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Anaesthesia

Anaesthesia

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Published by: grreddy8364320 on Oct 22, 2010
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02/28/2013

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ANAESTHESIA

ORDER OF SENSATION LOSS IN LOCAL ANAESTHESIA Temperature Pain Touch Deep pressure ORDER OF SENSATION LOSS IN SPINAL ANAESTHESIA 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

thought without learning is perilous. burn dressing Preferred in asthmatics. shivering. Pethidine.Confucius . Used in endoscopy Droperidol Etomidate Causes adrenal cortex suppression Pain on injection No analgesic effect preferred in Porphyrias Trilene Maximum analgesia. alcoholic cirrhosis. Propofol Day care surgery Ketamine Dissociative anesthesia Used in head. and Pentazocine.CHARACTERISTICS OF SOME COMMONLY USED ANAESTHETICS CONTINUED… Halothane Useful in Asthmatics. Thiopentone Highly lipid soluble sodium Contraindicated in acute Porphyria. hypertension Fentanyl/ Neurolept analgesia . version. Side-effectsHepatitis. Postoperative shivering is managed with Tramadol. Sevoflurane Fastest induction Used in pediatric surgery Not used in closed circuit with soda-lime.. Porphyria Avoided in. hyperthermia. neurosurgery. neck surgery. malignancy. cardiac catheterization.MI. Not to be used with soda-lime Longest acting local anesthetist Shortest acting anesthetist Dibucaine > Tetracaine > Bupivacaine Chlorprocaine Lignocaine maximum dose Lignocaine maximum dose Without adrenaline With adrenaline 3 mg/kg= 200mg (average adult) 7 mg/kg = 500mg (average adult) QUOTE CORNER Learning without thought is labour lost. angiography. Should not be used again in next three months Enflurane Contraindicated in epilepsy Isoflurane Decreases ICT Used in myocardial infarction. uterine relaxation (hence not used in post-partum hemorrhage as relaxant effect increases bleeding) Increases ICT (intracranial tension) Sensitizes heart to Cathecholamines.

a Las Vegas hospital suspended workers for betting on when patients would die.ELEVENTH HOUR ANAESTHESIA 195 Longest acting muscle relaxant Doxacurium > Pipecuronium > Pancuronium > d-Tubocurare. MUSCLE RELAXANTS In renal failure In hepatic failure Myasthenia gravis Short cases Obstetrics Arterial surgery To reduce blood pressure Rapid sequence induction Asthmatics Carcinoid tumour Shortest acting muscle relaxant Succinylcholine < Mivacurium CONDITION Vecuronium / Atracurium Atracurium 1/10th Atracurium Atracurium / Ropacurium / Mivacurium All except Gallamine Pancuronium Tubocurare Rocuronium / Ropacurium Pancuronium (avoid Metacurine and Succinylcholine) 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. .

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. TEMPE-Topical Eutectic Mixture for Premature Ejaculation.Henry Ford ELEVENTH HOUR ANAESTHESIA 197 . *Circuit used in spontaneous respiration is Mapleson A *Eutectic Lignocaine + Prilocaine – Decreases the melting point of the mixture. Useful in surface anaesthesia. drug overdose. *Madelson’s syndromeBilateral diffuse alveolar opacities caused due to aspiration of acid gastric contents after anesthesia.regional anaesthesia that utilizes intravenous injection of the local anaesthetic agent to bring it to the nerve trunks and endings. Ether and Succinylcholine Due to excessive release of Ca++ from sarcoplasmic reticulum. *Bier’s block. QUOTE CORNER There is no happiness except in the realization that we have accomplished something. epilepsy. alcohol abuse.

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