Anesthesia 6 Induction Steps drugs equipment

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.

Premedications

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 labelled (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

•     Slow injection of the drug into the vein till the eye lash reflex is obtained

•     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 I, )

•     Breathing circuits, face mask, inhalation set (Check list I, )

•     IV 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, ETCO2 

•     Anesthesia machine monitors (Oxygen analyser, gas monitor)

•     Emergency drug tray (Check list II, see).

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Anesthesia 5 General

GENERAL ANESTHESIA

General anesthesia is a reversible, drug-induced state of non-responsiveness to outside stimuli.

      With the use of agents such as the muscle relaxants, modern general anesthesia aims at a balance between ‘relaxation’, ‘analgesia’ and lack of awareness.

      General anesthesia is achieved by using intravenous or inhalational agents (gases or vapours)

•     Patient receives a premedication one hour before the anesthetic procedure

•     The next step to anesthesia is induction which can be achieved by administration of intravenous drugs or inhalation agents

•     On induction, muscle relaxation is necessary to facilitate tracheal intubation. Relaxation during maintenance of anesthesia is also required.

Intravenous Inducting Agents

Intravenous anesthetic agents are used commonly in anesthesia as induction agent. Induction is more rapid and smoother than that associated with inhalational agents. Sometime for maintenance also, these agents can be used.

 

             The intravenous agents (IVA) can be classified as:

      A.  Rapidly acting agents:

             1.   Thiopentone (Barbiturate).

             2.   Etomidate (Imidazole compound).

             3.   Propofol (Phenol group).

             4.   Propanidid (Eugenol derivative).

      B.  Slower acting:

             1.   Ketamine (Phenocyclidine derivative).

             2.   Diazepam and other benezodiazepine derivative.

             3.   Morphine, fentanyl, alfentanyl, sufentanil (Narcotics).

             4.   Haloperidol, droperidol with opioids.

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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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