ORDER OF SENSATION LOSS IN LOCAL ANAESTHESIA
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Temperature
Pain
Touch
Deep pressure
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ORDER OF SENSATION LOSS IN SPINAL ANAESTHESIA
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Preganglionic b fibres
Cold
Warm
Pin prick
Pain
Touch
Pressure
Motor
Vibration / proprioception
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CONTRAINDICATIONS TO SPINAL ANESTHESIA
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Hypotension and hypovolemia
Uncooperative and mentally ill person
Infants and children
Vertebral abnormalities
Local sepsis
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ELEMENTS OF PRIMARY SURVEY
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Airway with cervical spine control
Breathing and ventilation
Circulation with control of hemorrhages
Dysfunction of central nervous system
Exposure in a controlled environment
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*Bier’s block- regional anaesthesia that utilizes intravenous injection of the local anaesthetic agent to bring it to the nerve trunks and endings.
*Eutectic Lignocaine + Prilocaine –
Decreases the melting point of the mixture.
Useful in surface anaesthesia.
TEMPE-Topical Eutectic Mixture for Premature Ejaculation
Lignocaine max doseWithout adrenaline 3 mg/kg= 200mg (average adult)
Lignocaine max doseWith adrenaline 7 mg/kg = 500mg (average adult)
Shortest acting muscle relaxant Succinylcholine < Mivacurium
Longest acting muscle relaxant Doxacurium > Pipecuronium > Pancuronium > d-Tubocurare.
Longest acting local anesthetist Dibucaine > Tetracaine > Bupivacaine
Shortest acting anesthetist Chlorprocaine
*Malignant hyperthermia
autosomal dominant Seen with Halothane, Ether and Succinylcholine
Due to excessive release of Ca++ from sarcoplasmic reticulum.
*Circuit used in spontaneous respiration is Mapleson A
MUSCLE RELAXANTS
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CONDITION
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In renal failure
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Vecuronium / Atracurium
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In hepatic failure
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Atracurium
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Myasthenia gravis
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1/10th Atracurium
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Short cases
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Atracurium / Ropacurium / Mivacurium
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Obstetrics
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All except Gallamine
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Arterial surgery
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Pancuronium
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To reduce blood pressure
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Tubocurare
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Rapid sequence induction
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Rocuronium / Ropacurium
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Asthmatics
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Pancuronium (avoid Metacurine and Succinylcholine)
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Carcinoid tumour
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Vecuronium
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*Aminoglycosides causing neuromuscular blockade Neomycin > Streptomycin > Gentamycin
White
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Oxygen
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Blue
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Nitrous oxide
|
Black
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Compressed Air
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Yellow
|
Vacuum
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GASES
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COLOUR CODES
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Oxygen
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Black body with white shoulders
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Nitrous oxide
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Blue
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Carbon dioxide
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Grey
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Cyclopropane
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Orange
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Air
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Grey body , black and white quartered shoulders
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Entonox
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Blue body, white and blue quartered shoulders
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