1. Anaesthesia Revision Dr Rob Stephens Rob Stephens UCL/UCLH
Consultant in Anaesthesia UCLH
Hon Senior Lecturer UCL
Thanks to Dr Roger Cordery

2. www.ucl.ac.uk/anaesthesia/people/stephens Google UCL Stephens
Google UCL Anaesthesia Student

6. Contents
Anaesthesia Basics
Analgesia
Fluid Basics
Airway /kit Basics

7. Anaesthesia Basics Check out podcast Conduct of Anaesthesia At

9. Anaesthesia Triad of Anaesthesia Hypnosis Analgesia
+/-Neuromuscular paralysis 

10. Anaesthesia Triad of Anaesthesia Hypnosis Analgesia
+/-Neuromuscular paralysis 

11. Anaesthesia- Hypnosis
Hypnosis= reducing consciouness
Either I/v or volatile
I/V Thiopentone Propofol
CVS RS NS Depressants
I/V Ketamine
CVS stimulant Dissociative anaesthesia’ RS spared
Volatiles- gasses- Sevoflurane, Isoflurane
Breathe in, then out
CVS depressants, RS vary

12. Anaesthesia Triad of Anaesthesia Hypnosis Analgesia
+/-Neuromuscular paralysis 

15. Anaesthesia Analgesia
Psychology, local, regional, systemic
Systemic – ‘ladder’ plus adjvants (extras)
Simple –Paracetamol
NSAID – oral, I/v
s/e GI/platelets/ asthma/renal
Opioids = any drug acting on opioid receptors
s/e N+Vomit / constipation / RS /NS
Weak vs potent
I/m , PCA (cautious i/v) Oral ,transdermal
Gabapentin, Amitriptyline, Nitrous oxide etc

16. Anaesthesia Triad of Anaesthesia Hypnosis Analgesia
+/-Neuromuscular paralysis 

17. Anaesthesia Neuromuscular
To allow intubation and easy ventilation
No movement for surgery
NMJ Nicotinic Cholinergic antagonists
Non-competitive/depolarising = Sux
Competitive/non- depolarising = the others
Sux = 2 acetylcholine molecules
Others – Atracurium, Rocuronium, Vec..
Reversal- inhibit the enzyme that breaks down Ach (Cholinesterase) with Neostigmine

18. Anaesthesia: 3 classical phases
Preoperative – v important
Induction- going to sleep
Dangerous
Mostly Analgesia, Iv hypnosis, paralysis
O2, Air, ABCD
Maintenance –during surgery
Emergence – once surgery has ended
?postop?

19. Analgesia Psychology, local, regional, systemic
Systemic = ladder + adjuvants
Postop pain – depends on expected needs
?Intraop block/epidural
Everyone gets Paracetamol regularly 1G QDS
?add NSAID regularly eg Ibuprofen TDS
?add DiHydroCoedine regular
?need stronger – oral PRN Oral Morphine
? need stronger - PCA

20. Analgesia- PCA
Patient Controlled Analgesia Morphine IV 1mg/ml §§ 1mg bolus No background 5 min lockout Nursing Obs

22. Fluid Therapy Everyone gets confused!
Think about why you’re called to see patient
Hx, Exam, Ix, Management
How can you monitor fluid status?
Colloids / Crystalloids / Blood products
Colloids vs Crystalloids – no evidence

23. Fluid Therapy Colloids / Crystalloids / Blood products
Colloids vs Crystalloids – no evidence
Crystalloid – Saline / Glucose / Hartmann’s
Saline – Na Cl, add K+, acidosis
Glucose = water, no electrolytes, hyponatraemia
Hartmann’s- K+, Ca+ less Cl, has lactate, no acidosis
Colloids
smaller volumes / artificial- allergy
gelatin or plant starches in saline/Hartmann’s-like

24. Fluid Therapy Concept of a ‘Fluid Challenge’
What’s your endpoint / target / want to change ?
ml fluid over 15 mins
Doesn’t really matter what
Hartmann’s or ‘balanced’ colloid
Review patient- has it changed?
Get help after 2-3 challenges
May need more monitoring / drugs
Get help if unwell!

25. ABG Arterial blood gas Like venous – apart from 0xygen.
pH pCO2 sBEx (sHCO3)
Oxygen- what’s the Fi02
Other stuff UCLH happen to have bought
Eg Na, K, lactate, CO, Hb, MetHb
New way of thinking- ‘Stewart’ (gold medal)

26. Airway Airways obstruct Under Anaesthesia If consciousness reduced
Likely if GCS <8

27. Airway 0 Give Oxygen 1 Airway Manouvers
Head tilt / chin lift / jaw thrust
2 Airway Adjuncts
Guedel
3 Airway kit eg Laryngeal Mask Airway
4 Definitive Airway
Intubate- Cuffed Oral EndoTracheal Tube / Tracheostomy
5 Surgical Airway –
Cricothyroid /Tracheostomy

28. Summary Anaesthesia- triad Hypnosis – IV Gas
Analgesia – local, regional systemic
Preoperative / 3 phases / Postoperative
Fluids
Equipment
Welcome in theatre anytime