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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.

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Administration of Anaesthesia

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  1. Administration of Anaesthesia Presenter: Dr S Spijkerman Slides: Prof EE Oosthuizen SBAH & UP

  2. TYPES OF ANAESTHESIA • General Anaesthetic • Unconscious • Regional Anaesthetic • Awake / Sedated • Combined General - Regional • Conscious sedation • New name: Procedural sedation

  3. 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

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

  5. 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

  6. Factors that influence the choice of Anaesthetic (contd) • Availability of equipment and drugs • Skills and experience of the anaesthetist • Preferences of the patient

  7. Factors that influence the choice of Anaesthetic (contd) CONCLUSION: Every Anaeshetic must be tailor-made for the individual patient and the specific surgical procedure!

  8. Preparation for Theatre • Signed (informed) consent • Mass (kg) • Empty bladder • “Nil per os” • Preoperative medication • Chronic medication • Dentures / artificial limbs, eyes • Jewels

  9. Preparation for Theatre(cont’d) • All make-up removed • Appropriate theatre attire • Identity and allergy tags • Vital signs recorded

  10. CONSENT • Voluntarily • Not retrospectively • Informed • Permission only includes permissible risks

  11. 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

  12. AIRWAY Maintenance of the Airway • Facemask & oropharyngeal airway • Endotracheal intubation • LMA

  13. Indications for Intubation • Protection of the airway • Maintenance of the airway • Controlled ventilation (relaxants) • Surgery on head and neck (access) • Longer procedures (>30 minutes) • Babies & small children

  14. 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

  15. Popular Laryngoscope Blades Macintosh Miller

  16. 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

  17. Complications of Intubation • Sore throat • Incorrect placement • Trauma • Regurgitation / Aspiration • Bronchospasm • “Stress response”

  18. Rapid Sequence Induction To be performed on all patients with a risk for aspiration: • Not fasted • Delayed stomach emptying • Regurgitation (hiatus hernia)

  19. 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

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

  21. Traditional Components of a Balanced General Anaesthetic • HYPNOSIS • ANALGESIA • MUSCLE RELAXATION (not essential)

  22. 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

  23. Duty of Anaesthetist during an Anaesthetic Anaesthetist / Anaesthesiologist is the perioperative physician!

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

  25. Signs of an Overdose of Anaesthesia • Hypotension without other cause • Bradycardia • Respiratory depression / apnoea in spontaneously breathing patients

  26. 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

  27. Record Keeping Good record keeping ensures an easy defence! If it wasn’t recorded, it wasn’t done!

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