21
The Practical Conduct of Anaesthesia
PREPARATION FOR ANAESTHESIA
TABLE 21.1
Equipment Required for Tracheal Intubation
Correct size of laryngoscope and spare (in case of light failure)
Tracheal tube of correct size + an alternative smaller size
Tracheal tube connector
Wire stilette
Gum elastic bougies
Magill forceps
Cuff-inflating syringe
Artery forceps
Securing tape or bandage
Catheter mount(s)
Local anaesthetic spray – 4% lidocaine
Cocaine spray/gel for nasal intubation
Tracheal tube lubricant
Throat packs
Anaesthetic breathing system and face masks – tested with O2 to ensure no leaks present
INDUCTION OF ANAESTHESIA
Anaesthesia is induced using one of the following techniques:
Inhalational Induction
The most common indications for inhalational induction of anaesthesia are listed in Table 21.2.
TABLE 21.2
Indications for Inhalational Induction
Young children
Upper airway obstruction, e.g. epiglottitis
Lower airway obstruction with foreign body
Bronchopleural fistula or empyema
No accessible veins
POSITION OF PATIENT FOR SURGERY
FIGURE 21.1 Positions on the operating table. (A) Lithotomy position. (B) Lateral position. (C) Prone position. (D) Trendelenburg position.
Positioning during anaesthesia is discussed extensively by Martin & Warner (1997).
MAINTENANCE OF ANAESTHESIA
Inhalational Anaesthesia with Spontaneous Ventilation
Delivery of Inhalational Agents – Airway Maintenance
Use of the Face Mask: Inhalational anaesthesia usually involves the use of a face mask. The face mask has many variants of type and size, and selection of the correct fit is important to provide a gas-tight seal.