Transcript Administration of Anaesthesia

Administration of
Anaesthesia
Presenter: Dr S Spijkerman
Slides: Prof EE Oosthuizen
SBAH & UP
TYPES OF ANAESTHESIA
• General Anaesthetic
– Unconscious
• Regional Anaesthetic
– Awake / Sedated
• Combined General - Regional
• Conscious sedation
– New name: Procedural sedation
PHASES OF A GENERAL
ANAESTHETIC
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Pre-op evaluation and medication
Preparation of equipment and drugs
Intravenous access
Induction of unconsciousness
Management of the airway
Maintenance of Anaesthesia
Wake-up and reversal of muscle
relaxation (NDMR)
8. Observation and support in PACU
Start to plan the
Anaesthetic when you do
the preoperative
assessment of the patient!
Factors that influence the
choice of Anaesthetic
• Physiological status of the patient
(physiological reserves)
• Anatomical abnormalities
• Pathology necessitating surgery
• Nature of the procedure
• Duration of the procedure
• Current medication
Factors that influence the
choice of Anaesthetic (contd)
• Availability of equipment and drugs
• Skills and experience of the anaesthetist
• Preferences of the patient
Factors that influence the
choice of Anaesthetic (contd)
CONCLUSION:
Every Anaeshetic must be tailor-made for
the individual patient and the specific
surgical procedure!
Preparation for Theatre
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Signed (informed) consent
Mass (kg)
Empty bladder
“Nil per os”
Preoperative medication
Chronic medication
Dentures / artificial limbs, eyes
Jewels
Preparation for Theatre(cont’d)
• All make-up removed
• Appropriate theatre attire
• Identity and allergy tags
• Vital signs recorded
CONSENT
• Voluntarily
• Not retrospectively
• Informed
• Permission only includes permissible
risks
Induction of Unconsciousness
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Surgical team must be on hospital premises
Preflight checklist of equipment and drugs
Emergency drugs and equipment
Meticulous identification of drugs
Positioning on the table
Monitors connected
Patent, running intravenous line
Vitals recorded before take-off
Proper intravenous access
Routes of induction:
IV / Inhalation / IM / Rectal
AIRWAY
Maintenance of the Airway
– Facemask & oropharyngeal airway
– Endotracheal intubation
– LMA
Indications for Intubation
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Protection of the airway
Maintenance of the airway
Controlled ventilation (relaxants)
Surgery on head and neck (access)
Longer procedures (>30 minutes)
Babies & small children
Intubation technique
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Opening of the mouth
Laryngoscope in left hand
Tongue to the left
Slide blade over the tongue
Deeper & shallower to find epiglottis
Lift, not hinge
Tip of McIntosh  vallecula
Tip of Miller posterior to epiglottis
Popular Laryngoscope Blades
Macintosh
Miller
Correct placement of
Endotracheal Tube?
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See tube passing through cords
Auscultate
See bilateral chest movement
Press on chest and listen
Oximetry (late sign)
Capnography
High index of suspicion
Complications of Intubation
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Sore throat
Incorrect placement
Trauma
Regurgitation / Aspiration
Bronchospasm
“Stress response”
Rapid Sequence Induction
To be performed on all patients
with a risk for aspiration:
Not fasted
Delayed stomach emptying
Regurgitation (hiatus hernia)
RSI
Check all equipment before take-off,
then:
1. Preoxygenate for 3 minutes
2. Induction with rapid acting agent
3. Cricoid pressure (Sellick’s maneuver)
4. Suxamethonium
5. Intubate & inflate cuff
6. Confirm correct placement of tube
7. Release cricoid pressure
PREOXYGENATION
• 100% Oxygen
• Tight fitting mask
• 3-5 minutes
OR
• 3-5 Vital Capacity Breaths with 100% O2
Traditional Components of a
Balanced General Anaesthetic
• HYPNOSIS
• ANALGESIA
• MUSCLE RELAXATION
(not essential)
Duty of Anaesthetist during
an Anaesthetic
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Oxygenation status
Awareness
Maintain correct plane of Anaesthesia
Haemodynamic / respiratory monitoring &
manipulation
Positioning
Ensure well-being of the patient
perioperatively
Create optimal surgical conditions
Postoperative pain management
Duty of Anaesthetist during
an Anaesthetic
Anaesthetist / Anaesthesiologist is the
perioperative physician!
Inadequate Anaesthesia
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Tachycardia / Dysrhythmias
Hypertension
Sweating / Salivation / Tears
Movement if not relaxed
Dilation of pupils
Increased breathing efforts if not
paralysed
Signs of an Overdose of
Anaesthesia
• Hypotension without other cause
• Bradycardia
• Respiratory depression / apnoea in
spontaneously breathing patients
Intraoperative Monitoring
• Monitor changes in physiology
• Senses are the most valuable monitors!
• Anaesthetist must be able to integrate all
the parameters and respond accordingly
• Meticulous record keeping
Record Keeping
Good record keeping ensures an easy
defence!
If it wasn’t recorded, it wasn’t done!