general anesthesia
DESCRIPTION
for newbies anaesthesia assistanceTRANSCRIPT
BASICof GENERAL ANESTHESIA
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DEFINITIION
Total or partial loss of sensation, especially tactile
sensibility, induced by disease, injury, acupuncture,
or an anesthetic, such as chloroform or nitrous
oxide.
Local or general insensibility to pain with or without
the loss of consciousness, induced by an anesthetic.
A drug, administered for medical or surgical
purposes, that induces partial or total loss of
sensation and may be topical, local, regional, or
general, depending on the method of administration
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TYPES
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GENERAL ANESTHESIA
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GENERAL ANESTHESIA ??
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RESPIRATORY SYSTEM
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EQUIPMENT
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ANESTHESIA MACHINE
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M.A.L.E.S
Cannulation Tray
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LARNGOSCOPE
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HUMIDIFICATION
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1. Analgesia - opiod
-I/v Fentanyl 50-100 mcg
2.Anesthetic Agents
Inhalation – Sevoflurane , isoflurane,
Desflurane
Intravenous – propofol, etomidate,
ketamine, thiopentone, midazolam
DRUGS IN USE
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cont
3. Maintenance
IV induction agents is generally 5 to 10
minutes duration.
To maintain - mixture of oxygen, nitrous
oxide, and a volatile anesthetic agent
supplemented by intravenous anesthetics
-opioids fentanyl, morphine and sedative
hypnotics -propofol or midazolam.
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4. Muscle relaxation / Neuromuscular blockade
Acetylcholine, the natural neurotransmitter
substance at the neuromuscular junction, causes
muscles to contract when it is released from nerve
endings. Muscle relaxants work by preventing
acetylcholine from attaching to its receptor.
depolarising drug – suxamethonium.
Non depolarising (NDMR) - pancuronium,
rocuronium, vecuronium, atracurium, mivacurium,
and
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5. Reversal
anti-cholinesterase increasing both the level and
duration of action of the neurotransmitter acetylcholine.
Neostigmine 0.05 mg plus
Atropine 0.04mg or
Glycopyrolate 0.2 mg
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AIRWAY MANAGEMENT
To enable mechanical ventilation, an
artificial airway is used
endotracheal tube
laryngeal mask airways
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ENDOTRACHEAL TUBE
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LARYNGEAL MASK AIRWAY
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SELLICK MANEUVER
WHAT – cricoid pressure WHY - preventing regurgitation of
stomach content to the lung WHO – Pt ; RSI, full stomach HOW - applying pressure 30-40N with
thumb, index and middle finger WHERE - to the cricoid cartilage to
occlude esophagus. WHEN – ETT in place confirmed by
auscultation of air entry equal
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CRICOID PRESSURE
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MONITORING
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MONITORING ECG – heart rate and rhythm
SpO2 – haemoglobin saturation with O2
BP ( NIBP / IBP - art line)
CVP - measure volume status and fluid access.
Gas analyzer - Agent concentration measurement
of inhalation agent (sevo,iso)
Capnography - measures the amount of carbon
dioxide expired by the patient's lungs.
Temperature measurement - hypothermia or fever
or malignant hyperthermia
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COMPLICATIONS
Haemodynamicly instability Awareness During Surgery -awake
and aware. Post operative nausea and vomiting
(PONV) Anesthetic Toxicity Hypothermia Malignant Hyperthermia Bronchospasm Larnygospasm Stridor
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POSTOPERATIVE CARE
A – airwayB – breathingC – circulation, color, consciousnessD – drainage ( fluid and drain tube)E – elimination ( urine output)F - fluid therapyPain management PCAM Epidural Analgesia drug
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NURSE RESPONSIBILITIES1.pre operative
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Cont 2. Intra operative
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Cont 3. Post operative
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HANDLE WITH CARE……
FRAGILE!!!
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CRISIS AND MANAGEMENTWHAT WOULD U DO????
1.DIFFICULT INTUBATION- Fibre optic - DIT trolley- bougie- cookairway- LMA proseal- Em drugs – atropine, adrenaline,
amiodarone, magnesium sulphate- Surgical approach – tracheostomy
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2.DISSATURATION- Check probe- Call for help- BVM- Secretion – endotrachial suctioning- Bronchospasm – aerosol therapy –
MDI salbutamol- ABG- Stop operation
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MASSIVE BLOOD LOSS Check and record blood loss ABG GXM, DIVC regim DIVC screening – PTAPTT, INR Fluid challange colloid – hartman, gelafusin,
voluven Urine output Hypovolumic shock – seizure, increase
temp., tacyhcardia, increace BP, hypoventilation, increase co2.
Hypothermia – warming pt. Stop Op
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Disarrythmias - collapes
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MANAGEMENT
Call for help Emergency trolley Em drugs – atropine , adrenaline,
amiodarone, magnesium sulphate Treat causes - 6H 5T ABG BVM CPR Stop Op
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The Hs and Ts
Hs- Hypovolemia- Hypoxia- Hydrogen ion – acidosis- Hyperkalaemia / hypokalaemia- Hypothermia- Hypoglycemia / hyperglycemia
Ts- Toxins- Cardiac temponade- Tension pneumothorax- Thrombosis – heart attack’- Thromboembolism ( pulmonary
embolism- Trauma
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POST OPERATIVELY
1. PAIN Recheck BP compare with base line data Heart rate - tachycardia Pain score – 0 – no pain, 3-5 - moderate, 6-8 –
severe, 9- 10 – worst pain Check operation site Check for bladder distention Pain managent Analgesic as Dr. ordered
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2. PONV
Causes ?? Laparoscopic surgery, ENT, anaesthetic
drugs- opiod , pain, Gynae/Obs ,increase ICP/IOP
Management?? Suction Prop up and head turn to lateral Fluid Antiametic – maxalon 10mg as ordered Informed anesthetist - ? Increase ICP / IOP
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