Anesthesia

1. Mallampati Grading , ASA Scoring

 2. Instruments ( ET Tube , Nasotracheal Tube , O2 delivery devices, Canula)

Endotracheal Tube Nasopharyngeal airway DOUBLE LUMEN TUBE

LMA Pro seal LMA Intubating LMA ARMOURED TUBE

RAE TUBE GUEDELL AIRWAY Tracheostomy Tube

Nasal cannula Simple Face Mask Non-rebreathing mask Venturi Mask Anesthesia Mask

FiO2: 0.24-0.45 FiO2: 0.44-0.60 FiO2: 0.6-0.9 FiO2: 0.24-0.6 FiO2: 1

(2-6L/min) (6-8L/min) (6-10L/min) (2-12L/min)

3. Complications of Spinal Anesthesia and Epidural anesthesia

• Most common complication in SA - hypotension, Prevention IVF if not resolved

phenylephrine>ephedrine

• The most common post op complication is urinary retention.

• For post op shivering, treatment is pethidine.

• Post dural puncture headache- 12-24 hrs after block, involves occipital area. For
treatment caffeine and NSAIDs is first line, followed by IVF, epidural patch etc.

• High spinal anesthesia

• Total spinal anesthesia - respiratory depression, bradycardia.

 4. Inhalational Anesthetics uses and side effects

HALOTHANE ISOFLURANE SEVOFLURAN DESFLURANE

E
Color Red Purple Yellow Blue
↑MAC- 0.75 1.12 2 6
↓potency
↓Blood gas 2.25 1.3 0.63 0.42
partition-
↑solubility
CNS Contra-indicated for 2nd agent of choice 3rd agent of Agent of choice
neurosurgery. for neurosurgery, Mc choice for for
used neurosurgery. neurosurgery.
CVS Sensitizes myocardium to Causes coronary steal 2nd choice for Most cardio
arrythmogenic effect of phenomenon. CVS surgeries stable, agent of
catechol-amines, avoided for It decreases systemic choice in CVS
CVS surgeries vascular resistance surgeries.
maximally, used in
“Hypotensive
anesthesia” to control
blood field during
surgery
Respiratory Best bronchodilator, best for - Mc Used for -
system asthma patients Asthma Pts
Liver Autoimmune/ Halothane 3rd best 2nd best Best for hepatic
hepatitis surgeries

Muscle Maximum muscle relaxation

 5. Intravenous anesthetics Uses

SODIUM PROPOFOL KETAMINE ETOMIDATE

THIOPENTONE
Appearance Yellow Milky white solution, made
amorphous up of egg, lecithin and
powder soyabean oil.
CNS Friend of CNS, Decreases ICP, first Increases ICP, Decreases ICP,
enemy of all choice in head injury dissociative cerebroproctective.
Decreases ICP patients and neurosurgery anesthesia No analgesia
Used in
narcoanalysis

RESPIRATORY Bronchoconstric Respiratory depression Bronchodilation Bronchodilation

SYSTEM tion
CVS Decreases BP, Decreases BP,decreases Increase BP and It is the most
increases HR HR HR cardiostable agent
Contraindication Shock, asthma, Shock ▪ Epilepsy
acute ▪ Glaucoma
intermittent ▪ Schizophren
porphyria, heart ia
diseases ▪ Ischemic
heart
disease

Indications DOC for Day IV induction of choice for IV induction of

care surgery ▪ acute Intermittent choice for
porphyria Asthma
▪ LMA insertion. ▪ Shock
▪ Day care surgery ▪ Cyanotic
▪ Malignant heart
hyperthermia disease
Propofol is the only IV
induction agent with
antiemetic properties
Used as a component of
TIVA- total IV
anesthesia.
Side effects Pain during MC- injection site pain Post operative ▪ High incidence of
injection ▪ Propofol should not be delirium nausea and
used >48hrs, it can vomiting.
cause propofol infusion ▪ Over long term
syndrome use, it can cause
▪ Pancreatitis adrenal
suppression by 11
beta hydroxylase
Inhibition.
6. Side effects of Local anesthetics

• Grouped into aminoester and aminoamides.

• Aminoester- one “i” in drug names, cocaine, procaine, chlorprocaine, benzocaine.

• Aminoamides- two “i” in drug names, lignocaine, bupivacaine, prilocaine, dibucaine.

1. BENZOCAINE- associated with meth-hemoglobinemia.

2. LIGNOCAINE- is used in intra-venous regional block.

▪ Lignocaine toxicity causes- peri-oral numbness, tremors, seizures.

▪ It is contra-indicated in hypertension, coronary artery disease, end arteritis.

3. BUPIVACAINE- most cardiotoxic LA drug

▪ It is never given IV, can cause arrhythmias. In case of cardiac side effects,
treatment is done with 20% intralipid, amiodarone.

▪ Bupivacaine, procaine, mepivacine are contra-indicated in surface anesthesia.

▪ It is the best ocular anesthesia

4. DIBUCAINE- most potent and most toxic local anesthetic, not used clinically as much.

▪ Used for dibucaine number test to identify an indivisuals susceptibility to

develop scholine apnea.

• EMLA CREAM- used for surface anesthesia, it has equal mixture of lignocaine2.5%
+procaine 2.5%.

• IVRA- used in limb surgeries most commonly.

▪ Tourniquet is applied with pressure of 50+ systolic BP on upper limb and

100+ systolic BP in lower limb.

▪ Most common drug used for IVRA is 0.5% lignocaine.

▪ IVRA is contra-indicated in Sickle cell anemia, Raynauds disease, Peripheral

vascular disease.
7. Muscle relaxants classification and reversal agents

• It can be depolarizing and non-depolarizing.

• Non depolarizing neuromuscular blockers, act by competitive antagonism.
• The first muscles to relax include head and neck muscle and last to relax is diaphragm
▪ D-tubocurare- 1st NMB introduced by Harold Grifith. Associated with maximum
histamine release.
▪ Atracurium- degraded by Hoffman degradation, releases Laudanosine as metabolite
which can lead to epilepsy. It is muscle relaxant of choice in acute/ chronic liver
dysfunction, renal failure, pediatric patients and elderly.
▪ Mivacurium- shortest NDMR, used in day care surgery.
▪ Pancuronium- it has maximum renal excretion, it increases BP and HR, therefore
muscle relaxant of choice in shock.
▪ Vecuronium- CVS stable, excretion via biliary tract therefore avoided in patients with
jaundice.
▪ Rocuronium- fastest acting MR, used for ETT. Used in rapid sequence intubation.
▪ Succinylcholine- fastest and shortest acting depolarizing MR, the most common side
effect of succinylcholine is muscle soreness, hyperkalemia.
❖ Scholine apnea- a single dose of succinylcholine producing apnea, Dibucaine
number test is done to identify an indivisuals susceptibility to develop scholine
apnea.
Malignant hyperthermia-

8. Malignant hyperthermia diagnosis and management

Malignant hyperthermia- it is triggered by succinylcholine, inhalational agents like halothane,

isoflurane, desflurane, ether etc and lignocaine.

DOC is dantrolene sodium.

Layers pierced in spinal anesthesia are Skin > Subcutaneous Tissue > Supraspinous Ligament >
Interspinous Ligament > Ligamentum Flavum > Epidural Space > Dura Mater > Arachnoid Mater >
Subarachnoid Space

CPCR
• Correct ratio-
▪ Adults- 30:2, with 1 or 2 rescuers
▪ Pediatric case- 30:2 0r 15:2 with 1 or 2 rescuers
▪ Neonate- 3:1 with mmandatory 2 rescuers.
• The correct steps of CPCR are-
▪ Check for scene safety
▪ Call for help
▪ Tap the person and ask if he is okay.
▪ Check pulse
▪ Check breathing and ensure no foreign body is in the oral cavity, if yes clear it.
▪ If breathing and pulse present- put patient in recovery position ( left lateral position)
▪ If breathing - but pulse + give rescue breaths and monitor pulse
▪ If no breathing or pulse then initiate CPR 30:2 ratio
Mapelson A (Magill)- Spontaneous ventilation

Mapelson D (Bain's)- Controlled ventilation

Mapelson E (Ayre's T piece)- Bagless,Valveless

Mapelson F (Jackson Reev's modification of E)- Pediatric patients