Q General
Anesthesia
Pain relief
inu relacant)
.
paralysis (mu.
unconcious
No
memory/amnesia
loss of reflec response
Only monitor
Mild sedation
& angiolysis
Below the waist level eveything
numbness
Loss of reflexe resposnse
Unconscious
Analgesics
Amnesia
Muscle relaxant
For muscle paralaysis
Px-fully unconscious
Outside OT
Lorazepam aprazaloma BZD
PpI ,H2 blockers
Anti secretion
5HT3 antagonist
Prokinetics
Antibiotics: 60 mins prior to sx
Normal
Room
Air: 21%02
N2:78%
Lungs also filled with n2
O2 so while
Sx we give preoxygenatn
7 shut off n2o &inhaled ax agent
Space in which the spinal nerves close to the spinal cord is
Subarachanoid space
Block the spinal nerves little away from the spinal cord
epidural space
Local ax agents used
AMERICAN SOCIETY OF ANESTHESIOLOGISTS PHYSICAL STATUS CLASSIFICATION (IMP)
I. No comorbidities
II. Mild systemic disease (controlled)
III. Moderate systemic disease (uncontrolled)
IV. Severe systemic disease (end organ damage)
V. Moribund patient who will not survive without surgery
VI. Brain dead – organ transplant
Class 1 - uvula, sp,hp,tonsillar pillars
Class 2: base of the uvula,sp ,hp
Class 3 : sp+hp
Class 4 : only hp
Mpc 1&2 easy intubation
3 &4 difficulty intubation
Class 4 most difficult
Thyroid disorders - continue on day of surgery- make patient euthyroid
Hypothyroidism - levothyroxine
Hyperthyroidism - carbimazole, PTU
Cellular metabolism co2 goes to heart
Heart send to lungs
Then lungs expelled the co2
Dead space
exhalation
Malignant hyperthermia
*AD
Ryanodine Receptor 1 gene defect
R/f
Succinyl choline
Inhalation Ax agenets
Rx : dantrolene na
Hyperthermia muscle rigidity
Spontaneous breathing
attempt by the px
Asthma ,copd
Seen children
Membran between heart n lungs
very thin while heart beat ,
vibration Contraction occurs
Travel to the lungs then into the
Trachea
Respiratory distress
Fall in bp
Tachycardia
& ---
,
recum ,
nore ,
acilla - Never
give core
body temp
Most accurate I temperature measurement
-> core
body temp
Pt is aware under
anesthesia
↓
So,
depth of anesthesia
~
- is reg
for measuring
↓
m/ :
Bispectral inde
↓
check EEG
Under
to deep anesthetic Pt aware
- O
11 u
under
- Go
Anesthesia 40
X
To check degree of
Neuromuscular blockade general ax
Etco2
Best method to detect
apnea in children
Capnography
Gold standard to detect :
ENdotracheal intubation
-
Glycine
Excitation NT -
Induction dose 3-5 mg/kg
T4-T3 convertion
prevented
Redistribution Accidental intraarterial
injection of vasospasm
Liver
Mc iv anesthetic agent
Na nitroprusside, EDTA
Phencycli dine derivatives
O
->
have 1"i" -> have "i"
& &
X
-
&
- -
2
-
-
-
- -
-
Prilocaine -
= -
-
(only ester that metabolise in live)
*
#
-
- Cocaine
↓
↑UR , UTN
midriasis
- Bupivacaine
Plain-Inglghignone/lidocain
-
↓
les LA in blood
-
adrenaline-Amg/kg les In reach heart
less EA toxicity
↓
So
,
higher dose can be
given
-
Chlorprocaine
-
Dibucaine
Bupivacaine
2 5% Prilocaine &
lignocaine + 2 5%
. .
↓
Extectic micture of LA .
.
A s
80000000= (50 % 02 + 50 %
N20) -
7 -
Black
* White
Blue
Yellow
limb value
inspiratory
one
way
->
2
7 >
- Y
&
T &
Ventilator
p
↑
So , 50 % of this can be reusd
-C A
- (as Co is absorbed)
&
O+N20 + Sero
& seroT
↓
/-
↑ No
D
& expiratory
limb CO2 cos
CO2
absorber
↑
+
02 No
con or
sero
NO
Sero
02 + N20 +
Step ladder pattern
->
->
HyperThermia
for inhalational
agent mu-rigidity
-
are
triggering agent
: Sch
D:
Malignant Hyperthermia - AD inheritance
R
: ↓
d/+ faulty RyR1gene (an Chr-19)
Dantrolens Sodium d
alt Rayodine receptor gene
Dx : Muscle
↓V
rigidity
a
Halo
by Caffine
have
test
=> asystole
- -
--
-
-
change after
=> Scycles
↑
-
d , site = lower Yrd of sternum ·
30 : 2-adult
Chest compression
·
3: 1-neonate
-
compalowe a
adrenaline-lig iv
Cundiluled)
↓ repeat after
Intubation
3-5 mir
I breath Gr
every
=
↓ ↓
ArgBu
1st 24he 10 breaths 1min
after
:.
induce coma -
for the every
saved
Pt is
↓
CT scan
hythera
-
-
by
Has TTM (Transient
trachea MX (
at Rt
Para-a
&
sternal
area
at
&
&
ope I heart
DAED : automated external
① Manual defibrillator defibrillator
Cart
Airway
: -
①
②
① laryngoscopes
& ② AMBU
③ ⑤ & Gaudel's
oro-pharyngeal
air
way
④ Naso-pharyngeal
air
way
↓ ① ① ↓ & ET tube
Miller Macintosh
-
~
--
9 sternal
Rt Para
~
-
