ANAESTHESIA

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ANAESTHESIA ANALGESIA in AE

• Joanne Bradford

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Anaesthesia in AE

• Local anaesthesia
• Local infiltration
• Regional anaesthesia
• Conscious sedation
• Dissociative anaesthesia
• Rapid sequence intubation

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Local anaesthesia

• Indications
• Uses
• Contraindications
• Toxic effects/Complications
• BE PREPARED FOR RESUSCITATION

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Local anaesthesia

• Agents
• Lignocaine
• Bupivacaine
• Dose
• Adjuncts additives
• Topical anaesthesia
• Regional anaesthesia

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Regional anaesthesia

• Peripheral nerve blocks
• Haematoma blocks
• Intravenous arm block (Biers block)

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Some common nerve blocks

• Orofacial blocks
• Wrist block
• Ring (digital) block
• Intercostal block
• Femoral nerve block
• Ankle block
• Penile block

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Wrist block
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Wrist block
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Digital block
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Digital block - Toes
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Femoral block
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Ankle block - the sole
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Ankle block - dorsum
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Intercostal block
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Penile block
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Conscious sedation

• minimal depression in the level of consciousness
  while maintaining a patent airway responding
  appropriately to stimulation or commands.
• Indications
• Agents
• Benzodiazepines
• Narcotics
• Route i.v. commonly
• Side effects

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Rapid sequence intubation (RSI)

• a technique for emergency airway control
  designed to minimize the adverse physiologic
  responses to endotracheal intubation.
• ABCs
• Preparation
• Monitor
• Preoxygenate
• Premedicate
• Sedate

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Rapid sequence intubation (RSI)

• Cricoid pressure
• Intubate
• ETT placement
• Maintenance of sedation paralysis
• Monitor
• Appropriate disposal of patient

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Dissociative anaesthesia

• ..is characterized by amnesia, analgesia,
  sedation with maintenance of protective reflexes.
• Agent Ketamine
• Routes of administration
• Side effects
• Advantages
• Contraindications/Special precautions

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Management of anaesthetized patient

• Patient selection
• Informed consent
• Preparation
• Patient
• Personnel
• Equipment
• Medication
• Monitoring
• Disposition

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Management - Monitoring

• O2 sat
• Respiration depth, rate
• HR
• BP
• Patient responsiveness/ awareness
• Done before, during and after the procedure by
  both nursing and medical personnel.

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Management - Disposition

• Discharge criteria conscious sedation
• Normal vital signs for ½ hr
• Minimal or no nausea, vomiting or dizziness
• Able to retain oral fluids
• Able to void
• Receives,comprehends retains discharge
  instructions
• Responsible person available to accompany patient
• Appropriate transportation from hospital

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Analgesia in AE

• Physical modalities
• Explanation
• Splintage
• Dressings
• Definitive Rx
• Pharmacological modalities
• Systemic
• Nonsystemic
• Others

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Pharmacological Agents

• SYSTEMIC
• Oral parenteral medication
• Non-opioids
• NSAIDs
• Acetaminophen
• Ketamine
• Opioids
• Codeine
• Pethidine
• Morphine
• Fentanyl

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Pharmacological agents

• NONSYSTEMIC
• Local anaesthetics
• Lignocaine
• Bupivacaine
• Others
• Topical agents (NSAIDs, ethyl chloride spray,
  EMLA)
• Alternative/allopathic
• Adjuncts

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Management of patient with pain

• ABCs
• ? Acute or chronic
• Appropriate modality
• ? Physical /or Pharmacologic
• Pharmacological
• Route of administration
• Dose
• Side/toxic effects
• Adjuncts

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Analgesia in special situations

• Head injury
• Migraine
• Abdominal pain ( acute abd., renal colic)
• SCD
• Special Groups (children, elderly,pregnancy)
• Asthma
• Chronic pain
• Drug addiction

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Suggested reading

• Tintinalli et al Emergency Medicine. A
  comprehensive study guide 5th Ed. Chap. 33
• Rosen et al Emergency Medicine. Concepts
  Clinical Practice 4th Ed. Chap. 21
• Roberts et al Clinical Procedures in Emergency
  Medicine 3rd Ed. Chaps. 31 - 35
• Annals Emerg Med. 2855-74, 1996
• Emerg Med Clin North Am 15399-415, 1997