the conduct of general anaesthesia Flashcards
what is general anaesthesia
period of controlled unconsciousness, during which you will feel nothing and after which will remember nothing
stages and phases of GA
pre-op assessment and planning
preparation
anaesthesia
post-op care period
GA: preparation
must make sure everything is in line for patient coming to theatre
right people
rights skills e.g. neuro, cardiac (anaesthetic specialist)
right place
right time
GA: monitoring
ECG oxygen saturation non-invasive BP end tidal CO2 airway pressure monitoring
GA: induction
first phase of anaesthetic
can be performed IV or inhalation
during induction may see patient move through the planes of anaesthesia
intravenous induction
multi-stage approach
patient receives multiple drugs - analgesic, hypnotic, +/- muscle relaxant
planes of anaesthesia
analgesia + amnesia
delirium to unconsciousness
surgical anaesthesia
apnoea to death (obvs want to avoid)
reasons to intubate
protection from aspiration (haven't fasted) need for muscle relaxation shared airway case need for tight CO2 control minimal access to patient
3 options for how people breath under anaesthesia
spontaneous ventilation
controlled ventilation
supported ventilation
how is breathing monitored
saturation probe
end tidal CO2
airway pressure monitoring
risks of anaesthetic induction
anaphylaxis to agents used regurgitation and aspiration airway obstruction and hypoxia laryngospasm CVS instability rarely, cardiac arrest
what other risks are there
awareness eye injury hypothermia pressure injuries VTE nerve injury
GA maintenance
keeping patient asleep
inhalational agent or IV anaesthesia (cont infusion)
what else does anaesthetist due during maintenance
vigilance contant adjustment anticipation analgesia anti-emesis documentation communication advocacy
