General Anesthesia

 

General anesthesia

 General

anesthesia

is a state of

unconsciousness and from loss the of protective reexes resulting administration of one or more general anesthetic agents.  A variety of medications may be administered, with the overall aim of ensuring amnesia, analgesia, relaxation of skeletal muscles.

 

Phases of General •

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Induction anesthesia aintenance !mergence

 

Pre"oxygenation

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before giving any induction drug patients has to be oxygenated at least for #"$ minutes by holding the mask close to the face.

 

Induction •

ost general anesthetics today are induced either by intravenous in%ection or breathing a volatile anesthetic through an anesthetic circuit &inhalational induction'

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  (nset of anesthesia is faster with intravenous in%ection than with inhalation, taking about )*+* seconds to unconsciousness

induce

total

 

-ont •

ost of the inductions drug that we use are /etamine, thiopental ,opioids ,propofol  –

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After the induction drugs are given patients will fall a sleap and are atun increased risk of airway obstruction since they can not protect the airways An inhalational induction may be chosen by the anesthesiologist where intravenous access is di0cult to obtain, where di0culty maintaining the airway is anticipated, or due to patient preference preference &e.g. children'

 

Indication for endotracheal intubation •

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Provide a paten Provide patentt air way Prevent Pr event inhalation of gastric content 1eed a fre2uent suctioning 3acilitate positive pressure of the lung (perative position other than supine (perative site near or involving the upper airway Air way maintenance di0cult by mask

 

4ni0ng position •

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!xtension at atlanto"occipital %oint 3lexion at lower cervical spine

 

Position of the head and neck for oral intubation

 

5ules of Intubation •

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Always have a suction unit available. An intubation attempt should never exceed #* seconds.   (xygenate the patient pre and post intubation with a bag"valve"mask.&)**6 ('. 7ave sedative medication available if needed. &e.g. ida8olam )$mg9#ml' Always recheck tube placement manually guided by oxygen saturation readings. &4po'.

 

 5ules of 4uctioning •

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1ever suction further than you can see. Always suction on the way out. 1ever suction for longer than)$ seconds. Always oxygenate the patient before and after suctioning.

 

 :echni2ue  : echni2ue of !:: intubation ). In Inate ate the lun lungs gs w with ith oxygen xygen . :ak ake e the laryngos laryngoscope cope with you yourr left hand #. Ins Insert ert th the e lar laryng yngosc oscope ope b blad lade e gen gently tly in the right side of the mouth. ;. Ini Initial tial vie view w of the o oro ropha pharyn rynx x $. In Inse sert rt th the e bl blad ade e be betwe tween en th the e epiglottis iew of tthe he p phar harynx ynx < ep epigl iglotti ottis s

 

 :echni2ue  : echni2ue of of !:: intubation ?. @if @iftt the b blad lade e tow towar ards ds th the e cei ceilin ling g . >ie iew wo off th the e la lary rynx nx B. 5etract the lip to impr improve ove the view view.. )*.Insert the tracheal tube )). Cse a bougie to help the tube while your assistant applies cricoids pressure,if pressur e,if necessary necessary ).4ecurely Dx the tube in place

 

-ont

 

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-ont •

Ehen we make sure that we can ventilate the patient a short acting muscle relaxant will be given and proceed to intubation

 

-ont •

Ehen we make sure that we can ventilate the patient a short acting muscle relaxant will be given and proceed to intubation

 

-ont..

 

-ont

 

-ont

 

-ont

 

-ont •

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After patient is intubated the cuF of the endotraceal tube must be inated until the leak of air around the tube disapears 3unction of the cuF   –

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to prevent aspiration to prevent gas leak to the atmosphere

 

-ont •

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conDrmation of correct endotracheal tube placement y visuali8ing as it passes the vocal cords illateral movement of the chest y auscultation and breath sounds must be heard billaterally Absence of air entry during epigastric auscultation

 

aintenance •

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egins when the patient is at an ade2uate depth of anesthesia for the start of surgery and continues until surgery is completed. >igilance on the part of the anesthetist is re2uir re2uired ed to  –

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maintain homeostasis &>ital signs, acid" base balance,tempratur balance,temprature,coagulation e,coagulation < volume status'< regulate regulat e anesthetic depth.

 

aintenance -ont •

 :his re2ires re2ires an anesthetic mixture to keep the patient asleep and a relaxant to keep the patient parali8ed and ventilated  –

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7alothane with opiods for maintenance and long acting muscle relaxants like pancronium ,vecronium

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As the operation comes to end the concentration of anesthetics is decreased and patient is allowed to breath. A reversal has to be given atropine with neostigmine

 

5ules of extubation •

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patient should be out of relaxant and must be breathing spontaneously ,deeply and regularly  all secretions sec retions should be sucked out patient should be awak a wake e enough to obey commands

 

-omplications -omplicati ons of general anesthesia •

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3ailed intuba intubation tion Aspiration (ne lung intubation Helayed awakening awakening  Hental damage