06/27/2017

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By Live Dr - Wed Feb 11, 3:47 am

Anaesthesia

ORDER OF SENSATION LOSS IN LOCAL ANAESTHESIA ORDER OF SENSATION LOSS IN SPINAL ANAESTHESIA
Temperature 

Pain

Touch

Deep pressure

Preganglionic b fibres 

Cold

Warm

Pin prick

Pain

Touch

Pressure

Motor

Vibration / proprioception

CHARACTERISTICS OF SOME COMMONLY USED ANAESTHETICS

Prilocaine Safest local anaesthetist 

Produces methemoglobinemia

Succinylcholine Non-competitive muscle relaxant 

Used during intubation.

Produces fasciculations

Produces biphasic block

Significant hyperkalemia with Succinylcholine is seen in

Burns, paraplegia, tetanus

Atracurium Undergoes Hoffman elimination 

Used in hepatic and renal failure

Cocaine Naturally occurring 

Produces vasoconstriction

Peripheral sympathomimetic action

Nitrous oxide Second gas effect 

Diffusion hypoxia

Only analgesic effect

It inactivates cobalt in vitamin B 12 ; irreversibly inactivates enzyme Methionine synthetase

Megaloblastic anaemia occurs after exposure for periods of more than 3-12 hours.

It can be prevented by pretreatment with Foilnic acid

Ether Inflammable 

Causes increased blood glucose levels in diabetics

TRIVIAL TRUTH

Every year, surgical tools are left in approximately 1,500 patients in the USA. Fatter patients are more prone to having a surgical tool left inside of them due to the additional amount of space in their bodies.

ELEVENTH HOUR ANAESTHESIA                                                                                                         194

CHARACTERISTICS OF SOME COMMONLY USED ANAESTHETICS CONTINUED…

Halothane Useful in 

Asthmatics, version, uterine relaxation (hence not used in post-partum hemorrhage as relaxant effect increases bleeding)

Increases ICT (intracranial tension)

Sensitizes heart to Cathecholamines.

Side-effects-

Hepatitis, malignancy, hyperthermia, shivering.

Postoperative shivering is managed with Tramadol, Pethidine, and Pentazocine.

Should not be used again in next three months

Enflurane Contraindicated in epilepsy
Isoflurane Decreases ICT 

Used in myocardial infarction, neurosurgery, alcoholic cirrhosis.

Sevoflurane Fastest induction 

Used in pediatric surgery

Not used in closed circuit with soda-lime.

Thiopentone sodium Highly lipid soluble 

Contraindicated in acute Porphyria.

Propofol Day care surgery
Ketamine Dissociative anesthesia 

Used in head, neck surgery, angiography, cardiac catheterization, burn dressing

Preferred in asthmatics, Porphyria

Avoided in- MI, hypertension

Fentanyl/ Droperidol Neurolept analgesia , Used in endoscopy
Etomidate Causes adrenal cortex suppression 

Pain on injection

No analgesic effect

preferred in Porphyrias

Trilene Maximum analgesia. 

Not to be used with soda-lime

Longest acting local anesthetist Shortest acting anesthetist
Dibucaine > Tetracaine > Bupivacaine Chlorprocaine
Lignocaine maximum dose 

Without adrenaline

Lignocaine maximum dose 

With adrenaline

3 mg/kg= 200mg (average adult) 7 mg/kg = 500mg (average adult)

QUOTE CORNER

Learning without thought is labour lost, thought without learning is perilous.- Confucius

ELEVENTH HOUR ANAESTHESIA                                                                                                          195

Longest acting muscle relaxant Shortest acting muscle relaxant
Doxacurium > Pipecuronium > Pancuronium > d-Tubocurare. Succinylcholine < Mivacurium
MUSCLE RELAXANTS CONDITION
In renal failure Vecuronium / Atracurium
In hepatic failure Atracurium
Myasthenia gravis 1/10th Atracurium
Short cases Atracurium / Ropacurium / Mivacurium
Obstetrics All except Gallamine
Arterial surgery Pancuronium
To reduce blood pressure Tubocurare
Rapid sequence induction Rocuronium / Ropacurium
Asthmatics Pancuronium (avoid Metacurine and Succinylcholine)
Carcinoid tumour Vecuronium
Aminoglycosides causing neuromuscular blockade
Neomycin > Streptomycin > Gentamycin

Colour coding of gas cylinders

GASES COLOUR CODES
Oxygen Black body with white shoulders
Nitrous oxide Blue
Carbon dioxide Grey
Cyclopropane Orange
Air Grey body , black and white quartered shoulders
Entonox Blue body, white and blue quartered shoulders

Piped gas supplies

White Oxygen
Blue Nitrous oxide
Black Compressed Air
Yellow Vacuum
ELEMENTS OF PRIMARY SURVEY
Airway with cervical spine control 

Breathing and ventilation

Circulation with control of hemorrhages

Dysfunction of central nervous system

Exposure in a controlled environment

TRIVIAL TRUTH

In 1980, a Las Vegas hospital suspended workers for betting on when patients would die.

ELEVENTH HOUR ANAESTHESIA                                                                                                         196

CONTRAINDICATIONS TO SPINAL ANESTHESIA
Hypotension and hypovolemia 

Uncooperative and mentally ill person

Infants and children

Vertebral abnormalities

Local sepsis

*Malignant hyperthermia is autosomal dominant

Seen with Halothane, Ether and Succinylcholine

Due to excessive release of Ca++ from sarcoplasmic reticulum.

*Circuit used in spontaneous respiration is Mapleson A

*Eutectic Lignocaine + Prilocaine –

Decreases the melting point of the mixture.

Useful in surface anaesthesia.

TEMPE-Topical Eutectic Mixture for Premature Ejaculation.

*Madelson’s syndrome-

Bilateral diffuse alveolar opacities caused due to aspiration of acid gastric contents after anesthesia, alcohol abuse, drug overdose, epilepsy.

*Bier’s block- regional anaesthesia that utilizes intravenous injection of the local anaesthetic agent to bring it to the nerve trunks and endings.

QUOTE CORNER

There is no happiness except in the realization that we have accomplished something.Henry Ford

ELEVENTH HOUR ANAESTHESIA                                                                                                          197

 

 

Anaesthesia

 

ORDER OF SENSATION LOSS IN LOCAL ANAESTHESIA

ORDER OF SENSATION LOSS IN SPINAL ANAESTHESIA

Temperature

Pain

Touch

Deep pressure

 

Preganglionic b fibres

Cold

Warm

Pin prick

Pain

Touch

Pressure

Motor

Vibration / proprioception

 

CHARACTERISTICS OF SOME COMMONLY USED ANAESTHETICS

Prilocaine

 

Safest local anaesthetist

Produces methemoglobinemia

Succinylcholine

 

Non-competitive muscle relaxant

Used during intubation.

Produces fasciculations

Produces biphasic block

Significant hyperkalemia with Succinylcholine is seen in

Burns, paraplegia, tetanus

Atracurium

 

Undergoes Hoffman elimination

Used in hepatic and renal failure

Cocaine

 

Naturally occurring

Produces vasoconstriction

Peripheral sympathomimetic action

Nitrous oxide

 

Second gas effect

Diffusion hypoxia

Only analgesic effect

It inactivates cobalt in vitamin B 12 ; irreversibly inactivates enzyme Methionine synthetase

Megaloblastic anaemia occurs after exposure for periods of more than 3-12 hours.

It can be prevented by pretreatment with Foilnic acid

Ether

Inflammable

Causes increased blood glucose levels in diabetics

 

TRIVIAL TRUTH

Every year, surgical tools are left in approximately 1,500 patients in the USA. Fatter patients are more prone to having a surgical tool left inside of them due to the additional amount of space in their bodies.

 

ELEVENTH HOUR ANAESTHESIA                                                                                                         194

CHARACTERISTICS OF SOME COMMONLY USED ANAESTHETICS CONTINUED…

Halothane

 

Useful in

Asthmatics, version, uterine relaxation (hence not used in post-partum hemorrhage as relaxant effect increases bleeding)

Increases ICT (intracranial tension)

Sensitizes heart to Cathecholamines.

Side-effects-

Hepatitis, malignancy, hyperthermia, shivering.

Postoperative shivering is managed with Tramadol, Pethidine, and Pentazocine.

Should not be used again in next three months

Enflurane

Contraindicated in epilepsy

Isoflurane

Decreases ICT

Used in myocardial infarction, neurosurgery, alcoholic cirrhosis.

Sevoflurane

Fastest induction

Used in pediatric surgery

Not used in closed circuit with soda-lime.

Thiopentone sodium

Highly lipid soluble

Contraindicated in acute Porphyria.

Propofol

Day care surgery

Ketamine

 

Dissociative anesthesia

Used in head, neck surgery, angiography, cardiac catheterization, burn dressing

Preferred in asthmatics, Porphyria

Avoided in- MI, hypertension

Fentanyl/ Droperidol

Neurolept analgesia , Used in endoscopy

 

Etomidate

Causes adrenal cortex suppression

Pain on injection

No analgesic effect

preferred in Porphyrias

Trilene

Maximum analgesia.

Not to be used with soda-lime

 

Longest acting local anesthetist

Shortest acting anesthetist

Dibucaine > Tetracaine > Bupivacaine

Chlorprocaine

 

Lignocaine maximum dose

Without adrenaline

Lignocaine maximum dose

With adrenaline

3 mg/kg= 200mg (average adult)

7 mg/kg = 500mg (average adult)

 

QUOTE CORNER

Learning without thought is labour lost, thought without learning is perilous.- Confucius

 

ELEVENTH HOUR ANAESTHESIA                                                                                                          195

Longest acting muscle relaxant

Shortest acting muscle relaxant

Doxacurium > Pipecuronium > Pancuronium > d-Tubocurare.

Succinylcholine < Mivacurium

 

MUSCLE RELAXANTS

CONDITION

In renal failure

Vecuronium / Atracurium

In hepatic failure

Atracurium

Myasthenia gravis

1/10th Atracurium

Short cases

Atracurium / Ropacurium / Mivacurium

Obstetrics

All except Gallamine

Arterial surgery

Pancuronium  

To reduce blood pressure

Tubocurare

Rapid sequence induction

Rocuronium / Ropacurium

Asthmatics

Pancuronium (avoid Metacurine and Succinylcholine)

Carcinoid tumour

Vecuronium

 

Aminoglycosides causing neuromuscular blockade

Neomycin > Streptomycin > Gentamycin

 

Colour coding of gas cylinders

GASES

COLOUR CODES

Oxygen

Black body with white shoulders

Nitrous oxide

Blue

Carbon dioxide

Grey

Cyclopropane

Orange

Air

Grey body , black and white quartered shoulders

Entonox

Blue body, white and blue quartered shoulders

 

Piped gas supplies

White

Oxygen

Blue

Nitrous oxide

Black

Compressed Air

Yellow

Vacuum

 

ELEMENTS OF PRIMARY SURVEY

Airway with cervical spine control

Breathing and ventilation

Circulation with control of hemorrhages

Dysfunction of central nervous system

Exposure in a controlled environment

 

TRIVIAL TRUTH

In 1980, a Las Vegas hospital suspended workers for betting on when patients would die.

 

ELEVENTH HOUR ANAESTHESIA                                                                                                         196

CONTRAINDICATIONS TO SPINAL ANESTHESIA

Hypotension and hypovolemia

Uncooperative and mentally ill person

Infants and children

Vertebral abnormalities

Local sepsis

 

*Malignant hyperthermia is autosomal dominant

Seen with Halothane, Ether and Succinylcholine

Due to excessive release of Ca++ from sarcoplasmic reticulum.

 

*Circuit used in spontaneous respiration is Mapleson A

 

*Eutectic Lignocaine + Prilocaine –

Decreases the melting point of the mixture.

Useful in surface anaesthesia.

TEMPE-Topical Eutectic Mixture for Premature Ejaculation.

 

*Madelson’s syndrome-

Bilateral diffuse alveolar opacities caused due to aspiration of acid gastric contents after anesthesia, alcohol abuse, drug overdose, epilepsy.

 

*Bier’s block- regional anaesthesia that utilizes intravenous injection of the local anaesthetic agent to bring it to the nerve trunks and endings.

 

QUOTE CORNER

There is no happiness except in the realization that we have accomplished something.Henry Ford

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ELEVENTH HOUR ANAESTHESIA                                                                                                          197

 

 

 

 

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