ANESTHESIA 4 Premedication

GENERAL PRINCIPLES

Premedication and Anesthesia

Premedication is the prescribing of drugs to be administered preoperatively. These are usually agents prescribed by the anesthetist, at the preoperative visit.

•     To reduce anxiety

•     To relieve pain

•     To dry saliva.

Morphine Sulphate

•     Morphine is a narcotic analgesic

•     It depresses awareness, anxiety, pain.

It is used :

•     As a premedicant.

Diazepam

•     This is a minor tranquilizer

•     It relieves tension and anxiety

•     It is used mainly as a premedicant.

Antisialgogue

•     These produce drying of the salivary and respiratory secre-tion

•     The drugs include atropine sulphate, glycopyrrolate and hyoscine

•     One of them is used as a premedicant drug along with analgesics.

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ANETHESIA Equipment 3 anesthesia room

ANESTHESIA ROOM

The anesthesia room is used for preoperative preparation of the patient and;

•     Induction of anesthesia.

•     Giving regional techniques.

•     Short term observation of patients after anesthesia.

It is situated next and on the way to the OT

The anesthesia room should have:

•     A tiltable and portable table

•     An Anesthesia machine

•     Intubation equipments

•     A drug trolley

•     A blood pressure instrument

•     Oxygen saturation monitoring equipments

•     Suction apparatus.

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ANESTHESIA Equipment 2 Duties Checklist

THE DUTIES OF THE ANESTHESIA
NURSE AND ORA

The anesthesia nurse and operating room assistant (ORA) must familiarise himself/herself with the basic principles of all the equipments and drugs used in a particular theater in which she/he works.

•     The maintenance of anesthesia equipment is the task of the maintenance unit. It is the anesthetist’s direct responsibility to finally check that the apparatus is working correctly before use.

•     The anesthetist may give some tasks to the ORA depending on the ORA’s ability and knowledge.

•     The anesthesia nurse or ORA with an understanding of mechanical equipment may obtain further information from the technical booklets supplied with a particular anesthesia machine or equipment.

•     Information regarding working of the apparatus, functions, handling, safety precautions, ‘dos’ and ‘don’ts’ are important for the safety of both the patients and the equipment. These rules must be observed.

•     Detailed information about New machines and equipments should be obtained from the technical booklets supplied with a particular machine before installation and use

•     It is the duty of the ORA with this information to keep the equipments in functioning order, checking its functions and preparing the machine for use each day (see Fig. AIII.1)

•     He also makes available the appropriate accessories and drugs required for each procedure

•     The understanding of the working of the apparatus and steps of the procedure will help in selecting the right equipment and preplanning for the procedure.

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Anesthesia & Equipment 1

4. Anesthesia Equipment and Anesthetics

INTRODUCTION

Administration of anesthesia is an essential technique in the operation theater and is required for most surgical patients.

•     The technique selected is related to the surgical procedure and the drugs and equipment available in the OT.

•     It is planned so as to suit each patient’s specific needs.

•     All anesthesia technique used should be safe for all types of patients.

In anesthesia potent drugs are used and they:

•     Produce loss of consciousness

•     Depress circulation

•     Depress respiration

•     Produce sympathetic blockade and muscle paralysis.

Anesthetics drugs or the surgical procedures may result in:

•     Unwanted respiratory or circulatory reflex responses (Side effects)

•     Sometimes, the procedure may demand unphysiologic positioning of the patient producing circulatory or respiratory interferance

•     The procedure may cause massive blood loss.

      These are some of the effects that the anesthetists should anticipate and take care to counteract and provide ‘safe anesthesia’ covering all these factors. To achieve this objective an anesthetist needs to master the knowledge of the effects of relevant drugs and equipments used during the procedure. Various anesthetic procedures are used which includes:

•     General anesthesia.

•     Regional includes epidural spinal and caudal blocks.

•     Local techniques usually administered by surgeon for minor procedures.

•     Monitored anesthesia care (MAC) is a combination of local infiltration with IV analgesia the potential vital signs and analgesia needs are monitored and further medication provided.

•     Conscious sedation analgesia. This is used for short-term surgical and diagnostic procedures like endoscopy.

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ELECTRIC EQUIPMENT 13 Prevention electrocution

PREVENTION OF GROSS ELECTROCUTION
IN THE OPERATING THEATER

1.   Avoid portable distribution boards whenever possible.

2.   Use ceiling-mounted pendant supplies whenever possible, as they are less likely to be damaged than those on the floor and are unlikely to become wet. Keep water and electricity apart.

3.   Avoid the use of long mains supply cables, and avoid damage to cables by knotting, equipment’s wheels, etc.

4.   Notify engineering staff of any visible damage to equipments or cables.

5.   Make sure that regular maintenance records are kept and are available for inspection by the user.

Internet Website

1.   American Society for Laser Medicine and Surgery. http:/www.aslms.org.

2.   Association for Advancement of Medical Instrumentation (AAMI). http:/www.aami.org.

3.   Occupational Safety and Health Administration. http/www.osha.gov.

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ELECTRIC EQUIPMENT 12 Ultrasonic surgical systems

ULTRASONIC EQUIPMENT

The CUSA (Cavitron Ultrasonic Surgical Aspirator) is used in the body to fragment and aspirate relatively soft tumor tissue.

•    Ultrasonic techniques are well established in neurosurgery for rapid, efficient removal of intracranial and spinal cord tumors.

•    Their use is in resection and dissection applications in:

     a.  Liver.

     b.  Kidney.

     c.  Spleen.

     d.  Pancreas and urology, the application is gaining popu­larity.

•    Ultrasonic surgery is carried out with the aid of a special instrument known as the CUSAtm—(Cavitron TM Ultrasonic Surgical Aspirator).

•    This is an acoustic vibrator which consists of three distinct components (Fig.):

     a.  Transducer: A magnetic device which converts electro-magnetic energy into mechanical vibrations. The transducers is composed of a stack of nickel alloy laminations. A magnetic field is produced by a coil placed around the laminations and causes mechanical motion of approximately 300 microns.

     b.  Connecting body: Mechanically couples the motion of the transducer to the surgical tip; it also amplifies the vibration motion of the transducer.

     c.  Surgical tip: Completes the motion amplification and also contacts the tissue. The tip is relatively long compared to its diameter and is constructed to provide adequate motion amplification.

•    The electric coil which is permanently fitted in the hand piece, surrounds the transducer. This coil receives 23,000 cycles per second (hertz) alternating electric current from the console and activates the transducer

•    The hand piece is connected to the console by a cable which includes the tubing for circulating fluid between the cooling water canister in the console and the hand piece

•    Since the electric coil has a current flowing through it and the transducer lamination are moving back and forth 23,000 times per second, heat is generated and absorbed by the water circulating within the hand piece

•    This keeps the hand piece at a comfortable temperature for the surgeon.

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ELECTRIC EQUIPMENT 11 Cryosurgical Systems

CRYOSURGICAL SYSTEMS

Cryotherapy, the application of extreme cold to tissues and is a useful technique for the destruction of tissues. It is characterized by minimal bleeding or pain in the postoperative period. Cryosurgical systems are well established in many surgical specialities including:

•    General surgery,

•    Gynecology,

•    Dermatology,

•    Neurology, and

•    Urology.

     The first practical equipment for the control and maintenance of extreme low temperature in surgery was produced in 1962. The apparatus was not very sophisticated and used liquid nitrogen to achieve low temperature in the region of –196 degree Celsius. This very low temperature was subsequently found to exceed requirements, and Amoils developed a more simple apparatus which used nitrous oxide or carbon dioxide to achieve temperatures in the region of –70 degree Celsius. The design principles established by Amoils (Fig. 2.6) are still used in modern cryosurgical equipment which employs high-pressure, non-syphon cylinders of N2O and CO2.

•    Cryosurgical systems consist of flexible tubing connecting the gas flow control unit to a cryoprobe or working tip which comprises two concentric tubes

•    The inner tube delivers nitrous oxide or carbon dioxide at pressures between 4,000 kPa and 6,000 kPa to a narrow orifice in the end

•    The sudden expansion of this gas through the ‘Joule- Thompson Orifice’, produces a rapid drop in temperature of the probe surface forming an ice ball

•    The expanded gas is then returned at atmospheric pressure along the outer tube

•    Some cooling along the shaft of the probe occurs and can be a disadvantage, for example in neurosurgery

•    To overcome this, Spembley manufacture a probe which employs a reversed gas flow. This design enables the incoming gas to be carried to the probe tip via the outer of the two concentric tubes; it is allowed to expand through an annular orifice, being finally released through the central tube.

•    The incoming gas acts as an insulating barrier and the cooling is confined to the probe tip.

          Cryosurgery has been useful in the treatment of early skin cancer. It is being explored in the treatment of prostate, liver and bone.

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