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General Anesthesia (GA)

General Anesthesia (GA). What’s general anesthesia ？ How to anesthetize the patient ？. Four clinical end points of GA. Classification of General Anesthesia. Inhalational GA Intravenous GA Combined GA. Procedure of GA. Induction from awake to sleep (hypnotic) and ready for surgery

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General Anesthesia (GA)

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  1. General Anesthesia (GA)

  2. What’s general anesthesia？ • How to anesthetize the patient？

  3. Four clinical end points of GA

  4. Classification of General Anesthesia • Inhalational GA • Intravenous GA • Combined GA

  5. Procedure of GA • Induction from awake to sleep(hypnotic) and ready for surgery • preoxygenation • induction with intravenous or inhalational anesthetics • Tracheal intubation , mechanical ventilation • Maintenance four endpoints • Emergence Awake, spontaneous respiration no residual muscle relaxation

  6. Tracheal intubation • Open and seal the air way • ventilation • Deliver inhalational anesthetics stiletto

  7. Tracheal intubation

  8. Special Apparatus McCoy Mccoy Polio Polio Soper Soper Hinged blade tip

  9. Supraglottic Devices Combitube Laryngeal Mask Airway

  10. Difficult airway Apparatus Tracheotomy

  11. Verify Position • chest expansion bilaterally • listening over the epigastrium and the lung fields • Continuous waveform capnography • exhaled CO2 ,esophageal detector device (EDD) • If in doubt, laryngoscope to visualize the tube passing through the vocal cords • If still in doubt, bag-mask ventilation • chest x-ray (when feasible) above the carina

  12. Anesthetic Machine • Composition of AM • Gas supplies • Vaporizer • ventilator • Breath circle

  13. Maintenance and Monitoring

  14. Depth of Hypnotic effect

  15. Neuromuscular Function • TOF

  16. Autonomic stability evaluation ECG SPO2 BP CVP T

  17. BIS Autonomic stability evaluation PETCO2 Sevoflurane BIS

  18. What about analgesia ? MAC Spinal reflex Intravenous GA analgesic

  19. Emergence • Conscious • Spontaneous respiration Head rise5 s , tongue protrude VT > 500ml SpO2 >95% (inspiration air) • No residual relaxation TOF ratio > 90% • Analgesia PCA

  20. Special techniques for management of anesthetized patient

  21. Deliberade Hypotension • Methods • Inhalational anesthetics • isoflurane • Vasodilator • Nitroprusside sodium • Nitroglycerine • Autonomic ganglia blocker • Objectives • facilitate surgery • decrease blood loss • Safety stand • ≥70 % of Basic lever • SAP ≥ 80mmHg • MAP ≥ 60~70mmHg • Time limit • 30~90 min

  22. Hypothermia • Objectives • Decrease MR • Maintain Basic metabolic requirement of Cell • Grades • Low hypothermia 35 ℃ ~ 32 ℃ • Middle hypothermia 31 ℃ ~ 26 ℃ • Deep hypothermia ＜25 ℃ • Methods • Extracorporeal • Cardiopulmonary Bypass

  23. Cardiopulmonary Bypass • Basic parts of the Set • Preload and hemodilution HCT 20%~25% Hb 70 ~ 80 g/L • Heparin 300~400 U / kg ACT>480~ 600s • Pup flow2.2~2.8L/(m2.min) 100~150 ml/kg (child) • Myocardial protectionK+ 20mmol/L

  24. Autologous transfusion Preoperational hemodilution ANH 10~15ml/kg Blood Salvages anticoagulation Prof. Wang Xue-ren xrwang@mail.hust.edu.cn

  25. The best safety lies in f e a r

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