Induction of Anesthesia – General Anesthesia

by Brian Warriner, MD

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    00:00 When the patient arrives in the operating room, they have a blood pressure cuff placed on them. A cardiogram's placed, pulse oximetry, and end-tidal carbon dioxide level are always done. And in the United States, it's a required monitor to put a temperature probe on the patient or in the patient's mouth or nose. Make sure an intravenous is in place, give a small dose of a drug such as Fentanyl, 1-3 micrograms/kg is what I normally use.

    00:27 The induction drug in a healthy individual who's hemodynamically stable, my preferred drug is Propofol. I use 2-2.5 milligrams/kg and I follow this immediately with Rocuronium, 0.6 milligrams/kg, which is a moderate but not large dose of Rocuronium. When I'm doing a patient that requires neuromuscular blockade, I often use a nerve stimulator such as the one shown in this picture. It's hooked up to the forearm. The current is adjusted through the stimulator and you examine the thumb for twitches, as stimulations occur. And the usual rate of stimulation is 4 twitches over 2 seconds. This is called the Train of Four.

    01:15 And the assessment of the Train of Four can give us some indication of how deeply paralyzed the patient is, whether it's safe to proceed with intubation, whether it's safe to proceed with with surgery, or at the end of the case, whether it's safe to attempt to reverse the patient.

    About the Lecture

    The lecture Induction of Anesthesia – General Anesthesia by Brian Warriner, MD is from the course Anesthesia.

    Included Quiz Questions

    1. Is easy to perform, but not a very specific test
    2. Is a very accurate method to assess the airway
    3. Should be done several days before surgery
    4. Can only be performed by a qualified anesthesiologist
    1. Monitoring the depth of muscle block
    2. Monitoring muscle tone
    3. Giving anesthesia
    4. Monitoring airways
    5. Monitoring respiratory rate

    Author of lecture Induction of Anesthesia – General Anesthesia

     Brian Warriner, MD

    Brian Warriner, MD

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