Professional Documents
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Anaesthesia Outside OT
Anaesthesia Outside OT
Anaesthesia Outside OT
RESPONSIBILITIES
Away from familiar territories…
• The indifferent reflexes shown by the non
operating room staff in emergency situation
• Insecurity due to a very realistic anticipation
of lack of equipment and staff support
• Despite these factors, we should be held
responsible if something happens…!
What is there in a name….?
CHALLENGES
EQUIPMENT
Don't expect Volks Wagens! But ensure the
Ambassador is not leaking petrol !
CHA LLE N G E S
STAFF
Lonely walk through
dangerous paths!
CHA LLE N G E S
PROCEDURE
Poor illumination
CHALLENGES
PATIENT
Dealing with the most
important person in any
setting...
• Children
• anxious patients
• Claustrophobic patients (especially in MRI suites)
• • Elderly or confused patients
• Patients undergoing painful procedures
• Patients requiring burns dressings.
.
ANA E S TH E TIC
TECHNIQUE
CHOICE OF ANAESTHESIA
• less invasive
• cost and time saving
• high rate of failure
• high chance of airway and respiratory depression
Definition of general anesthesia and levels of sedation
/analgesia [Approved by the ASA,2009]
MAINTAIN THE BALANCE…
…….Regional anaesthesia
DOCUMENTATION OF
ANAESTHESIA
HAZARDOUS
FOR ANAESTHETIST
IF OMITTED
.
DEXMEDITOMIDINE
.
DEXMEDITOMIDINE
.
PROPOFOL- an easy method….
Load with 2 mg/kg over 10 minutes in a 50
mL syringe-pump
For e.g. 10 kg child: 20mg=2mL X 6 =
12mL/hr (for first 10 mins) ; then…
If you set the maintenance as half this dose
(i.e. 6 mL/hr)
This will be equivalent to 100 ug/kg/min
infusion of propofol…..
There is substantial variability in the
response to each agent between
individuals.......
•A
Anesthesia for MR IMAGING
•.
Contrast media
• Allergic reaction
• History
• Symptoms: skin reactions, airway obstruction,
angioedema, and cardiovascular collapse.
• Treatment: corticosteroids, H1 and H2
blockers. Oxygen, epinephrine, β2-agonists,
and intubation , IV fluids
• Prevention: corticosteroids
Anesthesia for CT
• Less complex
• Use standard monitoring
• Less anesthetic time
• Higher levels of radiation exposure
Anesthesia for MRI-Physical environment
• High magnetic field
• Uncertain duration
• Need specialized compatible equipment
• Radiofrequency noise
• Metallic implants or implanted devices
• Patients with implanted pacemakers, ICDs, or
pulmonary artery catheters may not have MRI scans.
Special circumstances -
Magnetic resonance imaging
(MRI)
• NEVER take any ferrous metal into the MRI suite – includes
laryngoscopes, scissors and stethoscopes and mobile phones.
• In an emergency, take the patient out of the MRI room, do not
take the emergency equipment to the patient.
• can keep noise blockers in patients ears
Dedicating these two things to those who
sacrificed theirs’ for MRI Machines
.
MRI- Conduct of anaesthesia
•A
MRI SUITE
.
Electroconvulsive therapy (ECT)
• Mainly to treat major depression
• Typically, ECT is performed twice weekly until there is a
lack of further improvement [6 to 12 treatments over 2 to
4 weeks]
• Physiologic effects:
> a grand mal seizure tonic phase : 10 to 15 s,
>clonic phase :30 to 50 s.
Electroconvulsive therapy (ECT)
• > first reaction: parasympathetic discharge lasting 10–15 s.
This can result in bradycardia, hypotension, or even
asystole
>following reaction: hypertension,arrhythmias, tachycardia,
lasts for 5-10min↑O2 consumptionM.I.
Left ventricular systolic and diastolic function can remain
decreased up to 6 h after ECT
ICP, intraocular and intragastric pressure increase
Contraindication :
•A
Was there 4 quite some time; now a hero!
• ,
Anaesthesia for electroconvulsive therapy,Vishal Uppal, Jonathan Dourish, Alan Macfarlane
oxfordjournals.org