Anaesthesia and Associated Diseases: General Principles

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ANESTHESIA AND ASSOCIATED DISEASES

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Dr Sunita Goel
Lecturer in Anaesthesiology
BJ Wadia Childrens Hospital

GENERAL PRINCIPLES :

Many of the patients are neonates, some pre-term and thus demand special consideration.
In many cases the pathophysiology of the surgical disease dictates the optimal anesthesia management. The anesthesiologist should understand the effects of the lesion on normal physiology.
Surgery may be required immediately e.g. (congenital diaphragmatic hernia, tracheo-esophageal fistula) and there may not be time for optimal preparation of the patient. However, in most cases some time is available for preoperative resuscitation and the optimum
time for surgery must be decided by consultation between anesthesiologist, neonatologist and surgeon.
For emergency abdominal surgery, the problem of full stomach must be considered (even if the patient has not eaten for some time, secretions accumulate in the stomach and emptying may be delayed by obstruction or ileus.
- Newborn and small infants aspirate stomach contents through a gastric tube, preoxygenate and perform awake intubation)
- Older children, aspirate stomach contents and perform a "crash" induction combined with cricoid pressure (Sellick's Maneuver).
- Remember: For crash induction in children (< 10yrs) succinylcholine does not increase intra-abdominal pressure at this age, and pretreatment with curare is not indicated.
During thoracoabdominal surgery, blood loss may be considerable; be prepared to handle major blood transfusion.
For major abdominal surgery, always place intravenous lines in the upper limbs. The I.V.C. may become occluded during the operation and thus transfusion via the lower limb veins would be useless.
During limb surgery bronchial secretions (often serosanguinous) may accumulate and interfere with ventilation. Therefore all endotracheal intubation must have straight or plug and chain (Cobb) connectors to facilitate per operative tracheobronchial toilet; wherever this becomes necessary.
During thoracotomy, V:Q ratios in the lungs are disturbed. Therefore increase the inspired oxygen concentration and check the arterial oxygen tension.
In infants and small children, retraction of the lungs may obstruct major airways, impairing ventilation or it may compress the heart and great veins, leading to a precipitous fall in cardiac output and hence blood pressure. Constant breath- breath by monitoring via stethoscope is essential and a Doppler flow meter should be used to monitor pulse and blood pressure. In the event of bradycardia, hypotension or impaired ventilation.
- ask the surgeons to remove all retractors immediately
- Ventilate the patient with 100% oxygen.
Patients requiring minor surgery ( e.g. herniotomy) may be preterm and/or have other condition that may complicate anesthesia and require special consideration.

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