheral nerve blocks, plexus blocks, and neuro-axial blocks. Regional anesthesia can provide anesthesia for surgery, post-op analgesia, or chronic pain treatment. Factors like the anesthetic used, patient position, and injection speed affect its spread. Spinal and epidural blocks involve injecting anesthetic into the subarachnoid or epidural space and have risks like anaphyl
History of anaesthesia
The document provides a history of anaesthesia from ancient times to the 20th century. It discusses early uses of opium, cannabis, cocaine, and carotid compression for pain relief in ancient civilizations. It then covers key developments like Crawford Long's first use of ether anaesthesia in 1842, Morton's public demonstration of ether anaesthesia at the Ether Dome in 1846, Simpson's introduction of chloroform in 1847, Koller's discovery of cocaine as a local anaesthetic in 1884, and Bier's first spinal anaesthesia in 1898. The 20th century saw advances in airway management and new anaesthetic agents that improved safety and efficacy.
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2) Preoperative preparation such as evaluations, medications, and ensuring adequate hydration and intravenous access.
3) Induction of anesthesia through preoxygenation, intravenous or inhalational methods, and airway management including intubation.
4) Maintenance of anesthesia by maintaining homeostasis, monitoring depth to prevent awareness, and using various anesthetic methods and ventilation techniques.
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The document discusses the goals and process of a preanaesthetic evaluation. The anaesthesiologist aims to optimize the patient's medical condition, assess fitness for anaesthesia, and identify any risks. They take a full medical history, examine the patient, and order relevant investigations. For higher risk patients, evaluation may involve multiple specialists and days of preparation. The anaesthesiologist discusses the planned anaesthetic with the patient and obtains consent. Premedication is sometimes used to reduce anxiety, secretions, nausea/vomiting, or enhance the effects of anaesthesia.
The practice conduct of anesthesia
This document summarizes the practice of anesthesia. It discusses preoperative, intraoperative, and postoperative management. Preoperative management includes taking a patient history, performing an examination, ordering relevant investigations, and administering premedication drugs. Intraoperative management involves monitoring the patient, choosing a position and type of anesthesia, inducing and maintaining anesthesia, administering fluids, and extubating the patient. Postoperative management consists of transferring the patient to the ward or ICU, providing pain management, and treating any complications.
ards.pptx
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The document discusses postoperative care and chest complications. It covers several key points:
1) Respiratory complications occur in up to 15% of major surgeries and can negatively impact outcomes through increased mortality, morbidity, hospitalization duration, and costs.
2) Patients face respiratory risks in the immediate postoperative period from issues like atelectasis, pulmonary edema, and respiratory failure due to changes in lung volumes and function.
3) Preventing postoperative pulmonary complications requires evaluating patient risk factors, optimizing pre- and postoperative pulmonary status through measures like smoking cessation, treating infections, and encouraging deep breathing exercises.
general post operative care
This document provides guidance on general post-operative care including monitoring in the post-anesthesia care unit, vital signs, fluid and electrolyte balance, wound care, nutrition, mobilization, medications, and follow-up care. It outlines assessments of respiratory, cardiovascular, neurological and other body systems and recommendations to prevent complications and promote healing in the immediate postoperative period. Discharge criteria and the importance of communication with patients and their families is also discussed.
PREOPERATIVE ASSESSMENT PREPARATION.pptx
The document discusses the key aspects of preoperative assessment and preparation. It outlines the goals of preoperative assessment as reducing risks, identifying existing medical conditions, and planning management. A thorough assessment involves taking a medical history, physical exam, evaluation of systems like cardiac, respiratory and more. Proper preparation includes discussing the procedure with the patient, obtaining informed consent, giving instructions, and ensuring readiness in the operating theater. The overall aim is to minimize complications and optimize outcomes for the patient's surgery.
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The document discusses various techniques for monitoring the brain during anesthesia to prevent neurological insults. It describes electroencephalography (EEG) techniques like raw EEG, bispectral index, and entropy which can detect cerebral ischemia. It also discusses evoked potentials like somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) using electrical stimulation to assess spinal cord and brain function. Additional monitoring methods covered are intracranial pressure (ICP), cerebral blood flow (CBF), brain oxygenation, and electromyography (EMG) for nerve function. The document emphasizes multimodal monitoring as the gold standard to reduce intraoperative neurological injury.
Cerebral oximetry brain protection in cardiac surgery
Cerebral oximetry provides real-time monitoring of cerebral oxygen saturation during surgery using near-infrared spectroscopy. It detects oxygen desaturation events in 17-23% of cardiac surgeries which can lead to adverse neurological outcomes in 6% of cases. Cerebral oximetry is based on the different absorption spectra of oxygenated and deoxygenated hemoglobin, allowing measurement of cerebral oxygen saturation. It provides advantages over other monitoring methods by directly measuring cerebral oxygenation throughout surgery.
Pulmonary hypertension and anesthesia
Pulmonary hypertension is defined as a mean pulmonary artery pressure greater than 25 mmHg. It is classified based on whether the elevation in pressure is pre-capillary or post-capillary. The pathogenesis involves various changes in the pulmonary vasculature that lead to increased pulmonary vascular resistance. Diagnosis involves symptoms, physical exam findings, imaging like echocardiogram, and right heart catheterization. Treatment aims to improve hemodynamics and symptoms through pulmonary vasodilators and diuretics. Anesthetic management of pulmonary hypertension patients requires optimizing preload, afterload, and contractility while avoiding triggers of pulmonary hypertension. Close monitoring is important both intraoperatively and postoperatively.
Nitrous oxide: Is the Debate Closed?
This document discusses the debate around the safety of nitrous oxide. It summarizes the findings of several major studies on this topic, including the ENIGMA trials which found mixed results about nitrous oxide's effects. While some studies suggested nitrous oxide may increase complications, others found no difference or even potential benefits. The document concludes that the evidence is still unclear and more research is needed, as abandoning nitrous oxide based on the current evidence may be premature.
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The document discusses the ongoing debate around the safety of nitrous oxide (N2O) as an anesthetic agent. Both proponents and opponents of N2O cite various studies but there is no consensus. The ENIGMA trials in particular raised concerns about N2O, though others argue the results have limitations and do not definitively prove N2O is unsafe. The long-term effects of N2O also remain unclear as more data is needed. The debate around N2O's risks and benefits continues in the anesthesia community.
Tracheostomy care
- A tracheostomy is a surgical opening created in the trachea to allow for breathing assistance or to bypass an obstruction.
- Tracheostomies are performed to provide mechanical ventilation, facilitate weaning from ventilation, bypass obstructions like larynx cancer, maintain an open airway in comatose patients, or remove secretions more easily.
- Tracheostomy care involves examining the tube and site, humidifying air, suctioning secretions, maintaining cuff pressure, changing dressings and tubes, and addressing any complications. Frequent repositioning, deep breathing, coughing and chest physiotherapy also help clear secretions.
Choosing medical specialty. Anesthesiologists, there are no substitutes
1) Anesthesiology involves temporarily blocking sensation using various types of anesthesia like local, regional, and general anesthesia. General anesthesia causes a loss of consciousness, pain sensation, muscle reflexes, and decreased stress response.
2) In addition to administering anesthesia, anesthesiologists play important roles in intensive care units and pain clinics. While they do not have direct patient contact like front-line doctors, anesthesiologists are crucial for patient survival during surgery.
3) Anesthesiology combines applied physiology, pharmacology, and technical skills. It offers a work-life balance with relatively high compensation, low weekly time commitment, and not an intense call schedule. Future earnings are not the most important
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This document discusses acid-base balance and the anion gap. It contains the following key points:
1. The body strives for electrical neutrality by balancing cations and anions in the blood, and closely regulates hydrogen ion concentration.
2. The kidney plays an important role in regulating blood pH through reabsorption of bicarbonate and secretion of acids like ammonium and phosphate to balance the 4000 mmol of bicarbonate filtered daily.
3. Mixed acid-base disorders can be identified by calculating the bicarbonate gap, which should be zero for a single disorder but will vary if two disorders are present. This provides insight into the underlying condition(s).
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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
Assessment of airway
1. Difficult intubation can result in significant morbidity and mortality, so proper prediction allows time for equipment selection and experienced personnel.
2. Several physical exam findings can predict difficult airways, including reduced neck mobility, short chin-to-hyoid or thyromental distances, large tongue size, and reduced mouth opening.
3. Scoring systems like Mallampati, Wilson, and Cormack-Lehane grading can synthesize exam findings to predict difficult mask ventilation, intubation, or laryngoscopic views. Physical indicators are combined in some group indices to improve predictive power.
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1) The document discusses levels of sedation as defined by the American Society of Anesthesiologists, ranging from minimal sedation to general anesthesia.
2) It emphasizes the importance of understanding sedation levels to provide safe and effective sedation, noting risks like loss of protective reflexes at deeper levels.
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Conduction of general anesthesia
- 1. Dr. Wesam Farid Mousa Ass. Prof. Consultant of Anesthesia and ICU Dammam University
- 2. Overview • What is general anesthesia? • Preoperative preparation • Induction: Deparutre • Maintenance: Flying • Emergence: Landing • Transport
- 3. What is general anesthesia • Primary goals Amnesia Hypnosis Analgesia Immobolity
- 4. • Secondary goals Medical condition Surgical procedures Surgical settings
- 5. Examples for secondary goals • Patients with CAD: Oxygen supply-demand balance • Neurosugery: ICP control, brain relaxation and CPP maintenance • Obstetrics: anesthetics and fetal depression, difficult airway • Day surgery vs Inpatient: which kind of analgesic you should choose to minimize postoperative pain and decrease PONV?
- 6. Preoperative preparation • Preoperative evaluations for: Airway examination Pt’s medical condition Medications Laboratory data Consultant notes Last oral intake
- 7. • Preoperative hydration and correction of intravascular volume as needed: Intravenous access Fluid or blood transfusion as needed • Prescribe preoperative medications as needed: e.g. Anxiety: Benzodiazepine: Midazolam Pain: Opioid or NSAI Increased gastric acidity: cimetidine, omeprazole
- 8. Monitoring Standard monitoring for GA Qualified anesthetist presence ECG NBP Pulse oximetry Capnography
- 10. Induction Let the pt go off to sleep Preoxygenation 8L~10L/min IV or Inhalational induction Airway management
- 11. Induction techniques • Intravenous: the most common method • Inhalation: for special pt (as pt with difficult airway, pediatric pt) • Intramuscular :rarely used, only used in uncooperative pts and young children
- 12. Maintenance Increasing depth of anesthesia stageⅠ Amnesia Loss of consciousness Stage Ⅱ Delirium Injurious responses to noxious stimuli Stage Ⅲ Surgical anesthesia Painful stimulation does not elicit somatic reflexes or deleterious autonomic responses Stage Ⅳ Overdosage Circulatory failure
- 13. Maintenance Anethesia • Volatile • Nitrous oxide-opioid relaxant technique • IV anesthesia • Combinations
- 14. • Maintain homeotasis Vital signs Acid-base balance Temperature Coagulation Volume status
- 15. Maintain Ventilation 1. Spontaneous or assisted ventilation 2. Controlled ventilation Tidal volume: 10-12ml/kg Respiratory rate: 8-10 breaths/min
- 16. Maintain Intravascular Volume 1. fluids Crystalloid sollutions: Colloid sollutions: 2. Blood & blood products
- 18. Extubation • Awake extubation Indications Risk of aspiration Difficult airways Tracheal or maxillofacial surgery
- 19. • Awake extubation Criteria Awake Hemodynamically stable Full muscle strength Able to follow simple verbal commands Breathing spontaneously with adequate ventilation
- 20. • Deep extubation Indications Severely asthmatic patients Middle-ear surgery Open-eye surgery Inguinal herniorrhaphy
- 21. • Deep extubation Criteria Sufficient anaesthetic depth to avoid response to airway stimulation Spontaneous breathing with adequate ventilation
- 22. Goals to be met before discharge from recovery: awake Responsive Full muscle strength Adequate pain control
- 23. Transport It is the responsibility of the Anaesthetist
- 24. Questions