This document discusses guidelines for preoperative fasting in patients undergoing procedures requiring anesthesia. It outlines recommendations for fasting times for various foods and liquids in adults, children, and special populations. The primary goal of preoperative fasting is to reduce the risk of pulmonary aspiration by allowing time for gastric emptying. However, prolonged fasting can increase risks of dehydration, hypoglycemia, and patient dissatisfaction. The document reviews techniques to decrease gastric volume and increase gastric pH as additional measures to prevent aspiration during induction of anesthesia.
Supraglottic airway devices deliver gases above the vocal cords. The Laryngeal Mask Airway (LMA) was invented in 1981 and introduced improvements over prior extraglottic devices. There are now multiple versions of the LMA with variations in material, shape, and features. Proper selection and insertion technique are important for effective use of these airway devices.
An anesthesia circuit connects the anesthesia machine to the patient to deliver anesthetic gases and remove carbon dioxide. Various circuit designs exist, including open, semi-open, semi-closed, and closed systems. The ideal circuit is reliable, safe, and easy to use while imposing minimal resistance and dead space. The circle system allows for rebreathing of gases using low fresh gas flows and includes unidirectional valves, tubing, a Y-piece, reservoir bag, and carbon dioxide absorber. Soda lime is commonly used for carbon dioxide absorption but its interaction with anesthetic agents can produce toxic compounds.
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.
This document discusses the circle system used in anesthesia. It describes the components of the circle system including the absorber, canisters, unidirectional valves, fresh gas inlet, adjustable pressure limiting valve, and reservoir bag. It explains how the circle system works and how it can be configured as a closed, semi-closed, or semi-open system depending on the fresh gas flow. It also discusses the advantages and disadvantages of the circle system and components like the absorber, how it neutralizes carbon dioxide, and factors that influence compound A and carbon monoxide formation.
The document discusses different types of breathing circuits used in anesthesia. It begins by describing the basic components and functions of a breathing circuit, which delivers oxygen and anesthetic gases to patients while removing carbon dioxide. Circuits are classified as open, semi-open, semi-closed, or closed based on how exhaust gases are handled. Several specific circuit types are then outlined in detail, including the Mapleson A, Bain, Ayres T-piece, and Jackson-Rees systems. Key features and uses of each system are provided. Semi-closed circuits are explained as using a carbon dioxide absorber to remove carbon dioxide from exhaled gases so they can be rebreathed, allowing for lower fresh gas flow rates than open systems
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
- Cleft lip and cleft palate are congenital deformities caused by failure of facial structures to fuse properly during development in utero.
- The document discusses the epidemiology, classifications, embryology, etiology, pathophysiology, associated conditions, timing of surgery, anesthetic concerns, and postoperative care for patients undergoing cleft lip and cleft palate repair surgery.
- Key anesthetic considerations include the patient's young age, potential for a difficult airway, risk of multiple surgeries, shared airway with the surgeon, and potential for associated congenital anomalies.
Low flow anaesthesia systems aim to reuse exhaled gases and minimize fresh gas flow. John Snow recognized in 1850 that most inhaled anaesthetics are exhaled unchanged, and rebreathing exhaled gases could prolong their effects. Developments over the 20th century led to widespread use of circle absorption systems. Factors like cost and pollution concerns have renewed interest in low flow anaesthesia. It requires a well-functioning circle system, gas monitoring, and attention to factors like circuit volume and gas solubility when initiating and maintaining the desired anaesthetic concentrations with minimal fresh gas flows.
Supraglottic airway devices deliver gases above the vocal cords. The Laryngeal Mask Airway (LMA) was invented in 1981 and introduced improvements over prior extraglottic devices. There are now multiple versions of the LMA with variations in material, shape, and features. Proper selection and insertion technique are important for effective use of these airway devices.
An anesthesia circuit connects the anesthesia machine to the patient to deliver anesthetic gases and remove carbon dioxide. Various circuit designs exist, including open, semi-open, semi-closed, and closed systems. The ideal circuit is reliable, safe, and easy to use while imposing minimal resistance and dead space. The circle system allows for rebreathing of gases using low fresh gas flows and includes unidirectional valves, tubing, a Y-piece, reservoir bag, and carbon dioxide absorber. Soda lime is commonly used for carbon dioxide absorption but its interaction with anesthetic agents can produce toxic compounds.
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.
This document discusses the circle system used in anesthesia. It describes the components of the circle system including the absorber, canisters, unidirectional valves, fresh gas inlet, adjustable pressure limiting valve, and reservoir bag. It explains how the circle system works and how it can be configured as a closed, semi-closed, or semi-open system depending on the fresh gas flow. It also discusses the advantages and disadvantages of the circle system and components like the absorber, how it neutralizes carbon dioxide, and factors that influence compound A and carbon monoxide formation.
The document discusses different types of breathing circuits used in anesthesia. It begins by describing the basic components and functions of a breathing circuit, which delivers oxygen and anesthetic gases to patients while removing carbon dioxide. Circuits are classified as open, semi-open, semi-closed, or closed based on how exhaust gases are handled. Several specific circuit types are then outlined in detail, including the Mapleson A, Bain, Ayres T-piece, and Jackson-Rees systems. Key features and uses of each system are provided. Semi-closed circuits are explained as using a carbon dioxide absorber to remove carbon dioxide from exhaled gases so they can be rebreathed, allowing for lower fresh gas flow rates than open systems
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
- Cleft lip and cleft palate are congenital deformities caused by failure of facial structures to fuse properly during development in utero.
- The document discusses the epidemiology, classifications, embryology, etiology, pathophysiology, associated conditions, timing of surgery, anesthetic concerns, and postoperative care for patients undergoing cleft lip and cleft palate repair surgery.
- Key anesthetic considerations include the patient's young age, potential for a difficult airway, risk of multiple surgeries, shared airway with the surgeon, and potential for associated congenital anomalies.
Low flow anaesthesia systems aim to reuse exhaled gases and minimize fresh gas flow. John Snow recognized in 1850 that most inhaled anaesthetics are exhaled unchanged, and rebreathing exhaled gases could prolong their effects. Developments over the 20th century led to widespread use of circle absorption systems. Factors like cost and pollution concerns have renewed interest in low flow anaesthesia. It requires a well-functioning circle system, gas monitoring, and attention to factors like circuit volume and gas solubility when initiating and maintaining the desired anaesthetic concentrations with minimal fresh gas flows.
This document discusses various methods of monitoring patients under anaesthesia. It covers basic monitoring including vital signs and advanced instrumental monitoring of cardiovascular, respiratory, temperature, neuromuscular and central nervous systems. For each system, both non-invasive and invasive monitoring techniques are described along with their clinical indications, principles of operation, normal values and potential complications. Maintaining vigilance through multimodal monitoring is important to prevent anaesthesia complications.
This document discusses breathing systems used in anesthesia. It defines a breathing system and lists its main components. The key requirements of an effective breathing system are to deliver accurate gas concentrations, eliminate carbon dioxide, minimize dead space, and have low resistance. Various configurations are described, including open, semi-open, semi-closed and closed systems. Popular breathing circuits like Mapleson A, B, C, D, E and F are explained along with the Ayre's T-piece and reservoir bag. The document provides details on how different breathing systems function during spontaneous and controlled ventilation.
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
Airway anatomy its assessment and anaesthetic implicationAPARNA SAHU
The document discusses airway anatomy, including definitions of the airway and its subdivisions. It describes the structures of the upper airway from the oral cavity to the larynx in detail. This includes the muscles, cartilages, and functions of the oral cavity, nose, pharynx, larynx. It discusses the implications of airway anatomy for airway management and anesthesia, such as the need for humidification during intubation. Difficulties that can arise from various anatomical structures are also summarized, such as from deviations of the nasal septum or injuries to the turbinates during nasotracheal intubation.
This document discusses Minimum Alveolar Concentration (MAC) and related concepts:
- MAC is defined as the minimum alveolar concentration of an inhaled anesthetic needed to prevent movement in 50% of patients during surgery. It allows comparison of anesthetic potency.
- Meyer-Overton hypothesis links anesthetic potency to lipid solubility. Exceptions to this rule exist.
- MAC derivatives measure concentrations needed for other clinical endpoints like unconsciousness or amnesia.
- Many physiological, pharmacological, and pathological factors can increase or decrease an individual's MAC. Precise anesthetic dosing requires accounting for these factors.
The document provides a history of anesthetic agents, beginning with diethyl ether in 1846 and progressing to modern volatile agents like sevoflurane. It discusses the properties of each agent that made them viable or led to their discontinuation. It also defines the minimum alveolar concentration (MAC) concept for measuring anesthetic potency based on immobilization during incision. Factors that increase or decrease MAC values are outlined.
Bronchial asthma and COPD are chronic respiratory conditions characterized by airway inflammation and obstruction. Bronchial asthma involves reversible airflow limitation due to bronchospasm while COPD involves irreversible airflow limitation from lung damage. Key differences are that asthma typically presents earlier in life and has a family history, while COPD is mainly caused by smoking. Preoperative treatment aims to prevent bronchospasm during anesthesia and surgery by optimizing lung function and suppressing airway reflexes.
One Lung Ventilation (OLV) is a technique that isolates ventilation to one lung during surgery using double lumen tubes (DLTs) or bronchial blockers. DLTs allow control of ventilation to each lung and switching between single and dual lung ventilation. Placement is confirmed with fiberoptic bronchoscopy. OLV reduces the risk of cross contamination during certain procedures. Preoperative pulmonary function tests assess risk, with an FEV1 <40% or DLCO <40% indicating high risk. During OLV, hypoxic pulmonary vasoconstriction and gravity divert blood flow away from the non-ventilated lung to reduce shunting. Anesthesia aims to maintain cardiovascular stability and minimize inhibition of hypo
This document discusses various supraglottic airway devices that can be used for airway management during anesthesia and difficult airway situations. It begins by outlining the advantages of supraglottic devices over endotracheal intubation. It then provides detailed classifications and descriptions of numerous supraglottic devices, including LMAs, i-gels, laryngeal tubes, and more. Placement techniques, sizing considerations, and diagnostic tests for ensuring proper placement are also reviewed. The document serves as a comprehensive guide to the use of supraglottic airway devices for airway management.
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 various paediatric breathing circuits used in anaesthesia. It describes the key components and classifications of breathing circuits. The most commonly used circuits include the Mapleson A (Magill) system, which is best for spontaneous breathing but requires high fresh gas flows. The Mapleson D and Bain circuits are efferent reservoir systems that work efficiently for controlled ventilation. The Ayre's T-piece is a simple no-valve circuit designed for paediatric use. The document provides details on the construction, functioning and advantages of these different breathing circuit designs.
The document discusses the difficult airway, including its definition, causes, assessment, and management. It defines difficult ventilation and difficult intubation. Causes can be related to the anesthesiologist, equipment, or patient factors like congenital syndromes or acquired conditions. Assessment involves history, physical exam including airway indices like Mallampati score, and radiologic evaluation. Management includes preparing a difficult airway cart and having alternate plans for securing the airway.
This document discusses the laryngeal mask airway (LMA), including its history, design, indications, contraindications, side effects, necessary equipment, proper preparation and placement technique, verification of correct placement, securing, and potential problems. It also describes different types of LMAs such as the flexible, intubating, C-Trach, ProSeal, and classic LMAs.
In critical care medicine the invasive life saving techniques are often employed and when all goes well such interventions will be withdrawn to all for normal physiology to resume. Identifying this point for safe withdrawal for the resumption of normal respiratory function is of utmost importance.
Regional anesthesia such as spinal or epidural anesthesia is preferred over general anesthesia for cesarean sections due to lower risks for both mother and baby. Spinal anesthesia provides rapid onset but a finite duration, while epidural anesthesia allows for gradual onset and better control of sensory levels via a catheter. Both techniques require careful management of hypotension through fluid administration and vasopressors. Neuraxial opioids can enhance analgesia without negatively impacting the neonate. The goals are to provide adequate anesthesia and analgesia for surgery and postoperatively while maximizing safety for mother and baby.
The document discusses different types of breathing systems used in anesthesia, including their components, principles of function, and classifications based on gas flow patterns and carbon dioxide elimination methods. Key systems described include the Mapleson A, B, C, and D circuits as well as the Bain system.
The document discusses post-extubation stridor, which is upper airway obstruction that can occur after a patient is extubated from a ventilator. It defines post-extubation stridor and reviews risk factors such as duration of intubation and cuff pressures. The cuff leak test is presented as a way to identify patients at risk. Studies are reviewed showing steroids given before extubation can reduce the risk of stridor. Clinically, it recommends identifying at-risk patients, performing the cuff leak test, and considering steroid treatment for high-risk patients before extubation.
This document discusses different types of breathing circuits used in anesthesia. It begins by introducing open, semi-closed, and closed breathing circuits. Open circuits are now obsolete and involved pouring anesthetic agents over a mask. Semi-closed circuits include Mapelson circuits A-F, with Type D (Bain) most commonly used for controlled ventilation. Closed circuits involve rebreathing of exhaled gases after carbon dioxide absorption by soda lime, making them very economical. Key components and properties of soda lime and factors affecting its carbon dioxide absorption are described.
mapleson circuits used in anesthesia practice, are in their way out but it is as important to know the mechanism with which the gases flow to and fro through them.
This document discusses supraglottic airway devices. It begins by introducing supraglottic airway devices as those that maintain airway patency by sitting above the glottic opening. It then classifies devices based on generation, sealing mechanism, number of lumens, and discusses indications, contraindications, advantages, and disadvantages of supraglottic airway devices. Specific devices like LMA Classic, Flexible LMA, Ambu Aura, Soft Seal LMA, and Intubating LMA are then described in more detail. Problems associated with devices and techniques to reduce aspiration are also covered.
REGURGITATION AND ASPIRATION DURING ANESTHESIA abiysileshi
Regurgitation and aspiration is a rare but potentially devastating complication of general anesthesia. Aspiration occurs when gastric contents are inhaled into the lungs. Factors that influence the risk include conditions affecting the lower esophageal sphincter tone and gastric volume. Aspiration can range from asymptomatic to life-threatening pulmonary complications such as chemical pneumonitis or bacterial pneumonia. Prevention strategies include proper pre-operative fasting, reducing gastric acidity, use of rapid sequence induction and cricoid pressure during intubation. Immediate management depends on the patient's stability and may involve airway protection, monitoring or transfer to the ICU.
The document discusses anesthesia considerations for pregnant patients undergoing non-obstetric surgery. It notes that around 1-2.5% of pregnant women require such surgery each year. The risks to the fetus rise with procedures, so evaluation of risks vs benefits is important. The goals of anesthesia management are to maintain maternal oxygenation, cardiac output, oxygen delivery and uterine blood flow. Fetal monitoring may be used after 16 weeks to check for distress.
This document discusses various methods of monitoring patients under anaesthesia. It covers basic monitoring including vital signs and advanced instrumental monitoring of cardiovascular, respiratory, temperature, neuromuscular and central nervous systems. For each system, both non-invasive and invasive monitoring techniques are described along with their clinical indications, principles of operation, normal values and potential complications. Maintaining vigilance through multimodal monitoring is important to prevent anaesthesia complications.
This document discusses breathing systems used in anesthesia. It defines a breathing system and lists its main components. The key requirements of an effective breathing system are to deliver accurate gas concentrations, eliminate carbon dioxide, minimize dead space, and have low resistance. Various configurations are described, including open, semi-open, semi-closed and closed systems. Popular breathing circuits like Mapleson A, B, C, D, E and F are explained along with the Ayre's T-piece and reservoir bag. The document provides details on how different breathing systems function during spontaneous and controlled ventilation.
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
Airway anatomy its assessment and anaesthetic implicationAPARNA SAHU
The document discusses airway anatomy, including definitions of the airway and its subdivisions. It describes the structures of the upper airway from the oral cavity to the larynx in detail. This includes the muscles, cartilages, and functions of the oral cavity, nose, pharynx, larynx. It discusses the implications of airway anatomy for airway management and anesthesia, such as the need for humidification during intubation. Difficulties that can arise from various anatomical structures are also summarized, such as from deviations of the nasal septum or injuries to the turbinates during nasotracheal intubation.
This document discusses Minimum Alveolar Concentration (MAC) and related concepts:
- MAC is defined as the minimum alveolar concentration of an inhaled anesthetic needed to prevent movement in 50% of patients during surgery. It allows comparison of anesthetic potency.
- Meyer-Overton hypothesis links anesthetic potency to lipid solubility. Exceptions to this rule exist.
- MAC derivatives measure concentrations needed for other clinical endpoints like unconsciousness or amnesia.
- Many physiological, pharmacological, and pathological factors can increase or decrease an individual's MAC. Precise anesthetic dosing requires accounting for these factors.
The document provides a history of anesthetic agents, beginning with diethyl ether in 1846 and progressing to modern volatile agents like sevoflurane. It discusses the properties of each agent that made them viable or led to their discontinuation. It also defines the minimum alveolar concentration (MAC) concept for measuring anesthetic potency based on immobilization during incision. Factors that increase or decrease MAC values are outlined.
Bronchial asthma and COPD are chronic respiratory conditions characterized by airway inflammation and obstruction. Bronchial asthma involves reversible airflow limitation due to bronchospasm while COPD involves irreversible airflow limitation from lung damage. Key differences are that asthma typically presents earlier in life and has a family history, while COPD is mainly caused by smoking. Preoperative treatment aims to prevent bronchospasm during anesthesia and surgery by optimizing lung function and suppressing airway reflexes.
One Lung Ventilation (OLV) is a technique that isolates ventilation to one lung during surgery using double lumen tubes (DLTs) or bronchial blockers. DLTs allow control of ventilation to each lung and switching between single and dual lung ventilation. Placement is confirmed with fiberoptic bronchoscopy. OLV reduces the risk of cross contamination during certain procedures. Preoperative pulmonary function tests assess risk, with an FEV1 <40% or DLCO <40% indicating high risk. During OLV, hypoxic pulmonary vasoconstriction and gravity divert blood flow away from the non-ventilated lung to reduce shunting. Anesthesia aims to maintain cardiovascular stability and minimize inhibition of hypo
This document discusses various supraglottic airway devices that can be used for airway management during anesthesia and difficult airway situations. It begins by outlining the advantages of supraglottic devices over endotracheal intubation. It then provides detailed classifications and descriptions of numerous supraglottic devices, including LMAs, i-gels, laryngeal tubes, and more. Placement techniques, sizing considerations, and diagnostic tests for ensuring proper placement are also reviewed. The document serves as a comprehensive guide to the use of supraglottic airway devices for airway management.
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 various paediatric breathing circuits used in anaesthesia. It describes the key components and classifications of breathing circuits. The most commonly used circuits include the Mapleson A (Magill) system, which is best for spontaneous breathing but requires high fresh gas flows. The Mapleson D and Bain circuits are efferent reservoir systems that work efficiently for controlled ventilation. The Ayre's T-piece is a simple no-valve circuit designed for paediatric use. The document provides details on the construction, functioning and advantages of these different breathing circuit designs.
The document discusses the difficult airway, including its definition, causes, assessment, and management. It defines difficult ventilation and difficult intubation. Causes can be related to the anesthesiologist, equipment, or patient factors like congenital syndromes or acquired conditions. Assessment involves history, physical exam including airway indices like Mallampati score, and radiologic evaluation. Management includes preparing a difficult airway cart and having alternate plans for securing the airway.
This document discusses the laryngeal mask airway (LMA), including its history, design, indications, contraindications, side effects, necessary equipment, proper preparation and placement technique, verification of correct placement, securing, and potential problems. It also describes different types of LMAs such as the flexible, intubating, C-Trach, ProSeal, and classic LMAs.
In critical care medicine the invasive life saving techniques are often employed and when all goes well such interventions will be withdrawn to all for normal physiology to resume. Identifying this point for safe withdrawal for the resumption of normal respiratory function is of utmost importance.
Regional anesthesia such as spinal or epidural anesthesia is preferred over general anesthesia for cesarean sections due to lower risks for both mother and baby. Spinal anesthesia provides rapid onset but a finite duration, while epidural anesthesia allows for gradual onset and better control of sensory levels via a catheter. Both techniques require careful management of hypotension through fluid administration and vasopressors. Neuraxial opioids can enhance analgesia without negatively impacting the neonate. The goals are to provide adequate anesthesia and analgesia for surgery and postoperatively while maximizing safety for mother and baby.
The document discusses different types of breathing systems used in anesthesia, including their components, principles of function, and classifications based on gas flow patterns and carbon dioxide elimination methods. Key systems described include the Mapleson A, B, C, and D circuits as well as the Bain system.
The document discusses post-extubation stridor, which is upper airway obstruction that can occur after a patient is extubated from a ventilator. It defines post-extubation stridor and reviews risk factors such as duration of intubation and cuff pressures. The cuff leak test is presented as a way to identify patients at risk. Studies are reviewed showing steroids given before extubation can reduce the risk of stridor. Clinically, it recommends identifying at-risk patients, performing the cuff leak test, and considering steroid treatment for high-risk patients before extubation.
This document discusses different types of breathing circuits used in anesthesia. It begins by introducing open, semi-closed, and closed breathing circuits. Open circuits are now obsolete and involved pouring anesthetic agents over a mask. Semi-closed circuits include Mapelson circuits A-F, with Type D (Bain) most commonly used for controlled ventilation. Closed circuits involve rebreathing of exhaled gases after carbon dioxide absorption by soda lime, making them very economical. Key components and properties of soda lime and factors affecting its carbon dioxide absorption are described.
mapleson circuits used in anesthesia practice, are in their way out but it is as important to know the mechanism with which the gases flow to and fro through them.
This document discusses supraglottic airway devices. It begins by introducing supraglottic airway devices as those that maintain airway patency by sitting above the glottic opening. It then classifies devices based on generation, sealing mechanism, number of lumens, and discusses indications, contraindications, advantages, and disadvantages of supraglottic airway devices. Specific devices like LMA Classic, Flexible LMA, Ambu Aura, Soft Seal LMA, and Intubating LMA are then described in more detail. Problems associated with devices and techniques to reduce aspiration are also covered.
REGURGITATION AND ASPIRATION DURING ANESTHESIA abiysileshi
Regurgitation and aspiration is a rare but potentially devastating complication of general anesthesia. Aspiration occurs when gastric contents are inhaled into the lungs. Factors that influence the risk include conditions affecting the lower esophageal sphincter tone and gastric volume. Aspiration can range from asymptomatic to life-threatening pulmonary complications such as chemical pneumonitis or bacterial pneumonia. Prevention strategies include proper pre-operative fasting, reducing gastric acidity, use of rapid sequence induction and cricoid pressure during intubation. Immediate management depends on the patient's stability and may involve airway protection, monitoring or transfer to the ICU.
The document discusses anesthesia considerations for pregnant patients undergoing non-obstetric surgery. It notes that around 1-2.5% of pregnant women require such surgery each year. The risks to the fetus rise with procedures, so evaluation of risks vs benefits is important. The goals of anesthesia management are to maintain maternal oxygenation, cardiac output, oxygen delivery and uterine blood flow. Fetal monitoring may be used after 16 weeks to check for distress.
This document discusses premedication, which is the administration of drugs before anesthesia induction. It has psychological and pharmacological components. Pharmacological premedication aims to provide anxiolysis, analgesia, amnesia and other effects. Common drugs used include benzodiazepines, barbiturates, opioids, NSAIDs, antacids and anticholinergics. Factors like a patient's physical status, surgery type and risk of aspiration are considered. The goals of premedication are to minimize anxiety and discomfort from surgery and anesthesia, while facilitating recovery.
Transitional hypothermia in preterm newbornsCMCH,Vellore
Newborn hypothermia, especially in extremely preterm infants, remains a significant challenge. Studies show hypothermia rates among preterm newborns below 1500g vary widely, from 31-78%. Currently, the AAP and NRP recommend delivery room temperatures of at least 75°F and avoiding hypothermia or hyperthermia in newborns. More data is still needed but prevention efforts should focus on continuous temperature monitoring, warming delivery rooms, incubators, and educating staff on managing temperatures in preterm infants.
This document summarizes spinal anaesthesia techniques for children. It notes that spinal anaesthesia provides a good alternative to general anaesthesia for newborns undergoing lower abdominal or lower extremity surgery in the first 6 months of life, as it reduces the risk of postoperative apnea. The technique requires experienced providers due to the technical challenges of performing lumbar puncture in newborns. Spinal anaesthesia is most effective for short surgeries lasting less than 90 minutes. Complications are rare when performed correctly by trained staff, but may include traumatic puncture, respiratory issues, or post-dural puncture headache in older children.
Modern Trends in Paediatric Preparation and Premedication discusses:
1. Various risk factors for pre-op anxiety in children and interventions like behavioral and pharmacological approaches.
2. Psychological effects of surgery and anesthesia on children and the importance of pre-medication.
3. Guidelines for monitoring patients under sedation and different levels of sedation.
4. Common drugs used for pre-medication like midazolam, ketamine and fentanyl, their doses, routes of administration and potential complications."
Newborn Care: Temperature control and hypothermiaSaide OER Africa
Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: resuscitation at birth, assessing infant size and gestational age, routine care and feeding of both normal and high-risk infants, the prevention, diagnosis and management of hypothermia, hypoglycaemia, jaundice, respiratory distress, infection, trauma, bleeding and congenital abnormalities, communication with parents
The fetal circulation has several anatomical shunts that direct blood flow away from the lungs and toward the placenta, including the ductus arteriosus, foramen ovale, and ductus venosus. These shunts orient oxygenated blood to the brain and heart while directing deoxygenated blood to the placenta. After birth, changes in pulmonary vascular resistance and oxygen levels cause closure of the ductus arteriosus and foramen ovale, modifying the circulation to prioritize the lungs over the placenta.
This document discusses the fetal circulation system. It defines fetal circulation as the circulation of oxygenated and deoxygenated blood and nutrients to the fetus. It describes how the placenta functions as the respiratory center and site of nutrient/waste exchange for the fetus. It details the anatomy and physiology of fetal circulation, including the roles of the umbilical cord, ductus venosus, ductus arteriosus, and foramen ovale in shuttling blood between the fetus and placenta. After birth, these fetal circulatory structures close as the baby transitions to extrauterine life.
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.
The document summarizes fetal and neonatal thermoregulation. It discusses how the fetal temperature is usually 0.3-0.5°C higher than the mother's due to the fetus's high metabolic rate. At birth, the neonate must rapidly increase heat production through nonshivering thermogenesis in brown adipose tissue to survive in the cooler extrauterine environment as its temperature drops. The fetus is protected from hyperthermia by inhibitors in the placenta that prevent nonshivering thermogenesis. Disruptions to umbilical blood flow can cause the fetal temperature to rise.
This document provides an overview of pediatric anesthesia considerations. It discusses key differences in pediatric physiology compared to adults, including higher oxygen consumption and metabolic rate in infants, differences in the cardiovascular and respiratory systems, and immature hepatic and renal function in young children. It also reviews airway anatomy variations, appropriate tube and LMA sizes, and pharmacokinetic considerations for commonly used anesthetic drugs in pediatrics. The principles of maintaining temperature, adequate oxygenation and IV fluids are emphasized for safe pediatric anesthesia.
The document discusses the normal fetal and newborn heart. In the fetus, circulation bypasses the lungs, but with the first breath, circulation changes to allow flow through the lungs as the ductus arteriosus and foramen ovale close. Several potential abnormalities of the newborn heart are also outlined, including patent ductus arteriosus where the ductus fails to close, and various septal defects or underdeveloped structures that prevent normal circulation.
The document summarizes cardiac development and fetal circulation. During cardiac morphogenesis, the heart forms from clusters of cells on either side of the embryo that fuse to form the primitive heart by day 22. The heart then undergoes looping and septation to form the four chambers. In fetal circulation, blood bypasses the lungs via the ductus arteriosus and bypasses the liver via the ductus venosus to reach the placenta for gas and nutrient exchange. Blood then returns to the heart via the umbilical vein and inferior vena cava before mixing in the atria via the foramen ovale.
This document discusses strategies for minimizing anxiety and stress for pediatric patients undergoing preoperative preparation. It recommends providing information to patients and families about the procedures, allowing a parent to be present during premedication and induction, using distraction techniques during anxious parts of preparation like mask placement, and promoting a child-friendly environment in waiting and operating areas with toys, TV, and clowns to reduce fear of the unknown. Staff should be educated about evidence-based practices to deliver safe and family-focused care for pediatric surgical patients.
Preoperative sedation and premedication in pediatrics Nida fatima
Sedation and premedication
Why? --Aims of premedication!
When?
How?
Drugs for premedication!
Routes for administration!
Side effects & complications!
Parental Anxiety
SEPARATION ANXIETY
Kids not small adults
Sedative -omitted for neonates and sick infants.
child's age, body weight, drug history, allergic status and medical or surgical conditions
Avoid needles!!
Oral premedication ≠ risk of aspiration pneumonia
Allay Anxiety & fear.
Reduce saliva and airway secretions.
Enhance the hypnotic effects of general anaesthesia.
Reduce postoperative nausea & vomiting.
The document summarizes fetal circulation, which involves two umbilical arteries carrying deoxygenated blood to the placenta, one umbilical vein carrying oxygenated blood from the placenta, and several shunts that bypass the lungs and liver including the ductus venosus, foramen ovale, and ductus arteriosus. At birth, the transition to postnatal circulation occurs rapidly initiated by the baby's first breath, which causes changes including the closing of the shunts.
This document discusses aspiration, which is the misdirection of oropharyngeal or gastric contents into the larynx and lower respiratory tract. It covers several topics related to aspiration including gastric secretion, the lower esophageal sphincter, how aspiration occurs, types of injury (aspiration pneumonitis and pneumonia), signs and symptoms, risk factors, prevention, chemoprophylaxis, and treatment. The main points are that aspiration can cause chemical injury or infection in the lungs, risk factors include impaired consciousness and anatomical abnormalities, and prevention focuses on reducing gastric acidity and emptying contents before anesthesia.
The document discusses peptic ulcer disease. It defines peptic ulcers as breaks in the stomach or duodenal lining that can be caused by an imbalance of factors like acid and pepsin production. About 70-90% of ulcers are associated with Helicobacter pylori bacteria. The document covers topics like anatomy, causes, symptoms, complications, diagnosis and treatment of peptic ulcers.
This document discusses pulmonary aspiration, including its definition, classification, risk factors, prevention, and management. Pulmonary aspiration is the entry of materials like secretions or stomach contents into the lungs. It can cause aspiration pneumonitis or pneumonia. Risk factors include a full stomach, delayed gastric emptying, and certain medical conditions or procedures. Prevention involves reducing gastric acidity through medications and proper positioning. Management depends on the severity and may include oxygen, bronchodilators, antibiotics, ventilation, and ICU care as needed.
The document discusses preoperative fasting guidelines and the risks of pulmonary aspiration during surgery. It summarizes a study that compared gastric fluid volume and pH in patients who either fasted overnight or drank 150mL of water 2 hours before surgery. The study found that patients who drank the water had significantly lower gastric fluid volumes (5.5mL vs 17.1mL) after surgery, but similar pH levels. This suggests that allowing clear fluids like water 2 hours before surgery may be safe and help reduce patient discomfort from long fasting times.
This document provides information on peptic ulcer disease, including its prevalence, risk factors, types, clinical manifestations, diagnosis, medical and surgical management, complications, nursing care, and follow up. Some key points:
- Peptic ulcers affect 4-10 per 1000 people in India and are more common in males aged 30-60. Risk factors include H. pylori infection, smoking, alcohol, NSAIDs.
- Types include acute, chronic, gastric, and duodenal ulcers. Chronic ulcers erode through the stomach/duodenal wall.
- Symptoms include abdominal pain relieved by food. Tests include endoscopy, biopsy to detect H. pylori.
- Treatment
This document provides information on gastroesophageal reflux disease (GERD) in infants and children. It discusses the pathophysiology, clinical manifestations, diagnostic evaluation, and management of GERD. Key points include:
- GERD is caused by involuntary passage of gastric contents into the esophagus due to incompetence of the antireflux barriers. It can lead to complications like failure to thrive, respiratory issues, or apparent life-threatening events.
- Diagnostic evaluations include upper gastrointestinal imaging, 24-hour pH probe monitoring, and endoscopy. Medical management involves positioning, feeding changes, and acid suppression medications. Surgical options are considered for severe cases or those that do not respond to medical therapy
Gastroesophageal Reflux Disease and Antireflux SurgeryHassan s1
this presentation describes the pathophysiology and presentation of gastroesophageal reflux disease. it also discusses the medical and surgical management of gastroesophageal reflux disease.. what makes this presentation unique is that it explains the short and long term effects of antireflux surgery and patient's satisfaction with this surgery with references.
Gastroesophageal Reflux Disease and Antireflux SurgeryHassan s1
this presentation describes the pathophysiology and presentaion of gastroesophageal reflux disease. It also discusses the medical and surgical management of gastroesophageal reflux disease. What makes this presentaion unique is that it also explains the short and long term effects of antireflux surgery and patient's satisfaction with surgery with references.
Esophagitis is inflammation of the esophagus that can have various causes like acid reflux, infections, medications, radiation, and more. Common symptoms include dysphagia, heartburn, and painful swallowing. Diagnosis involves endoscopy and biopsy. Treatment depends on the underlying cause but may include lifestyle changes, antacids, H2 blockers, proton pump inhibitors, and surgery in some cases. Complications can include strictures and Barrett's esophagus.
This document discusses anaesthesia considerations for emergency laparotomy in critically ill patients. Key points include:
- Patients often present late with sepsis, dehydration, electrolyte imbalances, and respiratory compromise from abdominal issues.
- Preoperative resuscitation is important to optimize the patient's condition through fluid resuscitation and correction of acidosis over 2-4 hours.
- During resuscitation, airway and breathing are prioritized through oxygen supplementation. Circulation is addressed through IV access and fluid administration while monitoring urine output and electrolytes.
- Full preoperative optimization can improve outcomes, but delays in surgery should be avoided for septic patients once initial resuscitation is underway.
This document discusses anaesthesia considerations for emergency laparotomy in critically ill patients. Key points include:
- Patients often present late with sepsis, dehydration, electrolyte imbalances, and respiratory compromise from abdominal issues.
- Preoperative resuscitation is important to optimize the patient's condition through fluid resuscitation and correction of acidosis and electrolyte abnormalities over 2-4 hours.
- During resuscitation, airway and breathing are prioritized through oxygen supplementation. Circulation is addressed through IV access and fluid administration while monitoring urine output and electrolytes.
- Full preoperative optimization improves outcomes, but delays before surgery should be avoided in septic patients where early surgical management is beneficial
This document discusses peptic ulcer disease, focusing on duodenal ulcers. It defines peptic ulcers and describes the pathogenesis, including protective and damaging factors. Helicobacter pylori infection plays a major role in ulcer development and the mechanisms by which it causes injury are explained. Diagnosis involves endoscopy, biopsy and testing for H. pylori. Treatment involves eradicating H. pylori with antibiotics and proton pump inhibitors. Complications of duodenal ulcers like bleeding and perforation are discussed. Bleeding ulcers are classified by the Forrest system and managed initially with endoscopic methods or surgery depending on severity. Perforated ulcers require surgical repair.
This case study describes a 69-year old Filipino woman diagnosed with gastroesophageal reflux disease (GERD) and ischemic heart disease. She experienced symptoms like heartburn, acid indigestion, hiccups, and difficulty walking. Her medical history and examinations led doctors to diagnose her conditions. She was prescribed various medications to manage her diseases. Dietary interventions included a low salt, low fat, high fiber diet to help control her conditions and prevent further complications. Her nutritional status was assessed as mild underweight.
Peptic ulcer disease and GERD are common digestive disorders caused by an imbalance between gastric acid and the stomach's protective mechanisms. Peptic ulcers form when the stomach or duodenal lining is broken down, typically due to H. pylori infection or long-term NSAID use. GERD occurs when stomach acid backs up into the esophagus, often due to a weak lower esophageal sphincter. Both are treated using proton pump inhibitors to reduce acid production along with antibiotics for H. pylori if present. Lifestyle changes like sleeping upright and smaller meals can help prevent acid reflux.
anesthesia for obstructed inguinal herniaPramod Sarwa
This document discusses the anesthetic management of pediatric patients presenting with obstructed inguinal hernias. Key points include: children with this condition require urgent resuscitation for dehydration and shock prior to surgery; an NG tube should be placed to decompress the stomach and reduce risk of aspiration; anesthesia induction must include protection of the airway and prevention of regurgitation; and postoperative analgesia should involve a multimodal approach including regional techniques like caudal blocks in addition to systemic medications.
Rumination syndrome is a functional gastrointestinal disorder characterized by effortless regurgitation of recently ingested food into the mouth. It occurs due to involuntary contractions of the abdominal muscles. The regurgitated food is undigested and there is no associated nausea, vomiting or pain. Rumination syndrome has a prevalence of around 2.8% worldwide and is more common in those with eating disorders or fibromyalgia. It is diagnosed using high-resolution manometry and impedance monitoring during a test meal. Treatment involves education, reassurance and behavioral therapies like diaphragmatic breathing which can be aided by biofeedback.
This document discusses infantile hypertrophic pyloric stenosis (IHPS), a condition where the pylorus becomes thickened and obstructed. It presents in infants 2-8 weeks old with projectile vomiting. Risk factors include being male and a firstborn. Diagnosis involves physical exam finding an olive-sized mass and testing for metabolic alkalosis. Treatment is typically pyloromyotomy surgery to divide the thickened muscle. Post-op care focuses on rehydration and monitoring for complications like apnea.
Apnea of prematurity is common in preterm infants, especially those born before 28 weeks gestation or weighing less than 1800g. It is caused by immature development of the respiratory control centers in the brain. Treatment includes caffeine which reduces apnea by blocking adenosine receptors. Other supportive measures like positioning and CPAP may help as well. Apnea spells usually resolve by 36-37 weeks corrected gestational age. Before discharge, infants should have a period of at least 5-7 days without any recorded apnea events while off caffeine therapy.
Peptic ulcer disease is caused by acid in the stomach or duodenum. The most common types are gastric ulcers in the stomach and duodenal ulcers in the proximal duodenum. Risk factors include H. pylori infection, NSAID use, and medications like steroids. Diagnosis involves endoscopy, barium swallow, or H. pylori testing. Treatment includes proton pump inhibitors, H2 blockers, antibiotics to eradicate H. pylori, and sometimes surgery for complications.
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).
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
1. PRESENTED BY- Dr RICHIE SANAM
1ST YEAR POST GRADUATE
MODERATOR- Dr SUBRAHMANIAM MD PROF
DEPT OF ANAESTHESIA AND CRITICAL CARE
MEDICINE
2. History
Introduction
Primary goal
Pre-operative fasting guidelines in adults
and children
Fasting in special cases
-children
-diabetes
-trauma
-obstetrics
3. JOSEPH LISTER In the
year 1882
“While it is desirable that
there be no solid matter in
the stomach when
chloroform is administered,
it will be found very salutary
to give a cup of tea or beef-
tea about two hours
previously.”
4. DEFINITION- Prescribed period of time before
a PROCEDURE where patients
are not allowed the oral
intake of liquids or solids
Preoperative fasting times
allow for gastric emptying
and reduction of aspiration risk
6. Reduce the occurrence of
pulmonary aspiration
WHAT IS PULMONARY ASPIRATION
Aspiration of gastric contents occurring
after induction of anaesthesia,
during a procedure or in the immediate
period after surgery.
8. In 2011 ASA published updated Practice
Guidelines for Preop-Fasting and Pharmacologic
Intervention for the Prevention of Perioperative
Aspiration
Guidelines deal with healthy patients of all ages
9. PROLONGED FASTING
DEHYDRATION PATIENT DISSATISFACTION
HYPOGLYCEMIA
pre-op fast does not guarantee an empty stomach
timing of last fluid ingestion has little relation to
volume of gastric contents at induction
12. Clear fluid includes
water,PEDIALYTE, fruit juice
Without pulp, carbonated
beverages,
Clear tea and black coffee
A clear liquid is a solution
(as opposed to a suspension)
that contains no particulate
matter.
Type of liquid ingested
important than volume
infants < 5 months 10 ml/kg
children and adults 15 ml/kg
13. The fasting recommendations
for breast milk is 4hrs
does contain milk solids
cleared from the stomach
more quickly than nonhuman milk
14.
15. Allowing infants and children to have oral intake
closer to the time of surgery can help reduce patient
irritability, parental stress, and risk of dehydration
Children are encouraged to have clear fluids up
to 2 hours before surgery.
Rapid fluid turnover and high metabolic rate makes
dehydration and hypoglycaemia more likely in the
fasting child than potential aspiration.
16. Children who have had unrestricted clear fluids until 2
hrs prior to surgery have residual gastric volumes equal
to or less than those fasted overnight
younger the child, the smaller the glycogen stores;
therefore,the occurrence of hypoglycemia
Good hydration may reduce post-operative nausea and
vomiting
17. Who have not fasted the requisite length of time and
have sustained a severe injury during this period
esophageal dysmotility
Incompetent gastroesophageal sphincters
(gastroesophageal reflux diseases)
delayed gastric emptying times
abdominal conditions associated with ileus, vomiting, and
electrolyte disorders
18. Diabetic autonomic nueropathy is the most common form
of nueropathy
Diabetic gastroparesis is associated with increased risk
during GA
GASTROPARESIS is caused by vagal degeneration
AWAKE OR RSI IS NEEDED in patients with GASTROPARESIS
19. Treated as having full stomach
At risk of aspiration of gastric contents DURING INDUCTION OF
GA
REASON
TAKEN FOOD JUST SWALLOWED BLOOD From
B4 INJURY DELAYED GASTRIC ORAL OR NASAL
EMPTYING injury
DUE TO STRESS
NON PARTICULATE ANTACIDS BEFORE INDUCTION OF
ANESTHESIA
20. ALL PREGNANT WOMAN SHOULD UNDERGO A PRE-
OP EVALUATION REGARDLESS OF PLANNED
DELIVERY MODE OR TYPE OF ANESTHETIC
TECHNIQUE
PREGNANT WOMEN WHO UNDERGO GA ARE AT
INCREASED RISK FOR MORTALITY FROM
PULMONARY ASPIRATION OF GASTRIC CONTENTS
MORTALITY-5-15%
TIMELY ADMINISTRATION OF NON-PARTICULATE
ANTACIDS
H2 RECEPTOR ANTAGONISTS AND OR
METOCLOPRAMIDE FOR ASPIRATION PROPHYLAXIS
22. In 1946 Mendelson first
described aspiration pneumonitis
In pregnant woman undergoing
anesthesia
Nitrous oxide and ether anaesthesia
administered by face mask for
operative delivery was complicated
by aspiration in 66 women from 44 016 maternities (0.15%)
between 1932 and 1945.
CURTIS LESTER MENDELSON
23. Also known as ACID ASPIRATION SYNDROME
This syndrome is due to the irritation of bronchioles
by gastric HCL, producing bronchiolar spasm,
a peribronchiolar exudates, and congestion.
Aspiration of acidic and usually sterile gastric contents
into the lungs.
Mendelson went on to show that acid was responsible for
this asthma-like syndrome
24. EARLIEST AND MOST RELIABLE
SIGN OF ASPIRATION IS HYPOXEMIA
presence of wheezing and ronchi,
which may be localised to one lung
Aspiration of solid material causes
plugging of the large airways and is
often fatal.
In those who aspirated liquid, a syndrome of dyspnoea,
cyanosis and tachycardia was observed.
25. Bronchospasm, pulmonary oedema and ventilation
perfusion mismatch all contribute to worsening arterial
hypoxaemia
patients were at risk of aspiration from the presence of
25 ml residual gastric volume (RGV) or volume > 0.3–0.4
ml/kg and pH>2.5
Maximal pulmonary damage is achieved at an aspirate
pHvalue of 1.5
Recovery after 24–36 h was universal
26. PHASE-1-PROFOUND DYSPNEA AND
TACHYPNEA.BRONCHOSPASM IS OFTEN
PRESENT.CHEST X RAY NORMAL
PHASE-2-LATENT PERIOD
INCREASED CYANOSIS AND HYPOXEMIA
MINOR CHEST X RAY ABNORMALITIES
PHASE-3-RESPIRATORY FAILURE,PROFOUND
HYPOXEMIA
REDUCED COMPLIANCE
DIFFUSE BILATERAL INFILTRATES
PHASE-4-HYPOXEMIA UNRESPONSIVE TO OXYGEN
METABOLIC AND RESPIRATORY ACIDOSIS
27. Moderate amounts of aspiration will only present after
6-8 hrs
Severe liquid aspiration may cause immediate collapse
Suction through E T TUBE showing bile stained fluid is
often diagnostic
Cxr and ABG are helpful in long term cases
30. Tilt the operating table to a 30-degree head-down
position
Larynx at a higher level than
the pharynx
To allow gastric content to drain to the outside
maintain cricoid pressure, suction the mouth and pharynx
31. endotracheal intubation should be performed(if extubated)
immediate inflation of the endotracheal cuff to prevent
further aspiration
Quickly suction through the endotracheal tube before
administering 100% oxygen by PPV
orogastric tube should be inserted to empty the stomach
pH value of the gastric content should be determined.
Tracheobronchial aspirate is collected for culture and
sensitivity tests
32. Only way to maintain adequate oxygenation is to institute
mechanical ventilation with 100% oxygen and the addition
of positive end-expiratory pressure
Analysis of arterial blood gases should be performed to
determine the severity of hypoxemia
Application of PEEP is recommended to improve pulmonary
function
Membrane oxygenator may be indicated if paO2
CONTINUES TO FALL below 50mmHg
33. Bronchial lavage is contraindicated and is likely to
aggravate the injury by removing or dispersing
surfactant
Ultimate degree of pulmonary destructioncant be guaged
at the time of destruction
Early diagnosis and appropraite management will
decrease mortality
Role of steroids is controversial
34. Pre-operative fasting guidelines
Premedication with drugs which decrease risk
of aspiration
Specialised induction techniques
Gastric decompression by a wide bore
orogastric tube
37. In the absence of c/i nasogastric drainage
should be used to reduce residual gastric
volume
prior to induction of anaesthesia for patients
with bowel obstruction or paralytic ileus.
Nasogastric tubes (NGT) REDUCE LOS tone
and may be associated with GER around the
tube.
The presence of an NGT does not appear to
reduce the effectiveness of cricoid pressure
in cadaver studies.
38. Basal skull fracture
Severe midface trauma
Recent nasal surgery
Coagulopathy
Oesophageal varices or stricture
Recent banding or cautery of oesophageal varices
Gastric bypass surgery
40. Decrease risk of aspiration
Routine use of drugs as prophylaxis is not recommended by
ASA guidelines
Beneficial in
full stomach patients
Symptomatic GERD
HIATAL HERNIA
presence of NG TUBE
MORBID OBESITY
DIABETIS GASTROPARESIS
PREGNANCY
41. Empty the stomach by medication
Apomorphine slow I .V of1-3mg is given until vomiting
occurs
Then naloxane o.4 mg which will suppress vomiting
Atropine and glycopyrrolate will control salivation,they
decrease gastric acid secretion but decrease los tone
42. Dopamine D2 receptor antagonist
Prokinetic agent that stimulates gastric motility
Antiemetic
Used to treat nausea GER AND DIABETIC GASTROPARESIS
43.
44. AGENTS USED
IN OLDEN DAYS 0.3MOLAR SODIUM CITRATE 30ml
solution was used to nuetralise gastric contents
Sodium citrate is a clear, soluble, non-particulate alkali.
45. Effective at raising gastric pH, but may cause an increase
in gastric volume.
Failure to neutralise gastric acidity in some patients may
be related to inadequate mixing with stomach contents
Unfortunately, the DURATION OF ACTION of sodium citrate
is dependent on the rate of gastric emptying and may be
as short as 20 minutes, thereby not providing adequate
prophylaxis at the time of recovery.
In some patients it is emetogenic.
46. H2 antagonists or proton pump inhibitors can
alter the volume and pH of gastric contents.
Timing of administration is important, a single
dose of ranitidine, lanzoprazole or rabeprazole
given a few hours before surgery reduces the
volume and acidity of gastric secretions.
Omeprazole needs to be given the night prior to
and on the morning of operation. There is no
evidence to support the routine use of these
drugs.
47.
48.
49. MOST POTENT SUPPRESSORS OF GASTRIC ACID
SECRETION
INHIBITORS OF H-K-ATPASE
50. What equipment must be prepared and
checked prior to undertaking RSI?
Anaesthetic machine and breathing circuit
Routine patient monitoring applied
Airway equipment
Tipping trolley
Suction switched on and immediately to hand
Drugs – including emergency drugs
A trained assistant
51.
52.
53.
54. The application of cricoid pressure to prevent passive
regurgitation at induction of anaesthesia was proposed
by Sellick (1961).
55. ANATOMY
The cricoid cartilage is a ring-
shaped cartilage which when
pressed backwards onto the
vertebral column will occlude
the upper end of the
oesophagus
Applied with thumb and index
finger
Pressure of 25-30 newtons
56. Elevating the patients chin
(without displacing cervical spine)
Pushing the CRICOID CARTILAGE posteriorly to close
esophagus
57. Lower oesophageal sphincter pressure decreases as
anaesthesia is induced
cricoid pressure should, therefore be applied whilst the
patient is still awake and increased immediately
consciousness is lost
Cricoid pressure should be maintained until the trachea
has been intubated, the cuff inflated and the correct
position of the tube confirmed
58. Cricoid pressure should still be maintained if active
vomiting occurs
BECAUSE risk of aspiration outweighs the potential risk of
oesophageal rupture from high intraoesophageal pressures
Applying cricoid pressure is difficult in patients with short
and thick necks
If pressure has been applied incorrectly the larynx may be
pushed away from the midline, making the process of
intubation difficult
59.
60. Worsen laryngoscopic View without providing
Effective prevention Of aspiration
In case where the applied pressure is not central, there is a
risk of tracheal deviation
A very high contact pressure can lead to a flattening of the
tracheal lumen
If the operator applies the maneuver before the patient loses
consciousness, then the patient may cough which increased
intragastric pressure
This method is strictly against in patients with acute
vomiting.