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Consent
HISTORY
Review Surgical illness Co existing medical illness Medications Allergies and drug reaction Previous anaesthetic history Relevant family history Addiction
PHYSICAL EXAMINATION
Vital signs Cardiovascular system Respiratory system Other systems ( CNS, abdomen, extremities)
INVESTIGATIONS
ROUTINE
Complete haemogram Sugar, urea, creatinine ECG Chest Xray Serum electrolytes Coagulation studies LFT Thyroid profile Miscellaneous
SPECIAL
PREOPERATIVE PREPARATION
Optimization of co-morbid conditions
Cardiovascular diseases Respiratory disease Endocrine diseases
Aspiration prophylaxis
CHECKING OF MACHINE
Check pipeline and cylinder supplies Test flowmeter Perform leak check of machine and breathing system Check scavenging system Vaporiser
CHECKING OF EQUIPMENT
Functioning laryngoscopes Proper size endotracheal tubes Others
SEQURE IV LINE
Life line of the patient
Intravenous Anaesthesia
Suitable for most routine purposes
COMPLICATIONS
Regurgitation and vomiting Intra arterial injection of Thiopentone Perivenous injection and tissue necrosis CVS, respiratory depression Anaphylaxis Aggravation of porphyria Others
Inhalation Anaesthesia
Done in paediatric age group Patients with airway obstruction
COMPLICATIONS
Slower induction Problem in stage 2 of anaesthesia Laryngospasm & bronchospasm Raises intracranial pressure Environmental pollution
MAINTAINENCE OF ANAESTHESIA
Nitrous oxide or Medical air Inhalational agents Muscle relaxants
Transfusion therapy required when blood loss is more than 20% of the total blood volume
COMPLICATIONS
Laryngeal spasm Regurgitation
Management
Oxygen therapy Analgesia IV fluids to continue Continue monitoring
In critically ill patients, shift to ICU and provision for mechanical ventilation
COMPLICATIONS
Post operative nausea and vomiting Pain Ventilatory depression Haemodynamic instability Acute renal failure Surgical complications