1. Safe anesthesia for sterilization
Dr. S. Parthasarathy
MD, DA, DNB, Dip Diab.MD ,DCA, Dip software based statistics,
PhD (physiology)
Associate professor Dept of anaesthesiology and critical care , MGMCRI puducherry

2. Prof. Ravishankar !!

3. Why was this topic given ??
Thinking ??

4. Subramaniya bharathiyar
முப்பது கோடி முகமுடையாள் ,உயிர் மொய்ம்புற வொன்றுடையாள் –
இவள் செப்பு மொழி பதினெட்டு உடையாள் எனிற்  சிந்தனை ஒன்றுடையாள் . 
Safe conduct is essential
Population of India in 2013 ! -1,270,272,105 (1.27 billion)

5. We have to put a full stop some where !!

6. safety

7. There was one question ?? Which is the greatest risk in anesthesia ??
Safety margin is its maximal risk !!
What is that ??
Thio 3 or 6
Ketamine 1- 3
Spinal 2 or 3 ml ??

8. Preanaesthetic checkup
Is it there ??
Akin to God ??
Harakiri
Briyani served
Missed !!

9. Preanaesthetic check up ??
Previous surgical history
Previous anaesthetic history
Snoring
Fasting – means what ??
Systemic illness
Why should I tell my fits to this doctor for PS ??

10. Clinical examination Fever Sub involution Previous laparotomy
Systemic diseases
Dental, polio , etc..
PV findings
Baby fine ??

11. Investigations Hb. Concentrate on Hb targets and not on PS targets !!
Urine complete
Pus cell cast –
ECG ???

12. Sterilization is an elective case

13. Systemic illness
Better to do it in medical colleges or tertiary care institutions

14. Examples Bronchial asthma Nebulized drugs , regional anesthesia
Diagnosis !!!

15. Anemia Hb 9 gm % -- possible borderline
Can we give blood – improve Hb and operate ?? NO

16. Cardiovascular disease
Possible with minimal risks
Cardiac grid
Idealize
Talk with physician
Convince for a Vasectomy

17. Preanaesthetic concerns
Jewels, dentures, glasses. Removed
Consent form
Beware = empty the bladder
Ovarian cyst ??

18. Equipments Anaesthesia machine Suction Laryngoscope Drugs ET tubes
Pulse oximetry
BP apparatus
How many are working ??
Drugs
LMA

19. All are available – nearby

20. Anaesthetic options

21. Dhoni has lost in Ranchi
Is it possible !!
Activate an epidural
12 to 14 ml of 1.5 to 2 % ligno
with adrenaline.
If facilities permit,
fentanyl 25 mic. gm.
Level of T6
Upto 36 hours similar doses

22. Intrathecal prior intravenous access and adequate preloading
hyperbaric bupivacaine (1.8 to 2.2 ml)
Relaxation but head down in lap
No urgency and monitoring
No polypharmacy
Back preparation

23. General anaesthesia Controlled GA Spontaneous LMA TIVA – drugs
Technique is changing
but the narcotic is mostly
pentazocine 20 – 30 mg. IV

24. General anesthesia – continued
Preoxygenation and RSI
Scoline one more dose
With or without ET tube
Or rare atracurium relaxants with ?? Post op care centres
LMA is available in some centers and used as emergency equipment
Aspiration ??

25. Lot of studies Propofol fentanyl Propofol remifentanyl
Propofol isoflurane
are described – similar results
Rarely propofol and ketamine is used .

26. But what is common A masala of 1.Inj. Atropine 0.6 mg
2.Inj. Diazepam 5 mg
3. Inj Pentazocine 30 mg
4. . Inj ketamine 40 – 70 mg ( 1.5 mg / kg )
Mask oxygen – few puffs –
Scoline= 0.5 mg / kg SOS

27. Have we seen this book ??

28. The Govt of India says ?? Pethidine + promethazine IM
followed by pethidine IV shots and local
Obese and uncooperative patients controlled GA
No ketamine
No mention about spinal
Continuously talk with patient

29. It is safe
But is it anesthesia ??

30. Monitoring
Pulse oximetry , ECG, NIBP !! ETCO2 ??

31. Complications Difficult identification and mobilization of the tubes
Local skin infections bladder inj.
Intraoperative bleeding perforation
Delayed hemorrhage diffi. Pneumo
Bowel laceration
Vascular injury
Failure

32. If urgent sterilization(disinfection) is needed

33. Postoperative pain
Incision Pneumo peritoneum Tubal ischemia NSAIDs Narcotics are reserved – not for pain but for the night Day care ??

34. Some other options

35. Post op period Some nurse Medical officer
Trained in picking up complications

36. Stick to basics and expect the unexpected
To summarize
No routine working
Preop – no systemic illness , fasting -baby ??
Anaesthetic options -- but TIVA with ketamine
The Govt. stops
Monitoring
Complications
Post op pain
Trained personnel
Stick to basics and expect the unexpected

37. Hiccups, problems, defects
Yet surgeries are successful
Experience -
surgeon, anaesthesiologist , staff
BMI of patients

38. I may not have told something new
I emphasize that practice old things foolproof

39. Long live ISA

40. Thank you all