short note of management of general anaesthesia

1. GENERAL ANAESTHESIA
MANAGEMENT

2. General anaesthesia is described as a
reversible state of consciousness with in
ability to respond to a standardized surgical
stimulus . In modern anaesthetic practice
this involves the triad of: unconsciousness,
analgesia, muscle relaxation.

3. General Anaesthesia
Assessment
• Planning 1: Monitors - Induction
• Planning 2: Drug - Maintenance
• Planning 3: Fluids - Emergence
• Planning 4: Airway management - postoperative

4. Objectives of anaesthesia
• Unconsciousness
• Amnesia
• Analgesia
• Oxygenation
• Ventilation
• Airway management
• Reflex managemet
• Muscle relaxion
• Monitoring

5. Role of anaesthetists
• Preoperative evaluation and patient preparation
• Intraoperative management
- General anaesthesia
Inhalation anaesthesia
Total IV anaesthesia
- Regional anaesthesia
Spinal, Epidural & caudal blocks
Peripheral nerve blocks
pain management (acute and chronic pain)
• Postanaesthesia care (PACU management)
• Anaesthesia complication & management
• Case study

6. Physical status of classification
• Class I : A normal healthy patient
• Class II : A patient with mild system disease (no functional
limitation)
• Class III : A patient with severe systemic disease ( some
functional limitations)
• Class IV : A patient with severe systemic disease that is a
constant threat to life (functionally incapcitated)
• Class V : A moribund patient who is not expected to survive
without the operation
• Class VI : A brain-dead patient whose organs are being
removed for donor purposes
• Class E : Emergent procedures

7. Anaesthetic plan
Premedication
General
• Airway management
• Induction
• Maintenance
• Muscle relaxation

8. Intraoperative management
Monitoring
• Positioning
• Fluid management
• special techniques

9. NPO status
• NPO, Nil Per oral, means nothing by mouth
• Solid food: 8 hours before induction
• Liquid : 4 hours before induction
• Clear water: 2 hours before induction
• Pediatrics : stop breast milk feeding 4 hours before
induction

10. General Anaesthesia
• Monitor
• Preoxygenation
• Induction
• muscle relaxants
• Mask ventilation
• Intubation & ETT position confirmation
• Maintenance
• Emergence

11. Airway exam
• Mallampati classification

12. Induction agents
• Opioids – fentanyl
• Propofol , Thiopental and Etomidate
• Muscle relaxants:
Depolarizing
Nondepolarizing

13. Induction
• IV induction
• Inhalational induction

14. General anaesthesia
• Reversible loss of consciousness
• Analgesia
• Amnesia
• Some degree of muscle relaxation

15. Intraoperative management
• Maintenance
Inhalational agents : N2O, Sevo, Deso, Iso
Total IV agents : Propofol
Opioids : Fentanyl, Morphine
Muscle relaxants
Balance anaesthesia

16. Intraoperative management
• Monitoring
• Position – supine, lateral, prone, sitting, lithotomy
• Fluid management
- crystalloid vs colloids
- NPO fluid replacement : 1st 10 kg Weight-
4ml/kg/hr,2nd 10 kg weight-2ml/kg/hr and
1ml/kg/hr there after
-Intraoperative fluid replacement: minor procedures 1-
3ml/kg/hr, major procedures 4-6ml/kg/hr, major abdominal
procedures 7-10 kg/ml

17. Intraoperative management
Emergence
• Turn off the agent ( inhalational or IV agents)
• Reverse the muscle relaxants
• Return to spontaneous ventilation with adequate
ventilation and oxygenation
• Suction upper airway
• Wait for patient to wake up and follow command
• Hemodynamically stable

18. Postoperative management
• Post-anaesthesia care unit (PACU)
- Oxygen supplement
- Pain control
- Nausea and vomiting
-Hypertension and hypotension
Surgical intensive care unit (SICU)
- Mechanical ventilation
- Hemodyanamic monitoring

19. General anesthesia
Complication and management
• Respiratory complication
- Aspiration – airway obstruction and pneumonia
- Bronchospasm
- Atelectasis
- Hypoventilation
• Cardiovascular complication
- Hypertension and hypotension
- Arrhythmia
- Myocardial ischemia and infarction
- Cardiac arrest