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By ULY CLINIC

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ANESTHESIA

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Introduction

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Anesthesia is a state of controlled reversible loss of consciousness usually accompanied by analgesia, muscle relaxation, amnesia and areflexia. It is usually induced for the purpose of facilitating surgery and other therapeutic or diagnostic procedures. It is a continuum of clinical services that range from monitored anesthetic care, sedation to deep general anesthesia or it can be regional anesthesia alone or combined with light general anesthesia. 

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 Anesthesia may be achieved with either

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  • Regional anesthesia alone e.g. spinal/epidural anesthesia, arm block

  • General anesthesia

  • A combination of regional and general anesthesia

  • Regional anesthesia with sedation

  • Local anesthesia through topical application/spray or infiltration of local anesthetics

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The provision of anesthetic services usually cover the whole peri-operative period i.e. preoperative care, intra operative care and post-operative care. Thus anesthetic services include the use of medicines for premedication, induction of anesthesia, maintenance of anesthesia, reversal or recovery from anesthesia and post-operative care.

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 Note:

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  • Anesthetic medicines and sedatives MUST be provided by medical practitioners who are properly trained and have appropriate experience with their use

  • Medicines and equipment for resuscitation should be immediately available whenever general anesthesia, regional anesthesia or sedation is administered.

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General Anesthetics

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Used for induction of anesthesia as boluses or for maintenance of anesthesia as continuous infusions in Total Intra–Venous Anesthesia (TIVA). 

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Ketamine IV, 1–2 mg/kg  OR Thiopental IV, 3–5 mg/kg  OR Propofol IV, 1.5–2.5 mg/kg for induction of anesthesia and 6–12 mg/kg/hour IV infusion for maintenance in TIVA, if volatile agent use for maintenance of anesthesia is contraindicated OR Etomidate, IV, 0.3 mg/kg (0.2–0.6 mg/kg)  

 

Inhalational anaesthetic agents (for induction and/or maintenance) Halothane 2–4% in air, oxygen or oxygen/nitrous oxide and  maintenance 0.5–1.5% OR Isoflurane 1.2–2.5%, titrate to desired effect OR Sevoflurane 5–7%

 

Maintenance: 0.5–3% sevoflurane with or without the concomitant use of nitrous oxide.

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Muscle Relaxants

 

Suxamethonium IV, 1–1.5 mg/kg OR Pancuronium I.V 0.04–0.1 mg/kg OR Rocuronium 0.9 mg/kg, IV. OR Atracurium 0.4–0.5 mg/kg I.V over 60 seconds followed by 0.08–0.1 mg/kg 20–45 minutes after initial dose for maintenance or infusion at 0.05–0.1 mg/kg/min (For patients with renal impairment) 

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Contraindications: in patients with risk for developing Suxamethonium induced hyperkalaemia, e.g. upper or lower motor neuron defect, prolonged chemical denervation, direct muscle trauma, tumour or inflammation, thermal trauma, disuse atrophy, severe infection 

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Medicines for Reversal Of Neuromuscular Blockade Neostigmine IV 50µg/kg with atropine IV, 20µg/kg (maximum 1.2mg) OR Glycopyrrolate IV, 10 µg/kg  OR Sugammadex 2–4mg/kg 

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Analgesics for Pain Management in Peri–operative Period

Opioid analgesics

 

  • Tramadol IM/IV, 50mg 6hourly Morphine, IV/IM, 3–5mg as a single dose, then further boluses of 1– 2mg/minute.Maximum dose of morphine 0.1–0.2 mg/kg, and monitor vitals closely OR

 

  • Fentanyl IV, 1–2 µg/kg  OR Pethidine: 1–2mg/kg (used for analgesia during anesthesia, and also during labour) 

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Antagonists of Opioids

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For opioid over–dosage

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  • Naloxone: 0.4mg–2mg IV, alternatively may be given intramuscularly or subcutaneously. For reversal of opioid sedation initial dose 0.1–0.2mg IV at 2–3 minutes intervals to the desired degree of reversal.

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Non–Opioid Analgesics

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  • Paracetamol IV injection 15mg/kg 8hourly

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Updated on, 27.10.2020

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References

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1. STG page number 10-12

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