ANAESTHESIA JOTTING - It must NOT cause pain

o STP causes pain

FAST-TRACKING
- It must be ANALGESIC
- A.k.a. enhanced recovery o Ketamine is analgesic
- Definition o STP is anti-analgesic; it increases pain
o It consist of techniques to expedite recovery - If inadvertently injected into tissue, it shd not
from surgery, with minimal pain, minimal cause any deleterious effect
complications and improved outcomes o STP causes
o You want to discharge the px right from the - It shd not cause any emergent phenomenon e.g.
operating room to the ambulatory centre for hallucination, uncontrolled talking, etc
the px to go home o Ketamine causes emergent phenomenon
- Things used to fast-track px - Cardio-stable
o short acting-acting inhalational anesthetics o STP - - hypotension
Propofol o Ketamine - - - HTN and Tachycardia
Sevoflurane, Desflurane o Medazolam and Etomidate are cardiostable
o Opioids e.g. Remifentanil - It must not cause histamine release
o Muscle relaxants e.g. rapacuronium o STP causes histamine release, and so is
o AVOID SUXAMETHONIUM because it cause contraindicated in asthma
choline pain esp MYALGIA - It must NOT be porphyrinogenic e.g. STP and other
- Requirements: px shd be Barbiturates
o Able to walk - NO resp depression
o Non-drowsy, - No drug-drug interaction
o Not vomiting - Should NOT accumulate in the blood
o Able to tolerate oral discharge - Must NOT cause Nausea and vomiting
o Not In pain o Propofol is anti-emetic
o Not in excessive blood loss - NO residual effect

DISCUSS POST-OP ANALGESIA FOR A 2 YEAR OLD WHO AWARENESS UNDER ANAESTHESIA
HAD ANALGESIA
Introduction
- NEVER say morphine
- AUA is a problem in anaesthesia and distressing to
- Do say injectables. Although, Initially , you may give
the px esp. if accompanies by recall of the painful
Parenteral
nature of the surgery
- Caudal analgesia e.g. bupivacaine
- AUA is where a px under General Anaesthesia,
- Wound infiltration with bupivacaine
vividly remembers events that occur
- Oral Paracetamol, 6 hrly and 8 hrly
intraoperatively

Causes
CHARACTERISTICS OF IDEAL INTRAVENOUS
- Why the px is aware
INDUCTION AGENTS
o The Depth of anaesthesia is light
- Should cause hypnosis or sleep in one arm-brain - What makes the depth of anaesthesia light /
circulation time i.e. rapid onset of action of < 1 Predisposing factors to light depth of anesthesia
minute o Patient factors
o E.g. Na-thiopental (STP) Alcoholism
- Rapid Effect e.g. propofol has rapid effect
 Smoking
Hyperthyroidism
Phaeochromocytoma
Pregnant women
Shock during shock you want to
resuscitate to maintain blood pressure, so
cut the flow of aneasthetic agents
underdosing
o Anaesthetic factors
Faulty machine
Miscallibration of machine
Impurities in volatile agent, reducing the
saturated vapor pressure of the agent
Anaesthetist being unaware that
anaesthetic agents in the vaporizer have
finished
Omission or late commencement of
volatile agent
Inadequate dosing
Failure to recognize the signs of
awareness

Monitoring the Depth of anaesthesia

- Through clinical examination

o Tachycardia
Masked by Heart block, B-blocker,
hypothyroidism, diabetes, renal failure
o Hypertentsion
Masked by Heart block, B-blocker,
hypothyroidism,
o Sweating
o Tachypnea
o Tear production
o Movement/grimacing
o Pupil dilatation and reactivity to ligh
- Others
o Lower esophageal motility
o SPEC
o EEG