PROCEDURE EPIDURAL 1

EPIDURAL ANESTHESIA

Objectives

· To provide anesthesia for procedures and surgical inter­ventions (i.e., urological, gynecological, obstetrics, abdominal and orthopedic surgeries) by introducing local anesthesia into the epidural space.

· This technique is also used for providing postoperative analgesia.

· Written consent for procedure is required.

Position

Same as for spinal anesthesia.

Premedication

• Oral premedication given.

Procedure

1. Procedure explained to the patient.

2. On a tiltable table.

   3. Performed at any level of spinal cord according to the desired level of analgesia.

   4. Thoracic, lumbar or caudal epidural practiced.

   5. The duration of action can be prolonged by intermittent

       injections through an epidural catheter.

   6. Epidural needles are thick and curved tips (16, 18, 20 G)

   7. Intravenous line started.

   8. Patient attached to ECG, Sp0₂ and NIBP monitor.

   9. Scrub and wear sterile gown and gloves.

  10. Check the epidural set on the sterile trolley for the items required, proper size needle and catheter;           proper fitting of syringe into the hub of epidural needle.

  11. Fill in a 20 ml syringe the local anesthesia to be injected into the epidural space.

  12. Read the label of drug vial carefully for the name,percentage, baricity, expiry date. Confirm it with       assistant.

13. Local anesthetic to be used for skin infiltration taken into a

2 ml syringe (2 cc. 2% xylocaine)

Any questions be sent to drmmkapur@gmail.com
All older posts are stored in archives for access.
Visitors that follow may post contributions to the site.
To create consumer/provider engagement visit www.surgseminar.blogspot.com
www.drmmkapur.blogspt.com

ANESTHESIA Procedure 1 2+3 INSTRUMENTS

Equipments Required for Tracheal Intubation

Intubation tray

· Laryngoscope and blades.

· Tracheal tube (Correct size, a size smaller and a size bigger).

· Tracheal tube connector.

· Stillete

· Magill's forceps.

· Gum elastic bougies, Size : 6 mm.

· 10 ml cuff inflating syringe.

· Plastic clamp.

· Securing tape/adhesive.

· Catheter mount.

· Local spray (4% Lignocaine).

· Lubricant anesthetic jelly.

· Sterile throat packs, gauze piece.

· Anesthesia machine and breathing system, face masks, oropharynx and nasopharyngeal airway.

Checkingthe tube position Position of the tracheal tube is checked for correct placement in trachea:

· By watching the chest movements on manual ventilation.

· Auscultating the chest for breath sounds.

· End tidal C0₂ value if it is attached to a capnometer.

· Compliance of the reservior bag.

· Opacification of the transparent tube during exhalation and normal oxygen saturation.

Fixing the tube The tube is attached to facial skin by adhesive tape which encircles the tube or using a cotton tape which encircles the head.

 

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitors that follow may post contributions.

To create consumer/provider engagement visit www.surgseminar.blogspot.com

www.drmmkapur.blogspot.com

Nasal tracheal Intubation procedure 3

Tracheal Intubation

Follows 1V induction of anesthesia in cases of GA

Emergency intubation is another reason for Nasal intubation.

Objectives

· To ensure a clear airway for anesthetized patients.

· To protect airway from regurgitation and aspiration.

· To aid and assist in control of ventilation when muscle relaxants are used.

· To facilitate suction of respiratory tract.

· To prevent collapse of lungs in thoracic operations.

   NASAL INTUBATION is also used in cases where surgery is required in the oral cavity
   and the pharynx

Position for Laryngoscope and Intubation

· Supine.

· Flexion of the head at the neck and extension of the head at the atlanto-occipital level, the so called‘sniffing’ position.

· The head is elevated placing a low pillow or ring Oral cavity axis (OA); Pharyngeal axis (PA) and laryngeal axis (LA) are different. In this all three axis brings into alignment position and vocal cords will be viewed best with laryngoscope.

Procedure

· Awake intubation in neonates sometimes.

· Emergency awake intubation in adults when airway is compromised.

· Adequate anesthesia and muscle relaxation is the usual technique.

· After 1V or inhalational induction of anesthesia, short acting depolarizing muscle relaxant, Suxamethonium (Scoline) (! To 1.5 mg/kg) or non-depolarising relaxant 1V given.

· Assited ventilation is maintained via mask with 100% O_{2 or} with 50% N₂O in Oxygen till the muscle relaxation occurs and then tracheal intubation is performed.

· Handle of the laryngoscope held in the left hand.

· The laryngoscope blade is inserted between the teeth at the right side of the mouth and the tongue is displaced on the left side.

· The blade is advanced until the epiglottis comes into view and then lifts it upwards.

· The vocal cords will b identified. If they are not seen, an assistant is asked to push downward on the larynx.
In oral surgery the pharynx needs to be packed with  ribbon gauge to prevent aspiration
of blood. 

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives fo access and review

Visitors that follow the site may post contributions.

To create consumer/provider engagement visit www.surgseminar.blogspot.com

www.drmmkapur.blogspot.com