ANESTHESIA TECHNIQUES

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GENERAL ANESTHESIA General anesthesia is the abolition of pain or sedation by a temporary reversible loss of consciousness. Premedication • Anxiolytics - decreases anxiety Midazolam, Benzodiazepine, Diazepam • Anti-emetics – to reduce nausea or vomiting Ondansetron, Metoclopramide • Antacids – Ranitidine • Anti-sialagogues – to decrease tracheo-bronchial secretions Atropine, Glycopyrolate • Antibiotics – to decrease infections Amoxicillin, Cephalosporin • Analgesics – opioids Morphine, Fentanyl Pre-oxygenation It is done to reserve oxygen saturation so that the patient doesn’t go into hypoxia during the intubation. The intubation takes time where the patient’s airway is blocked and saturation might drop. Pre-oxygenation is done for 3 minutes where FiO2 = 100%. Induction IV agents • Propofol – mostly used • Thiopentone sodium – for an epileptic patient exclusively • Ketamine – pediatrics Inhalational agents • Isoflurane – mostly used • Sevoflurane - pediatrics Muscle relaxants • Succinyl choline – depolarizing agent given before intubation (or for short time procedures) • Atracurium, Vecuronium – non depolarizing agents (mostly used) – maintenance relaxants Intubation • Oral or nasal intubation • Direct laryngoscopy, video laryngoscopy or fibreoptic bronchoscopy can be done to aid intubation. • The patient end of the infraglottic airways reach the carina of the trachea • The patient end of the supraglottic airways reach the larynx. • Cuffs of the tubes are inflated with cuff syringe • Auscultate for lung sounds to confirm the airway position. • The tube is then secured with tapes. Maintenance of anesthesia • Oxygen + inhalational agent + nitrous oxide + Atracurium or Vecuronium Maintenance is done until suturing is complete. Reversal Neostigmine + Glycopyrolate (myopyrolate inj) Glycopyrolate is given to reduce secretions caused due to neostigmine Extubation • Suction the airway • Deflate the cuff • Remove the intubated airway • Oxygenate the patient through face mask • Disconnect the monitors • Monitor the vitals

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