Conduct of Anaesthesia Flashcards
What is the process of anaesthesia
Pre-op assessment preparation induction maintenance emergence recovery pot op car and management
What considerations are taken into preparation
Planning,
Is the patient fit for surgery
correct patient, correct procedure, right or left side
pre medication- (typically analgesia or drugs that help anaesthesia e.g. drugs for gastric secretions)
Prepare drugs, IV access, monitoring
What occurs during IV induction of anaesthesia
Need quietness as hearing i last to go, can be in theatre or separate room. IV agents are induced mainly by propofol but can also be thiopentone. Induction is rapid takes one brain arm circulation, around 20s in a healthy individual
What are the risks if IV induction anaesthesia
Easy to overdose, particularly if induction is taking longer so more agent is given. A rapid loss of airway reflexes, apnea is very common especially with opiods
What occurs during gas induction of anaesthesia
Gas induction is very common in the younger children and those with special needs. Sometimes good to give sedative oral pre med. important to keep parent/carer happy. causes a slow induction and there are obvious planes of induction.
What are the planes of anaesthesia
Initial sedation disenhibition excitation heightened reflexes anaesthesia
How is consciousness monitored during this process?
verbal contact patient movement respiratory pattern processed EEG planes of anaesthesia
What is paramount when inducing anaesthesia
Maintaining airways. Lose control of soft palate and throat muscles. Simple manoeuvres include head tilt, chin lift and jaw thrust
Jaw thrust requires a good thrusting, push hard.
What is the first option of the simple manoeuvres don’t work
Face mask, comes in various sizes and forma tight seal around the mouth.
What is a Guedel?
Oropharyngeal airway, a rigid plastic tube that is intubated down the throat. It is only tolerated by completely unconscious patient. Light patients may induce vomiting or laryngospasm
What is a laryngeal airway mask?
Cuffed tube with a mask that sits on the glottis. come ina wide ranfee of sizes
What is an I-gel
What is meant by protecting the airway
Used in trauma situations its easy to use and allows access first time. It does not protect the airway
Stopping any contents moving down the windpipe
What is a laryngospasm
Who tends to get these
Forced adduction of the vocal cords caused by stimulation during the light planes of anesthesia
hypersensitve airways, typically small airways,
What is endotracheal intubation
How do you abolish the laryngeal reflexes
The placement of a cuffed tube into the trachea. The oral route is most commonly used although can also be through the nasal palate or trachea, Laryngeal reflexes must be abolished.
This can be done using local anaesthetic and a fibre optic scope. In unconscious patients use muscle relaxant and sniffing in the morning air position
When should intubation be used
protect from stomach contents
if muscle relaxants are required
shared airway with risk of contamination e.g. tonsillectomy
Tight control of blood gases e.g. neurosurgery
restricted access to airway e.g. max-fax
What are the biggest risks for unconscious patients
Airway obstruction Exposure, may lead to clotting disorders loss of proteftive reflexes e.g. corneal abrasion VTE consent pressure areas
What is the role of the anaesthetist during the procedure
Continue to care for the unconscious patient,
deliver muscle relaxants
analgesia
monitoring and providing physiological support
fluid management
documentation and recording
What forms of monitoring may be used in the unconscious patient
Respiratory parameters Agent monitoring Temperatures Urine output invasive venous/arterial monitoring EEG ventilator disconnection
Some risk factors of becoming aware during operation
Paralysed and ventilated Previous episodes of awareness Chronic CNS depressant use Cardiac surgery major trauma Ga C-section
What class of patients are not as many drugs given too?
What is helping there become less adverse side effects
Trauma patients
EEG machines
What occurs at the end of surgery
Muscle relaxation is reversed Anaesthetic agent swear off Normal respiration is resumed airway reflexes and control comes into play extubation
Where does recovery happen?
PACU (post anaesthetic care unit) the anaesthetist has responsibility after the agent has worn off. Many patients do not have airway control or conciounsess. Make sure pain is controlled.
