INDUCTION

5. GENERAL ANAESTHESIA
* Intravenous drugs
* Inhalation anesthesia

5.1 The intravenous route is used to provide:

* Unconscious state for induction of anesthesia ie. Thiopental, Etomedate, Ketamine
* Analgesia i.e. morphine, fentenil, alfentanil
* Muscle relaxant to facilitate intubations and condition of
Relaxed muscles for operation

5.2 In most instances, a combination of these two is utilised.
Intravenous routes, is used for inducing the anesthetic state.
The inhalation route is used for maintaining the anesthetic state.
The volatile inhalation anesthetics are:
* Diethyle ether
* Divinyle ether
* Chloroform
* Ethyle chloride
* Trichlorethylene
* Halothane
The gases used in inhalation anesthesia are:
* Nitrous oxide
* Cyclopropane
* Ethylene
Other gases used are:
* Oxygen
* Carbon dioxide

GAS EXCHANGE
These agents rely on the alveoli of the lungs, for exchange to blood for their action.
The final destination for actions is the C.N.S.
The partial pressure of these inhalational agents, has to be adequate in the C.N.S.
This is achieved through the partial pressure maintained
in the arterial blood by exchange in the alveolus.
The alveolar partial pressure is the first step towards achieving the
Anesthetic state.
In the same way on reversal can occur, if the inhalation agent is reduced, or eliminated from the respiratory circuit, the partial pressure in the alveolus fall back leading to a fall in the level, available in the CNS.

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CHECK OUT THE PATIENT

3. Undetected DISEASE AND RISK

3.1 ISCHAEMIC HEART DISEASE:
Patients with ischemic heart disease within three months of an
episode of Myocardial Infarction (MI) have a risk of 30%
possibility of a second MI.
Those between 4 and 6 months, the rate drops to 16%,those with an episode of more than 7 months the risk
drops to 6%.
Main complications are because of heart failure and arrhythmias.

3.2 HYPERTENSION
In cases of diastolic pressure of less than 110 mm Hg, there is
no increased risk in the absence of ischaemia of the myocardium.
Those with a diastolic pressure of more than 120 mm Hg, the risk
increases.

3.3 ENDOCRINE
Patients with a history of diabetes have an increased risk.
Those on steroid therapy, and with hypothyroidism, also carry a
high risk.
Hyperthyroid patients have a 2% chance of storm in the
Post operative period.

3.4 LIVER FUNCTIONS
Those with acute viral hepatitis have a 9% risk of mortality.
Those with acute fulminant hepatic failure have an 85% mortality.

3.5 PULMONARY
Infections, and chronic obstructive airway disease, increase the
risk of post-operative complications.
Thus, risk is increased in patients with asthma and with a
history of heavy smoking.

This information is required to set into motion an action plan
which is directed:

*Correct the effects of the disease process for which he
is undergoing surgery.
*Correct the effect of any undetected disease, so as
to reduce risk.
*Identify the need for intra-operative monitoring
devices.
*Identify correct choice of anesthetic technique to be
employed.
*Plan post-operative care.
*Prepare the patient emotionally for the anaesthetic
experience.

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NIRVANA

ANAESTHESIA
1. INTRODUCTION Surgical treatment of disease requires gaining access to deeper tissues through the skin.
* The skin being a sensitive organ, is well provided with sensory nerves.
* Thus, it becomes important to interrupt the sensory pathways of skin, and deeper tissues (anaesthesia) if surgical access is to be provided.
* There are essentially two primary modes of rendering a patient insensitive to pain while undergoing surgical procedures:
- General anesthesia (central nervous system depression)
- Regional anesthesia (local anesthetic agents).

2. PRE-ANAESTHETIC EVALUATION
1 A thorough clinical examination of the patient is essential to establish the health status of the patient.
2. To detect the metabolic effects of the disease process for which he is undergoing the surgical procedure.
3. To detect any other existing disease in the patient, that he might be undetected so far.

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THE OVERHEAD LIGHT

WHAT IS NEW IN OPERATING LIGHT?
Lighting in the operating suite is achieved by the use of main overhead fluorescent lights, Halogen lamps are used within the overhead surgical lights.
Halogen lamps have a higher (measurement of the hue that a light emits) than incandescent light.

The halogen light emits a pale bluish cast that is less fatiguing to the eyes. Auxiliary Surgical spotlights placed at spots for maximum effect.
The operation light produces 100,000 lux strong homogenous light. Camera system is equipped with a color temperature of 4,300 K natural resolution. All camera functions can be operated from a distance by means of an optional remote control device. In some operating suites, closed-circuit television cameras are mounted within the framework of the surgical lights, so that the course of the operation can be viewed by students or auxiliary personnel outside the OT.

The mobile hospital light has a leak proof storage battery that is recharged during normal operation. In the power loss the lamp automatically switches to battery operation, enabling examinations or operations to continue for up to five hours.

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TABLE POSITIONS 4

More TABLE positions

HOW DO YOU GET THE LATERAL POSITION OF EXTENSION?
This position is used for operations on the kidney and chest, but may be modified slightly for operations on the hip.
For the former operations the patient is positioned over the kidney bridge which is raised to extend this region.
Alternatively, if an operation table which incorporates a `break back' is used, extension is achieved by positioning the patient over the division in the centre section before adjusting the angle of the table top.

HOW IS THE GALL-BLADDER AND LIVER POSITION ARRANGED?
This is another modified supine position which is used for operations on the gall-bladder or liver.
The patient is positioned over the back elevator which is raised to produce extension; and thereby push the gall-bladder towards the anterior abdominal wall.

HOW TO ARRANGE FOR LITHOTOMY POSITION? This is used for operations on the external genital organs, Perineum, and anal region. The buttocks project well over the edge of the table at the junction of the centre and foot section, which is lowered or removed. The legs are flexed at the hips and knees, and raised with the feet supported in webbing slings suspended from the lithotomy poles. A douching funnel may be fitted below the perineal area to collect blood.
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