Remote environment anaesthesia

 

List:

·         Problems

·         Preparation

·         Risk-averse anaesthesia

 

Problems:

Unfamiliarity

Solution: communication

·      People

·      Processes

·      Layout

Deficiencies

Solution: preparation

·      Equipment

·      Monitoring

·      Drugs

·      Personnel

Hindrances

Solution: risk-averse anaesthesia

·      Space

·      Lighting

·      Obstacles

·      Remoteness

·      Moving table

·      Lead apron

 

Preparation:

Equipment

·      Airway: face masks, guedels, ETTs, LMAs, scopes, suction

·      Breathing: mechanical ventilator, air viva, oxygen cylinder full

·      Circulation: PIVC, pump set, A-line

·      External: pressure care, forced air warmer, fluid warmer

·      Emergency: defibrillator

Monitoring

·      Sat probe

·      NIBP

·      ECG

·      Capno

·      Art line

·      NMT

·      Temperature

Drugs

Ensure adequate supplies:

·      Hypnotic (volatile reservoir, propofol vials)

·      Reflex suppressant (opioid, relaxant)

·      Reversal (neostigmine, sugammadex)

·      Pressors (metaraminol, ephedrine)

·      Emergency drugs (adrenaline, atropine)

Personnel

·      Me: carry phone

·      Helper: present at all times

·      In-charge: knows we are here, can allocate help

 

Risk-averse anaesthesia:

Anaesthesia

·      Awake > general > sedation

·      Inhaled > intravenous

·      “Deep” > “light”

·      Relaxant > spont vent (generally)

Airway

·      ETT > LMA > native

·      Video > direct

·      Secure adhesive

·      Secure attachments

Access

·      Long IVC > short

·      Arterial line > she’ll be right

·      Secure adhesive

·      Secure attachments

·      Visible

Aftercare

·      Main PACU > local PACU

·      Awake > sedated

 

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