Project MUSE - Anaesthesia

Cover

Title Page, Copyright Page

Foreword

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pp. vii-

As a leader of modern anaesthesia in Hong Kong, Dr Lett has had the opportunity of exercising his expertise on all types of patients. Further, he not only organized the anaesthetic service but has also been teaching medical students and postgraduates for more than a quarter of a century. This book aims to bring the subject to students of medicine, dentistry and those who are considering learning about and, perhaps specializing in anaesthesia. The ...

Preface

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pp. ix-x

This book is aimed at all those medical and dental students, who have not yet known much about anaesthesia, but would like to learn something about its fundamentals. It is not meant to be a manual of 'how to become an anaesthetist in ten easy lessons', and is intended not to replace, but rather to supplement the number of already available texts. An attempt has been made to follow a patient about to have a surgical intervention, ...

I. INTRODUCTION

There is a time honoured controversy as to the most important single discovery in the history of the human race. Some opt for fire; some for the invention of the wheel; some for the growing of corn. For my part I would give my vote to the invention of anaesthetics. ...

1. Pain

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pp. 3-13

It has been said that the most humane application of chemistry is for the purpose of achieving anaesthesia. Although the benefits to the patient (derived from the increasing skill, knowledge and experience of the anaesthetists) can be felt in many fields of medical practice, e.g. cardio-pulmonary resuscitation, care of the unconscious patient, Intensive Therapy Units (I.T.U.), etc., it is mainly in the operating theatres that the ...

2. Development of Anaesthesia

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pp. 14-22

The word 'anaesthesia' is derived from the Greek and means 'without feeling'. Dioscorides, the Greek surgeon in the army of the Roman Emperor Nero, first used it in AD 60. It was introduced into general usuage in 1847 by the famous American thinker Oliver Wendel Holmes. It was believed that the first doctor to use diethylether was Crawford Williamson Long in 1842 in the U.S.A., but it has since been ...

II. ANAESTHESIA MANAGEMENT

3. The Pre-Operative Period

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pp. 25-50

The participation of anaesthetists in the immediate pre-operative care lowers the rate of morbidity and mortality in surgical patients. It is advisable that every patient due to undergo a surgical intervention should be seen by his anaesthetist beforehand, and therefore should be admitted to hospital earlier to allow sufficient time for this. The anaesthetist should review all past and present hospital records of his patient, ...

4. Preparing for Anaesthesia and Surgery

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pp. 51-64

The nursing staff will usually play the most active role in the period prior to the patient's operation. Most patients consider an operation an ordeal to go through. A cheerful, intelligent, thoughtful and understanding nurse can help considerably in the psychological preparation of the patient for operation. Patients should be reassured and, if possible, placed in beds next to other patients, preferably also intelligent, who ...

5. Induction of General Anaesthesia

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pp. 65-80

It should be realized that the induction of general anaesthesia and rendering the patient unconscious will immediately necessitate the institution of all those procedures that are essential for the care of the unconscious patient. The basis of all these are still (1) the institution and maintenance of a free airway, (2) continued respiration (either spontaneous or artificial) and (3) an adequate content of oxygen in the ...

6. Respiration and Anaesthesia

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pp. 81-112

The tongue is a striated muscular organ attached to the hyoid bone, floor of the mouth and symphysis of the mandible. In a conscious person, under normal circumstances, there is a gap between the tongue and the posterior pharyngeal wall. Regardless of the person's position, this gap will always be present due to the tongue maintaining sufficient tone (Fig. 6.1). ...

7. Maintenance of General Anaesthesia

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pp. 113-137

General anaesthesia can be maintained by the patient either (1) breathing spontaneously (if no profound muscular relaxations are required) or (2) being ventilated artificially (by means of intermittent positive pressure ventilation) with muscular relaxants administered intravenously (on top of the usually light general anaesthesia). Artificial ventilation is used when profound degrees of muscular relaxation are ...

8. Muscular Relaxation and Recovery

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pp. 138-156

Guedel's 'Table of Signs of Anaesthesia' (1920) divides anaesthesia into stages and planes and applies to patients without any pre-operative medication and anaesthetized with 'open' ether (Fig. 8.1). It shows the disappearance of various reflexes as well as muscular tone with deepening anaesthesia. During the four stages, the respiration, ocular movements, eye reflexes, secretion of tears, laryngeal and pharyngeal reflexes, respiratory response to skin incision and ...

9. Local and Regional Analgesia

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pp. 157-188

A local analgesic drug is one that temporarily blocks nerve conduction when applied locally to nerve tissue in appropriate concentration. Local analgesic drugs may be classified into three broad groups: 1. Hydroxy compounds. These are a small group of drugs used mainly for topical analgesia. Because of their toxicity, they are not used any more for injection. ...

10. Circulation and Anaesthesia

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pp. 189-207

Although the systemic circulation is responsible for tissue perfusion, the anaesthetist has to consider also the blood supply to all the organs, particularly the vital ones and bear in mind the effects, deleterious or otherwise, of the drugs, techniques and procedures employed during surgery and anaesthesia on this perfusion. Blood pressure (B.P) is the product of cardiac output (CO.) and peripheral resistance ...

11. Intravenous Supportive Therapy

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pp. 208-224

The intravenous administration of drugs, electrolyte solutions, plasma expanders and blood are an integral part of anaesthetic management. The total body water amounts to about 48.5% of the female and up to 56.8% of the male body weight and can be classified as extracellular and intracellular. The extracellular fluid volume is approximately 20% of the ideal body weight. It has two components: intravascular fluid or ...

12. The Post-Operative Period

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pp. 225-237

Patients who have been subjected to surgery and anaesthesia need continuous surveillance which cannot normally be adequately provided by the sporadic nursing care in a general ward. Special recovery units are set up to provide the necessary care, and usually they are of 2 types: (a) Recovery rooms are small rooms, usually alongside the anaesthetic room, and ...

13. Environmental Hazards in Operating Rooms

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pp. 238-255

There are a number of ways that people in the operating theatres (both patients and working personnel) may be adversely affected. Amongst these are pollution of the operating theatre's atmosphere by gases and vapours used in anaesthesia, hazards due to malfunctioning of electrical and other equipment and the risk of explosions and fires. ...

14. Anaesthesia as a Diagnostic or Therapeutic Aid

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pp. 256-270

Somatic nerve block (such as paravertebral) may be employed for the localization of prolapsed intervertebral discs, confirmation of a diagnosis of neuralgia, or differential diagnosis of somatic (such as intercostal neuralgia) and sympathetic pain (such as in angina plectoris or coronary insufficiency). ...

Ill ANAESTHESIA AND OTHER SPECIALTIES

15. Anaesthesia and Obstetrics

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pp. 273-284

During the anaesthetic management of obstetrical patients, one must be mindful of the fact that two lives are involved, the mother and the baby. There are basically two periods when anaesthesia (or analgesia) are required. The first one is when dealing with ordinary labour and delivery pains, the second one is during operative delivery, such as forceps, versions and caesarean sections, and possibly repair of episiotomy ...

16. Paediatric Anaesthesia

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pp. 285-294

In paediatric anaesthesia, two main points should be remembered: (a) the difference between the young developing child and the mature adult in relationship to the structure and function of some of the important systems, (b) the differences in the respective responses to the administered drugs and their significance (Chan and Lett, 1974). ...

17. Anaesthesia for Neurosurgery

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pp. 295-305

As in most other branches, but perhaps even more so, general anaesthesia for neurosurgical procedures must be carried out in such a meticulous manner that the whole procedure will be smooth. A smooth induction leading to a trouble-free maintenance, a scrupulous avoidance of hypoxia or hypercarbia and an uncompromising maintenance of a free airway at all times are the cornerstones on which the successful ...

18. Anaesthesia for Ear, Nose, Throat and Eye Operations

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pp. 306-312

Operations around the ears do not pose any particular problems, provided the patient's airway is carefully maintained and respiration is not depressed during adequate anaesthesia, so that coughing and straining are avoided. However, operations for nose and throat surgery present an additional problem (similar to dental surgery) that both the surgeon and the anaesthetist have to compete for the confined space of ...

19. Anaesthesia for Cardiac Surgery

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pp. 313-325

The anaesthetic management will largely depend on the nature of the procedure, the state of the patient and his age. It can safely be said that amongst the most spectacular advances in recent years are those pertaining to cardiac surgery and extra-corporeal circulation, but in this section only the outlines can be given. The occasions when anaesthesia would be required can conveniently be divided ...

20. One Lung Anaesthesia

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pp. 326-333

In thoracic operations it is necessary not only to isolate the alimentary from the respiratory systems, but very often, one side of the lung from the other. The main reason in the past was the need to protect the 'healthy lung' from being flooded by secretions, blood or other debris from the operated side. There are nowadays fewer patients with pulmonary TB, bronchiectasis, etc. and this therefore is no longer the ...

21. Anaesthesia for Laryngectomy

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pp. 334-335

Certain lesions occuring in the larynx or its vicinity are amenable to surgical treatment. The operative procedure are frequently laryngectomy with or without the block resection of glands of neck, or (as in carcinoma of the epiglottis, pharynx or upper esophagus) a pharyngo-laryngo-oesophagectomy (P.L.O.). If the lesion have caused respiratory difficulties before the operation, a preliminary ...

22. Anaesthesia and Corrective Spinal Surgery

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pp. 336-339

The commonest diseases requiring surgical interventions on the spine, especially in children (in Hong Kong), are: (1) Polyomyelitis, causing scoliosis in varying degrees. (2) Tuberculosis of the spine, leading to kyphosis. Both (1) and (2) can become quite severe. (3) Congenital abnormalities of the spine. (4) Idiopathic Scoliosis. ...

23. Anaesthetic Problems in Liver Disease

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pp. 340-346

Accurate diagnosis is most important in the treatment of patients with liver disease. A wide range of new laboratory tests and diagnostic techniques have been introduced, but a careful taking of the history and thorough physical examination are still of paramount importance. Unless these are carried out, patients with drug induced jaundice, alcoholism or physical signs of chronic liver disease (spider naevi, palmar ...

24. Induced Hypotension

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pp. 347-352

Most authorities agree that profound hypotension for surgical interventions should be employed mainly to 'make the impossible become possible' rather than to make the 'difficult become easy'. Deliberate reduction of the blood pressure may be achieved by interfering either with the peripheral resistance or at other sites. The conventional formula is: B.P. = C O , x P.R. ...

25. Malignant Hyperpyrexia Syndrome

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pp. 353-360

Denborough and Lovell (1960) described an Australian family, whose several members had died of hyperpyrexia of sudden onset during, or shortly after, general anaesthesia. Such complications were then referred to as 'ether convulsion', 'postoperative heat stroke' or other similar terms. The present term 'malignant hyperpyrexia' was introduced by Gordon (1966). Since then this syndrome (with a ...

Table of Some Normal Values

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pp. 361-366

Certain other established units, although they are not strictly in SI, will also continue to be used. They are the litre (1) equivalent to the cubic decimetre and the degree Celsius (C). The mode of presentation of SI units has been standardized. Symbols are written without a full stop and do not alter in the plural. Multiples and submultiples (decimal ...

Anaesthesia