Presentation for a lecture on_Anesthesia_1_part.pptx

Presentation for a lecture on_Basics of Anesthesia part 1

1. Anesthesiology History and Basic Concepts Anesthesiology , Reanimatology & Intensive care Faculty with Ambulance/Paramed course. TSMU of RF Health ministry

2. Anesthesiology Introduction

3. Anesthesiology Introduction Pedanius Dioscorides , Greek Physician Professor Oliver Wendell Holmes, Sr ( 1809 - 94 )

4. Anesthesiology Introduction

5. Anesthesiologyz Introduction

6. Anesthesiology Introduction A typical advertisement in those days for a laughing gas party, nitrous oxide party.

7. Anesthesiology Introduction Dr. William Edward Clarke Dr  Crawford Williamson Long  

8. The first successful demonstration of ether anaesthesia by William Thomas Green Morton (1819–1868) on October 16, 1846 at the Massachusetts General Hospital in Boston. Anesthesiology Introduction

9. Anesthesiology Introduction

10. Anesthesiology Introduction Aspects of the practice of medicine that are included within the scope of anesthesiology

11. Anesthesiology sleep or unconsciousness painlessness reduced or abolished reflexes and subsequent amnesia when necessary, reduced muscular tonus. Introduction

12. Anesthesiology TYPES OF ANESTHESIA

13. Anesthesiology inhalation anesthesia, where the agent is administered via inhalation; intravenous anesthesia, where the agent is given by intravenous injection or infusion; balanced or combined anesthesia, where both of the above methods are used. ANESTHESIOLOGICAL METHODS

14. Anesthesiology INTRAVENOUS ANESTHESIA

15. Anesthesiology INHALATION ANESTHESIA

16. Levels of Sedation/Analgesia a Reflex withdrawal from a painful stimulus is NOT considered a purposeful response . Anesthesiology General anesthesia

17. Anesthesiology General anesthesia Guedel’s stages of anaesthesia

18. 1 Analgesia Analgesia without amnesia . Later, analgesia and amnesia 2 Excitement Amnesia Irregular respiration Retching and vomiting may happen Stage ends with re-establishment of regular breathing. 3 Surgical Anesthesia 4 Medullary depression Severe CNS depression Medullary paralysis respiratory and vasomotor control ceases . Excitement, combative behavior Plane 1 roving eyeballs movements Plane 2 prog. loss of corneal reflex (surgery) Plane 3- pupils start dilating, muscle relaxation Plane 4- only abdo respi , fully dilated pupils Anesthesiology

19. Anesthesiology REGIONAL ANESTHESIA SPINAL ANESTHESIA EPIDURAL ANESTHESIA ANESTHESIOLOGICAL METHODS

20. Anesthesiology ANESTHESIOLOGICAL METHODS PERIPHERAL NERVE BLOCKS

21. Anesthesiology TYPES OF ANESTHESIA

22. Elective: operation at a time to suit both patient and surgeon; for example hip replacement, varicose veins. Scheduled : an early operation but not immediately life saving; operation usually within 3 weeks; for example surgery for malignancy . Classification of operation Anesthesiology

23. Urgent: operation as soon as possible after resuscitation and within 24 h; for example intestinal obstruction, major fractures. Emergency: immediate life-saving operation, resuscitation simultaneous with surgical treatment; operation usually within 1h; for example major trauma with uncontrolled haemorrhage , extradural haematoma Anesthesiology Classification of operation

24. Outline of a typical anesthesia procedure Anesthesiology General anesthesia PREOXYGENATION INDUCTION

25. Anesthesiology General anesthesia 1 Patient Positioning Position the patient to avoid nerve damage, pressure ulcers, and to maintain good blood flow. 2 Access to Airway Ensure safe and efficient oxygenation and ventilation of the patient. 3 Hemodynamic Monitoring Monitor patient's blood pressure, heart rate, and other vital parameters, and promptly address any changes. 4 Fluid and Electrolyte Management Ensure the patient receives proper hydration and electrolyte balance throughout the procedure . Intraoperative Patient Care

26. Anesthesiology

27. Outline of a typical anesthesia procedure Anesthesiology General anesthesia MAINTENANCE RECOVERY

28. Anesthesiology General anesthesia Postoperative Pain Management Pharmacologic Management Use non-opioid medications, local anesthetics, and opioids as needed, while ensuring patient safety and avoiding addiction. Non-Pharmacologic Management Use physical therapy, relaxation techniques, and alternative therapies to manage pain and improve outcomes . Patient-Controlled Analgesia (PCA) Empower the patient to self-administer pain medication within safe limits, under healthcare professional supervision.

29. Anesthesiology Preoperative Patient Evaluation Anesthesia routines Medical History Review Assess overall health and identify risk factors. Diagnostic Testing Ensure surgical eligibility and detect complications. Surgical Consultation Discuss patient expectations, surgical risks, and ask any questions .

30. Anesthesiology Perioperative medications Anesthesia routines Prescribed, over- the- counter, herbal and recreational medications need to be carefully considered at the time of the preoperative assessment. Individualized plans that take into account patient and surgical factors (and based on local guidelines) should be made and clearly communicated (in written form) to the patient and teams involved in their perioperative care.

31. • About 5– 14% of patients take perioperative herbal medication. • Of these, 70% do not disclose this fact to their doctor. • Content of herbal remedies may vary dramatically. • Most herbal remedies are harmless, but some may have important consequences for anaesthesia . • The ASA recommends that patients stop herbal medications 2w before surgery. Anesthesiology Anesthesia routines Herbal medicines and anaesthesia

32. Anesthesiology Anesthesia routines PREOPERATIVE ASSESSMENT

33. Anesthesiology Anesthesia routines

34. ASA Preoperative Fasting Recommendations A Examples of clear liquids include water, fruit juices without pulp, carbonated beverages, clear tea, and black coffee. B A light meal typically consists of toast and clear liquids. Meals that include fried or fatty foods or meat may prolong gastric emptying time. Both the amount and type of food ingested must be considered when determining an appropriate fasting period. Guidelines are intended for healthy patients of all ages undergoing elective procedures. They are not intended for women in labor. Anesthesiology Anesthesia routines Fasting Preoperative fasting is defined as the restriction of fluid or food intake prior to general anaesthesia (GA) or sedation.

35. Anesthesiology Anesthesia routines DRUG THERAPY PREMEDICATION To relieve anxiety – benzodiazepines. To prevent allergic reactions – antihistamines To prevent nausea and vomiting – antiemetics . To provide analgesia – opioids. To prevent acidity – proton pump inhibitor To prevent bradycardia and secretion – cholinolitics (atropine/ glycopyrollate )

36. Anesthesiology General anesthesia Antibiotic prophylaxis Antibiotic prophylaxis is administered to patients as part of a care bundle to mitigate the risk of surgical site (wound) infection. ** Other anaesthetic components of this bundle include maintaining patient homeostasis such as normothermia, adequate oxygenation, tissue perfusion and targeted glycaemic control.

37. The WHO recommends that antibiotic prophylaxis is given within 60min of surgical incision. One exception is with infected patients where it is planned to take surgical samples prior to administering antibiotics. It is recommended that prophylactic antibiotics are administered on starting anaesthesia ; however, earlier prophylaxis may be needed for procedures requiring a tourniquet . Anesthesiology General anesthesia Antibiotic prophylaxis Timing of prophylactic antibiotics Repeat antibiotic doses should be administered for procedures >2– 4h (typically where the duration >2 half- lives of the antibiotic) or with associated significant blood loss (>1.5L). Decisions on the choice of antibiotics and redosing should follow local guidelines or the advice of a microbiologist. *WHO – World Health Organization

38. Anesthesiology General anesthesia Venous thromboembolism prophylaxis Venous thromboembolic disease (VTE) is a common source of perioperative morbidity and mortality. Pulmonary embolism (PE) is a potentially avoidable cause of postoperative death and typically results from a deep vein thrombosis (DVT) originating from within lower limb venous plexuses. DVTs carry their own morbidity related to post- thrombotic chronic venous insufficiency and venous ulceration. Without VTE prophylaxis, historical data indicate the incidence of VTE in surgical patients is high, with up to 50% developing a DVT and 10% a PE.

39. Prophylaxis should normally be started as soon as possible (usually <14h after a non- elective admission)— unless patient, surgical or anaesthetic considerations preclude this. Anesthesiology General anesthesia Venous thromboembolism prophylaxis Prophylactic management

40. Pharmacological measures. Anesthesiology General anesthesia Venous thromboembolism prophylaxis Non- pharmacological VTE prophylaxis Graduated compression stockings Intermittent pneumatic compression devices IVC filters

41. Anesthesiology Useful websites http://www.aagbi.org/pdf/pre-operative_ass.pdf [Preoperative assessment. The role of the anaes thetist . The Association of Anaesthetists of Great Britain and Ireland. http://www.americanheart.org/presenter.jhtml?identifier=3000370 [American College of Cardiology / American Heart Association (ACC/AHA) Guideline Updateon Perioperative Cardiovascular Evaluation for Noncardiac Surgery

42. Reversal Agents/Anticholinergics Reversal Agents: all are acetylcholinesterase inhibitors, thereby allowing more acetylcholine to be available to overcome the neuromuscular blocker effect at the nicotinic receptor, but also causing muscarinic stimulation Neostigmine – shares duration of action with glycopyrrolate (see below) Edrophonium – shares duration of action with atropine (see below) Physostigmine – crosses the BBB, therefore useful for atropine overdose Anticholinergics: given with reversal agents to block the muscarinic effects of cholinergic stimulation, also excellent for treating bradycardia and excess secretions Atropine – used in conjunction with edrophonium, crosses the BBB causing drowsiness, so maybe bad at end of surgery for reversal, some use as premed for all children since they tend to become bradycardic with intubation and produce copious drool Glycopyrrolate – used in conjunction with neostigmine, does not cross the BBB Commonly Used Medications Questions? Thank you for listening .