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ANAESTHESIA
DR.RAHUL M. KONDEKAR
ASSOCIATE PROF.
DEPT. OF SHALYATANTRA
SRIGANGANAGAR AYURVEDIC
COLLEGE & HOSPITAL
ANAESTHESIA
1. General Anaesthesia (G.A.)
2. Regional Anaesthesia (R.A.)
GENERAL ANAESTHESIA
Defination :
Reversible loss of consciousness accompanied by
analgesia, hypnosis and loss of reflexes with or
without muscle relaxation
Subtypes :
1. Spontaneous breathing
2. Controlled ventilation
REGIONAL ANAESTHESIA
Only a part of the body is anaesthetised
Types
1. Central blocks
2. Peripheral blocks
CENTRAL BLOCK
1. Spinal Analgesia
2. Epidural Analgesia
3. Caudal Analgesia
ANATOMY
VERTEBRAL COLUMN
Spinal cord is protected by
vertebral column 33 vertebrae
4 spinal curves
Cervical 7
Thoracic 12
Lumber 5
Sacral 5
Coccygeal 4
Total 33
PERIPHERAL BLOCKS
1. Surface anaesthsia – LA cream
2. Infiltration block – subcut. tissue
3. Nerve blocks
4. Field block - Inguinal field block
NERVE BLOCKS
1. Upper extremity blocks
A Supraclavicular block
B Axillary block
C Elbow block
D Wrist block
E Digital block
NERVE BLOCKS
2. Lower extremity blocks
A. Sciatic nerve block
B. Femoral nerve block
C. Popliteal block
D. Ankle block
E. Digital nerve block
NERVE BLOCKS
3. Peribulbar block – eye operations
Cataract surgery
4. Penile block – circumcision
5. Dental block – tooth extraction
PREOPERATIVE CHECKUP
History
• Previous operation
• Diseases
Hypertension, diabetes, asthma and heart
diseases
• Medications
• Allergy
PREOPERATIVE CHECKUP
General examination
Pulse, B/P and temp.
Systemic exam
CVS and Resp. system exam.
Investigations
CBC, electrolytes, ECG and x ray chest,HIV,HbsAg,2D-Echo,Sr.Creatnine
Patient information about type of anaesthesia and its complications
Consent…..Most important
PREMEDICATION
Premedication ??????
1) To reduce the stress
2) For good outcome of surgery
3) Less anaesthetic drug requirement
4) Lesser intra-op complications
5) Post-op complications are reduced
GENERAL ANAESTHESIA
Cannulation
22 to 24 G cannula in children
20 to 18 G cannula for adult
I/V fluids
5% D/DNS/RL.
Haemacel soln.(Volume Expander)
Blood
GENERAL ANAESTHESIA
• Preoxygenation for 3 min.
Induction
• Fentanyl 1 mcg/kg
• Propofol 2 to 3 mg/kg
Intubation
• Tracrium 0.5 mg/kg muscle relaxant
or
• Scoline 2 mg/kg for emergency cases as rapid onset of action
GENERAL ANAESTHSIA
• Intubation with endotracheal tube
orLMA(laryngeal mask) or holding face mask
• E.T tube
Size 8 to 8.5 mm for men
Size 7 to 7.5 mm for female
Children Age/4 + 4 mm
INTUBATION
LARYNGEAL MASK
• L.M.A. size 4 for men
• L.M.A. size 3 for female
• L.M.A. size 1, 1.5, 2, 2.5 for
children
Insertion technique
ADVANTAGES OF LMA
1. Supraglottic device - no irritation of larynx
2. Easy to insert
3. Laryngoscope is not necessary – blind
intubation
4. Awake insertion possible
5. Life saving for difficult intubation
6. E.T tube can be passed through LMA
7. Tolerated at lighter plane of anaesthesia
MONITORING
Continuous monitoring
• 1. Electrocardiogram (E.C.G.)
• 2. SPO2
Saturation of Hb – normal 97%
• 3. End tidal CO2
• 4. Blood pressure
Systolic, diastolic and mean pressure every
5 min.
5. Temperature - warming matress
REVERSAL
• Reversal of relaxant drug Tracrium at the end of operation
• N2O and Isoflurane are stopped
• Only O2 given to the patient
Neostigmine 2.5 mg + atropine 1 mg
Oral suction
Extubation only when patient conscious and coughing
O2 by face mask
Monitoring of vital signs
Shifted to recovery room when vital signs are stable
RECOVERY
• O2 by face mask
• Monitoring SPO2, B/P and ECG
• Warming blanket
• Treat any complications
• Nausea/ vomiting – maxalon or zofran
• Adequate pain relief
• I/V Fentanyl or I/M Pethidine
• Aldrete scoring system
• Shifted to ward when vital signs are stable
SPINAL ANALGESIA
• Local anaesthetics
• Lignocaine 1% 2 ml for L.A. at L2-3 interspace
• Marcaine (Bupivacaine) 0.5% 2to 2.5 ml with fentanyl 25 mcg
Autonomic, sensory and motor nerve block upto T6-8 level
Duration 3 to 4 hours
SPINAL ANALGESIA
• Spinal needle – 25 G
pencil point needle
• Spinal cord 45 cm long
• 3 covering membranes
• Dura, arachnoid and pia
membranes
• Cerebro spinal fluid
(C.S.F.) is in
subarachnoid space
SPINAL ANALGESIA
Complications
• 1. Hypotension
Fluids, ephedrine 6 mg
• 2. Shivering
Warming blanket, Pethidine 25 mg, O2
• 3. Nausea, vomiting
Inj.Ondem
4. Respiratory depression – O2 inhalation
5. Headache – C.S.F. loss
6. Backache
ANATOMY OF EPIDURAL SPACE
EPIDURAL ANALGESIA
EPIDURAL ANALGESIA
• 18-16 G Touhy needle
inserted into epidural
space at any level
depending on site or
operation
• Catheter is inserted thro’
the needle upto 8 to 9 cm
at skin level
• Needle is removed and
catheter is fixed to the
back of the patient.
EPIDURAL- CATHETER
EPIDURAL ANALGESIA
Complications
• 1. Total spinal
• 2. Hypotension
• 3. Nausea and
vomiting
• 4. Patchy analgesia
• 5. Headache
• 6. Epidural abcess
• 7. Backache
CAUDAL BLOCK
• 21 G needle is inserted into thro’ sacral
haitus
• 15 TO 20 ml .25% marcaine injected
• Lower abdominal surgery
• Children for postop pain relief
Herniotomy, circumcision
EMERGENCY DRUGS
• 1. Atropine
Bradycardia pulse less than 50/min
2. Adrenaline
Cardiac arrest, allergy
3. Ephedrine 6 to 9 mg
low blood pressure
4. Labetolol 3 to 5 mg
Low blood pressure
EMERGENCY DRUGS
• 5. Hydrallazine
High blood pressure
• 6. Avil10 mg
Allergy
• 7. Dopamine, dobutamine
To increase blood pressure and cardiac
output
8. Hydrocortisone
Allergy
EMERGENCY DRUGS
• 9. Narcan
To reverse overdose of narcotics
• 10. Maxalon 10 mg
Nausea and vomiting
• 11. Zofran
Nausea and vomiting
SUMMARY
• 1. General and regional anaesthesia
• 2. Selection of patient for anesthesia is very important
• 2. Monitoring and safe anesthesia are vital throughout
anesthesia
4. Adequate recovery of patient before sending to
ward
ANY QUESTIONS???
• THANK YOU