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ANAESTHESIA GUIDELINES

Posted by SAMUEL ISABIRYE on February 18, 2013 at 8:25 AM

Anaesthesia main objectives during surgery are:

 

To relieve pain

To support physiological functions

To provide good conditions for the operation

GENERAL CONSIDERATIONS

The facilities for administering anaesthesia

must be:

 

Available and in a state of readiness at all times

Appropriate in quality and quantity

Compatible with safety

Staffing requirement for anaesthesia

 

Anaesthesia provider

An assistant for the anaesthesia provider

Adequate assistance in positioning the patient

Adequate technical assistance to ensure proper

functioning and servicing of all equipment

Before anaesthesia

 

Read the notes/ medical records of the patient

 

Assess the patient very carefully

The drugs, equipment, instruments and materials to

be used must be known

 

Prepare properly:

 

The workplace

The patient

During anaesthesia

 

Anaesthesia is administered (induction and

maintenance)

The patient must be monitored meticulously:

 

 

To ensure his/her wellbeing

UCG 2010

419

 

 

 

18. Miscellaneous conditions

To detect dangerous signs as soon as they arise

and appropriately treat them

Expertise in resuscitation is obligatory

If in trouble ask for help

 

After anaesthesia

 

The patient

 

Recovers from effects of anaesthesia

Has stable vital signs

Is returned to the ward in the fully conscious

state, no worse, or if at all possible, even better

than before operation.

ALWAYS PAY ATTENTION TO DETAIL.

The anaesthetist, surgeon and theatre staff

are on the same team.

Know your limits. Seek help Consult or refer to

a higher level of care

 

Types of Anaesthesia

 

Anaesthesia may be produced in a number of ways:

 

a) General anaesthesia

 

Basic elements: loss of consciousness, analgesia,

prevention of undesirable reflexes and muscle

relaxation

 

b) Regional or Local anaesthesia

 

Sensation of pain is blocked without loss of

consciousness.

The conduction of stimulus from a painful site to the

brain can be interrupted at one of the many points:

 

 

Surface Anaesthesia

Infiltration Anaesthesia

Intravenous regional anaesthesia

Nerve block/Plexus block

Epidural Anaesthesia

Spinal Anaesthesia

Preparation in the operating theatre

 

Should be in a constant state of preparedness for

anaesthesia

 

UCG 2010

420

 

 

 

18. Miscellaneous conditions

The following should be available, checked and

ready:

 

Oxygen source

Operating table that is adjustable and with its

accessories

Anaesthesia machine with accessories

Self inflating bag for inflating the lungs with O2

Appropriate range of face masks

Suction machine with appropriate range of

suction catheters

Appropriate range of oropharyngeal airways,

endotracheal tubes and other airways e.g.

Laryngeal mask airway

Laryngoscope with suitable range of blades

Magill’s forceps

Intravenous infusion equipment, appropriate

range of cannulae and fluids (solutions)

Equipment for regional anaesthesia

Adequate lighting

Safe disposal of items contaminated with body

fluids, sharps and waste glass

Refrigeration for storage of fluids, drugs and

blood

Anaesthetic drugs: general and local

anaesthetic agents

Muscle relaxants

Appropriate range of sizes of syringes

Monitors: stethoscope, sphygmomanometer,

pulseoximeter

Appropriate protection of staff against biological

contaminants. this includes: gowns, gloves,

masks and eye shields

Drugs necessary for management of conditions

which may complicate or co-exist with

anaesthesia must be at hand

UCG 2010

421

 

 

 

18. Miscellaneous conditions

Preoperative Management

 

Aim is to make the patient as fit as possible in the

given circumstance before surgery.

 

Assessment of the patient

 

Identify the patient and establish rapport

A standard history is obtained and an

examination done

Emphasis is on the cardio-respiratory systems

Investigations appropriately interpreted e.g.,

Hb

Establish health status/condition of the patient

Classify physical status of the patient according to

 

A.S.A. (ASA classification 1-5+ or - E).

Make a plan for anaesthesia based on the

information obtained.

Preparation of the patient

 

Explain the procedure to the patient and ensure

understanding

Ensure informed consent form is signed

Weight of every patient should be taken

check site and side of the operation

check period of fasting

remove

-

Ornaments /prosthesis that may injure the

patient

-

Make ups that may interfere with monitoring

 

rest of preparation according to condition of the

patient and nature of the operation (Condition

of deficits / imbalances should be corrected,

control chronic conditions)

Ability of the patient to withstand the stresses and

adverse effects of anaesthesia and the surgical

procedure will depend on how well prepared he is.

 

UCG 2010

422

 

 

 

18. Miscellaneous conditions

The commonly used drugs in anaesthetic

practice

 

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