TMC

Dr. Tushar ChokshiPrivate Practicing Anesthesiologist

M.D. ( Anesthesiology )

Medical College, VADODARA

TMC

MAGIC OF 1.5 IN ANESTHETIC

MANAGEMENT OF TONSILLECTOMY

( Plus, Minus, Divided or Multiplied )

TMC

An easy method for remembering various figures in practice of

anesthesia

TMC

Aims & Objectives

To study the magic of 1.5 in

anesthesia Practice

TMC

Most figures in anesthesia simplified as TOTAL

DIFFERENCEMULTIPLEDIVISION

Of

1.5( Based on Anesthetic Management of 1500 Tonsillectomy in last 15 years )

TMC

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

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

TMC

Investigations

Hb, TC, DC, ESR, BT, CT, FBS/RBS & SOS X-Ray Chest and/or

ECG

TMC

Nil By Mouth

Clear Water up to 3 hrs before Operation Solid 6 hrs before Operation

TMC

Premedication

Inj. Atropine 0.03 mg / kg

IM (15 minutes before) OR

IV (1.5 minutes before)

TMC

Infusion

Ringer Lactate 15 ml / Kg weight (Total)

Completed within 1.5 hours

TMC

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 )

TMC

Pre-Oxygenation

1.5 liters (P) or 3 liters (A) for

1.5 or 3 minutes

P-PediatricA-Adult

TMC

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

TMC

IPPR

For 1.5 minutes with

3 liters (P) / 4.5 liters (A) of Oxygen

TMC

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

TMC

MaintenanceOn 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 mark

TMC

Monitoring

Pulse Oxymeter and /or NIBP

SOS Capnography

TMC

Post-Operative Analgesia

Local Inj. Lidocaine 1.5 mg / kg in each tonsiller fosse

orLocal Inj. Bupivacaine 1.5 ml in

each tonsiller fosse

TMC

Outcome

Pleasant with Verbal Command &

Reflexes within 3 to 6 minutes of Extubation

TMC

Average Anesthesia Time

30 to 45 Minutes

TMC

Post operative NBM

Clear water after 3 hours &

Solid after 4.5 hours

TMC

Discharge

After 6 hrs of operation

TMC

Follow Up

on 3rd day

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.

TMC