Sangyaharana (Anaesthesia)

Syllabus – subtopics

1. 1Sthaniya Sangyaharana (Local anaesthesia) – Medicines, Techniques, Indications, Contraindications, Complications and Management
2. 2Kshetriya and Samanya Sangyaharana (Regional and General anaesthesia) - Medicines, Techniques, Indications, Contraindications, Complications and Management
3. 3Principles of preoperative assessment
4. 4Demonstration/Hands on Training - CPR
5. 5Demonstration/Hands on Training - maintenance of an airway / endotracheal intubation in a mannequin
6. 6Principles of safe General Surgery and Surgical Ethics

Learning objectives

At the end of this topic the student should be able to… (NCISM Table 3)

• Describe Local Anaesthetic Drugs, Techniques, Indications, Contraindications, Complications, and their Management.
• Explain Regional and General anaesthesia- Drugs, Techniques, Indications, Contraindications, Complications and their Management
• Describe principles of Preoperative assessment
• Describe Principles of safe General Surgery
• Elaborate the basic principles of CPR.Perform effective chest compressions and rescue breaths.Recognize the signs of cardiac arrest.
• Demonstrate airway management techniques, including endotracheal intubation, while emphasizing the importance of
• maintaining a clear airway through hands-on practice. C,L&G D,W A,PP-Practi cal,DOPS Non Lecture Hour Theory S.No Name of Activity Description of Theory Activity NLHT 4.1 Preoperative assessment 1. Patient interview and medical history collection 2. Physical assessment (vital signs, cardiovascular, respiratory, neurological) 3. Laboratory results review and documentation 4. Medication reconciliation 5. Allergy banding and sensitivity testing 6. Patient education (surgery, anesthesia, postoperative care) 7. Informed consent verification 8. Preoperative checklist completion NLHT 4.2 Safe General Surgery Preoperative Principles 1. Informed consent: Patient understanding of risks, benefits, and alternatives. 2. Accurate diagnosis: Confirm diagnosis before surgery. 3. Proper patient preparation: Optimize medical conditions, fasting, and medication. 4. Surgical site marking: Verify correct site and side. Intraoperative Principles 1. Asepsis and sterilization: Maintain sterile environment. 2. Proper anesthesia: Monitor and adjust anesthesia as needed. 3. Surgical team communication: Clear communication among team members. 4. Hemostasis: Control bleeding promptly. 5. Tissue handling: Minimize tissue trauma. Surgical Technique Principles 1. Respect tissue planes: Dissect along natural tissue planes. 2. Minimize dissection: Limit tissue damage. 3. Precise incisions: Make accurate, controlled incisions. 4. Gentle tissue retraction: Avoid excessive force. 5. Secure closure: Ensure proper wound closure. Postoperative Principles 1. Monitoring: Observe patient's vital signs and condition. 2. Pain management: Optimize pain relief. 3. Fluid management: Monitor and adjust fluid balance. 4. Wound care: Ensure proper wound dressing and closure. 5. Early mobilization: Promote timely recovery. General Safety Principles 1. Patient identification: Verify patient identity. 2. Medication safety: Ensure accurate medication administration. 3. Fire safety: Prevent surgical fires. 4. Electrical safety: Prevent electrical shock. 5. Infection control: Maintain proper infection control measures. Teamwork and Communication Principles 1. Clear communication: Ensure effective team communication. 2. Collaborative care: Foster teamwork among healthcare professionals. 3. Respect for patient autonomy: Prioritize patient-centered care. 4. Continuous learning: Encourage ongoing education and improvement. 5. Debriefing: Conduct postoperative debriefing sessions. Quality Improvement Principles 1. Monitor outcomes: Track surgical outcomes. 2. Identify errors: Analyze and learn from errors. 3. Implement changes: Improve processes based on data. 4. Continuous quality improvement: Regularly assess and improve care. 5. Patient feedback: Encourage patient feedback. Surgical Safety Checklist 1. Distribute a surgical safety checklist (e.g., WHO Surgical Safety Checklist). 2. Ask students to review and explain each item. 3. Role-play scenarios to demonstrate checklist usage Non Lecture Hour Practical S.No Name of Practical Description of Practical Activity NLHP 4.1 Demonstration of BLS (Basic life support) Steps 1. Assess the Situation: Ensure the scene is safe for both the rescuer and the victim. Check the victim for responsiveness by gently tapping and shouting. 2. Call for Help: If the victim is unresponsive, call for emergency medical services (EMS) immediately. If possible, ask a bystander to call EMS and fetch an Automated External Defibrillator (AED). 3. Check for Breathing: Look, listen, and feel for normal breathing for no more than 10 seconds. If the victim is not breathing or only gasping, begin CPR. 4. Chest Compressions: Position yourself over the victim's chest. Place the heel of one hand in the center of the chest, between the nipples. Place your other hand on top. Interlock your fingers and keep your arms straight. Push hard and fast, compressing the chest at least 2 inches deep at a rate of 100-120 compressions per minute. Allow the chest to fully recoil between compressions. 5. Rescue Breaths:After 30 compressions, give 2 rescue breaths. Tilt the victim's head back and lift the chin to open the airway. Pinch the nose shut and make a seal over the victim's mouth with yours. Deliver each breath over 1 second, watching for chest rise. Continue the cycle of 30 compressions and 2 breaths. 6. Using an AED: When the AED arrives, turn it on and follow the voice prompts. Attach the pads to the victim's bare chest as indicated. Ensure no one is touching the victim while the AED analyzes the heart rhythm. If a shock is advised, clear the area and press the shock button. Resume CPR immediately after the shock. NLHP 4.2 Maintenance of an airway / Endotracheal intubation in a mannequin Steps 1. Preparation: Ensure the mannequin is in a supine position. Gather all necessary equipment: laryngoscope, endotracheal tube, stylet, suction device, bag-valve- mask (BVM), and monitoring devices. 2. Assessment of the Airway: Check for any obstructions in the mouth and throat. Position the head to open the airway using the head-tilt-chin-lift maneuver or jaw-thrust maneuver if cervical spine injury is suspected. 3. Pre-oxygenation: Use a BVM to provide high-flow oxygen to the mannequin for several minutes to ensure adequate oxygenation before intubation. 4. Laryngoscopy: Hold the laryngoscope in your left hand and insert the blade into the mannequin's mouth, sweeping the tongue to the left. Visualize the vocal cords using the laryngoscope. 5. Endotracheal Tube Insertion: Hold the endotracheal tube with a stylet (if used) in your right hand. Guide the tube through the vocal cords into the trachea. Remove the stylet once the tube is in place. Inflate the cuff to secure the tube and prevent air leakage. 6. Confirmation of Tube Placement: Listen for bilateral breath sounds using a stethoscope. Observe chest rise and fall with each breath. Confirm placement with a capnography device to measure exhaled CO2. 7. Securing the Tube: Secure the endotracheal tube to the mannequin's mouth using tape or a commercial tube holder. Attach the tube to a ventilator or BVM for continued ventilation. 8. Post-Intubation Care: Monitor the mannequin for any signs of complications, such as desaturation or abnormal breath sounds. Ensure proper maintenance of the airway and equipment.

Important questions

• SAQ Write a note on local anaesthesia – drugs, techniques and complications. (Practice)