District Hospital Ganderbal

Better Anaesthesia care

Dr. Yasser Yousuf Wani

Low flow anaesthesia

1. Uses only 30% of routine gas flow2. Saving worth crores if implemented across the state

Low / Minimal Flow Anaesthesia

❖ Classically we use >4-5 L per minute of a mixture of Oxygen and Nitrous Oxide gas to provide safe General Anaesthesia to our patients.

❖ However it is possible to utilise only 0.5-1 L per minute of these gases now and this is known as Low Flow Anaesthesia. ❖ Advantages: 1. Economical 2. Low OT

pollution❖ Not used widely: 1. Monitoring 2. Habits 3.

Training

TIVATotal IntraVenous Anaesthesia

TIVA

TIVA❖ As the name suggests Anaesthesia is provided by

a continuous controlled intravenous infusion of drugs.

❖ Uses an Electronic Infusion Pump.❖ Advantages : 1. Immediate recovery 2. Less Post-Op

vomiting

❖ 3. Pollution free

❖ Not used widely: 1. Training 2. Device needed

Supra-Glotic Devices

L.M.A v/s Intubation

Laryngeal Mask Airways

❖ Classical General Anaesthesia uses Tracheal Intubation

❖ New LMAs now considered safe , better alternative for most surgeries (except Head and neck surgeries & Obstetrics)

❖ Advantages: 1. Haemodynamics 2. Safer ( Infections ) 3. Less Soar Throat

❖ Not used widely: 1. Training 2. Availability 4. No difference to anaesthesiologist

Patient on Deliberate Hypotensive Anaesthesia BP 96/42 Delibrate Hypotensive Anaesthesia

SBP 80- 90mmHgMAP 50-60 mmHgMAP reduction by 20-30%

Hypotensive Anaesthesia❖ Drugs used:

❖ 1. Nitroglycerine ❖ 2. Sodium Nitroprusside ❖ 3. Betablockers (Labetalol)❖ 4. Ganglion Blockers (Trimethophan)❖ 5. Central Alpha 2 Agonist

(Clonidine ,Dexmedetomidine)❖ 6. Opioid Remifentanil

❖ Our resources : Nitroglycerine , Nitroprusside ❖ Advantages :

– Decreases intratoperative blood loss.– Improves operative field.– Decrease duration of surgery.

❖ Not used widely: ❖ 1. Training ❖ 2. Monitoring ❖ 3. No difference to anaesthesiologist

Only oxygen used- No waste anaesthesia gasesAnaesthesia Waste Gases Management

Waste Gases Management

❖ Ideal is Scavenging system - Very expensive❖ Our alternatives -❖ 1. Closed circuit Anaesthesia- Minimal waste gases ❖ 2. Modified Bains Anaesthesia circuits- Waste gases

vented out of OT❖ 3. TIVA- Only Oxygen used

Gases vented out of OTMapleson D Bains Anaesthesia Circuit used in our OT