Anesthesia

1.  Often ,students of medicine,nurses,friends and
acquintances ask me how an anesthetic
procedure is selected for a particular surgery.
Some cases we give sub arachnoid block ,in
some an epidural , general anesthesia in some
while we prefer local anesthesia in some.
 WHY…?.
 There are certain guide lines which are
considered before deciding the type of
anesthesia to administer.

2.  1)The Patient
 2)The Surgery
 3)Available Facilities
 4)The Surgeon
 5)Self Assessment

3.  The patient is the first and foremost to be
considered before choosing the anesthetic
procedure.
 1)Age
 2)Sex
 3)Associated medical problems
 4)Other considerations

4.  Children under 5 years are never considered for local
or regional blocks. General anesthesia is the ideal
method.
 Children between 5 to15 are not considered for
regional blocks by many anesthetists as they are more
apprehensive and do not coperate.Fear and anxiety
are more .
 In elderly people physiological changes like
emphysema ,atherosclerosis and general debility are
against choosing GA.At the same time s..a.b also has
certain restraints like hypertension,IHD,calcifide
ligaments etc.,An epidural bloc is preferred, even for
upper abdominal surgery.

5.  Though sex is not as important as the age, the
female patient is more apprehensive and
nervous. Indian female is more modest and
shy. In such persons it is better to administer
GA.

6.  Cardio vascular diseases like
HTN,IHD,CCF,Congenital heart problems etc.,
we have to weigh the individual cases .
 DM,Hyper/Hypo Thyroidism and other
endocrinal/metabolic disorders to be
considered before deciding the plan of
anesthesia .
 Respiratory disorders like COPD,Emphysema
are better done under regional blocs than GA.,
 Renal disorders are also better done under GA.,
 Spinal is contra indicated in shock

7.  The type of surgery is of foremost importance
before deciding the anesthetic procedure. In
surgeries involving head,neck,thorax and upper
abdomen there is no alternative but GA.
 Upper limb surgeries can be managed under
regional(Brachial)bloc provided the duration of
surgery is under two hours. Lower limb/lower
abdomen/perennial surgeries can be done under
either sab or epidural bloc. Upper abdominal
surgeries like epigastric hernia repair can be done
under epidural .The advantage of epidural is we
can top up ,if required to prolong the duration by
keeping an epidural catheter –in-situ.

8.  We always have to consider the available facilities,
support and assisting staff while undertaking
anesthesia and surgery.
 a)whether a proper anesthesia machine in working
condition available,
 B)whether sufficient gases, nitrous and oxygen
available,
 Whether you are alone or working in a team,
 If trained technical staff available,
 What are the monitoring facilities available.
 Remember we cannot take up an abdominal
surgery in CT unit and vice versa.

9.  Anesthetist should always consider the
surgeon, fresh or experienced, is he fast or
slow, irritable and grumbling or calm and
cooperative. We choose an anesthetic
depending on the attitude of the surgeon and it
makes a lot of difference.

10.  Before taking up a case for anesthesia ,one
should always assess his/her competency to
administer anesthesia and manage the
complications, if required. Our experience and
temperament should be assessed without
inhibition or ego.