I/V INDUCTION OF GENERAL ANESTHESIA - SUMMARY

BASIC PRINCIPLE:-

1. From the patients"s view point,induction of anesthesia is very important time, partly because anxiety is maximal especially in unpremeditated person. So, there should not be any UNDUE DELAYS and that the ENVIRONMENT IS PEACEFUL, gives an impression of confidence and HAS NO DISTRACTING NOISES.
2. The basic principle is to induce anesthesia in a PROPERLY EQUIPPED ENVIRONMENT WITH A PROPERLY TRAINED ASSISTANT. Anesthesia should NEVER be induced WITHOUT SUPPORT.
3. All routine patients should be induced with an ECG, PULSE OXIMETER AND A NIBP cuff in place
4. There should be a RELIABLE I/V ACCESS.
   

ELECTIVE I/V INDUCTION:-

1. A great advantage to the anesthesiologist is the RAPID PASSAGE from consciousness to the plane of surgical anesthesia with few excitation side effects.
2. Doses of I/V induction agents are predictable for population, but not for individuals. TITRATION TO RESPONSE is the key to success for individual patient
3. PRE OXYGENATION is often recommended and is MANDATORY for emergency cases and patients with difficult airway.
4. Pain on injection if experienced, make sure that injection is not going S/C or intra-arterial.
5. The GREATER THE DOSE of drug and the FASTER the injection rate, the quicker the sleep is induced and the MORE ADVERSE the physiological SIDE EFFECTS.Practical experience is the best guide as to how fast to induce anesthesia in particular patient, the less fit responding BEST to SLOW INDUCTION
6. ALWAYS ALLOW SUFFICIENT TIME for the induction agent to act in patient with a SLOW CIRCULATION TIME.
7. Remember that an I/V induction administers a potent drug to a patient and from then onwards, the anesthesiologist has no control over the subsequent actions and pharmacology of the agent. This contrasts with the volatile agents which can be removed by ventilation.
   

ALTHOUGH MINIMAL MONITORING IS REQUIRED, NOTHING REPLACES A VIGILANT ANESTHESIOLOGIST WITH HIS OPEN EYES AND EARS AND THE FINGER ON THE PULSE OF THE PATIENT.

CLINICAL PEARLS:

1. It is a bad practice and produces a risk of AWARENESS for relaxants to be given before consciousness is lost.
2. It is vital, once consciousness is lost, to achieve immediate control of airway and to ensure a continued supply of oxygenated gas to the lungs.
3. The insertion of an oral airway should not be done in an unrelaxed patient in a lighter plane of anesthesia
4. Patient fails to go to sleep when:

• the cannula is not in the vein
• There is venous obstruction (e.g, inflated tourniquet)
• The wrong drug has been given.
• The drug is taking an unusually long time to reach its target receptors because THE CARDIAC OUTPUT is SERIOUSLY LOW.
• It is very easy TO OVERDOSE SICK PATIENTS BY FAILING TO WAIT LONG ENOUGH FOR A RESPONSE.