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TECHNIQUES OF GENERAL ANAESTHESIA

Posted by SAMUEL ISABIRYE on February 18, 2013 at 8:40 AM

Requirements for all:

 

Take and record baseline vital signs

Establish intravenous line and commence

infusions

1. General anaesthesia with spontaneous

respiration

Induce anaesthesia by:

 

Intravenous route (adults)

UCG 2010

427

 

 

 

18. Miscellaneous conditions

Or

 

Inhalation route (children, patient with difficult

airway)

Maintenance

 

Secure a clear airway using an oropharyngeal

airway

The mask is placed on the face

Titrate concentration of inhalation against

response of the patient

Monitor, record every 5 min. or more

frequently, BP, Pulse, Respiration, Colour,

oxmetry

Indication:

 

This technique may be used for operations on

limbs, perinium, superfial wall of chest and

abdomen

Suitable for operations lasting less than 30 min

2. General anaesthsia with controlled

ventilation

Induce anaesthesia:

 

Intravenous/ inhalation (see above)

Tracheal intubation

-

when spontaneously breathing (for children)

or

-

under relaxation by suxamethonium and

laryngoscopy

-

confirm correct tube placement by presence

of breath sounds on both chest sides

-

connect the breathing / delivery system to

the endotracheal tube

 

Maintenance

 

Titrate concentration of inhalation agent against

response of the patient

A selected long acting muscle relaxant is given

Intermittent positive pressure ventilation is

done

Monitor vital signs (as above)

UCG 2010

428

 

 

 

18. Miscellaneous conditions

At the end of the operation when the patient

shows signs of respiratory effort

Neostigmine is given to reverse the effects of the

long acting muscle relaxant

 

Indication:

 

All operations that require a protected airway and

controlled ventilation e.g. intraabdominal,

intrathoracic and intracranial operations

 

3. Rapid sequence induction of general

anaesthesia

Also called crash induction

 

 For patients with “full stomach” and at risk of

regurgitation e.g. emergency surgery, distended

abdomen.

Crash induction steps

 

Establish an intravenous line and commence

infusions

Preoxygenation for > 3 min.

Induce with selected intravenous anaesthetic

agent

Assistant applies cricoid pressure

IV suxamethonium is given

Laryngosopy is done

Trachea is intubated and correct tube

placement confirmed

The cuff of the endotracheal tube is inflated

then cricoid pressure released

The position of the tube is fixed by strapping

and an airway is inserted.

Then connect to breathing circuit/ system to

maintain anaesthesia.

 

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