Surgical Care at the District Hospital
Part 1 2 3 4 5 6 Primary Trauma Care Manual
Resusciation and Anaesthesia
Resuscitation and Preparation for Anaesthesia and Surgery
Management of emergencies and cardiopulmonary resuscitation
Other conditions requiring urgent attention
Intravenous access
Fluids and drugs
Drugs and resuscitation
Preoperative assessment and investigations
Anaesthetic issues in the emergency situation
Important medical conditions for the anaesthetist
Practical Anaesthesia
General anaesthesia
Anaesthesia during pregnancy and for operative  delivery
Pediatric anaesthesia
Conduction anaesthesia
Specimen anaesthetic techniques
Monitoring the anaesthetized patient
Postoperative management
Anaesthetic infrastructure and supplies
Equipment and supplies for different level hospitals
Anaesthesia and oxygen
Fires, explosions and other risks
Care and maintenance of equipment
Hypertension
 


> PREPARATION FOR GENERAL ANAESTHESIA
> INTRAVENOUS INDUCTION
> INTRAMUSCULAR INDUCTION
> INHALATIONAL INDUCTION
> MAINTENANCE OF ANESTHESIA
> FAILED INTUBATION



PREPARATION FOR GENERAL ANAESTHESIA

Make sure that an experienced and trained assistant is available to help you with induction. Never induce anaesthesia when alone with the patient.

Before starting, check that you have the correct patient scheduled for the correct operation on the correct side. The responsibility for this check belongs to both the anaesthetist and surgeon. The surgeon should mark the operation site with an indelible marker before the patient comes to the operating room.

Check that the patient has been properly prepared for the operation and has had no food or drink for the appropriate period of time. It is normal to withhold solid food for six hours preoperatively, but a milk feed can be given to babies up to three hours preoperatively. Clear fluids are regarded as safe up to two hours preoperatively if gastric function is normal.

Measure the patient’s pulse and blood pressure, and try to make him or her as relaxed and comfortable as possible.

Induction of anaesthesia is a critical moment. Before inducing anaesthesia – check.

Before you start, check the patient’s progress through the hospital up to this moment. Then check that your actions will be the right ones. It is also vital to check your equipment before you give an anaesthetic. The patient’s life may depend on it.

Make sure that:

:: All the apparatus you intend to use, or might need, is available and working
:: If you are using compressed gases, there is enough gas and a reserve oxygen cylinder
:: The anaesthetic vaporizers are connected
:: The breathing system that delivers gas to the patient is securely and correctly assembled
:: Breathing circuits are clean
:: Resuscitation apparatus is present and working
:: Laryngoscope, tracheal tubes and suction apparatus are ready and have been decontaminated
:: Needles and syringes are sterile: never use the same syringe or needle for more than one patient
:: Drugs you intend to use are drawn up into labelled syringes
:: Any other drugs you might need are in the room.


Always begin your anaesthetic with the patient lying on a table or trolley that can be rapidly tilted into a head-down position in case of sudden hypotension or vomiting.

Before inducing anaesthesia, always ensure adequate inserting an indwelling needle or cannula in a large vein, unless this is impossible.

The choice of technique for induction of anaesthesia

:: Intravenous injection of a barbiturate, ketamine
::   Intramuscular injection of ketamine
:: Inhalational induction (“gas induction”).


> PREPARATION FOR GENERAL ANAESTHESIA
> INTRAVENOUS INDUCTION
> INTRAMUSCULAR INDUCTION
> INHALATIONAL INDUCTION
> MAINTENANCE OF ANESTHESIA
> FAILED INTUBATION



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