Anaesthetists Handbook - MEDICAL EDUCATION at University ...

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Pain management and postoperative careKetamineIt is an antagonist at NMDA receptors; these receptors have asignificant role in chronic pain.1. Ketamine is not an ideal first line drug in postoperative painmanagement in patients with chronic pain because of thepsychomimetic adverse effects.2. There is no evidence that pre-emptive use of this medicine canprevent development of chronic pain.3. In occasional opioid tolerant cases, low-dose ketamine (10-25mg bolus or 0.50-1 mg kg -1 hour -1 infusion) has been usedsuccessfully.Regional anaesthesiaSatisfactory postoperative pain relief in chronic pain patients isdifficult exclusively with pharmacological means, because of neuronalchanges resulting in hyperalgesia.1. Single shot central neuraxial, paravertebral, peripheral nerveblocks, local infiltration and joint injections provide good painrelief in the immediate postoperative period. Ensure enoughanalgesics and normal medications are prescribed under‘regular medications’ – otherwise patient will wake-up in themiddle of the night with agonizing pain.2. Continuous catheter infusions are especially helpful. Epiduralmixtures of local anaesthetics and opioids provide superiorpostoperative pain control in chronic opioid dependent patients.3. Although regional block can provide pain relief for acute surgicalpain it is important to continue the background analgesicmedications and adjuncts for managing underlying chronic painand to prevent withdrawal syndrome.Ineffective analgesia can lead to anxiety, distress, drug seekingbehaviour and demands, as well as pain. It delays recovery anddischarge.116 Anaesthetists Handbook January 2010
Pain management and postoperative careFurther readingS. Balasubramanian, I. Hadi. Perioperative pain management inpatients with chronic pain. CPD Anaesthesia 2006; 8(3): 109-113.Treatment of PONVThis guideline for the treatment of postoperative nausea and vomitingin adult patients was last reviewed in 2006.This is not the guideline for prophylaxis against PONV, which is onpage 227.Anaesthetists Handbook January 2010 117
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Department of AnaesthesiaAnaestheti
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Document control for approved clini
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ContentsTrauma list anaesthetist (t
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ContentsStudy leave 81Junior doctor
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ContentsIndications for investigati
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ContentsRenal patients - clinical g
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Introduction and scope of guideline
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Introduction and scope of guideline
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Airway assessmentManaging difficult
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Managing difficult airways• Flexi
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Managing difficult airways• Manuj
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Resuscitation - advanced life suppo
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Resuscitation - advanced life suppo
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Duties of the on call anaesthetists
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Getting senior helpGetting senior h
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On call casesGetting senior helpYou
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Supervision for sick patientsGettin
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Calling the senior resident anaesth
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Perianaesthesia Care Unit (PACU)PAC
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PACUThe surgical team responsible f
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PACU6. Oxygen and intravenous thera
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Integration with the critical care
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Inter-hospital transfersInter-hospi
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Inter-hospital transfersConsultant
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Signing onAdministrative issuesYour
Page 65 and 66: Administrative issuesMobile phones
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Page 69 and 70: Administrative issuesMain theatre r
Page 71 and 72: CLWrota processes• To complete ca
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Page 75 and 76: Education and trainingthe Royal Col
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Page 91 and 92: Clinical adverse event reportingCli
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Page 129 and 130: IndicationsEpidural anaesthesia and
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Page 133 and 134: Assessment and treatment optionsEpi
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Page 143 and 144: Allergies and adverse drug reaction
Page 149 and 150: Awareness during anaesthesiaPrevent
Page 151 and 152: Fractured neck of femur:management
Page 153 and 154: Fractured neck of femurGuidelines f
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Page 157 and 158: Patients who take insulinManagement
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Indications for investigationsFull
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Preoperative assessment and investi
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SevofluraneSevoflurane[Dr Mark Port
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Sevofluranemust be considered on it
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Gabapentin in acute painSide-effect
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Blood and blood productsBlood and b
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Blood and blood productsWhen the un
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Blood and blood productsCross match
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Blood and blood productsBlood Cool
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Blood and blood productsHaematology
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Blood and blood products25322 so th
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Blood and blood productsfactors, ha
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Day case anaesthesia6. Social crite
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ENT anaesthesiaENT anaesthesia{Dr C
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ENT anaesthesiaIntraoperative• In
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Miscellaneous issuesMiscellaneous i
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Miscellaneous issuesideally be cont
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Miscellaneous issuesinstruction man
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Miscellaneous issuesRemifentanilRem
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Miscellaneous issuesCentral neuraxi
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Miscellaneous issuesAnalgesia Fenta
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Miscellaneous issues• Diclofenac
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Miscellaneous issues• Associated
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Miscellaneous issues• Everyone wi
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Miscellaneous issues• If fasting
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Miscellaneous issueslabour ward ana
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Miscellaneous issuesThere is no cli
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Patient monitoring in and out of th
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Miscellaneous issuessuch as Hartman
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Miscellaneous issues• Abdominal a
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Miscellaneous issuesPrevention of p
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Miscellaneous issuesDifferent clini
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Recovery and patient handoverMiscel
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For afternoon list (pm)Diabetic Pat
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Miscellaneous issuestake part in th
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Miscellaneous issuesSee page 37 for
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Waiting list initiatives[Appraised
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Major Incident ProcedureStaff assem
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Major Incident Procedure• In coop
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Finding your way round theUniversit
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• Coffee room.• Quiet room (fiv
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Anaesthesia department lead clinici
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Trust organisational structureTrust
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Telephone numbersLabour ward……
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IndexIndexAabsence, 68adenotonsille
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Indexemergency department, 222emerg
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Indexmortality review, 93MRI scansa
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Indexstudy leave, 81applications, 6
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NotesAnaesthetists Handbook January
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NotesAnaesthetists Handbook January
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