Practice Guidelines in Anesthesia SK Malhotra, VP Kumra, B Radhakrishnan, SM Basu
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1PRACTICE GUIDELINES IN ANESTHESIA2
3PRACTICE GUIDELINES IN ANESTHESIA
Editor SK Malhotra MD FICA Professor Department of Anesthesia and Intensive Care Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh, India Editorial Board Members VP Kumra MD DAc FICA Emeritus Consultant Sir Ganga Ram Hospital, New Delhi, India President Indian College of Anaesthesiologists B Radhakrishnan MD MPhil FICA Principal Academy of Medical Sciences Kannur, Kerala, India SM Basu MD DA (London) FICA Ex-President Indian Society of Anaesthesiologists
4
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Practice Guidelines in Anesthesia
First Edition: 2016
9789351529880
Printed at
Contributors
5
  • Abdul Qayoom Dar MD FRCA
  • Professor
  • Department of Anesthesiology and Critical Care
  • Sher-i-Kashmir Institute of Medical Sciences (SKIMS)
  • Srinagar, Jammu and Kashmir, India
  • Amit Sharma MD
  • Consultant Anesthesiology
  • Department of Anesthesiology and Critical Care
  • Army College of Medical Sciences and Base
  • Hospital
  • New Delhi, India
  • Anil Agarwal MD MNAMS FICA
  • Professor
  • Department of Anesthesiology
  • Sanjay Gandhi Postgraduate Institute of Medical
  • Sciences (SGPGIMS)
  • Lucknow, Uttar Pradesh, India
  • Anjan Trikha MD FICA
  • Professor
  • Department of Anesthesiology
  • All India Institute of Medical Sciences (AIIMS)
  • New Delhi, India
  • Ashok Kumar Saxena MD FAMS FICA
  • Professor
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • New Delhi, India
  • BB Mishra MD
  • Chief Medical Officer
  • Dhanwantri Hospital
  • NTPC, Telangana, India
  • Bikash Ranjan Ray MD
  • Assistant Professor
  • Department of Anesthesiology
  • All India Institute of Medical Sciences (AIIMS)
  • New Delhi, India
  • Dalim Kumar Baidya MD
  • Assistant Professor
  • Department of Anesthesiology
  • All India Institute of Medical Sciences (AIIMS)
  • New Delhi, India
  • Girija Prasad Rath MD DM
  • Additional Professor
  • Department of Neuroanesthesiology
  • All India Institute of Medical Sciences (AIIMS)
  • New Delhi, India
  • Gundappa Parameswara MD FICA
  • Senior Consultant Anesthesia
  • Manipal Hospital Bengaluru
  • Adjunct Professor (Anesthesia)
  • Kasturba Medical College
  • Manipal, Karnataka, India
  • Jayashree Sood MD FFARCS PGDHHM FICA
  • Chairperson
  • Department of Anesthesiology
  • Pain and Perioperative Medicine
  • Sir Ganga Ram Hospital, New Delhi, India
  • JP Sharma MD FICA
  • Professor and Head
  • Department of Anesthesiology
  • Intensive Care and Pain Management
  • Himalayan Institute of Medical Sciences (HIMS)
  • Himalayan Institute of Hospital Trust (HIMT)
  • Dehradun, Uttarakhand, India
  • 6Kamal Kishore MD
  • Assistant Professor
  • Department of Anesthesiology
  • Sanjay Gandhi Postgraduate Institute of Medical
  • Sciences (SGPGIMS)
  • Lucknow, Uttar Pradesh, India
  • LD Mishra MD PhD FICA
  • Professor and Head
  • Department of Anesthesiology
  • Institute of Medical Sciences
  • Banaras Hindu University
  • Varanasi, Uttar Pradesh, India
  • Mahesh Kumar Arora MD
  • Professor and Head
  • Department of Anesthesiology
  • All India Institute of Medical Sciences (AIIMS)
  • New Delhi, India
  • Mridula Pawar MD
  • Professor
  • Vardhman Mahavir Medical College and
  • Safdarjung Hospital
  • New Delhi, India
  • Mritunjay Varma MD FRCA
  • Consultant
  • Anesthesia and Intensive Care
  • Newcastle-upon-Tyne Hospital, New castle, UK
  • Naresh Dua MD
  • Consultant
  • Department of Anesthesiology
  • Pain and Perioperative Medicine
  • Sir Ganga Ram Hospital, New Delhi, India
  • Nidhi Kumar MD
  • Assistant Professor
  • Department of Anesthesiology, Intensive Care and Pain Management
  • Himalayan Institute of Medical Sciences (HIMS)
  • Himalayan Institute of Hospital Trust (HIMT)
  • Dehradun, Uttarakhand, India
  • P Ranjan MD
  • Professor and Head
  • Division of Pediatric Anesthesia
  • Institute of Medical Sciences
  • Banaras Hindu University
  • Varanasi, Uttar Pradesh, India
  • Parshotam Lal Gautam MD
  • Professor and Head
  • Department of Critical Care Medicine
  • Dayanand Medical College and Hospital
  • Ludhiana, Punjab, India
  • Prashant Kumar MD PDFNA
  • Professor
  • Department of Anesthesiology
  • Pt BDS Postgraduate Institute of Medical Sciences
  • University of Health Sciences
  • Rohtak, Haryana, India
  • Raminder Sehgal MD FICA
  • Senior Consultant
  • Department of Anesthesiology
  • Pain and Perioperative Medicine
  • Sir Ganga Ram Hospital, New Delhi, India
  • Rashmi Datta MD DNB
  • (Gen Medicine and Aviation Medicine)
  • Consultant Anesthesiology
  • Department of Anesthesiology and Critical Care
  • Army College of Medical Sciences and Base
  • Hospital
  • New Delhi, India
  • RK Tripathi MD FICA
  • Professor and Head
  • Department of Anesthesia and Critical Care
  • Era's Lucknow Medical College
  • Lucknow, Uttar Pradesh, India
  • Sarla Hooda MD
  • Professor and Head
  • Department of Anesthesiology
  • Pt BDS Postgraduate Institute of Medical Sciences
  • University of Health Sciences
  • Rohtak, Haryana, India
  • 7Seema Partani MD
  • Assistant Professor
  • Department of Anesthesia
  • Geetanjali Medical College
  • Udaipur, Rajasthan, India
  • SK Malhotra MD FICA
  • Professor
  • Department of Anesthesia and Intensive Care
  • Postgraduate Institute of Medical Education and Research (PGIMER)
  • Chandigarh, India
  • Sunanda Gupta MD PhD FAMS FICA
  • Professor
  • Department of Anesthesia
  • Geetanjali Medical College
  • Udaipur, Rajasthan, India
  • Susheela Taxak MD
  • Professor
  • Department of Anesthesiology
  • Pt BDS Postgraduate Institute of Medical Sciences
  • University of Health Sciences
  • Rohtak, Haryana, India
  • T Prabhakar VSM MD PDCCC (Neuroanesth), FICA
  • Principal Dean
  • Era's Lucknow Medical College
  • Lucknow, Uttar Pradesh, India
  • VP Kumra MD DAc FICA
  • Emeritus Consultant
  • Sir Ganga Ram Hospital, New Delhi, India
  • President
  • Indian College of Anesthesiologists
8
Foreword
9The specialties of anesthesia, intensive care and pain management are becoming dynamic facets in the field of medicine. Continuous advancement is being made in improving the quality care of patients undergoing surgical procedures. Practice Guidelines in Anesthesia is an integral component that provides basic recommendations for anesthetic practice. The Indian College of Anaesthesiologists (ICA) that is an academic branch of Indian Society of Anaesthesiologists has come out with the first edition of Practice Guidelines in Anesthesia. The various chapters include the topics covering preoperative preparations, monitoring, intra- and postoperative problems and their management. It also covers the chapters dealing with pain management and the field of intensive care therapy. All the chapters have been meticulously selected and authored by distinguished clinicians.
The guidelines always provide the basic framework for carrying out the rational and acceptable patient care. We must permit some amount of flexibility in individual situations and the anesthesiologists should always exercise his own clinical experience and judgment. Moreover, each hospital may modify these guidelines as per their local resources and infrastructure.
I applaud the efforts of Indian College of Anaesthesiologists in taking this unique initiative. I wish to congratulate Dr SK Malhotra (Editor), and the editorial board members for their commendable job.
I hope that the readers would find all topics interesting and beneficial in day-to-day anesthetic practice.
VP Kumra MD DAc FICA
Emeritus Consultant
Sir Ganga Ram Hospital
New Delhi, India
President, Indian College of Anaesthesiologists
Preface
11Practice guidelines in the field of Anesthesia are well established that form the foundation of recommendations for practicing anesthesiologists at the time of publication. These incorporate the recent advances in current anesthesia practice and training in the field. It is not feasible to include all the topics in one issue, therefore 23 topics have been selected in this first edition of Practice Guidelines in Anesthesia being published by Indian College of Anaesthesiologists (ICA), an academic wing of Indian Society of Anaesthesiologists. The topics cover the field of anesthesia, pain management and critical care. It includes the basic principles of providing anesthetic services as well as those required in specialized areas. The guidelines would be reviewed from time to time and revised accordingly as per advancement of practice and technology. Similarly, in each subsequent publication, new chapters would be added.
In the field of preoperative preparation, various chapters have been included such as preoperative fasting guidelines and checking the anesthesia equipment. A chapter on infrastructure requirements for operation theater has also been added. The guidelines for perioperative problems include difficult airway management, central venous access, monitored anesthesia care, toxicity of local anesthetics, anaphylactic reactions and blood transfusion therapy. The topics of perioperative fluid therapy and hypothermia are included keeping pediatric patients in mind. A chapter on obstetric anesthesia guidelines has also been added. In the field of pain management, ultrasound-guided nerve blocks and acute pain management have been highlighted. Management of head injury and managing postanesthesia care unit (PACU) have also been discussed.
Practice guidelines should always be considered as the studies in their evolution. A balance must be kept between broad principles and minute detail. The same should be considered between professional view and the evidence as well as desired and minimum standard of practice. These guidelines should not replace the need for individual clinical experience of the anesthesiologists in providing best possible services to the patient. Also, these guidelines may be modified as per the availability of equipment and infrastructure in an individual hospital. The practice guidelines, however, do not guarantee any precise outcome.
I hope that the present document on Practice Guidelines in Anesthesia would be useful to the practicing anesthesiologists. However, suggestions are welcome from readers to improve the subsequent edition.
We are indebted to all distinguished authors who have spared their time and energy in contributing to the first edition of Practice Guidelines in Anesthesia.
SK Malhotra12131415