Anaesthesia for General, Urological and many other specialities.
Anesthetic considerations for general surgical procedures involve preoperativepatient assessment and optimization, intraoperative management ofanesthesia and vital functions, and postoperative care. The primary goals are toensure the patient is unconscious (hypnosis), pain-free (analgesia), has no memoryof the event (amnesia), and has appropriate muscle relaxation for the surgery.
Preoperative considerations
Patient Assessment: A thorough evaluation of the patient's medical history, physical condition (e.g., using the American Society of Anesthesiologists (ASA) physical status scale), current medications (including herbal remedies and anticoagulants), and allergies is essential.
Comorbidities: Conditions like diabetes, high blood pressure, sleep apnea, or pulmonary disease must be well-managed before elective surgery.
Lifestyle Factors: Patients are advised to stop smoking to reduce respiratory complications and improve healing. Obesity can also increase risks.
Fasting Status: Patients must adhere to strict fasting guidelines (typically no solid food for 6-8 hours and clear liquids up to 2 hours before surgery) to minimize the risk of regurgitation and dangerous aspiration of stomach contents while unconscious.
Airway Assessment: The anaesthetist evaluates the patient's airway to anticipate potential difficulties with ventilation and intubation.
Monitoring: Continuous monitoring of vital signs is standard, including heart rate, blood pressure, oxygen levels (pulse oximetry), and temperature. Processed electroencephalogram (EEG) monitors may be used to assess the depth of anaesthesia.
Drug Administration: A balanced approach typically involves a combination of agents to achieve the goals of general anaesthesia:
o Induction Agents: Intravenous drugs like propofol or etomidate are commonly used to induce unconsciousness quickly.
o Maintenance Agents: Anaesthesia is maintained using a volatile gas (e.g., sevoflurane, desflurane, or isoflurane) mixed with oxygen and/or nitrous oxide, or via total intravenous anaesthesia (TIVA).
o Analgesics: Opioids (e.g., fentanyl) provide pain relief.
o Neuromuscular Blockers (Paralytics): Medications are used to relax muscles, which facilitates intubation and provides optimal surgical conditions, especially for abdominal or chest procedures.
Airway Management: A breathing tube (endotracheal tube) or other airway device is inserted to protect the airway and allow for mechanical ventilation while the patient's natural breathing is suppressed.
Physiological Stability: The anaesthesia team actively manages the patient's fluid balance, blood pressure, and body temperature to maintain organ perfusion and prevent complications.
Intraoperative considerations
Postoperative considerations
Emergence and Recovery: At the end of surgery, anaesthetic agents are stopped, and neuromuscular blockers are reversed. The patient is moved to a recovery room for close monitoring as they wake up.
Pain and Nausea Management: Prophylactic and active management of postoperative pain, nausea, and vomiting (PONV) is crucial for patient comfort and timely discharge. Multimodal analgesia techniques, including regional nerve blocks, are often employed.
Discharge and Follow-up: The effects of general anaesthesia can last up to 24 hours. Patients are advised not to drive, operate machinery, or make important decisions during this time. For day-case procedures, a responsible adult must escort the patient home.