Anaesthetists procedures

An anaesthetist administers chemicals such as halothane (HI) to a patient before and during an operation to promote unconsciousness. Medical procedures such as operations would be impossible for the surgeon if the patient were awake and could move and they would also be traumatic for a patient who was aware of what the surgery entailed. 

For inhalational induction of anaesthesia in children, 6% sevoflurane in 50% nitrous oxide and oxygen is probably optimal. However, some anaesthetists consider it to be inferior to halothane for the management of the irritable or constricted airway and for anaesthesia for bronchoscopy. Sevoflurane is preferred for dental procedures as there is a lower risk of cardiac arrhythmias than with halothane, especially in children. In children with congenital heart disease, whereas the cardiac index is reduced by halothane it is preserved with sevoflurane. In adults, 8% sevoflurane is well tolerated and, provides rapid induction of anaesthesia without adversely affecting haemodynamic stability. 

Interestingly, anticholinesterases, ACH and ion antagonize competitively pancuronium bromide effectively however, its activity is virtually enhanced by general anaesthetics, for instance halothane, ether, enflurane etc. (see Chapter 4). Therefore, the latter substantial potentiation in pharmacological activity is particularly useful to the anaesthetist due to the faet that it is administered invariably as an adjunct to the anaesthetic procedure in order to cause simultaneous relaxation of the skeletal muscle. 

For one, it depends on your point of reference. As a patient undergoing a surgical procedure one would presumably choose to receive care of the utmost quality a surgeon and anaesthetist who were the best in their field using state of the art equipment and perfectly maintained facilities. The reality is that the quahty of care we provide and receive exists somewhere on a spectrum. We have to reach a balance between quality, available skills and resources which is acceptable to all parties and to us as a society. 

Figure 16.2 Anaesthetists compliance with new safety procedure over time (from Saint Maurice et al., 2010).

Anaesthetist informs team of special patient needs Surgeon briefs team on the surgical procedure Scrub-nurse and circulating nurse confirm instruments check... 

In a second example, Elaine Hart and Harry Owen observed 20 anaesthetists carrying out the difficult, and increasingly uncommon, procedure of general anaesthesia for Caesarean section in a simulated environment. They had first prepared a checklist of 40 items all viewed as important procedural checks by an expert panel. They found that on average the anaesthetists failed to carry out about a third of the recommended checks ... 

Pancuronium and vecuronium both have faster onset of action than tubocurarine, and they do not have significant cardiovascular side effects. Their intermediate duration of action makes them suitable for medium-sized surgical procedures (e.g. caesarean section). However, faster onset of action, fewer side effects and a shorter duration of action are still desirable features demanded by anaesthetists. 

---