Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.
INDUCTIONAND MAINTENANCE OF GENERALANAESTHESIA Dr Jesymin Choong ACCS CT2OVERVIEW The triad of anaesthesia The common pharmacological agents Induction sequences Maintenance of anaesthesia Intraoperative care Airway/ventilation Induction and maintenance of general anaesthesia 2023 2 Join at vevox.app Or search Vevox in the app store ID:113-562-107 Join:vevox.app ID:113-562-107 POLL OPEN Which best describes your experience 1. Doing or have done anaesthetic placement 0 2. Haven't done anaesthetic placement but have seen anaesthetic delivered 0 3. Have not done or seen any anaesthetic 0 4. I am a pro 0 5. I don't know what I am doing with my life 0 INDUCTIONAND MAINTENANCE OF GENERALANAESTHESIA 2023 4Why general anaesthesia for procedure?TRIAD OF GENERALANAESTHESIA Amnesia General Anaesthesia Paralysis Analgesia INDUCTIONAND MAINTENANCE OF GENERALANAESTHESIA 2023 6PHYSIOLOGICAL CHANGES INDUCED BY PAIN ◼ Stress response to any significant tissue injury and pain • Sympathetic nervous system mediated physiological changes – Fight or Flight • Activation of renin-angiotensin system • Metabolic changes – insulin resistance INDUCTIONAND MAINTENANCE OF GENERALANAESTHESIA 2023 7 Join:vevox.app ID:113-562-107 POLL OPEN Which of the following are acute physiological changes to pain/tissue damage? Vote for up to 4 choices ✔ 1. tachycardia 0 2. hypotension 0 ✔ 3. hyperglycaemia 0 4. state of anabolism (making more stored nutrients) 0 ✔ 5. fluid retention 0 ✔ 6. hypercoagubility 0 INDUCTIONAND MAINTENANCE OF GENERALANAESTHESIA 2023 8INDUCTIONAND MAINTENANCE OF GENERALANAESTHESIA 2023 9OTHER CONSIDERATIONS ◼ Immobilise the patient ◼ Eliminate involuntary muscle movements (or‘voluntary movement’) ◼ Specific procedures require absolute paralysis ◼ Airway protection ◼ Positioning during the procedure ◼ Duration of the procedure INDUCTIONAND MAINTENANCE OF GENERALANAESTHESIA 2023 10SOME PHARMACOLOGY…REMEMBERTHETRIAD Sedatives Neuromuscular Analgesia blockers INDUCTIONAND MAINTENANCE OF GENERALANAESTHESIA 2023 12 Join:vevox.app ID:113-562-107 POLL OPEN Which of the following is a sedative agent? Vote for up to 3 choices 1. morphine 0 ✔ 2. midazolam 0 3. propofol ✔ 0 4. fentanyl 0 ✔ 5. sevoflurane 0 INDUCTIONAND MAINTENANCE OF GENERALANAESTHESIA 2023 13 Join:vevox.app ID:113-562-107 POLL OPEN Which is a analgesia? Vote for up to 3 choices ✔ 1. morphine 0 ✔ 2. fentanyl 0 3. midazolam 0 4. propofol 0 5. alfentanil ✔ 0 INDUCTIONAND MAINTENANCE OF GENERALANAESTHESIA 2023 14 Join:vevox.app ID:113-562-107 POLL OPEN Which is a neuromuscular blocker? Vote for up to 2 choices 1. diazepam 0 ✔ 2. rocuronium 0 ✔ 3. suxomethonium 0 4. metaraminol 0 5. adrenaline 0 INDUCTIONAND MAINTENANCE OF GENERALANAESTHESIA 2023 15SEDATIVES/HYPNOTICS All works by potentiating GABA receptors (apart from ketamine). ◼ IV agents ◼ Volatile agents ◼ Propofol ◼ Sevoflurane ◼ Thiopental ◼ Isoflurane ◼ Etomidate ◼ desflurane INDUCTIONAND MAINTENANCE OF GENERALANAESTHESIA 2023 16What about benzodiazepine? ◼ Amnesia ◼ Adjunct for synergic effect INDUCTIONAND MAINTENANCE OF GENERALANAESTHESIA 2023 17ANALGESIA ◼ OPIODS ◼ Morphine ◼ Fentanyl ◼ Remifentanil ◼ Alfentanil ◼ Reduce the dose requirement for anaesthetic agents ◼ ‘Multimodal analgesia’ INDUCTIONAND MAINTENANCE OF GENERALANAESTHESIA 2023 18NEUROMUSCULAR JUNCTION BLOCKERS ◼ Prevent acetylcholine binding to the postsynaptic receptors ◼ Non-depolarising:rocuronium,atracurium ◼ Depolarising:suxomethonium INDUCTIONAND MAINTENANCE OF GENERALANAESTHESIA 2023 19KETAMINE ◼ NMDA receptor antagonist ◼ ‘Dissociative anaesthesia’ –‘awake’ but not memory ◼ sedation,analgesia,anxiolytic INDUCTIONAND MAINTENANCE OF GENERALANAESTHESIA 2023 20 Propofol Opioids Benzo’s ketamine Volatile Rocuronium, atracurium INDUCTIONAND MAINTENANCE OF GENERALANAESTHESIA 2023 21INDUCTION OF GENERALANAESTHESIA ◼ the transition from consciousness to unconsciousness at the outset of a general anaesthetic. ◼ Patient arrived 🡪 checklist 🡪 cannulation 🡪 standard monitoring 🡪 pre-oxygenation 🡪 induction 🡪 (intubation + ventilation) 🡪 maintenance ◼ IV induction vs volatile induction INDUCTIONAND MAINTENANCE OF GENERALANAESTHESIA 2023 22 Join:vevox.app ID:113-562-107 POLL OPEN Which order to give the following medications? 1. propofol > fentanyl > rocuronium 0 ✔ 2. fentanyl > propofol > rocuronium 0 3. propofol > rocuronium > fentanyl 0 4. rocuronium > propofol > fentanyl 0 INDUCTIONAND MAINTENANCE OF GENERALANAESTHESIA 2023 23 Join:vevox.app ID:113-562-107 POLL OPEN WHICH OFTHE FOLLOWING IS USED FOR MAINTENANCE OF ANAESTHESIA? Vote for up to 2 choices 1. Propofol ✔ 0 ✔ 2. Sevoflurane 0 3. Morphine 0 4. Fentanyl 0 5. Rocuronium 0 INDUCTIONAND MAINTENANCE OF GENERALANAESTHESIA 2023 24INTRAOPERATIVE CARE ◼ Temperature maintenance with prevention of hypothermia ◼ Care of patient positioning and protection of pressure areas and eyes ◼ Eye tapes ◼ No pressing on metals/wire ◼ Fluid homeostasis ◼ Management of bleeding INDUCTIONAND MAINTENANCE OF GENERALANAESTHESIA 2023 25 Join:vevox.app ID:113-562-107 POLL OPEN Which of the following reliably produces unconsciousness in a patient? Vote for up to 2 choices 1. Volatile agents ✔ 0 2. neuromuscular blockers 0 3. Opioids 0 4. Simple analgesia 0 5. Benzodiazepine 0 6. Intravenous anaesthetic agents ✔ 0 INDUCTIONAND MAINTENANCE OF GENERALANAESTHESIA 2023 26 Join:vevox.app ID:113-562-107 POLL OPEN Which of the following contributes significantly towards providing muscle relaxation for surgery? Vote for up to 3 choices 1. Volatile agents ✔ 0 ✔ 2. neuromuscular blockers 0 3. Opioids 0 4. Simple analgesia 0 ✔ 5. Benzodiazepine 0 6. Intravenous anaesthetic agents 0 INDUCTIONAND MAINTENANCE OF GENERALANAESTHESIA 2023 27 Triad of anaesthesia – amnesia + analgesia + paralysis Induction sequence:opioids followed by anaesthetic agent,then SUMMARY neuromuscular blockers if required Intraoperative care – maintenance of anaesthesia and other general care INDUCTIONAND MAINTENANCE OF GENERALANAESTHESIA 2023 28THANKYOU Questions? INDUCTIONAND MAINTENANCE OF GENERALANAESTHESIA 2023 29
