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ANAESTHETIC ASPECTS OF CARE (COMMON EQUIPMENT (Syringe Pumps - used for…
ANAESTHETIC ASPECTS OF CARE
AIRWAYS
LMA (laryngeal mask airway) - This is a simple device that sits above the larynx. Generally, used on patients who met the following criteria:
Surgery is relatively short in duration
No hx of reflux or heartburn
Adequately starved (6 hours)
Elective care (trauma or acute cases even if starved, may still be an aspiration risk)
Uncomplicated surgery and surgery which is not abdominal (gas in the peritoneum can increase aspiration risk or oxygenation issues)
Healthy weight
Supreme LMA - Sits above the larynx. Differs from the traditional LMA by: structurally more rigid, has a pre-formed curved for easier insertion, built in bite block and has an extra port that allows gastric access. Generally follows same conditions as standard LMA with the exception that they may be used on patients who have mild risk factors of aspiration such as being overweight or occasional reflux.
Nasopharyngeal - Made of soft plastic and is inserted up the patients nose to keep the oro pharynx patent. This should be never used on a patient whose current admission involves a head injury or skull fracture.
Auragain LMA - Same as supreme LMA except that you are able to intubate through it (with the aid of a fibreoptic scope you can place an ETT into the trachea.
(Gastric ports on the Auragain and Supreme LMAs do not fully protect the lungs from aspiration, only ETT can guarantee this)
Oropharyngeal (Guedal) - Oral airway used to assist in bag/masking patient or upon extubation to help keep airway patent. Prevents tongue from occluding the epiglottis.
Endotracheal Tube (ETT) - Is a plastic tube that is placed into the patient's trachea. When placed in the correct position, the cuff is inflated to anchor it into place and more importantly to prevent any aspirate the lungs. These tubes are generally used if patients meet the following criteria:
Have a full stomach or NBM status is unclear
Trauma or acutely ill patients who are starved BUT gastric motility has been compromised such as bowel obstructions, appendicitis or shock.
Are pregnant or recently given birth (prone to reflux and a large uterus exerts pressure on the lungs)
Obese (prone to reflux, large abdomen exert pressure on lungs making it more difficult to oxygenate)
Long surgery time
Certain types of surgery that put the airway at risk (back surgery requires patients to be face down and an ETT provides the best airway for this)
COMMON MEDICATION
Parecoxib (long acting anti-inflammatory)
Midazolam (anti-anxiety - usually given as a premed)
Rocuronium (non-depolarising muscle relaxant used to help with incubation and certain types of surgery)
Morphine (opiate analgesia)
Ondansetron (anti-emetic)
Antibiotics such as cefazolin or amoxiclav
Fentanyl (opoid that helps put the patient to sleep in conjunction with propofol and provides analgesia)
Suxametonium (quick acting depolarising musle relaxant used for emergency intubation and rapid sequence intubation)
Propofol (puts the patient to sleep)
Ephedrine (increases BP and pulse rate)
Glycopyrronium (increases pulse rate)
Neostigmine (reverses some muscle relaxants and MUST be given within 2 amps of glycopyrronium as this drug causes bradycardia)
Phenylephrine (increases BP, drops pulse rate)
Sugammadex (reverses Rocuronium and Vecuronium, which are non depolarising muscle relaxants)
GASES
Oxygen (Used for pre oxygenation and maintaining oxygenation during surgery)
Nirrous Oxide (pain relief during surgery and used in conjunction with oxygen)
Medical air (used in conjunction with oxygen/if not using nitrous oxide)
COMMON EQUIPMENT
Syringe Pumps - used for accurate drug infusions
Bair hugger - warming and cooling of patients
temperature probe - monitors patients temp
Nerve Stimulator - devise to see if a muscle relaxant given has been reversed
Suction - to suction vomit, aspirate, and blood away from airway
Fluid warmer - warms fluids and blood / maintaining body temperature throughout surgery
Crash trolley and defib - used to treat a patient who has suffered a cardiac arrest and also used to assist in other OT emergencies such as anaphylaxis
Level one transfuser - devise which rapidly delivers and heats fluids and blood products to a patient who has lost or is loosing a large amount of blood
Difficult intubtion trolley - contains all necessary equipment for a difficult airway
Video laryngoscope - devise that allows a video picture while intubating a patient
Fibreoptic bronchoscope - long narrow scope which is used to help with ETT placement or used to inspect the airway for damage (when a patient has aspirated)
Entropy - Monitors brain electricity that helps to indicate level of anesthesia
Optiflow - High flow nasal oxygen which delivers 30-70L/min
Spinal/epidural trolley - provides necessary equipment needed to administer a spinal (caeser patient) or an epidural (for pain relief post op)
Block trolley - contains all that is needed to administer regional anesthesia such as a shoulder block for an acromioplasty
Arterial/central line trolley - conatins all equipment required to place a central line to administer drugs, fluids and blood. Has equipment for placement of an arterial line to give a constant and accurate BP.