Anesthesia

ORDER OF SENSATION LOSS IN LOCAL ANAESTHESIA

Temperature Pain Touch Deep pressure

ORDER OF SENSATION LOSS IN SPINAL ANAESTHESIA

Preganglionic b fibres Cold Warm Pin prick Pain Touch Pressure Motor Vibration / proprioception

CONTRAINDICATIONS TO SPINAL ANESTHESIA

Hypotension and hypovolemia Uncooperative and mentally ill person Infants and children Vertebral abnormalities Local sepsis

ELEMENTS OF PRIMARY SURVEY

Airway with cervical spine control Breathing and ventilation Circulation with control of hemorrhages Dysfunction of central nervous system Exposure in a controlled environment

*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	CONDITION
In renal failure	Vecuronium / Atracurium
In hepatic failure	Atracurium
Myasthenia gravis	1/10th Atracurium
Short cases	Atracurium / Ropacurium / Mivacurium
Obstetrics	All except Gallamine
Arterial surgery	Pancuronium
To reduce blood pressure	Tubocurare
Rapid sequence induction	Rocuronium / Ropacurium
Asthmatics	Pancuronium (avoid Metacurine and Succinylcholine)
Carcinoid tumour	Vecuronium

*Aminoglycosides causing neuromuscular blockade   Neomycin > Streptomycin > Gentamycin

White	Oxygen
Blue	Nitrous oxide
Black	Compressed Air
Yellow	Vacuum

 

GASES	COLOUR CODES
Oxygen	Black body with white shoulders
Nitrous oxide	Blue
Carbon dioxide	Grey
Cyclopropane	Orange
Air	Grey body , black and white quartered shoulders
Entonox	Blue body, white and blue quartered shoulders