EMERGENCY ANAESTHESIA Dr. Bassam Al-Barzangi Jordan University Hospital

EMERGENCY ANAESTHESIA (1) Definition Is the type of ANAESTHESIA administered for EMERGENCY OPERATIONS occurring within 24 hours of admission to Hospital or Diagnosis of Surgical Pathology. Resuscitation may be necessary prior to operation OR may be necessary at time of operation if there is no time to resuscitate prior to operation.

EMERGENCY ANAESTHESIA (CONT.) (2) Types of Emergency Operations 1- Trauma Preoperative evaluation and Preparation include: a- Resuscitation using ABC-Principles b- Determination of Nature & Extent of all injuries c- Information (as much as possible) about past history and history of trauma d- Stabilization of cervical spine in injuries above the clavicles e- Resuscitation with intravenous fluids f- Type and Cross-Match blood for transfusion g- Laboratory investigations (if time allows) like Cervical Spine X-Ray, ECG, Haematokrit and Urine for Blood

2- Obstetrical Preoperative Evaluation and Preparation include: a- History of Co-Morbidities b- Quick History and Physical Examination c- Resuscitation when needed vigorously (two lives at stake) d- Type and Cross-Match blood e- Special Precautions towards : * Supine Hypotensive Syndrome * Pregnancy Induced (Associated) Hypertension * Fetal Hypoxia * Acidic Resting Stomach Juice * Regurgitation

3- Neonatal (Congenital Anomalies) Special Precaution towards : a- Association of Multiple Anomalies b- Prematurity c- Temperature Control d- Fluid and Electrolytes Balance e- Response to Anaesthetic Drugs

4- Other Surgical Emergencies Special Precaution towards : a- Dehydration and Hypotension b- Uncontrolled Comorbidities c- Electrolytes and Acid-Base Disturbances d- Severe Infection

EMERGENCY ANAESTHESIA (3) Anaesthetic Considerations 1- Inadequate History and Investigations 2- Inadequate Preparation a- Not Fasting – Requires Rapid Sequence Induction of Anaesthesia b- Untreated Pre-Existing Diseases – Requires Resuscitation and Careful Choice of Anaesthetic Drugs and Techniques c- Unavailability of Appropriate Investigations – Requires Depending on Clinical Impression and Minimal Investigations d- Unavailability of Appropriate Cross-Matched blood – Requires use of Type-Specific blood or Group O-Neg blood transfusion in life saving procedures until proper Cross-Matched blood is available 3- Heat Loss should be prevented in all ages 4- Invasive monitoring should be applied when required 5- ICU-admission and IPPV institution when required 6- Local or Regional Anaesthesia should be used when feasible

EMERGENCY ANAESTHESIA (CONT.) (4) Facts The balance between proper preoperative preparation and urgency of operation is sometimes difficult. Inadequate correction of fluid, electrolytes and acid-base disturbances is always associated with increased perioperative mortality. Careful preoperative assessment and discussion between SURGEON and ANAESTHETIST is vital for successful operation.