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Recent Advances and Technique in Anaesthesia for Ss/Js in Raj. State Health System

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Training module Recent Advances And Technique In Anaesthesia For Ss/Js In Raj. State Health System. INDEX SESSION / SERIAL TOPIC PAGE NO. minute NO. 1. PROGRAMME 3 2. AIMS AND OBJECTIVE 4 DAY1 -a A. ANAESTHESIA MACHINE, EQUIPMENT AND TECHNIQUES 1a -30m 3. EXPERIENCE WITH THE GLOSVENT ANAESTHETIC 5-7 MACHINE 1b -30m 4. VAPORISERS 8 1c -30m 5. POSITIONING ON THE OPERARING TABLE 9-12 DAY1 -b B.PHARMACOLOGY 2a -45 m 6. NITRIC OXIDE AND PROPOFOL 13 -15 2b -45 m 7. LEVOBUPIVACAINE 16 -18 3-90m 8. ACUTE OXYGEN TREATMENT 19 -26 4a -45m 9. A NEW MANDATE FOR THE ANAESTHESIOLOGIST - 27 -32 CANCER PAIN SPECIALIST:EXPERTISE IN PRESCRIBING ANALGESICS. 4b -45m 10 EMERGENCY DRUGS IN ANAESTHESIOLOGY AND 33-34 CRITICAL CARE MEDICINE DAY2 C. ANAESTHESIA IN PATIENTS ASSOCIATED WITH COMORBID CONDITIONS 1-90 m 20 MONITERING DURING CAESAREAN SECTION 35-38 2a -45m 11. THR PATIENT WITH HEART DISEASE 39-42 2b -45m 12. ANAESTHESIA AND CHRONIC RENAL FAILURE 43 -45 3a -45m 13 ANESTHESIA AND LIVER DISEASE 46 -48 4-90m 14 CLINICAL MANAGEMENT OF DIABETES MELLITUS 49 -56 DURING ANAESTHESIA AND SURGERY 3b -45m 15 ANAESTHESIA FOR THE PATIENT WITH 57 -58 RESPIRATORY DISEASE DAY3 D .ANAESTHESIA - SPECIAL COSIDER ATION 1a -30m 16 A MOBILE ANAESTHESIA SERVICE 59 1b -60m 17 A PRACTICAL APPROACH TO EMERGENCY EYE 60 -64 ANAESTHESIA 2-90m 18 ANAESTHESIA FOR ELDERLY PATIENT 65 -69 3-90m 19 ANAESTHESIA FOR THE PATIENT REQUIRING 70 -83 EMERGENCY ABDOMINAL SURGER Y 4-90m 20 INDUCTION OF ANAESTHESIA IN PAEDIATRIC 84 -88 PATIENTS DAY4 F. REGIONAL ANAESTHESIA AND PAIN 1a -30m 21 INTRAVENOUS REGIONAL ANAESTHESIA - 89 -90 BIER”BLOCK 1b -60m 22 NERVE BLOCKS FOR ANAESTHESIA AND ANALGESIA 91 -98 OF THE LOWER LIMB 2-90m 23 POSTOPERATIVE ANALGESIA IN PAEDIATRIC DAY 99 -102 CASE SURGRRY 3-90m 24 THE PHARMACOLOGICAL MANAGEMENT OF 103 -10 5 NEUROPATHIC PAIN 4-90m 25 PAIN RELIEF IN LABOUR 106 -109 PROGRAMME DURATION- 4 Days TRANIES- NOT MORE THAN 5. SESSIONS /DURATIONS DAY-1 • 2 ANAESTHESIA MACHINE, EQUIPMENT AND TECHNIQUES SESSIONS EACH FOR 90 MINUTES • 2 SESSION EACH FOR PHARMACOLOGY 90 MINUTES DAY -2 . • 4 SESSION ANAESTHESIA IN PATIENTS ASSOCIATED WITH COMORBID CONDITIONS EACH FOR 90 MINUTES DAY-3 • 4 SESSION ANAESTHESIA-SPECIAL COSIDERATION EACH FOR 90 MINUTES DAY-4 • 4 SESSION REGIONAL ANAESTHESIA AND PAIN EACH FOR 90 MINUTES TEACHING/TEACHINGS AIDS- LECTURES POWER- POINT AND OHP PRESENTATIONS DEMONSTRATIONS VIDEO/LAPTOP - CD PRESENTATIONS SKILLS ON MANIKINS/DUMMIES HANDS ON EXPERIENCES OPERATION THEATERS FURTHER READINGS- 1. ANAESTHESIA UPDATES 2. BRITISH JOURNAL OF ANAESTHESIA 3. INDIAN JOURNAL OF ANAESTHESIA 4. ANNUAL CMES OF ISA . AIMS AND OBJECTIVES Sr. Topics Objectives 1 ANAESTHESIA • To introduce a new machine be reliable, easy to understand MACHINE, EQUIPMENT and operate, economical to run, require minimal servicing which AND TECHNIQUES can be carried out locally, and be versatile, so that the same machine can be used in all patients both as an anaesthetic machine in the operating room and as a ventilator in a recovery room • To provide basic knowledge of recent vaporisers. • To upgrade the basic ideology of positioning of patient in theaters,to avoid various complications with conventional position. 2. PHARMACOLOGY • To provide informations of newer drugs usefull at 30 to 100 beded hospitals like,propofol, nitric oxides and levobupivacaine. • To know about the importance of acute oxygen treatment in critical situations in theater as well in recovery room. • To make familer with recent analgesics usefull in the management of pain for the patients suffering from variety of cancers at district level and provide palliative treatment,to reduce the burden over the tertery centers. 3. ANAESTHESIA IN TO STRENGTHEN THE KNOWLEDGE OF ANAESTHESIST AT PATIENTS ASSOCIATED DISTRICT AND LESS AFFULENT HOSPITALS TO PROVIDE WITH COMORBID ANAESTHESIA IN PATIENTS AT HIGH RISK VIZ. HEART CONDITIONS DISEASE,HYPERTENSION,DIABETES MELLITUS,RENAL FAILURE AND LIVER DISEASES,THUS TO CURTAIL THE NUMBER OF REFERRAL TO THE TERTERY CENTERS. 4. ANAESTHESIA -SPECIAL • To provide anaesthesia in mobile surgical camps. COSIDERATION • To manage the patient of abdominal trauma very common in RTA at district levels including eye trauma. • To introduce certain newer aspects of GERIATRICS anaesthesia, since no. of patients requiring anaesthesia of age>70 years increasing, specially in village populations. 5. REGIONAL • To provide impitus for regional anaesthesia so that frequency . ANAESTHESIA AND of GA as wel las its complications can bereduced. PAIN • To provide knowledge of nerve blocks • To provide analgesia in children postoperatively which is difficult and of its immense impotance. • TO START A NEW ERA OF PAINLESS DELIVERY. EXPERIENCE WITH THE GLOSTAVENT ANAESTHETIC MACHINE In many parts of the world, anaesthetists have to work in difficult or isolated situations where medical supplies are erratic and servicing facilities are poor or non-existent. Most modern anaesthetic machines, however, are not designed to be used in these conditions, as they require high levels of maintenance and servicing by trained engineers and are dependent on continuous supplies of compressed gases and electricity. Consequently, when conditions are unfavorable, they are liable to malfunction or even fail completely. An anaesthetist working in such difficult conditions requires an anaesthetic machine which has been specifically designed to overcome these problems. It should therefore be reliable, easy to understand and operate, economical to run, require minimal servicing which can be carried out locally, and be versatile, so that the same machine can be used in all patients both as an anaesthetic machine in the operating room and as a ventilator in a recovery room or I.C.U. Most important of all, it must continue to function if either the electricity or oxygen supplies fail, situations that are all too common in parts of the developing world and that have been responsible for many tragedies. The Glostavent anaesthetic machine has been designed to fulfill these requirements precisely. In the development of the Glostavent, four separate components have been incorporated, each of which has, in its own right, already proved valuable in difficult environments. These are the draw-over anaesthesia system, the oxygen concentrator, the Manley Multivent ventilator, and the air compressor. 1. The Draw-Over Anaesthesia System Atmospheric air is used as the carrier gas, which is drawn over a low resistance vaporiser, in this case, the Oxford Miniature Vaporiser (O.M.V.), either by the negative pressure created during inspiration in spontaneously breathing patients, or by the action of bellows when breathing is controlled. IT CAN THEREFORE BE COMPLETELY INDEPENDENT OF THE SUPPLY OF COMPRESSED GASES. Oxygen from a cylinder or a concentrator can be added upstream of the vaporiser, to increase the inspired oxygen concentration. 2. Oxygen Concentrator This is an electrically powered device which produces a continuous supply of oxygen from atmospheric air, by first compressing the air and then directing it through canisters containing zeolite granules where the nitrogen is absorbed and the residual oxygen delivered to the patient. The zeolite granules are continually being re-activated and do not require changing. 3. Manley Multivent Ventilator This is a pneumatically driven version of the Oxford inflating bellows. It can be driven either by compressed air or oxygen and only requires a volume of driving gas equal to 1/10 of the patient's minute volume. When oxygen is used for driving the ventilator, it is automatically collected and returned to the breathing circuit. In other words the same oxygen is used twice, first to drive the ventilator and then for the patient to breathe. The bellows of the Multivent can also be operated manually. 4. Air Compressor This is an integral part of the oxygen concentrator, which has been modified to allow some of the compressed air generated by the concentrator to be diverted for use as driving gas for the ventilator, so that the concentrator provides both the driving gas for the ventilator and oxygen for the patient. In the design of the Glostavent, the four components are mounted on a single trolley, together with 2 reserve oxygen cylinders (figures 1 & 2). It was initially described under its original name of Oxyvent1 and subsequently as the Glostavent2. Although it has now been in regular use in several hospitals throughout the world for the past 6 years3 & 4, delivering anaesthesia safely to thousands of patients, few reports of its use have so far been published5, and a full description of its operation illustrating its many advantages is not available. Its potential as a safe, reliable and cost effective anaesthetic machine has been recognised by the Association of Anaesthetists of Great Britain & Ireland, the World Federation of Societies of Anaesthesiology and the Department for International Development, all of whom have contributed to its development. However, anesthetists practicing in difficult situations or in isolation need to be confident that it will perform predictably and reliably in their own environments, so that it can be used safely when monitoring facilities are limited or totally absent. Paediatric Use The use of the draw over technique is not recommended in small children breathing spontaneously, because of the resistance of the circuit and the deadspace of the valves6. For this reason, in children under 25kg, the Glostavent was converted for continuous flow use. This was achieved simply by occluding the open end of the reservoir tube with a bung, in order to allow the gas flow to build up sufficient pressure to pass through the vaporiser. A Mapleson E circuit was then attached to the common gas outlet, as with any standard continuous flow anaesthetic machine and oxygen administered at a flow rate of 4L/Min from either the cylinder of the concentrator. The O.M.V was shown to function equally satisfactorily for continuous flow and draw over anaesthesia, so that no change of vaporiser was required.
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