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Manual of Anaesthesia
Arun Kumar Paul
CHAPTER 1:
Preanaesthetic Evaluation
OBJECTIVES
HISTORY
ASSOCIATED ILLNESS NEEDING FURTHER INVESTIGATIONS
COMMON MEDICATIONS AND ANAESTHETIC IMPLICATIONS
PHYSICAL EXAMINATION
PREOPERATIVE DIAGNOSTIC INVESTIGATIONS
ASA PHYSICAL STATUS INDEX
FACTORS FOR SELECTION OF ANAESTHETIC TECHNIQUE
PREANAESTHETIC ROUTINE PREPARATION
COMMON CAUSES OF POSTPONEMENT OF OPERATION
ROUTINE REQUIREMENT BEFORE INDUCTION OF ANAESTHESIA
CHAPTER 2:
Preanaesthetic Medication
AIMS OF PREANAESTHETIC MEDICATION OR PREMEDICATION
CRITERIA FOR IDEAL PREMEDICATION
FACTORS FOR PROPER SELECTION OF PREMEDICANT DRUGS
COMMON DRUGS USED IN PREMEDICATION
MORPHINE SULPHATE
PETHIDINE HYDROCHLORIDE
PENTAZOCINE
DIAZEPAM
ATROPINE SULPHATE
HYOSCINE
GLYCOPYRROLATE
PROMETHAZINE
TRIMEPRAZINE
PROCHLORPERAZINE
METOCLOPRAMIDE
ONDANSETRON
ROUTES OF ADMINISTRATION OF PREMEDICANT DRUGS
CHAPTER 3:
Conduct of Anaesthesia
INDUCTION OF ANAESTHESIA
Inhalational Induction
Problems
Intravenous Induction
MAINTENANCE OF ANAESTHESIA
Signs of Anaesthesia
Light general anaesthesia
Deep general anaesthesia
Signs of lightening of anaesthesia
Signs of too deepening of anaesthesia
Endotracheal Anaesthesia
Objectives
Indications for Endotracheal Intubation
Advantages
Hazards of endotracheal intubation
Disadvantages of endotracheal anaesthesia
Nasotracheal intubation
Indications
Complications
Advantages of nasotracheal intubation
Disadvantages
Technique of endotracheal intubation
Caution
Technique of blind nasotracheal intubation
CHAPTER 4:
Inhalational Anaesthetic Agents
CRITERIA FOR AN IDEAL INHALED ANAESTHETIC DRUGS
Desirable Features
True Anaesthetic Gases
Following Factors Increase the Rate of Anaesthetic Induction
Following factors increase the rate of recovery from anaesthesia
Minimum alveolar concentration (MAC)
Nitrous Oxide
Entonox
Cyclopropane
Diethyl ether
Trichloroethylene
Halothane
Methoxyflurane
Enflurane
Isoflurane
Desflurane
Sevoflurane
Fluroxene
CHAPTER 5:
Intravenous Anaesthetic Agents
BARBITURATES
Thiopentone
Methohexitone
Propanidid
Althesin
Etanolone (Pregnanolone)
Ketamine
Etomidate
Propofol
Benzodiazepines
Main actions:
Uses in anaesthesia
Diazepam
Midazolam
Opioids
Fentanyl
Alfentanil
Sufentanil
Remifentanil
Hypersensitivity Reactions of iv Anaesthetics
Continuous Infusion of iv Anaesthetics
Total Intravenous Anaesthesia
CHAPTER 6:
Local Anaesthetic Drugs
SYSTEMIC TOXIC REACTIONS OF LOCAL ANAESTHETICS
Factors Responsible
Manifestations
Management
Prevention
Treatment
Cocaine
Procaine
Lignocaine
Prilocaine
Mepivacaine
Bupivacaine
Ropivacaine
Minimum Blocking Concentration (Cm)
CHAPTER 7:
Muscle Relaxants
ANTICHOLINESTERASE DRUGS
Neostigmine
Edrophonium
Monitoring of neuromuscular block
Peripheral Nerve Stimulator
CHAPTER 8:
Monitoring during Anaesthesia
CLINICAL MONITORING
SPECIAL BASIC MONITORS USED IN ANAESTHESIA
MONITORING THE ANAESTHETIC APPARATUS
Oxygen Supply
Breathing System (circuit)
CHAPTER 9:
Anaesthetic Equipment
MEDICAL GAS SUPPLY
Cylinders
Pin Index System (Fig. 9.1)
Cylinder valve (Fig. 9.2)
Piped gas supply
Liquid oxygen
Oxygen Concentrator
Compressed Air
Pressure Gauge (Fig. 9.3)
Pressure regulator (Reducing valve)
Flow restrictor
Flowmeters (Fig. 9.4)
Vaporisers
Ideal vaporiser characteristics
Boyle's bottle/glass-ether vaporiser (Fig. 9.5)
Trichlorethylene vaporiser bottle
Goldman halothane vaporiser (Fig. 9.6)
Back bar
Oxygen supply failure alarm
Plenum vaporisers
Common gas outlet
Bag mount (Fig. 9.8)
Rebreathing bag (Fig. 9.9)
Corrugated rubber tube (Fig. 9.10)
Adjustable pressure limiting valve (Expiratory valve) (Fig. 9.11)
Face mask and angle piece (Figs 9.12 and 9.13)
Anaesthetic Breathing System
Baralyme
Absorbers
Water's ‘to-and-fro’ system (Fig. 9.15)
Circle breathing system
Vaporiser outside the circle breathing system
Vaporiser inside the circle breathing system
MAPLESON'S CLASSIFICATION
Criteria for an ideal breathing system
Mapleson A System (Fig. 9.17)
Mapleson B System (Fig. 9.18)
Mapleson C System (Fig. 9.19)
Mapleson D System (Fig. 9.20)
Mapleson E System (Fig. 9.21)
Mapleson F System
Bain Circuit (Fig. 9.22)
ENDOTRACHEAL TUBES AND AIRWAYS
Endotracheal tubes (Fig. 9.23)
Oxford endotracheal tube (Fig. 9.24)
Armoured endotracheal tube (Fig. 9.25)
RAE (Ring, Adair and Elwyn) endotracheal tube
Laser resistant endotracheal tube
Microlaryngeal endotracheal tube
Tracheostomy tubes (Fig. 9.26)
Metal tracheostomy tubes (Fig. 9.27)
Double lumen endobronchial tubes
Oropharyngeal Airway
Nasopharyngeal airway (Fig. 9.31)
Laryngeal mask airway (Fig. 9.32)
Laryngoscopes
Endotracheal tube connections
Catheter mount (Fig. 9.39)
Intubating forceps (Magill) (Fig. 9.40)
Laryngeal spray
Gum elastic bougie
Stilet
Ventilators
SPINAL NEEDLE (FIG. 9.41)
EPIDURAL NEEDLE (FIG. 9.42)
EPIDURAL CATHETER
NERVE BLOCK NEEDLES
NERVE STIMULATOR FOR NERVE BLOCKS
PULSE OXIMETRY
ESTIMATION OF END-TIDAL CARBON DIOXIDE
WRIGHT RESPIROMETER (FIG. 9.43)
PERIPHERAL NERVE STIMULATOR
ARTERIAL BLOOD PRESSURE MONITORING
INVASIVE ARTERIAL BLOOD PRESSURE MONITORING
CENTRAL VENOUS PRESSURE (FIG. 9.44)
PULMONARY ARTERY PRESSURE MONITORING
OESOPHAGEAL STETHOSCOPE
BODY TEMPERATURE MONITORING
OXYGEN ANALYSER
CHAPTER 10:
Spinal Anaesthesia
ANATOMICAL CONSIDERATIONS
Spine
Spinal Cord
Indications of subarachnoid block
Contraindications
Technique of subarachnoid block
Common drugs used
Different types of block
Complications
Postdural puncture (Postspinal) Headache
CHAPTER 11:
Epidural Anaesthesia
CHAPTER 12:
Caudal Anaesthesia
CHAPTER 13:
Peripheral Nerve Blocks
FORM OF REGIONAL ANAESTHESIA
Uses
Advantages
Disadvantages
Contraindications
COMMON NERVE BLOCKS
Cervical Plexus Block
BRACHIAL PLEXUS BLOCK (FIG. 13.1)
MEDIAN NERVE BLOCK
ULNAR NERVE BLOCK
RADIAL NERVE BLOCK
SCIATIC NERVE BLOCK (FIG. 13.2)
Technique
FEMORAL NERVE BLOCK
THREE IN ONE BLOCK
INTERCOSTAL NERVE BLOCK (FIG. 13.3)
FIELD BLOCK FOR REPAIR OF INGUINAL HERNIA (Figs 13.4 and 13.5)
PENILE BLOCK
Indications of Penile Block
PUDENDAL NERVE BLOCK (FIG. 13.6)
STELLATE GANGLION BLOCK
COELIAC PLEXUS BLOCK
Complications
INTRAVENOUS REGIONAL ANAESTHESIA (BIER'S BLOCK)
CHAPTER 14:
Complications of Anaesthesia
NAUSEA AND VOMITING
Dangers of Vomiting
Prevention
Management
POSTANAESTHETIC RESTLESSNESS (AGITATION)
Factors Responsible
Manifestations
Management
HEADACHE
Factors Responsible
Management
RESPIRATORY OBSTRUCTION
A. Upper airway obstruction
B. Lower airway obstruction
Clinical Features
Management of upper airway obstruction
LARYNGOSPASM
Causes
Management
EPIGLOTTITIS
Management
LARYNGOTRACHEOBRONCHITIS (CROUP)
POSTINTUBATION LARYNGEAL OEDEMA
BRONCHOSPASM
Causes
Management
HICCUPS
PNEUMOTHORAX
Management
Pneumothorax during anaesthesia
ASPIRATION PNEUMONITIS
Manifestations
Management
Prevention
HYPOTENSION
Common Causes
Management
POSTOPERATIVE HYPERTENSION
Causes
Management
CARDIAC ARRHYTHMIAS
Causes
Management
POSTOPERATIVE BRADYCARDIA
Causes
Management
POSTOPERATIVE TACHYCARDIA
Causes
Management
POSTOPERATIVE PYREXIA
Management
POSTOPERATIVE SHIVERING
Causes
Manifestations
Management
POSTANAESTHETIC CONVULSION
Causes
Management
POSTOPERATIVE BLEEDING
Causes
Management
POSTOPERATIVE JAUNDICE
Management
POSTOPERATIVE HYPOXIA
Manifestations
Management
DELAYED RECOVERY FROM ANAESTHESIA
HYPERVOLAEMIA
Causes
Manifestations
Management
POSTOPERATIVE RENAL FAILURE
Causative Factors
Manifestations
Management
MALIGNANT HYPERPYREXIA
Manifestations
Diagnosis
Management
CHAPTER 15:
Difficult Intubation
EXPECTED DIFFICULT INTUBATION
Management
Management
UNEXPECTED DIFFICULT INTUBATION
Failed Intubation Drill
Complications
Transtracheal Ventilation/Oxygenation
CHAPTER 16:
Eye and ENT Anaesthesia
EYE ANAESTHESIA
Intraocular Pressure
Oculocardiac Reflex
Drug Interactions
ANAESTHESIA FOR EYE SURGERY
Criteria Needed
Effect of Anaesthetics on IOP
General Anaesthesia
Retrobulbar Block (Fig. 16.1)
Peribulbar Block
Strabismus Surgery
Glaucoma
Cataract Extraction
OPEN EYE INJURY
Special Considerations
RETINAL DETACHMENT SURGERY
Special Considerations
ANAESTHESIA FOR EAR SURGERY
Special Considerations
ANAESTHESIA FOR NOSE AND THROAT SURGERY
Special Considerations
Compromised Airway
Anaesthesia for Adenotonsillectomy
Postoperative Bleeding Tonsil
Laser Surgery
CHAPTER 17:
Obstetric Anaesthesia
PHYSIOLOGICAL CHANGES OF PREGNANCY
DIAGNOSIS OF PREGNANCY
PLACENTAL TRANSFER/EXCHANGE
Mechanism
Factors Determining the Rate and Extent of Transfer
Placental Transfer of Drugs
Pain During Labour and Delivery
Pain Relief During Labour
ANAESTHESIA FOR CAESAREAN SECTION
Anaesthetic techniques
Regional anaesthesia
Disadvantages
General anaesthesia
Advantages
Disadvantages
HYPERTENSIVE DISORDERS OF PREGNANCY
Preeclampsia/eclampsia
HAEMORRHAGE IN THE PARTURIENT
Management
Anaesthesia
ANAESTHETIC MANAGEMENT FOR NONOBSTETRIC SURGERY DURING PREGNANCY
Main Objectives
Certain points need adequate considerations
Anaesthesia
POSTPARTUM TUBAL LIGATION
LAPAROSCOPIC STERILISATION
DILATATION AND EVACUATION (D AND E)
HYSTEROTOMY
CHAPTER 18:
Paediatric Anaesthesia
PREOPERATIVE EVALUATION
Investigations
PREOPERATIVE PREPARATION
PREMEDICATION
ANAESTHETIC EQUIPMENT
MONITORING DURING ANAESTHESIA
ANAESTHETIC MANAGEMENT
FLUID MANAGEMENT
SIGNS OF DEHYDRATION
MAINTENANCE OF FLUID REQUIREMENT
SURGICAL FLUID/LOSS
BLOOD LOSS REPLACEMENT
PRACTICAL RECOMMENDATIONS
COMMONLY USED DRUGS DURING PAEDIATRIC ANAESTHESIA
CHAPTER 19:
Anaesthesia for Day-case Surgery
OUTPATIENT SURGICAL UNIT
Advantages of Outpatient Surgical Unit
PATIENT SELECTION
PREOPERATIVE EVALUATION
PREANAESTHETIC PREPARATION
ANAESTHESIA
REGIONAL ANALGESIA
GENERAL ANAESTHESIA
MONITORED ANAESTHESIA CARE
POSTOPERATIVE CARE
CRITERIA FOR DISCHARGE
CHAPTER 20:
Anaesthesia in Obese Patients
PATHOPHYSIOLOGY
PROBLEMS OF ANAESTHESIA
PREANAESTHETIC ASSESSMENT
PREMEDICATION
ANAESTHESIA
CHAPTER 21:
Geriatric Anaesthesia
PREANAESTHETIC ASSESSMENT
PREOPERATIVE PREPARATION
ANAESTHESIA
POSTOPERATIVE CARE
CHAPTER 22:
Cardiopulmonary Resuscitation
CHAPTER 23:
Anaesthesia and Common Coexisting Diseases
HYPERTENSION
Types
Complications
Assessment
Laboratory Investigations
Treatment
Hypertensive Crisis
Management of Anaesthesia for Hypertensive Patient
CONGESTIVE CARDIAC FAILURE
MITRAL STENOSIS
ISCHAEMIC HEART DISEASE
BRONCHIAL ASTHMA
CHRONIC OBSTRUCTIVE AIRWAYS DISEASE
DIABETES MELLITUS
Types
Complications
Treatment
Management of Anaesthesia
Management in presence of Ketoacidosis
THYROID DYSFUNCTION
Thyroid Function Tests
HYPERTHYROIDISM
Treatment
Management of Anaesthesia
Thyroid Strom/Thyrotoxic Crisis
Treatment
HYPOTHYROIDISM
PHEOCHROMOCYTOMA
LIVER DISEASES
Liver Function Tests:
Problems Relevant to Anaesthesia
Anaesthetic Management
Hepatic Encephalopathy
EPILEPSY
OBSTRUCTIVE JAUNDICE
MYASTHENIA GRAVIS
Myasthenic Syndrome
DISSEMINATED INTRAVASCULAR COAGULATION
ANAEMIA
Appendix
PHYSIOLOGICAL DATA
Blood
Proteins
Transaminases
Haematological
Haemoglobin (Hb)
Cerebrospinal Fluid
Metabolism
Some Normal Values
Air
Alveolar Air
Arterial Blood
Mixed Venous Blood
Other Data
Body Water (expressed as percentage of body weight)
Water Intake Output in Adults Per 24 Hours
Some Useful Facts in Infant and Adult
The Apgar Scoring System
Average Pulse, Respiration and Blood Pressure in Children
Doses of Some Drugs in Children
Endotracheal Tubes
Size of endotracheal tubes
Some Anatomical Measurements
Adults
Children
Approximate Length and Diameter of Endotracheal Tube in Children
Bibliography
INDEX
TOC
Index
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