ANESTHESIA REGIONAL

5.4 REGIONAL ANAESTHESIA

Technique used for the interruption of sensory pathways  involves

the  use  of local anaesthetic agents at different sites  in  the

nervous system and can be used -

   1.  On mucosal surfaces

   2.  For subcutaneous infiltration

   3.  For nerve blocks

   4.  For regional blocks (spinal and   extradural anaesthesia)

       

   5.  For intravenous regional anaesthesia

Substances used are:

a) Cocaine is used essentially for topical anaesthesia and thus

   for operations in the nasal cavity in a concentration ranging

   from 4-20%.

b) Procaine (Novocaine) the substance was introduced in 1905 and

   is not effective topically but is much less toxic than

   cocaine.

   It can be used for subcutaneous infiltration in a 0.5%

   solution; 2% solution is required for nerve blocks.

c) Lignocaine (Xylocaine) 0.5% solution is used for local

   infiltration. 1-2% for nerve block. The relative advantages

   and disadvantages of procaine and lignocaine are there.

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ANESTHESIA GENERAL

5.3 GENERAL ANAESTHESIA

The inhalation agent for inducting is in most instances delivered

through an endotracheal tube .

Short term barbiturates (pentothol) is injected intravenously.

This is referred to as induction and facilitates the introduction

of the endotracheal tube with the help of direct lyrangoscope

.

The tube is then connected with an anaesthesia machine  .

5.3.1 TECHNIQUE

The dose of anaesthetic to be given to any patient by inhalation

cannot be calculated based on milligrams of anaesthetic per

kilogram body weight.

* In addition, there is a problem of maintaining sufficient

ventilation.

* Both these objectives are obtained by frequent clinical

examination of the patient so as to ensure sufficient level

of anaesthesia and adequate ventilation.

* The mixture of the anaesthetic agent and oxygen is adjusted

to provide sufficient anaesthesia without causing excess

depression of the central nervous system by observing the

effect on reflexes.

* The ideal state to be maintained is a plane of anaesthesia

in the 3rd state.

The ideal plane will depend upon the surgical procedure to

be performed.

* In all events, 4th stage, a stage of overdosage is to be

avoided.

These reflexes are listed and the stages indicated in the

       are based on the effects described by Guedel

(1937).

 

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ANESTHESIA CHECK 2b

INTERCURRENT DISEASE (CONT)

3.4 LIVER FUNCTIONS

Those with acute viral hepatitis have a 9% risk of mortality.

Those with acute fulminant hepatic failure have an 85% mortality.

3.5 PULMONARY

Infections and chronic obstructive airway disease increase the

risk of post-operative complications.

Thus, risk is increased in patients with asthma and with a

history of heavy smoking.

This information is required to set into motion an action plan

which is directed:

i) Correct the effects of the disease process for which he

is undergoing surgery.

ii) Correct the effect of any inter-current disease so as

to reduce risk.

iii) Identify the need for intra-operative monitoring

devices.

iv) Make correct choice of anaesthetic technique to be

employed.

v) Plan post-operative care.

vi) Prepare the patient emotionally for the anaesthetic

experience.

 

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ANESTHESIA CHECK 2a

3. INTERCURRENT DISEASE AND RISK

3.1 ISCHAEMIC HEART DISEASE:

Patients with ischaemic heart disease within three months of an

episode of Myocardial Infarction (MI) have a risk of 30%

possibility of a second MI.Those between 4 and 6 months, the rate

drops to 16%,those with an episode of more than 7 months the risk

drops to 6%.

Main complications are because of heart failure and arrhythmias.

3.2 HYPERTENSION

In cases of diastolic pressure of less than 110 mm Hg, there is

no increased risk in the absence of ischaemia of the myocardium

those with a diastolic pressure of more than 120 mm Hg, the risk

increases.

3.3 ENDOCRINE

Patients with a history of diabetes have an increased risk.

Those on steroid therapy and with hypothyroidism also carry a

high risk.

Hyperthyroid patients have a 2% chance of storm in the

postoperative period.

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ANESTHESIA INTRODUCTION

ANAESTHESIA

1. INTRODUCTION

Surgical treatment of disease requires gaining access to deeper

tissues through the skin.

* The skin being a sensitive organ, is well provided with

sensory nerves.

* Thus,it becomes important to interrupt the sensory

pathways of skin and deeper tissues (anaesthesia)if

surgical treatment is to be given.

* There are essentially two primary modes of rendering a

patient insensitive to pain while undergoing surgical

procedure:

- General anaesthesia (central nervous system depression)

- Regional anaesthesia (local anaesthetic agents).

2. PRE-ANAESTHETIC EVALUATION

1. A thorough clinical examination of the patient is essential

to establish the health status of the patient.

2. To detect the effects of the disease process for which he is

undergoing the surgical procedure.

3. To detect any inter-current disease that he/she might be

suffering from.

 

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ONCOLOY 11

10.2 PALLIATIVE SURGERY

In cases where the carcinoma has spread and radical surgery

cannot be done. Palliative surgery is undertaken to bypass an

obstruction without removing the tumour (colostomy) and in some

cases to relieve the pain fig.

The use of chemotherapy and radiotherapy in combination with

surgery in various TNM stagings and gradings is in practice to

improve treatment outcomes.

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ONCOLOGY 10 SURGERY

10. SURGICAL OPTIONS IN CARCINOMA

10.1 Curative Surgery

This is planned for those cases where the primary tumour is

confined to the organ and the involved lymph nodes and

intervening lymphatics can be removed in one continuity (en-

block).

This is also referred to as radical surgery. The GI Tract is

then reconstructed see fig above

Curative surgery for secondries or recurrance is also possible

with follow up with markers and practice of second look in

colonic surgery.

 

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