Thursday, May 24, 2012

ANESTHESIA Procedures 1


Anesthesia Procedures
Preoperative Check
Objectives
· Patient identification and consent check for operation and anesthesia.
· Availability and check functioning of anesthesia machine, intubation sets, drugs, monitors.
· Casenote confirmation of operation decided upon for that particular patient.
Intravenous Induction
Objectives
  • To induce loss of awareness rapidly at the start of anesthesia.
  • Induction is achieved with intravenous agents (thiopentone 3-5 mg/kg, methohexitone 1-1.5 mg/kg, etomidate 0.3 mg/kg, propofol 1.5-2.5 mg/kg or ketamine 2 mg/kg).
Position
  • Supine.
Premedication
Any combination of anxiolite and antisialgogue.
Procedure
  • Intravenous cannula inserted into a peripheral vein, preferably on the dorsum of the hand and infusion fluid attached.
  • Drugs prepared in syringes and labeled (IV induction agent, muscle relaxant, atropine)
  • Patient connected to the monitor for ECG, non-invasive blood pressure (NIBP), and oxygen saturation.
  • 100% oxygen by mask before the drugs are injected.
  • Small test dose of intravenous induction agent given and effects observed for any anaphylactic reaction.
  • Rapid sequence induction technique used in emergency situation where the stomach is full or chances of regurgitation are a potential problem.
  • Anesthesia maintained with inhalational agent.
  • Tracheal intubation done using muscle relaxant.
Instruments
  • Intubation tray
  • Anesthesia machine ( check list 1, see page 99 )
  • Breathing circuits, face mask, inhalation set ( check list 1, see page 99 )
  • 1V cannula, infusion, fluid, spirit and iodine swab, adhesive plaster.
  • Drug tray and labels.
  • Normal saline bottle for dilution of drugs.
  • Induction agents-Thropentone, Propofol, Ketamine.
  • Arm boards.
  • Patient monitors for ECG, Spo2, NIBP, and ETCO2.
  • Anesthesia machine monitors (Oxygen analyser, gas monitor)
  • Emergancy drug tray(check list 11, see page 102 ).
Any questions be sent to drmmkapur@gmail.com
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