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Anesthesia

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Types of anesthesia GENRAL ANESTHESIA REGIONAL ANESTHESIA LOCAL ANESTHESIA. GENERAL ANESTHESIA Airway management Endotracheal intubation( Body cavities, ... – PowerPoint PPT presentation

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Title: Anesthesia


1
Anesthesia
  • GHAZI ALDEHAYAT MD


2
Ancient and Mediaeval times
3
Anesthesia
  • Anesthesia
  • Intensive care
  • Chronic pain management

4
Anesthesia
  • Anesthesia
  • CPR
  • Acute Pain control
  • Difficult Lines
  • Evaluating critical patints

5
Anesthesia
  • Theatre
  • Radiology
  • Interventional radiology
  • Cardiology
  • ECT
  • GI

6
Types Of Anesthesia
7
Types of Anesthesia
  • General Anesthesia
  • Local Anesthesia
  • Sedation

8
General Anesthesia
  • Preoperative evaluation
  • Intraoperative management
  • Postoperative management

9
Purpose of preoperative visit
  • Medical assessment of the patient.
  • Decide the type of anesthesia.
  • Establish rapport with the patient.
  • Allay anxiety and decrease pain.
  • Obtain informed consent.
  • Ask for further investigation.
  • Decide risk versus benefit .
  • Prescribe medications.

10
Pre-Operative Assessment
  • History
  • Indication for surgery
  • Surgical/anesthetic hx previous
    anesthetics/complications, previous intubations,
  • Medications, drug allergies

11
  • Medical history
  • CNS seizures, CVA, raised ICP, spinal disease,
    arteriovenous malformations
  • CVS CAD, MI, CHF, HTN, valvular disease,
    dysrhmias, PVD, conditions requiring endocarditis
    prophylaxis, exercise tolerance, CCS class, NYHA
    class
  • Resp smoking, asthma, COPD, recent URTI, sleep
    apnea
  • GI GERD, liver disease
  • Renal insufficiency, dialysis

12
  • Hematologic anemia, coagulopathies, blood
    dyscrasias
  • MSK conditions associated with difficult
    intubations arthritis, RA, cervical tumours,
    cervical infections/abscess, trauma to C-spine,
    Down syndrome,
  • scleroderma, obesity
  • Endocrine diabetes, thyroid, adrenal disorders
  • Other morbid obesity, pregnancy, ethanol/other
    drug use

13
  • FHx malignant hyperthermia, atypical
    cholinesterase (pseudocholinesterase), other
    abnormal drug reactions

14
Physical Examination
  • Physical exams of all systems.
  • Airway assessment to determine the likelihood of
    difficult intubation

15
  • Bony landmarks and suitability of areas for
    regional anesthesia if relevant
  • Focused physical exam on CNS, CVS and
    respiratory (includes airway) systems
  • General, e.g. nutritional, hydration, and mental
    status
  • Pre-existing motor and sensory deficits
  • Sites for IV, central venous pressure (CVP) and
    pulmonary artery (PA) catheters,
  • regional anesthesia

16
  • Investigations According to( ranged from none to
    most comlicated)
  • Age
  • Surgery
  • Medical condition
  • As clinically indicated
  • Low risk no further evaluation needed
  • Intermediate risk non-invasive stress
    testing
  • High risk proper optimization /-
    delaying/canceling procedure

17
  • American Society of Anesthesiology (ASA)
    classification
  • Common classification of physical status at time
    of surgery
  • A gross predictor of overall outcome, NOT used
    as stratification for anesthetic risk (mortality
    rates)
  • ASA 1 a healthy, fit patient (0.06-0.08)
  • ASA 2 a patient with mild systemic disease,
    e.g. controlled Type 2 diabetes, controlled
    essential HTN, obesity (0.27-0.4), smoker

18
  • ASA 3 a patient with severe systemic disease
    that limits activity, e.g. angina, prior MI, COPD
    (1.8-4.3), DM, obesity
  • ASA 4 a patient with incapacitating disease
    that is a constant threat to life, e.g. CHF,
    renal failure, acute respiratory failure
    (7.8-23)
  • ASA 5 a moribund patient not expected to
    survive 24 hours with/without surgery, e.g.
    ruptured abdominal aortic aneurysm (AAA).
  • ASA 6 Brain death patient
  • For emergency operations, add the letter E after
    classification

19
  • Medications
  • Pay particular attention to CVS and resp meds,
    narcotics and drugs with many side effects and
    interactions prophylaxis.
  • Risk of GE reflux Na citrate 30 cc PO 30 mins
    hour pre-op.
  • Risk of adrenal suppression steroid coverage
  • Risk of DVT heparin SC,LMW Heparin, Mechanical
    methods.

20
  • Optimization of co-existing disease
    bronchodilators (COPD, asthma), nitroglycerine
    and beta-blockers (CAD risk factors)
  • Pre-operative medications to stop
  • Oral hypoglycemics stop on morning of
    surgery
  • Antidepressants.
  • Pre-operative medication to adjust
  • Insulin, prednisone, coumadin, bronchodilator

21
  • Decide, whether to proceed with surgery ,to send
    patient for further management or to cancel the
    operation.
  • Discus anesthetic options.
  • Decide which is the most useful for the patient.
  • Informed concent.
  • Risk stratification .

22
Types of anesthesia
  • GENRAL ANESTHESIA
  • REGIONAL ANESTHESIA
  • LOCAL ANESTHESIA.

23
GENERAL ANESTHESIA
  • Airway management
  • Endotracheal intubation( Body cavities, Full
    stomach, prone position, compromised, Very long
    operations, Airway involvment )
  • Laryngeal mask Airway( peripheral, No indication
    for ETT)
  • Mask( very short, no indication for ETT)
  • Ventilation
  • Spontaneous ( No muscle relaxant)
  • Controlled ( With muscle relaxant)

24
GENERAL ANESTHESIA
  • PREPARATION
  • monitoring
  • position
  • Intravenous fluid
  • Warming
  • CONDUCT OF ANESTHESIA
  • PERIOPERATIVE MEDICINE

25
  • Monitoring according to paitent medical
    condition and surgery proposed
  • Basic ECG, NIBP,SpO2, EtCO2, Temp,FiO2,
    Anesthetic gases, Airway pressure, The presence
    of anesthetist all throug
  • procedure.
  • Others Nerve stimulator, Invasive Bp, CVP,
    CO, BIS, PA Catheter, TEE, UO Lab tests, ABGs,
    CBC, LFT , Coagulation, TEG

26
Basic Principles of Anesthesia
  • Anesthesia defined as the abolition of sensation
  • Analgesia defined as the abolition of pain
  • Triad of General Anesthesia
  • need for unconsciousness
  • need for analgesia
  • need for muscle relaxation

27
Recovery Maintinance Induction
Discontinue Inhalational Intravenous Intravenous(egThiopentone,Propofol) Inhalational( sevoflurane,Halothane) Hypnosis (unconsciousness)
Multimodal))Good Analgesi Opioids,Regional, Local NSAIDS Parasetamol Systemic (opiods,NSAIDS) Regional( Epidural,Spinal) LA N2O Systemic( opiods, Fentanyl,Remifentanil,Alfentanil) Analgesia
Reversal by Anticholinstrases( Neostigmine,) Atropine Non Depolarizing Depolarizing (suxamethoniom) Non Depolarizing (steroids, vecuronium) Benzylisoquinolonium Cis atracurium) Muscle Relaxation
28
Intravenous Anesthetic Agents
  • Thiopental
  • Thiobarbiturates
  • Uses for iduction, decrease ICP, Status
    epilepticus
  • CNS Hypnosis within 30 seconds ,decreased
    intracrainial pressure.
  • CVS depression, hypotension, tachycardia
  • Respiratory depression, spasm
  • CI porphyria
  • Arterial injection

29
Intravenous Anesthetic Agents
  • PROPOFOL ( Deprivan)
  • USES induction, maintenance, sedation in the
    ICU, sedation
  • Contra indicated in children.
  • CNS Hypnosis within 30 seconds ,decreased
    intracrainial pressure.
  • CVS depression more than Thiopental
  • Respiratory Depression, no spasm
  • Caloric load in the ICU, propfol infusion
    syndrome

30
Intravenous Anesthetic Agents
  • Ketamine
  • Phencyclidine
  • Uses, shock, burn, field.
  • CNS, dissociation, hallucination, analgesia,
  • Increased intracrainial pressure.
  • CVS Stimulation, hypertension, tachycardia
  • Respiratory, less depression.

31
Intravenous Anesthetic Agents
  • Etomidate
  • Stable cardiovascular
  • Steroid depression

32
Inhalational Anaesthesia
  • Halothane
  • Enflurane
  • Isoflurane
  • Sevoflurane
  • Desflurane
  • N2o
  • Xenon



33
Inhalational
  • Anesthesia induced by inhalational effec
  • Tdifferent in their potency, indicated by MAC.
  • Different in rapidity of induction and recovery.
  • Common pharmacological properties,
  • CVS depression with tachy or bradycardia
  • REP Depression.
  • CNS increased intracranial pressure

34
Opioid
  • Fentanyl
  • Morphine
  • Alfentanl
  • Remifentanil

35
  • All have almost the same pharmacodynamics of ,
  • Morphine, Analgesia, Sedation ,
    Respiratory depression, Nausea and vomiting,
    meiosis, constipation.
  • Different in their pharmakokinitcs.

36
Muscle relaxant
  • Depolarizing
  • Suxamethonium
  • Short acting, rapid onset,
  • Many Side effects, hyperkalemia, arrythmias,
  • Muscle pain ,Scoline apnea.

37
  • Non Depolarizing
  • Aminosteroid organ metabolism
  • Benzylisoquinolonium Histamine release,
  • Long acting

38
Local anaesthetics
  • Lidocaine, lignocaine,xylocaine
  • Bupivacaine ( marcaine)
  • Cocaine
  • Procaine

39
  • Regional ( spinal , epidural)
  • Local
  • Different side effects
  • Marcaine CI by intravenous
  • LA toxicity. Maximum doses,
  • Perioral numbness, tinnitus, conulsions, resp
    depression, Cardiac arrest
  • Treatment, ABC, symptomatic, intralipid(
    propofol)

40
Reversal
  • Neostigmine
  • Atropine

41
Monitoring
  • Basic ( ECG, BP, SPO2, EtCO2) Observation
  • Advanced ( IBP , CVP, CO .ETc

42
Awareness
  • Awarness
  • Definition
  • Types
  • Effect
  • Causes
  • Manegment

43
  • Thank you
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