Medical brain notes 7

  General anesthesia General anesthesia requires many preparatory steps. These include the pre-operative evaluation of the patient and the procurement and preparation of all equipment to be used, drugs to be given, intravenous cannulae to be inserted for the infusion of the necessary fluids, monitors, and the tools and techniques needed for the establishment of an open airway. Elsewhere in this you will find all of these topics addressed. Here, we will limit ourselves to a discussion of how to induce and maintain general anesthesia and how to ease the patient out of the drug-induced coma before transfer to the post-anesthesia care unit (PACU).   Induction, maintenance and emergence Once the preparations for general anesthesia are complete, the patient’s history and physical examination are reviewed, the machine and equipment are set up and tested, the patient is on the table, and the monitors are applied, we are ready to send the patient on one of the strangest journeys of his...

  Induction, maintenance and emergence Once the preparations for general anesthesia are complete, the patient’s history and physical examination are reviewed, the machine and equipment are set up and tested, the patient is on the table, and the monitors are applied, we are ready to send the patient on one of the strangest journeys of his life: general anesthesia. We will administer drugs by injection and inhalation that will take possession of the patient’s body. If we have used neuromuscular blocking agents, ventilation will cease, and the patient will be unable to move. In short, such an unconscious patient will have been reduced to a physiologic organism without a will.   To appreciate the enormity of this statement, consider the extreme of this con-dition: once general anesthesia has been established for some cardiac proce-dures, we might lower the patient’s temperature to the point where all currently monitored variables cease to show evidence of life. There will be no he...

  Post-operative care The post-operative care of the patient can be divided into an early and a continued phase. The early phase lasts from the moment the patient leaves the operating room until he is discharged from the Post-Anesthesia Care Unit (PACU) or its equi-valent. The care is then continued, a phase that can extend for days or even weeks. Early post-operative care Based on his medical condition and the planned operative procedure, we will have classified the patient as ambulatory (also known as outpatient), as ‘post-operative admit’ (the patient comes to the hospital on the day of the operation and is admitted to the hospital after his operation), or as an inpatient (the patient is already in the hospital, or will be admitted for pre-operative preparation, and will stay there post-operatively). Two categories of patients might bypass the PACU (formerly called the Recovery Room): (i) ambulatory patients who had a minor procedure and are expected to be ready for discharge in...