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Introduction to Anaesthesia

Introduction to Anaesthesia. Please select one BEST answer. Q1. The word Anaesthesia means…… A sleep Loss of sensation Loss of movement Loss of consciousness Loss of hearing. Please select one BEST answer. Q2. The job of the Anaesthetist is….. To give blood during surgery

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Introduction to Anaesthesia

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  1. Introduction to Anaesthesia

  2. Please select one BEST answer Q1. The word Anaesthesia means…… • A sleep • Loss of sensation • Loss of movement • Loss of consciousness • Loss of hearing

  3. Please select one BEST answer Q2. The job of the Anaesthetist is….. • To give blood during surgery • To follow the surgeons instructions • To evaluate the patient's clinical conditions • To help Operating Room's nurses • To give the patients the antibiotics

  4. Please select one BEST answer Q3. In Saudi Arabia the Anaesthetist is….. • A physician • A technician • A surgical senior nurse • A non-clinical physician • The head of the Operating Room nurse

  5. Please select one BEST answer Q4. Which of the following statements is TRUE? • Anaesthesia is contraindicated for patients with history of Asthma • Anaesthesia is safe for patients with history of allergy to Banana • Anaesthesia is not indicated for cesarean section • Anaesthesia is only indicated for patient of 1 year old and up • Anaesthesia is can cause bleeding

  6. Please select one BEST answer Q5. The following is/are contraindication for Inhalation Anaesthesia… • History of smoking • History of Diabetes Mellitus • History of hypertension • History of malignant hyperthermia • History of previous Anaesthesia

  7. Please select one BEST answer Q6. Which of the following in an Opioid? • Paracetamol • Acetaminophen • Volatren • Pethidine • Halothane

  8. Please select one BEST answer Q7. In Anaesthesia preoperative Airway assessment means….. • To see if the patient can talk or not • To check the airway equipment • To see if the patient can say aah • To check patient's ability to spell the word Anaesthesia • To check if the patient is easy to intubate

  9. Please select one BEST answer Q8. The word intubation means…… • Using test tube for blood analysis • Inserting nasogastric tube • Inserting an endotracheal tube • Inserting chest tube • Inserting an IV line

  10. Please select one BEST answer Q9. Which of the following is crucial to human brain? • Glucose • Fat • Protein • Vitamin E • Oxygen

  11. Please select one BEST answer Q10. Pain is evaluated according to………. • What the patient says • What the doctor believe • What the nurse think • What the relative says • What make wounds heal

  12. Objectives * Become aware of the role of an Anaesthetist and the scope of Anaesthesia * Appreciate theimplications of intercurrent general medical disease and its therapy in association with surgery and Anaesthesia

  13. General Anaesthesia

  14. General Anaesthesia Definition a state of total loss of consciousness resulting from general anaesthetic Drugs, and it is a reversible process Aim of Anaesthesia * unconsciousness * amnesia * analgesia * +/- paralysis

  15. General Anaesthesia Stages of Anaesthesia * stage 1: Induction a period between the administration of the induction and loss of consciousness * stage 2: Excitement marked excitement and delirious activity modern rapid onset drugs can by pass this stage DO NOT TOUCH THE PATIENT !

  16. General Anaesthesia Stages of Anaesthesia (cont.) * stage 3 : Surgical Anaesthesia * stage 4 : Overdose Anaesthesia ( Brain Stem and Medullary depression )

  17. General Anaesthesia Conducting Anaesthesia * Induction : ( intravenous vs inhalation ) * Maintenance : MAC (minimal alveolar concentration) The alveolar concentration of an inhaled anaesthetic that prevent movement in 50% of patients in response to a standardized stimulus e.g. surgical incision

  18. General Anaesthesia Conducting Anaesthesia (cont.) * Reversal : stop Anaesthetic , give muscle relaxant reversal, administer 100% Oxygen * Recovery ( PACU )

  19. General Anaesthesia Monitoring during Anaesthesia * ECG ( electrocardiograph ) * NIBPM ( non invasive Blood Pressure monitoring ) * Pulse oximeter (arterial O2 Saturation, SaO2%) * Capnograph ( End tidal CO2 ) * Inhalation Agents Concentration * PNM (peripheral neuromuscular monitoring) * BIS ( Bispectral index )

  20. Patients Assessment & Preparation

  21. General Anaesthesia Patients Assessment & Preparation To assess patient's fitness for Anaesthesia and assessment of risk factors by : * Relevant Medical history * Examination * Appropriate investigations * Identification of risk factors

  22. General Anaesthesia Identification of risk factors 1. Patient risk factors 2. Procedure risk factors

  23. General Anaesthesia 1. Patient risk factors * American Society of Anaesthesiology Classification ASA ( I – V )E I. A healthy Patient II. A patient with mild systemic disease III. A patient with severe systemic disease that limits activity but is not incapacitating

  24. General Anaesthesia Patient risk factors (cont.) ASA IV. A patient with an incapacitating systemic disease that is a constant threat to life V. A moribund patient not expected to survive 24 hours with or without operation E. If the procedure is performed as an Emergency

  25. General Anaesthesia Patient risk factors (cont.) * Respiratory ( severity of SOB, smoking, PFT ) * Cardiovascular (chest pain, smoking, Cholesterol, stress test )

  26. General Anaesthesia Patient risk factors (cont.) * Estimated functional capacity, based on daily activities 1 MET- can take care of self 4 MET run short distance 10MET participate in strenuous sport e.g. swimming

  27. General Anaesthesia Patient risk factors (cont.) * Difficult Airway risks – Mallampati, neck, tongue, teeth * Medications e.g. Dose, frequency of administration * Allergies e.g. LATEX * Fasting status ( 3hrs for clear liquid, 6hrs for solid )

  28. General Anaesthesia Patient risk factors (cont.) * Elective vs. Emergency Acute cases categories ( E1 , 2 , 3 , 4 ) Depends on urgency

  29. General Anaesthesia 2. Procedure risk factors * Minor e.g. Superficial, Endoscopy * Intermediate e.g. Head and neck, Prostate * Major e.g. Emergency in elderly, prolonged procedure + large fluid shift

  30. Premedication & Communication

  31. General Anaesthesia Premedication Prescription of therapy to reduce the risk in a particular patient * Decrease anxiety e.g. Benzodiazepams * Decrease airway secretion e.g. Anticholinergics * Prophylaxis against aspiration e.g. Antacids

  32. General Anaesthesia Communication * Between all members of the operative team i.e. Surgeon & Anaesthetist * Obtaining informed consent from the patient

  33. Operating Theater

  34. Operating Theater Personnel + duties * Anaesthetist * Anaesthesia Technician Safety issues * Gears * Equipments * Body fluids * Personel safety ( gowns , eye protection , sharps , disposables ) * Types of rubbish containers

  35. Operating Theater Equipments Anaesthesia Machine * Ventilator * Flow meters * Insp/Exp valves * Tubings * Vaporisers * O2 sources * N2O sources * Scavengers

  36. Operating Theater Airway Equipments * Ambu bag * guedel airway * Laryngoscope * Endotracheal tube ( ETT ) * Laryngeal mask ( LMA ) * Hudson mask * Nasopharyngeal airway

  37. Operating Theater Safety Alarms * Airway High pressure * Air leak * Low FIO2 * Low SaO2% * Low /High CO2

  38. Anaesthesia & Drugs

  39. Anaesthesia Drugs Hypnotics drugs which induce sleep e.g. intravenous induction agents, two main classes : * Barbiturate e.g. Thiopental * Non-barbiturate e.g. Propfol, Etomidate, Ketamine

  40. Anaesthesia Drugs Sedatives drugs which depress CNS, causing calmness and reduction of anxiety *Benzodiazepines e.g. Midazolam, Diazepam, Larazepam, Temazepam

  41. Anaesthesia Drugs Analgesics drugs which relieve pain, they can be classified as peripherally acting and centrally acting drugs e.g. NSAID ( Paracetamol, Diclofenac or Voltaren ) Opiates ( Morphine, Fentanyl ) Others ( Tramadol, TCA, Anticonvulsants, Clonidine )

  42. Anaesthesia Drugs Inhaled Anaesthetics Drugs which are administered via the respiratory system * Inorganic nitrous oxide ( N2O ) * Volatile agents

  43. Anaesthesia Drugs Volatile agents Drugs which induce general Anaesthesia They are liquid at room temperature but evaporates easily and administered by inhalation e.g. Sevoflurane, Isoflurane, Desflurane

  44. Anaesthesia Drugs Muscle relaxant known as neuromuscular blockers(NMB), cause reduction of muscle tone (paralysis) by inhibiting Acetylcholine (Ach) action at neuromuscular end plate Two main classes * Depolarizing NMB e.g. Suxamethonium * Non-depolarizing NMB e.g. Rocuronium, Vecuronium

  45. Anaesthesia Drugs Local Anaesthetic (LA) Drugs which produce reversible conduction blockade of impulses along central and peripheral nerve pathways (autonomic, sensory, somatic motor) Two main classes * Esters e.g. procaine, chlorprocaine, tetracaine * Amides e.g. Lidocaine (Xylocaine), Bupivacaine, Ropivacaine

  46. Anaesthesia Drugs Anticholinestrase * Drugs assist to antagonize the effect of non- depolarizing NMB e.g. Edrphonium, Neostigmine Anticholinergic * Drugs which competitively antagonize Ach at cholinergic postganglionic Muscrinic receptors (Heart, SM of GIT&GU) e.g. Atropine, Glycopyrolate

  47. Anaesthesia Drugs Sympathomometics * Naturally occurring (endogenous) catecholamine e.g. Epinephrine (Adrenaline), Norepinephrine (Noradrenaline), Dopamine * Synthetic catecholamine e.g. Isopreterenol, Dobutamine * Synthetic non-catecholamine direct- acting : phenylephrine indirect-acting : Ephedrine

  48. Common / serious postoperative problems

  49. Common / serious postoperative problems GIT * Nausea & Vomiting * Constipation ( decrease bowel motility secondary to Morphine ) CNS * Pain * Confusion/Delirium * Delayed recovery

  50. Common / serious postoperative problems Cardiovascular * low/high BP * Arrhythmias * MI * Bleeding

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