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45 NOTES TO PG

Dr. Ankit Yadavendra, M.B.B.S., Dr.V.M.G.M.C., Solapur

26-ANAESTHESIA
hyperpathia=hyperesthesia+ allodynia+ hyperalgesia
hypotensive anaesth-orthopedic Sx
ETT
thyromental dist>6.5cm
sternomental dist>12.5cm
adeq mouth opening>3nger breadth(pt)
movem of Cx spine
double lumen ETT
abs indication-resection of bronchopleural stula
Mx of preexisting drug Rx
herbal medicine, smoking-stop 6-8w bef
OCP-stop 4w bef
MAOI-stop 3w bef
clopidogrel-stop 5-7d bef
oral anticoagulant(warfarin)-stop 3-5d bef
Li-stop 2d bef
newer MAOI(selegiline)-stop 1d bef
LMW heparin-stop 12-14h bef
NPO-solid-6h, liquid-4h, BF infant-solid(milk)-4h,liquid-2h
insulin/oral hypoglycemia-omit morning dose
antiHTN(adr antag)-continue(except ACEI,ARB)
aspirin-75mg-continue(except closed space Sx), >75mg-stop 3-5d bef
antianginal, anticonvulsive, levodopa, only P pill, steroid-continue
abtc-1st-induction anaesth(-1h bef incision), 2nd-Sx>6h
anaesth machine(1st-1917)
Boyle continuous flow anaesth machine
high pressure system
cylinder-Mb steel alloy, MRI room-Al
size-A H
typeE O2 cylinder=660l O2
typeD O2 cylinder=470l O2
gas-colour
O2-Black Body, white shoulder
N2O-blue
N2-black
CO2-grey
air-grey body, black&white quartered shoulder
cyclOpRopANE-OrANgE

He-brown
entonox(50%O2+50%N2O)-Blue Body, blue&white shoulder
Halothane-Red
Enflurane-Orange
Isoflurane-Purple
Sevoflurane-Yellow(HE IS ROPY)
acetylene-maroon
H2-red
ARGoN-dARk GReeN
ChLOrinE-yELLOw
ethylene-purple
gas-pin index
air-1,5
O2-2,5
N2O-3,5
CO2(>7.5%)-1,6
CO2(<7.5%)-2,6
CyclOpropane-3,6
entonox-7
hoLe-cyLinder, pIN-machINe
liquid form-N2O, CO2, cyclopropane
gas-critical temp(C)
N2O=36.5
O2=119
air=140.6
1ml liqO2=840ml gas
tare wt-wt of empty cylind
lling ratio=(gas wt/wt of water cylinder can hold at 60F)100
lling ratio O2=0.65
yolk assembly-struct to hold cylinder to anaesth machine
press gauge-measure press inside cylinder
gas-press
O2=2000psig(pound sq inch gauge)
N2O=750psig
cyclopropan=60psig(press reducing valve not req)
press reducing valve=35-45psig
emergency O2 flush=35-75l/min
intermittent pressure system
flow control valve
O2-white, bigger, broad serration
N2O-blue, smaller, tiner serration
O2-N2O proportion device
provide x %of O2
min O2 req=25-28%
low press syst
rotameter-pyrex glass(Thrope) tube, bobbin(Al)-upper part denote gas flow
vaporiser(Cu)
altitude-vaporiser
desflurane vaporiser heated=39C

comm gas outlet


wheel-antistatic by add C
central supply lines(Cu)
gas-colour
O2-white
N2O-blue
air-black
vacuum/suction-yellow
DISS(Diam Index Safety System)
noninterchang screw for O2&N2O
O2 concentrator-zeolite[Al(OH)3] lattice absorb N2 fr air, provide 95%O2,5%argon
circuit
open-Schimmelbusch mask-open drop meth-ether,chloroform
semiclosed/semiopen-Mapleson system
A-Magill circuit-spontaneous ventilation Adult
coaxial circuit-Lack[Outer-Insp(LOIS), inner-exp], Penlon, Humphrey ADE, Mera F
D-Bain circuit-controlled ventilation(outer-exp, inner-insp)
E-Ayre T piece-spontaneous ventilation neonatE
F-Jackson Rees modif Ayre T piece-child<6y(<20kg)
valveless-E,F
closed
expired gas passed through cannister of sodalime[94%Ca(OH)2+ 5%NaOH+ 1%KOH]
absorb CO2, silica for hardness or barylime[80%Ca(OH)2+ 20%Ba(OH)2]
100g sodalime=23-26l CO2
indicator(4-8mesh size)-ethyl voilet, phenolphthalein, Mimosa Z
sodalime+trilene dichloroacetylene(neurotoxic)+ phosgene(ARDS)
sodalime+sevoflurane compound A(nephrotoxic)
AMBU(Articial Manual Breathing Unit)
neonat=240ml
child=500ml
adult=1-2l
Guedel oropharyngeal airway
prevent tonguefall
size=distance b/n angle of mouth&tragus
venture mask-max O2=60%
LMA(laryngeal mask airway)
supraglottic device
pt wt-size
1-5kg-1
5-10kg-1.5
10-20kg-2
20-30kg-2.5
30-50kg-3
50-70kg-4
70-100kg-5

>100kg-6
type-classic(autoclaved-40time), flexometal, intubation/fasttrack, proseal(controlled
ventillation)
ETT
preterm=gestational age(w)/10
1-6mth=2.5-3
6-12mth=3-3.5
1-6y=(age/3)+3.5
6-10y=(age/4)+4.5
adult mal=8-8.5, 21-22cm
adult fem=7.5-8, 20-21cm
cuff lies midtrachea-(2-2.5cm bel VC)
cuff pressure<25-30cmH2O
sudden in end tidal CO2(ETCO2)-venous air embolism
sudden in ETCO2-malign hyperthermia
shark n app-bronchospasm
armoured ETT(Nylon spiral)-NeuroSx anaesth
IT(Implant Tested)/Z79-passed ts toxicity testing
blind nasal intubation-#skull base
Guedel stage of anaesthesia
stagerespTVpupilsEPreflex
I(analgesia)-I-S-C-Dv-nil
II(excitement)-I-L-D-Dv-eyelash
III(Sx anaesth) planes
1-R-L-C-Dv-pharynx,skin,conjunctiva
2-R-M-dil-x central-corneal
3-R-S-dil-central-laryng
4-J-S-ful dil-central-carinal,anal
IV-apnoea
lacrimat-III pl 1,2a
lacrimat-III pl 4
TV-tidal vol, EP-eye position, I-irregul, R-regul, J-jerky, S-small, M-med, L-large,
Cv-converg, Dv-divergent
MAC(50% pt not respond to stimulus)
-child, anxiety, temp>42C, hypernatremia, c/c ingest alcohol/cocaine/amphetamine
-old age(6%/10y), opioid, sedation, hypoxia, hypothermia, hyponatremia, a/c ingest
alcohol/cocaine/amphetamine
MAC-Oil:gas partition coeff, Speed of induction&recovery(MOS)
MAC-bld:gas partition coeff, bld solubility, diffusion coeff
(Nani Dur SEE I Hai Meri)
N2O(104%)> Desflurane(6.0%)> Sevoflurane(2.0%)> Ether(1.92%)>
Enflurane(1.68%)> Isoflurane(1.15%)> Halothane(0.74%)> Methoxyflurane(0.16%)
Desflurane-max-speed of onset&recovery, min-B:G partit coeff, bld solubility,
diffusion coeff
Methoxyflurane-vice versa
elective Sx

preO2(3-4min)+IV induct+SMR IPPV(bag&mask) ETT


emergency(full stom) Sx
preO2(3-4min)+IV induct+SMR(SCh/rocuronium) no IPPV pressure on cricoid
cartilage(Sellick manoevre) cuffed ETT
Brewer Luckhardt reflex
intense pain
laryngospasm
reflex body movement
tachypnoea
preoperative digitalization prevents-intraoperative heart failure, postoperative heart
failure, supraventricular arrhythmia
morphine premedication=IM 10mg
postanasthetic shivering metab rate by=4time
position in suspected air embolism-head low, rt side up
inf alveolar n inltration at-3rd molar
landmark for lingual site block-mandibular foramen
peak pl conc of LA-intrapleural> intercostal> lumbar> epidural> brachial plex> s/c
neuraxial block
spinal needl-pencil tip(Sprotte, Whitacre), nonpencil tip(Quincke)
dose-old age, preg, abd tm
lingual n block-angle of mandible
postspinal headache last for=7-8d
preanesth med
atropine-CNS
hyoscine(scopolamine)-CNS
glycopyrrolate-no effect
pain on IV inj-etomidate> propofol> methohexitone> thiopentone> ketamine(0)
speed of recovery-propofol> methohexital> thiopentone> midazolam
DRUG
General anaesthetic
inhalational
volatile liquid-chloroform, diethyl ether, ethylCl, trichloroethylene
flurane-methoxyflurane, sevoflurane, halothane, enflurane, isoflurane, desflurane
gas-cyclopropane, N2O
intravenous
barbiturate-thiopentone, methohexital
non-barb
BDZ-midazolam, diazepam

phencyclidine-ketamine
steroid-pregnenolone
etomidate, propofol
IV anaesthetic
Thiopentone(1934)(all except HR)
yellow, amorphous powder, 6%anhydrous Na2CO3, prepared&stored in N2,
pH=10.5-11, S-Solubility, metab in liver, pt regains consciousness by redistribution,
microsomal enzyme inducer, releases histamine
CVS-periph vasodilator, BP, HR, myocard contractility
RS-RR
CNS-cerebral vasoconstrictor, cerebral bld flow, ICP, cerebral metab rate, sz
pain-threshold
c/i-a/c interm porphyria, variegate porphyria
dose-1-6mth infant=7mg/kg, children=5- 6mg/kg, adult=3-5mg/kg(2.5%)
onset time<30s, duration=15-20min
Methohexital
short act, cardiostable
Etomidate
act on GABA recept in RAS, cardiostable, nausea, vomiting, myoclonus,
adrenocortical suppression
Ketamine(all)
phencyclidine derivative, act on NMDA recept, dissoc anaesth, dissoc thalamic fr
limbic syst, metab to norketamine
CVS-sympath stim, BP, HR, myocard O2 demand
RS-min resp depress, maintain airway reflex, bronchodilator
CNS-ICP, cerebral metab rate, hallucination (audio>visual), amnesia
eye-IOP
GIT-salivary secretion, IAP
pain-threshold
c/i-HTN, CAD, aortic aneurysm, head inj, space occupying lesion brain, epilepsy,
glaucoma
dose=4-10mg/kg IM, 1-2mg/kg IV
PROpofol(1,6-diisopropylphenol)(opposite of ketamine)
milky white liq, soyabean oil, glycerol, egg lecithin, metab-liver(70%),lung(30%),
highly PROt bound
CVS-BP, HR
RS-RR, upper airway reflex
CNS-ICP, cerebral metab rate, sz
GIT-vomiting
antipruritic, antioxidant
neuroleptic analgesia=droperidol(2.5mg)+ fentanyl(50g)
neuroleptic anaesth=droperidol(2.5mg)+ fentanyl(50g)+ N2O
Inhalational anaesthetic

Ether
pungent, irritating to airway, inflammable
RS-bronchodil, preserves ciliary activity
pain-threshold
m-relax
hyperglycemia
c/i-cautery
Ethylene
c/i-cautery
Cyclopropane
fast induction
c/i-cautery
N2O(laughing gas)
prepared by heating NH4NO3 at 250C, 1.5time heavy than air, 35time more soluble
in bld than N2, irrevers oxidises Co atom of vitB12& methionine
synthetase&thymidylate synthetase megaloblast anem&periph neuropathy,
nausea,vomiting, teratogenic, not metab by body
CVS-pulm vasc resistance
RS-carotid body hypoxic drive
CNS-ICP, cerebral metab rate
pain-threshold
c/i-pulm HTN, venous air embolism, pneumothorax, lung cyst, intracran Sx,
tympanoplasty, vitreoret Sx
Methoxyflurane(3F atom)
vasopressor resist high output ren fail, boiling pt>75C, hepatitis
Halothane
shivering, hepatitis, centrilobular necrosis
CVS-sensitises heart to catecholamine, BP
RS-bronchodil
CNS-hypoxi drive, cerebral vasodil, ICP, potentiat compet NM blocker
GIT-hep bld flow&portal bld flow, fatal rate with hepatitis=20-40%
uterus-relax
pain-poor analgesic
c/i-ICP, liver dysfn, pheochromocytoma, malign hyperthermia, cardiac arrhythmia
Enflurane
tonic-clonic sz
c/i-Epilepsy, renal ds, malign hyperthemia
Isoflurane
pungent, coronary steal synd
CVS-periph vasodilator, BP, HR
CNS-ICP
c/i-severe hypovolemia, malign hyperthermia

Desflurane
pungent, eliminat by lung
CVS-BP, HR
RS-irritant to airway, breath holding, coughing, laryngospasm
GIT-salivatory
c/i-child, malign hyperthermia
Sevoflurane(7F atom)
sweet smelling
CVS-QT interval
CNS-sz, ICP
Muscle relaxant
centrally acting-BDZ, baclofen, mephenesin, tizanidine, carisoprodol, chlorzoxazone,
methocarbamol, orphenadrine, cyclobenzaprine
noncompet depol-SCh
compet nondepol
benzylisoquinolium(curium)
short act(10-20min)-mivacurium
interm act(20-50min)-cisatracurium, atracurium
long act(60-120min)-doxacurium, dtubocurarine, gallamine
ammoniosteroid(curonium)
short act-ropacuronium
interm act-rocuronium, vecuronium
long act-Pancuronium, Pipecuronium
sugammadex=vecuronium+ pancuronium+ rocuronium
SuccinylcHoline(suxamethonium)(all)
noncompet, depolarising, no fade on train of 4 stimulus, Hist release, ganglion
stimul, K+ level by 0.5mEq/l, RF
CVS-BP
CNS-ICP
GIT-IAP, LES tone
eye-IOP
c/i-stroke, cerebral palsy, burn, spinal cord inj, m dystrophy
dose=2mg/kg
onset<30s, duratiom=10-12min
dibucaine no.=%inh plasma Chsterase by dibucaine
norm=75-85%, abn<30%
AChesterase inhibitor,quinidine,Mg-action
benzylisoquinolium-curium
Atracurium(biquarternary)
75% metab by Hoffman degrad to laudanosine, 25% by alkaline ester hydrolysis,
histam release
Cisatracurium
3time more potent, metab 100%by Hoffman degrad
Mivacurium
shortest, slow onset, release histam, metab by pseudocholinesterase
dTubocurarine(monoquart)

long act, metab by kidn, max histam release, max ganglion block
Doxacurium
most potent, longest
Gallamine
cross placenta, metab 100% by kidn
c/i-preg, ren fail
aminosteroid-curonium
Vecuronium
interm act, metab liver, cardiostable
Rocuronium
most rapid onset, pain on inj
Ropacuronium
fastest, bronchospasm in child
Pancuronium
long acting, vagolytic, sympath stimul, metab by kidn, release histam
Metocurine
100% metab by kidn, contain I2
c/i-I2 sensitive pt
Gantacurium
ultrashort acting
Local anaesthetic
weak base, block Na ch fr inside, crosses neuronal memb in unionised form,
NaHCO3 speed& quality of anaesth
amide(ii)
interm act(LMP)-Lignocaine(lidocaine, xylocaine), Mepivacaine, Prilocaine
long act-bupivacaine, ropivacaine, dibucaine, etidocaine
ester(i)
short act-chlorprocaine, procaine
long act-tetracaine, benzocaine
EMLA=2.5%lignocaine+2.5%prilocaine
Lignocaine
conc(%)-block
2-jelly
0.5-IV regional block
1-n block
2-epidural anaesth, urethral procedure
4-topical anaesth
5-spinal anaesth
max safe dose=3mg/kg(300mg) without adr, 7mg/kg(500mg) with adr(1:2lac)
Bupivacaine
long acting, cardiotoxic, more lipid soluble
conc(%)-block
0.125-0.5-painless labour
0.5-spinal anaesth, n block
max safe dose=2mg/kg with/without adr
Prilocaine

methemoglobinemia
Benzocaine
methemoglobinemia, allergic rxn
Tetracaine
highest proT bind, longest
Cocaine
periph vasospasm, mydriasis
Opioid
Remifentanyl
shortest, metab by plasma esterase, equipotent to fentanyl, not given intrathecal
Sufentanil
short act, most potent
fentanyl
tone of chest m
Buprenorphine
ceiling effect
Pethidine
c/i-renal failure
Abbreviations
a-artery, AA-amino acid, abtc-antibiotic, AI-autoimmune
bef-before, bel-below, b/l-bilateral, bld-blood, b/n-between, bn-benign, br-branch,
Bx-biopsy
ca-carcinoma, carb-carbohydrate, c/i-contraindication, c/l-contralateral,
conc-concentration, cong-congenital, Cx-cervix
d-day, def-deficient, ds-disease, d/t-due to, Dx-diagnosis
E-estrogen
fem-female, fr-from
gld-gland, glu-glucose
h-hormone
idiop-idiopathic, i/l-ipsilateral, inf-infection, inj-injury
lig-ligament, LL-lower limb, l/t-leading to
m-muscle, maj-major, mal-male, MC-most common, met-metastasis, min-minor,
mtx-methotrexate, Mx-management
n-nerve, norm-normal
P-progesterone, pl-plasma, prot-protein, pt-patient
Rx-treatment
SCC-squamous cell carcinoma, sr-serum, Sx-surgery, sz-seizure
tm-tumour, ts-tissue
UL-upper limb, u/l-unilateral
vag-vagina, VC-vocal cord, vel-velocity, vert-vertebra, vit-vitamin, vol-volume
w-week, wt-weight
Xr-X ray
y-year
#-fracture

-degree
-(N.B.-THESE NOTES ARE ONLY FOR THE PURPOSE OF GUIDANCE AND HELP
TO PG ASPIRANTS, NOT FOR COMMERCIAL OR OTHER PURPOSE. REFERENCE
HAS BEEN TAKEN FROM VARIOUS STANDARD TEXTBOOKS. FOR ANY
FEEDBACK/QUERY PLEASE CONTACT- ankit.yadavendra@facebook.com or
dr.ankityadavendra@gmail.com )