magic of 1.5 as a figure in anesthetic management of tonsillectomy either in plus(+), minus(-), divided (/) or multiplied(x) for easy guidelines for practicing anesthesiologist

1. Dr. Tushar Chokshi
Private Practicing Anesthesiologist
M.D. ( Anesthesiology )
Medical College, VADODARATMC

2. MAGIC OF 1.5 IN
ANESTHETIC
MANAGEMENT OF
TONSILLECTOMY
( Plus, Minus, Divided or Multiplied )
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3. An easy method for
remembering various
figures in practice of
anesthesia
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4. Aims & Objectives
To study the magic
of 1.5 in
anesthesia Practice
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5. Most figures in anesthesia simplified
as
TOTAL
DIFFERENCE
MULTIPLE
DIVISION
Of
1.5( Based on Anesthetic Management of 1500 Tonsillectomy in last 15 years )
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6. Methods and Materials
Given around 1500 anesthesia
for surgery of Tonsils & Adenoids
in 3 private ENT Hospitals of
Vadodara City from 1995 to 2009
(15 years) without any major
complications, with all necessary
protocols and standard operating
procedures.TMC

7. Summary of Results
Age Group : 3 to 45 Years
ASA Group : ASA I or II (Mean 1.5)
PA Check-Up : 15 minute before giving
anesthesia
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8. Investigations
Hb, TC, DC, ESR, BT,
CT, FBS/RBS & SOS
X-Ray Chest and/or
ECG
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9. Nil By Mouth
Clear Water up to 3 hrs
before Operation
Solid 6 hrs before Operation
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10. Premedication
Inj. Atropine 0.03 mg / kg
IM (15 minutes before)
OR
IV (1.5 minutes before)
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11. Infusion
Ringer Lactate 15 ml / Kg weight (Total)
Completed within 1.5 hours
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12. Pre-Induction
Inj. Ondansetron 0.75 ml (P) / 1.5 ml (A)
Inj. Diclofenac Sodium 1.5 mg/kg
Most Common Antibiotics 15 mg/kg
All Intravenous ( No Sedation )
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13. Pre-Oxygenation
1.5 liters (P) or 3 liters (A)
for
1.5 or 3 minutes
P-Pediatric
A-Adult
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14. Induction
Inj. Ketamine 1.5 mg / Kg
+
Inj. Propofol 1.5 mg / Kg (Mix)
or
Inj. Thiopental Sodium 4.5 mg / kg
Slowly IV For 1.5 Minutes
Followed by Succinyl Choline 1.5 mg / Kg IV
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15. IPPR
For 1.5 minutes with
3 liters (P) / 4.5 liters (A)
of Oxygen
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16. Intubation
Oral or Nasal with cuff Portex ET Tube
(ET Size – Ht. in Feet + 1.5)
Laryn-Pack 1.5 Feet(P)/3 Feet(A) long
Cuff Pressure 3 / 6 / 9 ml
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17. Maintenance
On Anaesthesia Machine
1.5 L / 3 L O2 + 1.5 L / 3 L N2O
RR 15 / Minute & Tidal Volume 7.5 ml/kg
with maintenance of relaxation giving
Succinyl Cholene 30 mg(P) / 60 mg(A) every
3 Minutes
Isoflurane at 1.5 mark or 3 markTMC

18. Monitoring
Pulse Oxymeter
and /or
NIBP
SOS
Capnography
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19. Post-Operative Analgesia
Local Inj. Lidocaine 1.5 mg / kg
in each tonsiller fosse
or
Local Inj. Bupivacaine 1.5 ml in
each tonsiller fosse
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20. Outcome
Pleasant
with Verbal Command &
Reflexes within 3 to 6
minutes of Extubation
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21. Average Anesthesia Time
30 to 45 Minutes
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22. Post operative NBM
Clear water after 3 hours
&
Solid after 4.5 hours
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23. Discharge
After 6 hrs of
operation
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24. Follow Up
on 3rd day
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25. TMC
The Magic of 1.5 helps to
give safe and efficient
anesthesia with minimal
strain on memory and time
in Management of
Tonsillectomy with respect
to standard protocols of
Textbooks.

26. TMC