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, Spo_2, NIBP, and ETCO2.
• Anesthesia machine monitors (Oxygen analyser, gas monitor)
• Emergancy drug tray(check list 11, see page 102 ).

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