anesthetic technique

ANESTHETIC TECHNIQUE

Dr. Reza Aminnejad

Assistant Professor of Anesthesiology & Critical Care

Qom University of Medical Sciences

CHOICES FOR ANESTHESIA

General Anesthesia

Regional Anesthesia

Monitored Anesthesia Care (MAC)

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GENERAL ANESTHESIA

Immobility

Amnesia

Analgesia

Lack of Patient Harm

The American Society of Anesthesiologists (ASA) defines generalanesthesia as “a drug-induced loss of consciousness during whichpatients are not arousable, even by painful stimulation.”

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REGIONAL ANESTHESIA

Neuraxial (Spinal, Epidural, Caudal) Anesthesia

Peripheral Nerve Blocks

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MAC

Specific anesthesia service in which ananesthesiologist has been requested to participate inthe care of a patient undergoing a diagnostic ortherapeutic procedure

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CHOOSING AN APPROPRIATE ANESTHETIC TECHNIQUE

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DECISION MAKING PROCESS

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INHALED INDUCTION OF ANESTHESIA

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INDUCTION OF ANESTHESIA WITH SEVOFLURENE

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IV INDUCTION OF ANESTHESIA

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INDICATIONS OF RSI OF ANESTHESIAIncreased risk for aspiration of gastric contents

Clinically significant gastroesophageal reflux disease

Delayed gastric emptying

Unknown fasting state

Known full stomach

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SEQUENCE OF RSI

(1) preoxygenation

(2) intravenous administration of a hypnotic (e.g., propofol);

(3) immediate administration a of a rapid-onset neuromuscularblocking drug (e.g., succinylcholine 1.0-1.5 mg/kg orrocuronium 1.0-1.2 mg/kg);

(4) application of cricoid pressure (using force of 30 newtons,approximately 7 pounds);

(5) avoidance of ventilation via a mask or

(6) tracheal intubation; and

(7) release of cricoid pressure after confirmation of correctendotracheal tube placement

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MODIFIED RSI

Though ventilation via a mask is generally avoidedwith RSI, the use of positive pressure less than 20 cmH2O (called modified RSI)

should minimize the risk of gastric insufflation andmay be needed if the patient develops hypoxemiaprior to tracheal intubation.

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AIRWAY MANAGEMENT TECHNIQUES

Direct Laryngoscopy

Supraglottic Airway Placement

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MAINTENANCE OF ANESTHESIA

After induction of anesthesia and appropriate airwaymanagement, anesthesia is maintained typically byadministration of a combination of anesthetic drugs,each titrated to achieve the desired anesthetic goalwhile minimizing side effects.

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MAC

•The most dangerous anesthetic risk during MAC isrespiratory depression from excessive sedation.

•The manifestations of respiratory depression includeupper airway obstruction, hypoventilation, andhypoxemia.

•During MAC, end-tidal capnography can beaccomplished with a nasal cannula that has adedicated sampling line attached.

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ENVIRONMENTAL IMPACT

The environmental impact of inhaled anesthetics can be minimized

by use of

Total intravenous anesthesia

Low-flow anesthesia

Closed-circuit anesthesia

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ANY QUESTION?

THANKS FOR YOUR ATTENTION