ANAESTHESIA HANDBOOK International Committee of the Red Cross 19, avenue de la Paix 1202 Geneva, Switzerland T +41 22 734 60 01 F +41 22 733 20 57 E-mail: [email protected] www.icrc.org © ICRC, December 2018 Front cover: A. Liohn/ICRC ANAESTHESIA HANDBOOK 2 ANAESTHESIA HANDBOOK TABLE OF CONTENTS A. INTRODUCTION AND STANDARDS .................................9 1. INTRODUCTION ............................................................ 10 2. STANDARDS AND STANDARD EQUIPMENT .............. 13 2.1 Minimum standards ..........................................................13 2.2 Standard equipment .........................................................15 3. HYGIENE AND STERILIZATION ................................... 16 3.1 Key terms...............................................................................16 3.2 Techniques ............................................................................17 B. ADMINISTERING ANAESTHESIA .................................23 4. RUNNING A RESUSCITATION TEAM .............................. 24 4.1 Before the patient arrives ................................................24 4.2 When the patient arrives .................................................26 5. PRACTICAL RESUSCITATION ....................................... 29 5.1 Airway (see Chapter 8) ......................................................30 5.2 Breathing ...............................................................................30 5.3 Circulation .............................................................................31 5.4 Disability and exposure/environment ........................31 5.5 Resuscitation outcomes ���������������������������������������������������32 6. FASTING RULES ������������������������������������������������������������ 33 6.1 Adults .....................................................................................33 6.2 Children .................................................................................33 7. ANAESTHESIA IN THE ICRC ENVIRONMENT ............... 35 7.1 Overview ...............................................................................35 7.2 Ketamine ...............................................................................37 8. AIRWAY MANAGEMENT TECHNIQUES ...................... 42 8.1 When is a secure airway (endotracheal intubation or a surgical airway) needed? ..................42 8.2 General principles for improving airway management .........................................................43 8.3 Surgical airways ..................................................................44 8.4 Elective or semi-elective airway management ........45 9. VASCULAR AND INTRAOSSEOUS ACCESS ................ 46 9.1 Vascular access ....................................................................46 9.2 Intraosseus access ..............................................................46 TABLE OF CONTENTS 3 10. FLUID MANAGEMENT .................................................. 57 10.1 Adults .....................................................................................57 10.2 Children .................................................................................59 11. BLOOD TRANSFUSIONS .............................................. 63 11.1 Preparing for transfusion �������������������������������������������������63 11.2 Sources of blood and testing �����������������������������������������66 12. DRAWOVER ANAESTHESIA ......................................... 70 12.1 Principles ...............................................................................70 12.2 Parts ........................................................................................71 13. ULTRASOUND-GUIDED REGIONAL ANAESTHESIA ............................................................... 73 13.1 Generic principles ..............................................................73 13.2 Ultrasound machine ..........................................................75 14. PAIN MANAGEMENT .................................................... 76 14.1 Introduction .........................................................................76 14.2 Pain medication ..................................................................79 C. SPECIAL CONSIDERATIONS AND EMERGENCIES ....... 83 15. BURN MANAGEMENT ................................................... 84 15.1 Some crucial elements .....................................................84 15.2 <c>ABCDE .............................................................................85 15.3 Burn details ...........................................................................85 15.4 Airway and breathing .......................................................86 15.5 Circulation .............................................................................86 15.6 Surgical interventions .......................................................88 15.7 Additional considerations for anaesthesia in burn victims .....................................................................88 15.8 Additional considerations for the critical care of burn victims. ...................................................................89 16. CRUSH INJURIES ........................................................... 92 16.1 Clinical presentation .........................................................92 16.2 Management .......................................................................92 17. PAEDIATRIC ANAESTHESIA ����������������������������������������� 94 17.1 Preoperative assessment �������������������������������������������������94 17.2 Paediatric equipment .......................................................95 4 ANAESTHESIA HANDBOOK 17.3 Post-operative management .........................................97 17.4 Neonatal resuscitation ......................................................99 17.5 Post-resuscitation care ...................................................101 18. OBSTETRICS ................................................................ 103 18.1 Preoperative assessment �����������������������������������������������103 18.2 Preoperative management for emergency caesarean section .............................................................103 18.3 Choice of anaesthetic technique ................................104 19. HEAD INJURY/NEUROSURGERY ��������������������������������114 19.1 Preoperative .......................................................................115 19.2 Intraoperative ....................................................................116 19.3 Post-operative ...................................................................117 19.4 Summary .............................................................................118 20. ANAPHYLAXIS ............................................................ 120 20.1 Assessment and management ....................................120 20.2 Secondary management �����������������������������������������������121 21. LOCAL ANAESTHETIC SYSTEMIC TOXICITY (LAST)........................................................................... 123 21.1 Recognition ........................................................................123 22. MALIGNANT HYPERTHERMIA ���������������������������������� 126 22.1 Recognition ........................................................................126 22.2 Immediate management �����������������������������������������������126 22.3 Monitoring and treatment �������������������������������������������127 22.4 Follow-up ...........................................................................128 D. EQUIPMENT GUIDANCE AND REGIONAL BLOCKS ......131 23. ADMINISTERING OXYGEN ......................................... 132 23.1 Oxygen cylinders ..............................................................132 23.2 Oxygen concentrators ....................................................132 23.3 Operation ............................................................................133 23.4 Maintenance ......................................................................134 24. DIAMEDICA EQUIPMENT ............................................ 135 24.1 Glostavent® anaesthetic machine ...............................135 24.2 Vaporizer and breathing system .................................136 24.3 Oxygen concentrator ������������������������������������������������������138 24.4 Helix ventilator ..................................................................138 24.5 Portable anaesthetic machine (DPA 01™) ................140 25. REGIONAL BLOCKS .................................................... 142 25.1 Axillary brachial plexus block ���������������������������������������142 TABLE OF CONTENTS 5 25.2 Femoral nerve block ........................................................145 25.3 Popliteal sciatic nerve block �����������������������������������������147 25.4 Infraclavicular brachial plexus block ..........................149 E. MEDICAL CONSIDERATIONS ......................................155 26. TROPICAL DISEASES ................................................. 156 26.1 Malaria ..................................................................................156 26.2 Tuberculosis .......................................................................157 26.3 HIV .........................................................................................158 26.4 Typhoid ................................................................................159 26.5 Worms ..................................................................................159 26.6 Hydatid disease .................................................................160