Complications of Anesthesia
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
Risk factors for aspiration include pregnancy, esophageal disease, gastric disease, small bowel obstruction, ileus, trauma, diabetes, obesity, and recent food ingestion. Rapid sequence induction (RSI) and tracheal intubation should be used to decrease the risk of aspiration in such patients during general anesthesia. Although the effectiveness of cricoid pressure in preventing aspiration continues to be debated, cricoid pressure remains the mainstay for RSI due to its low risk/benefit ratio. Awake intubation is the technique of choice for securing the airway in patients at risk for aspiration who are also suspected of having difficult-to-manage airways. Pharmacologic agents are available to reduce the acidity or the volume of gastric contents, but do not prevent aspiration. Currently, the ASA Practice Guidelines do not recommend the routine use of any of these agents in healthy patients undergoing elective surgery.
Vascular Trauma
James Michael Forsyth in How to Be a Safe Consultant Vascular Surgeon from Day One, 2023
What are the priorities of management?The airway is the priority: Bleeding is currently being controlled with direct pressure, but as far as I am concerned, there is a real risk the patient will lose her airway as a result of expanding haematoma. You talk to the anaesthetist and you both agree the patient should be intubated sooner rather than later. This takes place over the next few minutes in A&E resus (rapid sequence induction).Do the basics down in A&E: Good large-bore IV access in both antecubital fossa. Send off bloods for FBC, U&Es, coagulation, group and save. Make sure the major transfusion protocol is initiated. For the moment, I would still employ a “permissive hypotension” approach and avoid giving IV fluids. I would give the patient tranexamic acid.You decide not to take the patient for a CT scan. There is no point. You already know the diagnosis, and a CT is not going to alter your plan. This patient is going straight to theatre.Now we go to theatre ….
Brachial plexus injury
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Manual of Neuroanesthesia, 2017
Goals of anesthesiaTo avoid aspiration of gastric contents in an emergency surgery. Rapid sequence induction may be required.To maintain hemodynamic parameters and avoid fluctuations in these parameters during anesthetic induction.To avoid agents interfering with electrophysiological monitoring.To be prepared with blood products in case of massive bleeding due to vascular injury.To avoid a venous air embolism (VAE) event and to detect it early in case of development during exposure of vascular structure at the injury site.
Twelve tips to maximise medical student exposure during surgical placements
Published in Medical Teacher, 2021
Usman Raja, Mohammad S. A. Amin, Ahmed Soualhi
It is easy to forget that the surgeons are not the only doctors in the room - without anaesthetics, modern surgery would not be possible as the two fields directly affect each other. Unfortunately, undergraduate anaesthetic training is often underplayed and highly variable between medical schools, despite containing a diverse number of highly relevant topics (Smith et al. 2018). So it might be a good idea to conduct your own learning to understand what exactly your counterparts do! (Patel 2018) The true value of learning from anaesthetists is getting familiar with perioperative management and physiology, and when paired with surgical rotations, the overall understanding is significantly improved (Patel 2018). Anaesthetists are always willing to teach students but might require some prompting. Consider asking about the triad of anaesthesia (analgesia, sedation, paralysis) and their methods for putting the patient to sleep and waking them up. Most surgeons have a leading role in managing trauma patients for which you might need an anaesthetist’s help to perform a rapid sequence induction, so you might want to ask about that too.
Success of Pediatric Intubations Performed by a Critical Care Transport Service
Published in Prehospital Emergency Care, 2020
Sriram Ramgopal, Sean E. Button, Sylvia Owusu-Ansah, Mioara D. Manole, Richard A. Saladino, Francis X. Guyette, Christian Martin-Gill
Of note, use of induction and NMB was associated with a higher odds of successful ETI. Cardiac arrest may have partially operated as a confounder with respect to induction, as patients in arrest are typically not induced prior to ETI. However, we obtained similar results in a model developed after exclusion of cardiac arrest, further supporting the independent role for induction and NMB in ETI success (results not shown). Use of medications for rapid sequence induction prior to ETI is associated with greater success in adults in the prehospital setting (38, 39). For patients in our study without cardiac arrest, this finding represents an important modifiable risk factor for patients requiring rapid sequence intubation. Further training to prehospital personnel on use of induction agents for pediatric rapid sequence induction for intubation may be associated with improved outcomes.
Dexmedetomidine infusion during caesarean section under general anaesthesia: Evaluation of maternal awareness using BIS, maternal and neonatal outcomes
Published in Egyptian Journal of Anaesthesia, 2018
Emad Eldeen A. Ibrahim, Mokhtar M. Amer, Mohamed E. Abuelnaga, Wafaa I. Abd-Elaal
Intravenous loading dose of DEX 1 mcg/kg was given over 10 min before induction of anesthesia. Pre-oxygenation with 100% oxygen was done for at least 3–5 min in 10–15 degree left uterine tilted position. Rapid sequence induction was performed using propofol 2 mg/kg and suxamethonium 1.5 mg/kg. Anesthesia was maintained using isoflurane (1–1.5% before delivery and 0.5–1% subsequently according to hemodynamic parameters), DEX 0.4 mcg kg−1 hr−1 continuous intravenous infusion after induction of anesthesia till peritoneal closure. Atracurium 0.4 mg/kg was given after the return of spontaneous respiration. After neonatal delivery, Fentanyl 1 micg/kg was given intravenously, and an infusion of 10 IU oxytocin in 500 ml ringer lactate solution was started.
Related Knowledge Centers
- Advanced Airway Management
- Anesthesia
- Apnea
- Pulmonary Aspiration
- Tracheal Intubation
- General Anaesthesia
- Pregnancy
- Emergency Physician
- Fasting
- Gastroesophageal Reflux Disease