Anaesthesia Residency Program

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General Considerations, Preparation for General Anesthesia, The Process of Anesthesia. Ppt Slides Electronics there. Premedication. Premedication is the first stage of a general anesthetic. This stage, which is usually conducted in the surgical ward or in a preoperative holding area, originated in the early days of anesthesia, when morphine and scopolamine were routinely administered to make the inhalation of highly pungent ether and chloroform vapors more tolerable. The goal of premedication is to have the patient arrive in the operating room in a calm, relaxed frame of mind. Most patients do not want to have any recollection of entering the operating room. The most commonly used premedication is midazolam, a short acting benzodiazepine. For example, midazolam syrup is often given to children to facilitate calm separation from their parents prior to anesthesia. In anticipation of surgical pain, nonsteroidal anti inflammatory drugs or acetaminophen can be administered preemptively. WHXS9_726Xw/hqdefault.jpg' alt='Anaesthesia Residency Program' title='Anaesthesia Residency Program' />Learn more about the Department of Anesthesia, Critical Care and Pain Medicine at Massachusetts General Hospital. Download Building Games For Psp Go Free Full Version'>Download Building Games For Psp Go Free Full Version. When a history of gastroesophageal reflux exists, H2 blockers and antacids may be administered. Drying agents eg, atropine, scopolamine are now only administered routinely in anticipation of a fiberoptic endotracheal intubation. Induction. The patient is now ready for induction of general anesthesia, a critical part of the anesthesia process. Torrent Numb3rs Season 6 Suits here. In many ways, induction of general anesthesia is analogous to an airplane taking off. It is the transformation of a waking patient into an anesthetized one. The role of the anesthesia provider is analogous to the role of the pilot, checking all the systems before taking off. The mnemonic DAMMIS can be used to remember what to check D  rugs, A  irway equipment, M  achine, M  onitors, I  V, S uction. Committed to transforming the field of anesthesiology and perioperative medicine by generating and translating knowledge into superior clinical practice. Non General Practice Vacancies Industry, University, Internships, Specialist, WildlifeExotic Summary please scroll down to see details of all jobs. Eversion carotid endarterectomy eCEA involves oblique transection of the internal carotid artery ICA at its origin at the carotid bifurcation, followed. Social work programs are now in the Education and Social Work program area of this website. The Health Care Assistant Certificate and Return to Registered Nurse. At the University of Calgary the majority of teaching and learning takes place in our Faculties and academic departments as well as our Continuing Education unit. RCSI Graduate Entry Medicine GEM is an accelerated four year medical degree programme for graduates of any discipline. Anaesthesia Residency Program' title='Anaesthesia Residency Program' />Ophthalmology f l m l d i or p l m l d i is the branch of medicine that deals with the anatomy, physiology and. FARAH-Afghanistan-April-10-2010Preoxygenation-before-anesthetic-induction.jpg' alt='Anaesthesia Residency Program' title='Anaesthesia Residency Program' />This stage can be achieved by intravenous injection of induction agents drugs that work rapidly, such as propofol, by the slower inhalation of anesthetic vapors delivered into a face mask, or by a combination of both. For the most part, contemporary practice dictates that adult patients and most children aged at least 1. However, sevoflurane, a well tolerated anesthetic vapor, allows for elective inhalation induction of anesthesia in adults. In addition to the induction drug, most patients receive an injection of an opioid analgesic, such as fentanyl a synthetic opioid many times more potent than morphine. Many synthetic and naturally occurring opioids with different properties are available. Induction agents and opioids work synergistically to induce anesthesia. In addition, anticipation of events that are about to occur, such as endotracheal intubation and incision of the skin, generally raises the blood pressure and heart rate of the patient. They provide access to specialist veterinary services in surgery, medicine, anaesthesia, medical imaging, emergency and critical care, neurology, clinical pathology. Opioid analgesia helps control this undesirable response. The next step of the induction process is securing the airway. This may be a simple matter of manually holding the patients jaw such that his or her natural breathing is unimpeded by the tongue, or it may demand the insertion of a prosthetic airway device such as a laryngeal mask airway or endotracheal tube. Various factors are considered when making this decision. The major decision is whether the patient requires placement of an endotracheal tube. Potential indications for endotracheal intubation under general anesthesia may include the following Potential for airway contamination full stomach, gastroesophageal GE reflux, gastrointestinal GI or pharyngeal bleeding. Surgical need for muscle relaxation. Predictable difficulty with endotracheal intubation or airway access eg, lateral or prone patient position. Surgery of the mouth or face. Prolonged surgical procedure. Not all surgery requires muscle relaxation. If surgery is taking place in the abdomen or thorax, an intermediate or long acting muscle relaxant drug is administered in addition to the induction agent and opioid. This paralyzes muscles indiscriminately, including the muscles of breathing. Therefore, the patients lungs must be ventilated under pressure, necessitating an endotracheal tube. Persons who, for anatomic reasons, are likely to be difficult to intubate are usually intubated electively at the beginning of the procedure, using a fiberoptic bronchoscope or other advanced airway tool. This prevents a situation in which attempts are made to manage the airway with a lesser device, only for the anesthesia provider to discover that oxygenation and ventilation are inadequate. At that point during a surgical procedure, swift intubation of the patient can be very difficult, if not impossible. Maintenance phase. At this point, the drugs used to initiate the anesthetic are beginning to wear off, and the patient must be kept anesthetized with a maintenance agent. For the most part, this refers to the delivery of anesthetic gases more properly termed vapors into the patients lungs. These may be inhaled as the patient breathes spontaneously or delivered under pressure by each mechanical breath of a ventilator. The maintenance phase is usually the most stable part of the anesthesia. However, understanding that anesthesia is a continuum of different depths is important. A level of anesthesia that is satisfactory for surgery to the skin of an extremity, for example, would be inadequate for manipulation of the bowel. Appropriate levels of anesthesia must be chosen both for the planned procedure and for its various stages. In complex plastic surgery, for example, a considerable period of time may elapse between the completion of the induction of anesthetic and the incision of the skin. During the period of skin preparation, urinary catheter insertion, and marking incision lines with a pen, the patient is not receiving any noxious stimulus. This requires a very light level of anesthesia, which must be converted rapidly to a deeper level just before the incision is made. When the anesthesia provider and surgeon are not accustomed to working together, good communication eg, warning of the start of new stimuli, such as moving the head of an intubated patient or commencing surgery facilitates preemptive deepening of the anesthetic. This maximizes patient safety and, ultimately, saves everyones time. As the procedure progresses, the level of anesthesia is altered to provide the minimum amount of anesthesia that is necessary to ensure adequate anesthetic depth. Traditionally, this has been a matter of clinical judgment, but new processed EEG machines give the anesthesia provider a simplified output in real time, corresponding to anesthetic depth. These devices have yet to become universally accepted as vital equipment. If muscle relaxants have not been used, inadequate anesthesia is easy to spot. The patient moves, coughs, or obstructs his airway if the anesthetic is too light for the stimulus being given. If muscle relaxants have been used, then clearly the patient is unable to demonstrate any of these phenomena. In these patients, the anesthesia provider must rely on careful observation of autonomic phenomena such as hypertension, tachycardia, sweating, and capillary dilation to decide whether the patient requires a deeper anesthetic. This requires experience and judgment. The specialty of anesthesiology is working to develop reliable methods to avoid cases of awareness under anesthesia. Excessive anesthetic depth, on the other hand, is associated with decreased heart rate and blood pressure, and, if carried to extremes, can jeopardize perfusion of vital organs or be fatal.