Administer Parenteral General Anesthesia 081-833-4548 INSTRUCTOR SFC HILL

OBJECTIVE As a Special Forces Medic given a patient requiring general parenteral anesthesia in a fixed or temporary facility, induce the patient to stage three of general anesthesia in accordance with JSOMTC student manual of anesthesia. Have a student read this slide out loud to the rest of the class.

REASON As a Special Forces Medic you must be prepared to anesthetize a patient requiring invasive procedures. Have a student read this slide out loud to the rest of the class.

PROCEDURES Insure anesthetist preparation Insure patient preparation Induce parenteral general anesthesia Emergency induction of parenteral general anesthesia Have a student read this slide out loud to the rest of the class.

Insure anesthetist preparation Inspect the anesthetist cart insure presents of anaphylaxis kit insure presents of SPARKS kit Insure the proper drugs are present in sufficient amounts and not out of date Preparation is the key to a successful procedure.

Insure anesthetist preparation Insure pharyngeal suction apparatus are operational and manual backup suction is present Switch on, set up and calibrate all monitors Clearly label all syringes with the appropriate agent and amount in milligrams Check all endotracheal equipment Endotracheal equipment includes cric kit.

Insure patient preparation Review preanesthetic visit (SF517) When the patient arrives, verify identity, and the nature and site of the scheduled operation Establish rapport with the patient Re-inform the patient of what will take place. Attempt to alleviate the patients anxiety with words of support and reassurance.

Insure patient preparation Insure a base line set of vitals has been established Insure established IV is patent Attach all monitoring devices Insure the patient has received the proper preanesthetic medication (five rights) NONE

Induce Parenteral general anesthesia Start induction 30 minutes after last premedication was given The premedication at 30 minutes should be at maximum effectiveness.

Induce Parenteral general anesthesia Muscle relaxation Diazepam (induction) 0.3 - 0.5 mg/kg Slow IV push QUESTION: Why is it slow IV push? ANSWER: Diazepam's has a high pH and causes respiratory depression when given to rapid.

REMEMBER! COMPONENTS OF GENERAL ANESTHESIA 1. Unconsciousness (Hypnosis) 2. Analgesia (Areflexia) 3. Muscle relaxation The components of general anesthesia are a very important factor in anesthesia pharmacology. Can any non-recycle tell me why this is so? We do not utilize a single drug produces all the effects that we need to cover all the components of general anesthesia. We have to utilize a combination or cocktail of drugs.

Induce Parenteral general anesthesia Unconsciousness Ketamine (induction) 1 - 2 mg/kg slow IV push QUESTION: Why is it slow IV push? ANSWER: Ketamine causes respiratory depression when given to rapid.

Induce Parenteral general anesthesia On completion of induction, a rapid sequence intubation should be preformed to protect the patients airway The patient should then be placed on anesthesia maintenance Rapid means to move with haste.

Emergency induction of parenteral general anesthesia

Emergency induction of parenteral general anesthesia Emergency patients should be stabilized prior to induction of anesthesia whenever possible With the unstable patient, induction should proceed when only the immediate surgical intervention will save the patients life

Induce Parenteral general anesthesia Muscle relaxation Diazepam (induction) 0.3 - 0.5 mg/kg Slow IV push If the trauma patient is hypotensive this step might be skipped or delayed.

Induce Parenteral general anesthesia Unconsciousness Ketamine (induction) 1 - 2 mg/kg slow IV push Remember Ketamine will increase the patients B/P by 20mm of mercury.

Induce Parenteral general anesthesia On completion of induction, a rapid sequence intubation should be preformed to protect the patients airway The patient should then be placed on anesthesia maintenance Rapid means to move with haste.

SUMMARY OF PROCEDURES Insure anesthetist preparation Insure patient preparation Induce parenteral general anesthesia Emergency induction of parenteral general anesthesia Have a student read this slide out loud to the rest of the class.

RESTATED OBJECTIVE As a Special Forces Medic given a patient requiring general parenteral anesthesia in a fixed or temporary facility, induce the patient to stage three of general anesthesia in accordance with JSOMTC student manual of anesthesia. Have a student read this slide out loud to the rest of the class.