ANESTHESIA CHANTING BY DR.

PARAS
 r

* ANAESTHESIA __
LOSS OF SENSATION

/
* EXCITATORY N -1 .
INHIBITORY N -1
.

→ GLUTAMATE → GABA
-

& loss OF SENSATION =

→ BY BLOCKING Natkt -
CHANNEL
→ BY INHIBITORY NOT -

GABA
→ BY BLOCKING EXCITATORY N -1.
-
GLUTAMATE

* TYPES
A. REGIONAL ANESTHESIA
B. GENERAL
ANESTHESIA
C. LOCAL ANESTHESIA
A. REGIONAL ANESTHESIA =

→ CAN'T CROSS B. B. B
→ NO LOSS OF CONCIOUS NESS
-

1. SPINAL ANESTHESIA
2. EPIDURAL ANESTHESIA
1. SPINAL ANESTUESIA=

-> SITE ADULT

=
-> L3-L4
CHILDREN -> LY-L5
->
PIERCE TILL ->
SUBARACHNOID SPACE
->
INDICATION ANY SX BELOW UMBILCUS

->
NEEDLE USED ↑

2. SPIDURAL ANESTHESIA

SITE-THORACIC / LUMBAR VERTEBRA

PIERCE TILL LIGAMENTUM FLAVUM
-> -

INDICATION -
SAME AS SPINAL ANESIHESIA
NEEDLE USED-TOUNY NEEDLE
 1.

B. GENERAL ANESTHESIA
-> CAN CROSS BBB
-> LOSS CONCIOUSNESS
OF PRESENT
* COMPONENTS G.A
OF

1. LOC- LOSS OF CONSCIOUS

2. LOSS OF REFLEX
3. AMNESIA
(NO-MEMORY)
Y. MUSCLE SHOULD RELAX
3. ANALGESIA CNO PAIN)
* STEPS

-> 3-5 MIN GIVE 100% On

1. INDUCTION -> N/INUALATIONAL
2. MAINTAINANCE - CONTINUE GA

3. REVERSAL -STOP GIVING G.A 02

REVERSIBLG AGENTS
FLUMAZENIL
eg.
CGABA ANTAGONIST]
C.
LOCAL ANGSTHESIA
-> LOSS OF SINSATION FROM SPECIFIC AREA

eg. LIGNOCAINE
 THEY ACT BY GABAN

* INHALATIONAL ANASTHETICS
I -> HALOTHANG RELEAS2-FLUORIDE
2 - ISOFLURANG ↓
3 - SEVOFLURANG CAUSE-ARRYTHEMIA
4 - DISFLURANE ADNEY DAMAGE
5- ENFLURANG MEPATO TOXIC
6 - METHOXYFLURANG- MOSTPOTENT BUT
NEPUROTOXIC.
-> MAC =
MINIMUM ALVOLAR CONC.
MIN MAC MAX. MAC
HI S D
MOSTPOTENT LEASTPOTENT

mAcasoswcX
->

-> BaS BLOOD

=
GAS SOLUBILITY
min. BUS
D I H
-

S
1. HALOTHANE and BEST USED IN CHILDREN
-> STORED IN
=

AMBER COLORED BOTTLE

-> HEART -
ARRHY TUMIA
-> HEPATOTOXL=
LIVER
-> LUNGF BRONCHODILATION usasFuL IN ASTumA

2. ISO FLURANE=NOT USED IN CHILDREN

-> AGENT CHOICE

OF FOR CARDIAC 4
NEUROSURGERIES

3. DESFLURANG-2nd BEST FOR DAY CARE SX.

-> BEST FOR MAINTANCE OF ANAESTHESIA
->
FOUL SMELLING CAUSE DYSPNOEA
-> MAXIMUM GREEN HOUSE EFFECT
-> CAN BE USED IN NEURO SX
4. SEVOFLURAN E =

SWEET
->
SMELLING
-> BEST SPECIALLY IN CHILDREN
-> SEVOFLURANG IS AGENTOF CHOICE

FORASTUMATISCARDIAC
SURGER e
g

->
AVODED IN REINAL PATIENT'S

5. XENON =
70 F
MAC NOA-NMDA
=

->
IDEAL ANSSTETIC AGENT
-> LOWESTBUS HENG FASTEST
-> NO GREEN HOUSE EFFECT
->
ONLY DISADVANTAGE - VERY EXPENSIS

6. N2O =
NITROUS OXIDG ->
-> CONTAIN O2
-> CAN CAUSE FIRE SO

2.2 IN LASER SURGERY

-> N2O CAN EXPAND CLOSED CAVITY SPACE

MENE 1.2 IN PNSUMOTORAX,
PNUMOPERITONSUM, INTESTINAL OBSTRUCTION
-> PIN INDEX 3,5
=
-> MAC 104.
=
-> NCO IS HAVING MAX. MAC So LaSS

POTENCY, HENCE ITFALS TO CAUSE GA

ALONE
↓
-> IT TAKE HELP OF OTHER INGALATONAL
AGENT LILE HALOTHANS TO PRODUCE
EFFST => TUIS IS ANOWN AS 2nd GAS EFFECT
↓
->
SO, WHEN NIOTHALOTUANG GOES OUT

FROM BODY THE TANE

OL WITH TUSM
WHICH CAUSES DIFFUSIONAL HYPOXIA --
THIS IS KNOWN AS 3rd GAS 9FF3Tor
FINA EFFECT

* DAL CARE SX

PSOFLURANS
ISFIORINS
Goses.
SEVOFLURING

I
MIDAZOLAM
I.V
ALFINTANIL
PROPOFOL
* 1.V ANESTHETICS AGENTS

I. THOPENTONE SODIUM = LOC -

1Sea
-> SMELL =
GARLIC
↑
-> AGENTOF
CHOICE FOR NEURO SURGERY
-> C.I IN
=

PORPHYRIA, HYPOTENSION,
HEARTBLOCK
-> COLOR = XELLOW COLOUR AMORIOUS POWPER
2. PROPOFOL =

[Link] receptor
=

-> COLOUR -> MILAY WHITE

-> COMPOSITION = D1-1S0 PROPYL ALCOHOL
+
E -> EG2 LECITHIN

9 GLYCEROL
->

-> SOYABBEN OIL

-> AGENTOFCHOICE FOR DAX CARS SX

-> PROLONG INFUSION -> GREEN COLOUR URING
-> CAUSE PAIN AT THE SITE OF INJECTION
-> USED FORTINA:
TOTAL IVANESTHESIA
-> AGENTOF CHOICE FOR OCULAR SX.
-> PAIN SITE
AT OR INJECTION
 3. NSTAMINE =

M.O.A-NMDA ANTAGONIS T

->
DISSOCIATIE ANESTESIA ZFFET
EXSS LIDS OPEN NOMEMORY
BUT
↑
& NO MEMORY
-> C.I IN NEUROSURGERY
-> USED IN SHOCK & ASTHMA
-> S2-POST OP UALLUUNATION
* NEURO MUSCULAR BLOCKER
1

-> RELAX THE MUSCLE

DEPOLARISING NON-ASPOLARISING

-> SUCCINY LCHOLING -> PANCURONIUM

->
SUXAMETONIUM
>
VECURONIUM
-> ATRACURIUM
-> I BRIEFLY CONTRACT
· NO CONTRACTION

2: NO CONTRACTION [Link] ONLY RELAXATION

- Na HYPERTHERMIAN
- n
-> MUSCLE PAIN +A -> PAIN -nt.
MUSCLE
-> TRAIN OF FOUR FOUR IN
-> TRAIN OF

-> SHORT ACTING CAN BE SHORT

OW

LONG ACTING

-> NO ANTIDOTE -> AWTIDOTE NCOSTIMING

=

PYRIDOSTIMING

* NON DEPOLARISING MUSCLE RELAXANTS

1. LONG ACTING DOXAT PANCURONIUM

2. INTERMEDIATE -
ACTING =
VECURONIUM
ROCURONIUM
ATRACURIUM
->
ATRACURIUM SHOWS HOFFMAN
ASGRADATION (NON ENIXMATIC BREADOWS
3. FASTACTING RAPACURONIUM
=
* LOCAL ANSSTHETICS =

I SHORT
ACTING CHLORPROTAINS
- > PROCAINE
2. INTERMEDIATE ACTING LIDIOCAING
:

3. LONG ACTING =
DIBUCAINE > BUPIVACAINE

BLOCK
MOA= NOT CHANNEL ALL FURANE

succylcholine.
caine.
* MALIGNANTHYPERTHERMIA higno
-> A.D
-> DUSTO MUTATION IN RYANODING
RECEPTOR at NEURO MUSCULAR Jn. on

chromosome No 194 17
-> EXCESSIVE Ca2+ RELEASE WHICH
LEAD TO EXCESSIVE MUSCLE CONTRACTION
↓ early Death
cause
of
HXPERAALEMIA - ARRATHMIA
MAGOGLOBIN UREA-LATS
of DEATH
cause

DOC DANTROLINE SODIUM

=
☆ ASA GRADING

☆ PIN INDEX =

5 6 7

1,5 AIR 1,6 Coz > 7% 7 ENTONOX

2,5 02 2,6 62<77 . 50%02

3,6 50% Nao
3,5 V20 cyclopropane

☆ CYLINDER
I. AIR 3. Nao 5. CYCLOPROPANE

GREY BODY WITH BLUE

BLACK & WHITE

SHOULDER
ORANGE
2. 02 4. CO2 6 .
ENTONOX

GREY BLUE BODY +

BLACK BODY WITH
WHITE SHOULDER WHITE SHOULDER
* INTUBATION POSITION
CHIN-LIFT
HEAD- TILT

* MALLAMPATI SCORING
-> USE TO PREDICTDIFFICULT INTUBATION

* ANASSTHESIA EQUIPMENTS
1. LARYNGOSCOPG
-> MCINTOSH -> MILLER
USED- ADULT -> USED-CHILDREN
2. ENDOTRACHEAL TUBE

A. CUFFED ENDOTRACHEAL TUBE

-> BEST BCI IT PREVENTS

ASPIRATION

RESISTANCE 21
OPENING
EXTRA
84

B. DOUBLE LUMEN ETT =

-> USED FOR LUNG SX

-> PROVIDE SINGLE LUNG
VENTILATION

C FLEXDMETALLIC TUBE
HEAD &
->
USED FOR SX OF
NECK,
PRONE POSITION SX
3. SUPRA GLOTTIC AIRWAY DEVICE
BPLACED ABOVE SUPRAGLOTTS
A-LMA-CLASSIC
-> ASPIRATION
CANTPREVENT

BLMA- PROSEAL

->
DRAIN PRESENT TO PREVENT
ASPIRATION

C LMA- SUPREME

->
EASX INSERTION
-> CAN POT GASTRIC TUBE
-> PREVENT ASPIRATION
4. VENTURI MASKS. AMBU BAG

* BOXI'S MACHINE

⑳>
60-1201/ permin
ANESTHETIC
AGENT

-> REMOVE CO2

OTUSR GASES
↓
ABSORB & REMOVE CO2 * ANESTASTIC AGENTS

* PURPOSE G
=
TURN PING
TOWNITS
-> HALOTHANE RED
-

-> TO SUPPLY
O2 -> SEVOFLURANE- YELLOW
-> TO PROVIDE ANESTHESIA - DESFLURANG- BLUE
->
ENPLURANE -
ORANGE
-> ISOFLURANS -
PURPLS
* CAPNOGRAPHY =

EXPIRATION PLATEAU

END-TIDAL
CO2=35-43mmHg
->
EXPIRATION INSPIRATORY
UPSTROKE
DOWN STROKE

INSPIRATION INSPIRATION

-> Rx FLOW RATS

BODY
-> CO2 IN
Rx FLOW RATS

-> SHARE
FINN

SSIN IN COPD

* MONITORING GA
[Link] Y. CAPNOGRAPHY
2. BP 5. TEMPERATURE
3. PULSE OXIMETRA
 * CIRCUITS / BREATHING SYSTEM

1. OPEN CIRCUIT
→ EASY BUT NOT USED
→ A CO2 IN ROOM CAN MAKE DOCTOR
UNCONCIOUSS

2- CLOSED CIRCUIT

Advantage
-
=

→ GAS FLOW CAN BE REDUCED

→ GAS CAN BE HUMIDIFIED

Disadvantage =

→
HEAVY SO DIFFICULT TO MOVE
3. SEMI CLOSED CIRCUIT =
MAPELSON CIRCUITS
> MAGIC GRCUIT = SPONTANEOUS
ADULT
BREATHING

>
BAIN CIRCUIT -
CONTROL BREATHING .

> AYRES TRECE __ PREMATURE BABY

Peppa
Rees years child
> IAIN = <8 .