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types of anesthesia 2.pptx
1.
2.
3.
4. History :
1st clinical practise was demonstrated by
Carl koller in 1884
Effective local anesthetic “ Procaine “
Founded in 1905
Lidocaine was founded By LOFGREN In
1948 and used by T. GORDH in 1949
5. Not irritant
Low systemic toxicity
Short onset of action
Effective
No allergic effects / reactions
6. Local anesthesia is defined as a loss
of sensation in a circumscribe area of
the body caused by inhibition of
conduction process in peripheral
nerves
Types :
Topical
Infiltration
7. Local anesthesia is available
in the form of gel or cream
which can be applied on the
surface of the skin
Drugs like – lidocaine ,
Tetracaine, cocaine,
benzocaine
8. Local infiltration anesthesia is
the technique of producing loss-
of-sensation restricted to a
superficial, localized area in the
body
Drugs used like – procaine ,
lidocaine, bupivacaine,
ropivacaine
10. Ocular complications – due to inj at wrong site
during dental procedures
Paresthesia – trauma to nerve
Facial nerve paralysis – occur when over dose of
anesthesia inj into deep lobe of parotid gland
Soft tissue injury over lips and mouth
Hematoma
Pain on injection
Infection – contaminated drugs / needles
Edema
11.
12. General anesthesia is defined as reversible loss of
consciousness / sensation in patient using
anesthetic drug.
Types :
Balanced anesthesia
Total inhalational anesthesia
Total intravenous anesthesia
15. 1. Premedication :
administration of drugs before induction. It is given 40 – 30mins prior
to the surgery
Goals
Analgesic
To reduce anxiety
Decreses secretion
Facilitate induction
Prevent post op nausea & vomiting
Facilitate post op analgesia
Drugs used :
Benzodiazepines
Barbiturates
Glyco ; atropine, ranitidine, metaclopramide
16. 2. Pre oxygenation :
after administration of pre
med, monitoring parameters
are connected and 100% of O2
for 3mins are administered to
reduce the stored nitrogen in
the body to increase the o2
reserve capacity. It is also
known as denitrification
17. 3 . Induction : it refers to transition from an
awake to an anesthetized stage
Routes : IV route and inhalational route
Inhalational :
Agents used – Sevoflurane, desflurane, N20,
halothene
Indications :
Young children’s
URT and LRT obstruction
No accessible veins
18. Intravenous :
Drugs used : induction agents + opioids + MR
Properties :
Rapid onset
Rapid recovery
Minimal cvs & Rs depression
No toxic reactions
No excitatory actions ( cough, hiccup)
Technique :
Access for good iv line
Preoxy is must and connect monitors
Doses varies with age and weight
Slow injection is recommended
19. 4. Intubation :
After the effect of muscle
relaxant and induction agents
patient becomes unconscious
and the next step is to secure
the airway.
Airway is secured by using
endotracheal tube Or LMA
Position is confirmed by
auscultation and capnography
20. 5. Maintanance :
The phase of anesthesia Is maintained with
33% of O2 + 66% of N20 + inhalational agent
6. Reversal and extubation :
At the end Of surgery, the effect of MR is
reversed by Neo + glyco
Once the pt able to breathe by own check for
vitals, remove the tube and suction the oral
cavity
21. Definition : It is a technique of GA which uses a
combination of agents given oly through IV route
without the Use of inhalational agent except O2 and
air
Indications :
Malignant hyperthermia
Long QT syndrome
H/0 severe PONV
Tubeless ENT / thoracic surgery.
Difficult intubation
22. Drugs : propofol, ketamine, etomidate, fentanyl
Adv:
No mask over face
No risk of hyperthermia
No incidence of PO delirium
Less PONV
Less OR pollution
Disadv :
Pain
Difficult finding vein.
Diff in obese pt
Risk of bac contamination
23. It refers to the delivery of gases / vapours to
respiratory system to produce anesthesia
Indications :
For IV cannulation in pediatric
Control of status epilepticus
Pt with difficult IV line
24. Advantages :
Easy to administer
Rapid induction
Easy and cheap
no cvs and rs depression
No toxic effects
No post op pain
Disadvantage :
Adverse drug effects
Nephrotoxicity, hepatotoxicity
PONV
Post op hyperthermia
25. Intra op :
Chances of aspirations,
Trauma to lips , teeth and tongue
Hypoxia and hemodynamics changes due to drug
Less / over fluid administration
Anemia
Air embolism
26. Post op :
Inadequate reversal
Laryngospasm
Bronchospasm
Bradycardia
Urine retention
Delayed :
Sore throat
Cough
Tracheitis
Hoarseness of voice
27.
28. It is the use of LA to block the sensation of pain
from a Larger region / particular region of the body,
such as arm / leg or abdomen.
Types :
Neuraxial block
Peripheral nerve block
Iv regional
29.
30. It refers to the local
anesthetic placed
around the nerves of
CNS such as spinal,
caudal and epidural
anesthesia
31. SPINAL ANESTHESIA
Skin
Subcutaneous tissue
Supraspinous ligaments
Interspinous ligaments
Ligamentum flavum
Durameter
Sub dural space
Arachnoid space
Subarachnoid space
33. Spinal tray
Sterile gloves
I v lines
LA with 2 ml syringe
Spinal drug ( bupi heavy 0.5% )
5ml syringe
Spinal needles
betadine solution
35. Assess for the correct site
Clean the area
Feel lumbar
Inject LA
After 2 – 3 mins introduce spinal needle
Remove stylet wait for CSF flow
Inject bupi and ask pt to lie immediately
Check for dermatome level
36.
37. It is used to detect the spread of spinal
anesthesia In patient
T10 – umbilicus
T4 – nipples
T6 – xiphoid
T12 – L1 – inguinal
S2- s4 - perineum
38. Types :
Dura cutting - Quincke & pitkin
Dura separating – whitacre
Sizes : 18 – 26 G
18 --- pink 22 – black 26 – brown
19 – ivory 23 – blue
20 – yellow 25 – orange
39. Advantages :
Cheap
High patient satisfaction
Maintain pt airway
Decresed blood loss
Disadvantage :
Difficult in elder
Hypotension
Pt can talk
Pt increase toxicity
41. EPIDURAL ANESTHESIA..
An anesthetic drug is injected into the epidural space
surrounding the fluid filled sac around the spine to
numb the larger region eg. Abdomen and legs
Layers piercing :
Skin
Subcutaneous tissue
Supraspinous ligaments
Interspinous ligaments
Ligamentum flavum
Duramater
42. Inform consent
Sterile epidural tray & gloves
NS 100ml
Betadine solution
Plaster
10,2ml syringe
Epidural set
Iv line and set
Needles, syringes
Drugs – bupivacaine 0.5, lignocaine 2.0, LA with
adrenaline, opioid
44. Monitor vitals
Prepare and clean
Feel lumbar and inject LA
Needle introduction ( L3 – L4)
Once space confirm introduce 2-
3ml of LA with adrenaline and
insert the cathether
Fix the cathether and bac filter
carefully
46. All operation below diaphragm
Poor risk patient
Cardiac and pulmo disease
GA contraindicated
Long duration surgery
Post operative pain relief ( drug infusion)
Risk in Ceaserean
50. Caudal anaesthesia, is a form
of neuraxial regional
anaesthesia conducted by
accessing the epidural space via
the sacral hiatus. It is typically
used in paediatrics to provide
peri- and post-operative
analgesia for surgeries below
the umbilicus. In adults it is
used for anorectal surgeries
51. Anesthesia and analgesia below
umblicus
To treat chronic pain in adults
Ano rectal surgeries in adult
Pediatric and neonatal
Inguinal herniorraphy
52. Infection at needle site
Coagulopathy
Pilonidal cyst
Congenital abnormalities of lower spine
Meninges
61. It is defined as a local
anesthesia induced
blockage of peripheral
nerve impulses from a
targeted body part with
a preserved level of
consciousness
63. No GA complications
Patient remains awake
Post op analgesia is maintained with
cathether
Less PONV – less opioids
Hemodynamic stability is maintained
Growing technique
64. Time delay
Discomfort during procedure
Block failure can occur
Nerve damage
LA toxicity
Seizures – in case of any arterial blockage
65. Pt refusal
Hemophilia
Anticoagulant drug
Infection at site
LA allergy
Pediatric patients
Blood stream infection
Peripheral neuropathy
Uncooperative patient
66.
67. This technique was first
introduced in 1908 by a
surgeon August bier
Bier block is a technique of
injecting Local anesthesia
solution through intravenous
route
68. Surgical procedures ( arm below
elbow)
Surgical procedure ( leg below knee)
Minor surgical procedures
Burn patient
69. Pt refusal
Compound fracture
Inability to locate IV line
Local skin infection
H/0 local anesthesia
allergy
Patient with vascular
injury
Sickle cell disease
70. Easy
Low incidence of block failure
Safe technique
Rapid onset and recovery
Contraindication
Chances of compartment syndrome