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LOCAL ANAESTHESIA Local anaesthetic drugs ( Table 23.2 ) may be used to provide anaesthesia and analgesia, as a sole agent or as adjuncts to general anaesthesia. Available techniques include topical anaesthesia, local infiltration, regional nerve blocks and cen...

Learning objectives To gain an understanding of: Techniques of anaesthesia and airway maintenance • Methods of providing pain relief • Learning objectives To gain an understanding of: Techniques of anaesthesia and airway maintenance • Methods of providing pain...

Management of the airway during anaesthesia Loss of muscle tone as a result of general anaesthesia means that the patient can no longer keep their airway open. There fore, patients need their airway to be maintained for them. The use of muscle relaxants wil...

Monitoring and care during anaesthesia A minimum basic monitoring of cardiovascular parameters is required during surgery . This includes: /uni25CF vascular /uni25CF electrocardiogram (ECG); /uni25CF blood pressure; /uni25CF adequacy of ventilation: /uni25CF...

Muscle relaxation and artificial ventilation Pharmacological blockade of neuromuscular transmission by neuromuscular blocking agents provides relaxation of muscles, allowing easy surgical access. However, the patient will need artificial ventilation. Neuromuscu...

PAIN Pain is defined as ‘ An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.’ Most patients will experience pain after surgery . This is usually managed by a combination of pai...

PREPARATION FOR ANAESTHESIA A surgeon’s role is to carry out, in cooperation with the anaes - thetist, a thorough preoperative assessment that recognises medical and anaesthetic risk factors and facilitates the optimi - sation of the patient’s condition (see ...

Pain control in malignant disease Pain is a common symptom associated with cancer, even more so during the advanced stages. In intractable pain, the under lying principle of treatment is to encourage independence of the patient and an active life in spite of ...

Paracetamol and non-steroidal anti - inflammatory drugs Paracetamol was first synthesised in 1878 by Morse and was - introduced for medical usage in 1883. However, because of misinterpretation of its safety profile, its use was limited until the 1950s, when the ...

Paracetamol and non-steroidal anti - inflammatory drugs Paracetamol was first synthesised in 1878 by Morse and was - introduced for medical usage in 1883. However, because of misinterpretation of its safety profile, its use was limited until the 1950s, when the ...

Principles of chronic pain management Non-pharmacological treatment This involves a multidisciplinary approach targeting the biopsychosocial model of health ( Figure 23.8 ). Early assess - ment and engagement with physiotherapy and exercise are key contributo...

Regional anaesthesia Regional anaesthesia involves central neuraxial or peripheral nerve or plexus blocks using local anaesthetic drugs. It has a clear advantage when general anaesthesia carries a higher risk of morbidity and mortality , such as in patients w...

Ventilation during anaesthesia Mechanical ventilation is required when the patient’s spon taneous ventilation is inadequate or when the patient is not breathing because of the e ff ects of the anaesthetic, analgesic agents or muscle relaxants. In volume contr...

Abdominal surgery The abdomen should be examined daily for excessive disten - sion, tenderness or drainage from wounds or drain sites. In certain operations, such as those for intestinal obstruction or oesophageal and gastric procedures, a nasogastric tube ma ...

Cardiovascular system Thirty per cent of patients undergoing non-cardiac surgery will have at least one cardiovascular risk factor. In this group 30-day mortality is 0.5–2% as a result of cardiac complications. Routine pulse, blood pressure and electrocardio...

DISCHARGE OF PATIENTS Patients discharged home need a ‘discharge letter’ detailing the postoperative plan. The discharge letter should include details of the final diagnosis, the treatment and any complications that may have occurred. There should be advice fo...

Deep vein thrombosis Deep vein thrombosis (DVT) is a well-known and, when complicated by pulmonary embolus, potentially fatal compli - cation of surgery ( Table 24.6 ). All hospitals must have a process for screening all surgical patients to identify those at...

Drains Drains are used to prevent accumulation of blood and sero sanguineous or purulent fluid. In clean surgery , such as joint replacement, blood collected in drains can be transfused back into the patient provided that an adequate volume is collected rapidl...