Administration of Anaesthesia

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Administration of Anaesthesia

• Presenter Dr S Spijkerman
• Slides Prof EE Oosthuizen
• SBAH UP

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TYPES OF ANAESTHESIA

• General Anaesthetic
• Unconscious
• Regional Anaesthetic
• Awake / Sedated
• Combined General - Regional
• Conscious sedation
• New name Procedural sedation

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PHASES OF A GENERAL ANAESTHETIC

• 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)
• Observation and support in PACU

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Start to plan the Anaesthetic when you do the
preoperative assessment of the patient!
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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

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Factors that influence the choice of Anaesthetic
(contd)

• Availability of equipment and drugs
• Skills and experience of the anaesthetist
• Preferences of the patient

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Factors that influence the choice of Anaesthetic
(contd)

• CONCLUSION
• Every Anaeshetic must be tailor-made for the
  individual patient and the specific surgical
  procedure!

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Preparation for Theatre

• Signed (informed) consent
• Mass (kg)
• Empty bladder
• Nil per os
• Preoperative medication
• Chronic medication
• Dentures / artificial limbs, eyes
• Jewels

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Preparation for Theatre(contd)

• All make-up removed
• Appropriate theatre attire
• Identity and allergy tags
• Vital signs recorded

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CONSENT

• Voluntarily
• Not retrospectively
• Informed
• Permission only includes permissible risks

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Induction of Unconsciousness

• 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

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AIRWAY

• Maintenance of the Airway
• Facemask oropharyngeal airway
• Endotracheal intubation
• LMA

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Indications for Intubation

• Protection of the airway
• Maintenance of the airway
• Controlled ventilation (relaxants)
• Surgery on head and neck (access)
• Longer procedures (gt30 minutes)
• Babies small children

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Intubation technique

• 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

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Popular Laryngoscope Blades
Macintosh
Miller
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(No Transcript)
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Correct placement of Endotracheal Tube?

• See tube passing through cords
• Auscultate
• See bilateral chest movement
• Press on chest and listen
• Oximetry (late sign)
• Capnography
• High index of suspicion

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Complications of Intubation

• Sore throat
• Incorrect placement
• Trauma
• Regurgitation / Aspiration
• Bronchospasm
• Stress response

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Rapid Sequence Induction

• To be performed on all patients with a risk for
  aspiration
• Not fasted
• Delayed stomach emptying
• Regurgitation (hiatus hernia)

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RSI

• Check all equipment before take-off, then
• 1. Preoxygenate for 3 minutes
• 2. Induction with rapid acting agent
• 3. Cricoid pressure (Sellicks maneuver)
• 4. Suxamethonium
• 5. Intubate inflate cuff
• 6. Confirm correct placement of tube
• 7. Release cricoid pressure

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PREOXYGENATION

• 100 Oxygen
• Tight fitting mask
• 3-5 minutes
• OR
• 3-5 Vital Capacity Breaths with 100 O2

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Traditional Components of a Balanced General
Anaesthetic

• HYPNOSIS
• ANALGESIA
• MUSCLE RELAXATION
• (not essential)

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Duty of Anaesthetist during an Anaesthetic

• 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

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Duty of Anaesthetist during an Anaesthetic

• Anaesthetist / Anaesthesiologist is the
  perioperative physician!

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Inadequate Anaesthesia

• Tachycardia / Dysrhythmias
• Hypertension
• Sweating / Salivation / Tears
• Movement if not relaxed
• Dilation of pupils
• Increased breathing efforts if not paralysed

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Signs of an Overdose of Anaesthesia

• Hypotension without other cause
• Bradycardia
• Respiratory depression / apnoea in spontaneously
  breathing patients

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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

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Record Keeping

• Good record keeping ensures an easy defence!
• If it wasnt recorded, it wasnt done!