Introduction

In the previous three modules you have learnt basic concepts of anesthesia with some basic skill to initiate anesthesia in organized work environment, introduced with basic anesthesia equipment and how to use them safely, the methods and check out procedure to organize comfortable and safe work environment and preparing patient for anesthesia and surgery by performing preanesthetic assessment to plan and implement safe anesthesia for each patient. We hope you have got much information to initiate anesthesia safely with understanding of the possible risks and hazards that might encounter and the methods and strategy to prevent these risks and management of anesthesia risk if it happened.

The anesthetic agent and muscle relaxants you have administered to initiate anesthesia last after 5 to 15 minutes, but the surgical procedure may take hours. The anesthesia provider is responsible to continue anesthesia at a sufficient depth required for the surgery until the procedure is finished. During maintenance of general anesthesia; you may administer potent intravenous or inhalation anesthetics with opioids or sedatives, muscle relaxants, and some vasopressors (e.g. ephedrine/adrenaline) to maintain stable internal environment. The surgical position may cause physical and physiological injury, the surgical stress and blood loss may sufficiently endanger the anesthetized patient life. At the end of surgery and anesthesia, the emergence excitement phase and the post operative period accompanied by hypertension, tachycardia, delirium, hallucination and other physiologic stress may be critical for some patient, need vigilant care by the anesthetist.

Intraoperative care, preparation and monitoring for patient who is anesthetized by spinal anesthetic technique are the same as general anesthetic with some specific care like monitoring of block height and systemic toxicity in spinal anesthetic.

In this module you will learn how to maintain safe anesthesia using different anesthetic agents including spinal anesthesia while managing some critical incidents if occur, using different monitor to understand the condition of the patient and manage appropriately for any alteration, preventing injury from surgical positioning and facilitating safe emergence and recovery.

In module I you have learnt how anesthesia is initiated and maintained as an introduction to have a glimpse of the process of anesthesia in order to get early clinical exposure. The subsequent sessions and module introduced you with basic clinical skill in air way management, preparing anesthesia work station, and patient assessment for maximizing patient safety while providing anesthesia for the required procedures. In this session you will learn to acquire knowledge, skill and the right attitude to maintain safe and balanced anesthesia for the surgical procedure using different anesthetic drugs.