ANESTHESIA:

01. Scoring to assess intubation

Mallampati scoring:
Class I — Faucial pillar, soft palate, uvula are seen
Class II — Faucial pillar, soft palate are seen
Class III — Only soft palate is seen

Samsons Young modification:

Class IV — Only hard palate seen
Class I, II: Easy intubation
Class III, IV: Difficult intubation

02. Nitrous oxide: It is non inflammable, non irritant, good analgesic but weak anaesthetic
agent. It is given along with 30-50% oxygen for balanced anaesthesia (blue coloured
cylinder)

03. Thiopentone: It is ultra short acting barbiturate which causes hypnosis during induction
of anaesthesia. It does not have analgesic effect. It causes hypotension, respiratory
depression, laryngeal and bronchospasm. Recovery is rapid.

04. Propofol: It is widely used induction agent which has got predictable onset and
recovery. It has got least side effects on CVS and respiratory system. It is also used for
total IV anaesthesia. Dose: 1-2.5 mg/kg.

05. Suxamethonium chloride (scoline): – It lasts for 2-4 minutes. It causes muscle
twitching, fasciculations— paralysis. – It is metabolised by plasma
pseudocholinesterase. Atypical or deficiency of this enzyme prolongs the action of the
scoline. Side effects are hyperkalaemia, myotonia, apnoea and cardiac arrest.

06. REVERSAL AGENTS: They are anticholinesterase drugs which increase the
acetylcholine and thus act as antagonising agents for non depolarising muscle relaxants.
They cause bradycardia. Neostigmine (2.5 mg) is used commonly along with atropine
(1.2 mg). Edrophonium (short acting) and pyridostigmine (long acting) are other drugs.

07. Boyle’s apparatus— It consists of— a. Cylinders for N2O and O2. b. Pressure guage –
to know the amount of gas remaining. c. Pressure regulator – to regulate the pressure of
gas used. d. Rotameter – to know the flow of gas. e Vaporiser.

08. Pin index code: It is safety mechanism to fix gas cylinder onto the Boyle’s machine.
Different gases have different pin index codes, so that interchanging of cylinders does
not take place. Pin index code for N2O is 3, 5. Pin index code for O2 is 2, 5.
09. Laryngeal mask airway (LMA): Laryngeal mask consists of a wide bore tube whose
proximal end connects to breathing circuit and distal end is attached to an elliptical cuff
which can be inflated

Advantages • Does not require laryngoscope for insertion • Does not cause irritation of
airway • Less incidence of laryngospasm, Contraindications • Pharyngeal pathology •
Full stomach as it can cause aspiration • Bronchospasm

10. COMPLICATIONS OF GENERAL ANAESTHESIA • Intra-arterial injection of the

drug. • Myocardial depression and cardiac arrest. • Hypertension. • Laryngeal and
bronchial spasm. • Cardiac arrhythmias. • Respiratory failure. • ARDS and .malignant
hyperthermia

11. Malignant hyperthermia: It is an inherited myopathic disorder occurs under

anaesthesia due to drugs like halothane, scoline. There is marked increase in metabolic
rate, with rise of temperature. There is high levels of CPK enzyme.
 Condition will cause metabolic acidosis and hyperkalaemia. It has got high
mortality.
 Treatment is IV dantrolene, cooling, oxygen and cold IV fluids.

12. REGIONAL ANAESTHESIA:

 Mode of action: It causes temporary conduction block of the nerve, thus
preventing the propagation of nerve impulse.
 Advantages of local anaesthetic agent: • Technically simpler. • General
anaesthesia is avoided. • Consciousness is retained. • Patient can have food
earlier after surgery.
 Drugs used: • Cocaine, procaine, cinchocaine—amino esters. • Lignocaine,
prilocaine, bupivacaine, ropivacaine— amino amides
 Side effects: Giddiness, headache, postural hypotension, tinnitus

13. NERVE BLOCK

• Block of inferior dental nerve and lingual nerves in the region of the mental foramen
for extraction of teeth.
• Finger block of digital nerves. Here plain xylocaine is used (without adrenaline).
• Intercostal block.
• Ankle block.
• Median and ulnar nerve block.
• Brachial plexus block (Winnie’s block): It can be given through– - Interscalene, -
Axillary, - Supraclavicular approaches.

14. INTRAVENOUS REGIONAL ANAESTHESIA (BIER’S BLOCK)

 Limb is exsanguinated and occluded with tourniquet. Pressure in the tourniquet
must be 30 mmHg more than the systolic pressure of the patient.
 Needle is placed in the selected vein. 40 ml of 0.5% xylocaine for upper limb
and 80 ml of 0.25% of xylocaine for lower limb is injected into the vein
  It gives very good analgesia for 2 hours.

15. SPINAL ANAESTHESIA

 It is the injection of local anaesthetic into the subarachnoid space causing loss of
sympathetic tone, sensation and motor function. The sympathetic block is 3
segments higher than sensory block, motor block is 3 segments lower than
sensory block.
 Position: Lateral decubitus position with head, hips and knees being fully
flexed
 Drugs used: Lignocaine 5% in 6% dextrose, 2 ml. Bupivacaine 0.5% in 5%
dextrose, 3 ml.
 Advantages • Economical • Hypotension reduces the bleeding • Adequate
relaxation is achieved • Respiratory complications are less
 Disadvantages and Complications • CSF leak and aseptic inflammation of
meninges causing headache. • Meningism. • Infection, occasionally, total spinal
block.
 Contraindications • Cardiac patient • Allergy • Increased intracranial pressure.
It may precipitate coning • Sepsis • Spinal tumours

16. SADDLE BLOCK:

It is used for surgeries in perineal and anorectal region. • It is spinal anaesthesia using
xylocaine or bupivacaine given in sitting position

17. EPIDURAL ANAESTHESIA

It is a potential space between dura anteriorly and ligamentum flavum posteriorly
which has got negative pressure inside.
 It extends from foramen magnum to sacral haitus.
 Touhy needle is used for epidural anaesthesia.
 Once the needle is in the space there will be sudden indrawing of air or saline
drop
 An epidural catheter is placed in the space and fixed. 2% xylocaine with
adrenaline or 0.5% bupivacaine is injected into the space to achieve anaesthesia
up to the desired level.
 Advantages • It can be used for continuous repeated prolonged anaesthesia. • It
can be used for postoperative analgesia. • It can be kept for several days.

18. CAUDAL ANAESTHESIA : Caudal space is the sacral component of epidural space
and access is through the sacral hiatus.
Indications • Haemorrhoidal surgery • Circumcision •Small procedures in the perineum
like cystoscopy
Complications
• Trauma to anal canal • Intravascular injection • Failure of caudal block
19. Lignocaine/lidocaine/xylocaine:
 It is the commonest local anaesthetic agent used.
 It is metabolized in the liver and excreted in the kidney as xylidines.
 It is also an antiarrhythmic drug and so commonly used in cardiology and
cardiac surgery.
 Side effects: Giddiness, headache, postural hypotension, tinnitus, circumoral
anaesthesia. Dose: 4 mg/kg effect lasts for 90 minutes
 Uses • Topical• Infiltration block • Field block • Nerve block • Epidural •
Spinal.
 Xylocaine with adrenaline has got longer duration of action
 But it should not be used in places where end arteries are present like glans
penis, ear lobule, tip of the nose, lip, fingers and toes.

20. ABSORBABLE SUTURE MATERIALS

• Plain catgut --It is absorbed by inflammatory reaction and phagocytosis—absorption
time is 7 days. – It is used for subcutaneous tissue, muscle, circumcision in children.
• Chromic catgut is catgut with chromic acid salt-- Its absorption time is 21 days. – It is
used for suturing muscle, fascia, external oblique aponeurosis, ligating pedicles, etc.
• Vicryl (Polyglactic acid): – It is synthetic absorbable suture material. – It gets
absorbed in 90 days. – Absorption is by hydrolysis. It is very good suture material for
bowel anastomosis, suturing muscles, closure of peritoneum. .
• PDS (Poly Dioxanone Suture material) is absorbable suture material

NONABSORBABLE SUTURE MATERIALS

• Silk is natural, multifilament, braided, non-absorbable suture material derived from
cocoon of silkworm larva
• Polypropylene (Prolene) is synthetic, monofilament suture material
• Polyethylene (Ethylene) is synthetic monofilament nonabsorbable suture material.
• Linen is derived from bark of cotton tree.
• Steel, Polyester, Polyamide, Nylon are other nonabsorbable suture materials

DAY CARE SURGERY

o Day care surgery is discharge within 23 hours (USA); surgery done without night stay
(UK).
o Day care surgery is an upcoming field in surgical practice.
o It is an unique method wherein general practitioner, nurse at day care ward and theatre,
surgeon, anaesthetist work in hand so that hospital stay and so the cost is reduced.
o Patient comes to hospital at morning for surgery and leaves the hospital on same day
evening.
Procedures done in day care surgery— • Excision of cysts, lipomas, bursae,
neurofibromas. • Lymph node biopsy, haemorrhoid surgery, endoscopies, circumcision,
hydrocele • Wound suturing, toe amputation

Advantages • Minimal hospital stay • Becomes cheaper • Patient acceptance

Contraindications: age > 70 years; high risk cardiac and respiratory patients; patients
with bleeding disorders