1. Administration of Anaesthesia
Presenter: Dr S Spijkerman
Slides: Prof EE Oosthuizen
SBAH & UP

2. TYPES OF ANAESTHESIA General Anaesthetic Regional Anaesthetic
Unconscious
Regional Anaesthetic
Awake / Sedated
Combined General - Regional
Conscious sedation
New name: Procedural sedation

3. PHASES OF A GENERAL ANAESTHETIC
Pre-op evaluation and medication
Preparation of equipment and drugs
Intravenous access
Induction of unconsciousness
Management of the airway
Maintenance of Anaesthesia
Wake-up and reversal of muscle relaxation (NDMR)
Observation and support in PACU

4. Start to plan the Anaesthetic when you do the preoperative assessment of the patient!

5. Factors that influence the choice of Anaesthetic
Physiological status of the patient
(physiological reserves)
Anatomical abnormalities
Pathology necessitating surgery
Nature of the procedure
Duration of the procedure
Current medication

6. Factors that influence the choice of Anaesthetic (contd)
Availability of equipment and drugs
Skills and experience of the anaesthetist
Preferences of the patient

7. Factors that influence the choice of Anaesthetic (contd)
CONCLUSION:
Every Anaeshetic must be tailor-made for the individual patient and the specific surgical procedure!

8. Preparation for Theatre
Signed (informed) consent
Mass (kg)
Empty bladder
“Nil per os”
Preoperative medication
Chronic medication
Dentures / artificial limbs, eyes
Jewels

9. Preparation for Theatre(cont’d)
All make-up removed
Appropriate theatre attire
Identity and allergy tags
Vital signs recorded

10. CONSENT Voluntarily Not retrospectively Informed
Permission only includes permissible risks

11. Induction of Unconsciousness
Surgical team must be on hospital premises
Preflight checklist of equipment and drugs
Emergency drugs and equipment
Meticulous identification of drugs
Positioning on the table
Monitors connected
Patent, running intravenous line
Vitals recorded before take-off
Proper intravenous access
Routes of induction:
IV / Inhalation / IM / Rectal

12. AIRWAY Maintenance of the Airway Facemask & oropharyngeal airway
Endotracheal intubation
LMA

13. Indications for Intubation
Protection of the airway
Maintenance of the airway
Controlled ventilation (relaxants)
Surgery on head and neck (access)
Longer procedures (>30 minutes)
Babies & small children

14. Intubation technique Opening of the mouth Laryngoscope in left hand
Tongue to the left
Slide blade over the tongue
Deeper & shallower to find epiglottis
Lift, not hinge
Tip of McIntosh  vallecula
Tip of Miller posterior to epiglottis

15. Popular Laryngoscope Blades
Macintosh
Miller

17. Correct placement of Endotracheal Tube?
See tube passing through cords
Auscultate
See bilateral chest movement
Press on chest and listen
Oximetry (late sign)
Capnography
High index of suspicion

18. Complications of Intubation
Sore throat
Incorrect placement
Trauma
Regurgitation / Aspiration
Bronchospasm
“Stress response”

19. Rapid Sequence Induction
To be performed on all patients with a risk for aspiration:
Not fasted
Delayed stomach emptying
Regurgitation (hiatus hernia)

20. RSI Check all equipment before take-off, then:
1. Preoxygenate for 3 minutes
2. Induction with rapid acting agent
3. Cricoid pressure (Sellick’s maneuver)
4. Suxamethonium
5. Intubate & inflate cuff
6. Confirm correct placement of tube
7. Release cricoid pressure

21. PREOXYGENATION 100% Oxygen Tight fitting mask 3-5 minutes OR
3-5 Vital Capacity Breaths with 100% O2

22. Traditional Components of a Balanced General Anaesthetic
HYPNOSIS
ANALGESIA
MUSCLE RELAXATION
(not essential)

23. Duty of Anaesthetist during an Anaesthetic
Oxygenation status
Awareness
Maintain correct plane of Anaesthesia
Haemodynamic / respiratory monitoring & manipulation
Positioning
Ensure well-being of the patient perioperatively
Create optimal surgical conditions
Postoperative pain management

24. Duty of Anaesthetist during an Anaesthetic
Anaesthetist / Anaesthesiologist is the perioperative physician!

25. Inadequate Anaesthesia
Tachycardia / Dysrhythmias
Hypertension
Sweating / Salivation / Tears
Movement if not relaxed
Dilation of pupils
Increased breathing efforts if not paralysed

26. Signs of an Overdose of Anaesthesia
Hypotension without other cause
Bradycardia
Respiratory depression / apnoea in spontaneously breathing patients

27. Intraoperative Monitoring
Monitor changes in physiology
Senses are the most valuable monitors!
Anaesthetist must be able to integrate all the parameters and respond accordingly
Meticulous record keeping

28. Record Keeping Good record keeping ensures an easy defence!
If it wasn’t recorded, it wasn’t done!