General Anaesthesia

General Anaesthesia brings the whole body into an anaesthetic state without sensation and also brings the body back to the original state.It was discovered by Dr.Martin in 1846 A.D Introduction

Patients who need general anaesthesia are Un cooperative Patients Children Injury Case Long duration of surgery –E.g:- Orbitotomy Mentally retarded patients.

Patient should not take solid diet within 6 hours of surgery and should not take liquid diet within 4 hours of surgery. If the patient has cough,fever,cold,skin disease,epilepsy,heart almeats,asthma,diabetes, hypertension and allergy a physician opinion is mandatory before GA. If the patient takes drugs for any reason physician opinion can be obtained. Preoperative Instructions

It is painless It makes patient care and without calm and without tension It brings the muscle to a relaxed state It brings the patient back to original state Advantages

The patient should be under starvation before GA, because the patients life will not be in danger.So the patient should be in empty stomach before surgery solid diet should be consumed before 6 hours and liquid diet should be consumed 4 hours before surgery. –0-6 months –4 hours –6 months-2 years-5 hours –2 years-adult –6 hours Starvation

Patient should be relaxed,wearing clean clothes before surgery. Artificial dentures,gold jewel like rings, bangles and nose rings should be removed. Children should be given preference Case sheet should be checked well Weight temperature and pulse should be recorded GA card should be noted Blood investigation should be done.(HB,RBC) If the patient is above 40 TC,DC, ESR,Blood sugar,urea, Creatinine,ECG should be done. Preoperative Preparation

In diabetic patient,fasting blood sugar is noted on the day of surgery If the patient takes any drugs for hypertension,cardiac problem,TB,Fits the morning or evening dose is taken and if there is any general problem.the physician or anaesthetist opinion is obtained. Blood group,BT,CT,HB urine sugar and blood sugar is done for long time surgery Starvation should be checked before premedication.

Drugs should be given 35 to 45 minutes before surgery.It is given intramuscularly It makes the patient without any fear and relaxed. Inj Atropine increases the pulse rate and controls the salivary secretion Inj.midazolam makes the patient to a sleepy state Inj.Atropine should not be given to cardiac and epileptic patient Premedication Dosage is given adjusted to the patientand weight. Example:- 6 months –1 Year –1/4 CC Atropine, 1/2 cc Fulsed Premedication

For Example;- 0-6 months -NO premedication 1 year –2 year -1/4 CC Atropine +3/4 cc Inj.fulsed 2 year-4 year - Inj.1/2cc atropine +Inj.1cc fulsed 4 year-7 year - Inj.1/2 cc atropine +1 ½ cc fulsed 7 year-12 year - Inj.1/2 cc atropine +Inj.2 cc fulsed 12 year-Adult - Inj.1 ccatropine +Inj.3 cc fulsed. Premedication

Important things for boyle’s apparatus –Cylinder (O2,N2O) –Mask with Circuit –Air way –Endotracheal Tube –Laryngoscope –Suction Apparatus –B.P.Apparatus –Pulse Oximeter –Medicines – Halothane or savoflurane Monkey spaner Cylinder key The Instrument and used to give GA is called Boyle’s Apparatus

Venflon:- 24 G-Yellow Colour 22 G-Blue colour 20 G –Pink Colour 18 G –Green Colour Butterfly needle (or) Scalpvein Set:- 21G,22G,23 G,24 G

Others:- 10 CC syringes 5 CC syringes 2 CC syringes IV Set Scissors Xylocaine Jelly Spirit Wipper(Dry cotton )

Injections:- Inj.Thiosel Inj.Sueul Inj.veeronium Inj.Norcuron Inj.Propofel Inj.Medazolam Inj.Fortwin Inj.Abopine or Glycopyolate Inj.Neestigmine Inj.Ketamine Inj.Fentanil All Emergency Injections.

If patient has respiratory infection then tube is introduced there are changes for sputum to block the tube causing stagnatia of liquid in lungs.This reduce the SPO2 Chances are there may be a reduction in pulse rate. The Instrument and used to give GA is called Boyle’s Apparatus

Deatiled about surgery should be know She should be checked whether all investigations are done. She should check whether all things necessary for GA are available At the end of surgery injection neostigmine & Atropine given for the recovery of anaesthesia. Things to be noted by nurse during given GA

Since the patient under GA can not swallow his secretions, suction apparatus sucks the saliva using suction catheter. Vomitting and secretion are also aspirated. Use of Suction apparatus

Patient is brought to recovery room after surgery patient is made to lie laterally with the head tiled backward and one leg folded Patients vital signs are monitored. Instructions to be given regarding food intake after recovery. Oral fluid after recovery – 0 –2 years after 3 hours. –2-12 years after 3 hours if there is no vomitting. –12 years Adult –After 4 hours if there is no vomitting 12 year to adult after 4 hours if there is no vomitting. Recovery Room

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