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Anaesthesia Outside the Operating Room Dr. Samanthi

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Anaesthesia Outside the Operating Room Dr. Samanthi Godawelage Senior Registrar - Anaesthesiology -Radiology Dept -Cardioversion -ECT -Dental Anaesthesia Problems ... – PowerPoint PPT presentation

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Title: Anaesthesia Outside the Operating Room Dr. Samanthi


1
Anaesthesia Outside the Operating Room
Dr. Samanthi GodawelageSenior Registrar -
Anaesthesiology
2
-Radiology Dept -Cardioversion -ECT
-Dental Anaesthesia
3
Problems related to isolated environment
  • Equipment might be old, not regularly serviced
    and not in standard use as in the rest of the
    hospital
  • Monitoring standards may not be adequate
  • Piped medical gases may not be supplied
  • Other personnel may be unaware of the problems
    facing the anaesthetist
  • Space may be limited by bully equipment making
    access to the patient difficult
  • Poor environmental conditions (eg Lighting,
    temperature)
  • Recovery facilities may not be available
  • Inadequate ventilation/scavenging causing
    pollution
  • Problem related to transferring patients

4
Problems related to patient
  • Patients who require general anaesthesia are
  • Infants or uncooperative children
  • Older children or adults with psychological
    behavioural or movement disorders
  • Intubated patients such as acute trauma victims
    and patients receiving intensive care
  • Interventional procedures radio-guidance or
    painful procedures like ECT, cardioversion which
    require amnesia

5
Problems related to the procedure
  • MRI related problems
  • Bleeding
  • Conversion from sedation to anaesthesia
  • Contrast related problems
  • Radiation

6
Anaesthetist may be asked to administer lV
contrast to the patient
  • Check the timing of injection with the
    radiographer
  • Contrast is viscous and can be difficult to
    inject
  • Automated contrast injectors can cause high
    pressures to be developed
  • Reactions
  • Renal effects
  • Oral contrast can cause aspiration

7
Anaesthesia for CT
8
  • Anaesthetist can remain in the room wearing X-ray
    protection or view the patient and monitors from
    the control room
  • The CT scanner does not interfere with monitoring
    equipment, but..
  • The scans are short and can be interrupted
  • The patient couch moves during examination
  • Temporarily interruption of ventilation to
    improve image quality immediately re-ventilate
  • Patient positioning

9
Anaesthesia for MRI
10
  • MRI has superceded CT for the examination of CNS
    and many orthopaedic conditions
  • MRI uses a static magnetic field which is
    permanently on and super-imposed rapidly changing
    magnetic fields and radio-frequency currents
  • Low ionising radiation is used and there are no
    known ill effects
  • Everyone must be screened before entering
    magnetic area and all ferro-magnetic items
    removed
  • MRI can last over an hour and an individual scan
    can last upto 20 minutes

11
MRI poses several unique problems to the
anaesthetist
12
  • High magnetic field which is always on
  • The bore of the magnet is narrow, noisy and
    claustrophobic. Access to the patient is
    difficult so air-way must be secured
  • Monitoring equipment can introduce stray
    radiofrequency current causing degradation of the
    image
  • The magnetic fields and radiofrequency currents
    interfere with monitoring. Currents induced in
    leads can cause burns

13
Solutions for MRI Anaesthesia
14
  • MRI compatible anaesthetic equipment or
    anaesthetic equipment kept outside the magnetic
    field
  • Monitoring during MRI
  • To minimize interference, use of Faraday cage and
    low band filters
  • ECG the ECG is distorted by the magnetic field
    due to currents induced on leads
  • Pulse oxymetry-prone to interference and burns
  • Capnography- for monitoring of adequacy of
    ventilation and as a disconnect alarm
  • Blood pressure-automated blood pressure
    recording can be performed using extended cable
    and nylon threads on cuff attachment. Invasive
    blood pressure measurements need long extension
    tubing

15
  • Anaesthesia for ECT
  • Electroconvulsive therapy (ECT) is an effective
    treatment for severe depression often not
    responding to drug treatment
  • General anaethesia is used to provide a brief
    period of amnesia and modify the motor effects of
    the seizure to protect the patient
  • Physiologic effects of ECT
  • Electrical stimulus- brief period of muscular
    contraction followed by the tonic and then clonic
    phases of the seizures
  • Cardiovascular effects of ECT- immediate
    parasympathetic response followed within seconds
    by a sympathetic response
  • The muscular activity of the seizure and the
    increased sympathetic activity causes a rise in
    myocardial oxygen consumption, increases CMRO2,
    cerebral blood flow, intracranial, intra-ocular
    intra-gastric pressure briefly

16
  • Contraindications
  • Recent myocardial infarction, intracranial
    pathology
  • Anaesthetic management
  • Many have medical problems
  • Effects of long term psychotropic drugs
  • An appropriate period of fasting is difficult to
    guaranty
  • Patients may already have had several
    anaesthetics
  • Pre-oxygenation and IV access
  • Induction agent
  • Sux to reduce muscle contraction
  • 100 O2 till spontaneous breathing resumes

17
Anaesthesia for Cardioversion
18
  • Elective Cardioversion
  • Adequate fasting and IV access.
  • Emergency Cardioversion
  • Haemodynamically compromised patient
  • un-fasted patient
  • Dose of induction agent should be adequate
  • To obtund the hypertensive response to intubation
  • But care must be taken not to compromise the
    blood pressure further

19
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