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Sellick Maneuver

The Sellick Maneuver is performed by applying gentle pressure to the anterior neck (in a posterior direction) at the level of the Cricoid Cartilage. The Maneuver is most often used to help align the airway structures during endotracheal intubation. The real value of this procedure is often misunderstood and therefore, is often underutilized. The REAL value of the Sellick Maneuver is to provide a means to prevent gastric insufflation and vomiting during ventilations in an unprotected airway. BLS and ALS medics can direct a member of the resuscitation team to provide this maneuver early and continually until a properly placed endotracheal tube has been inserted. Remember that aspiration pneumonitis has a high mortality rate and proper use of this method can minimize its occurance.

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Do you feel pain on your hinge ? Maybe you’ve got arthritis. But don’t worry, because there are many treatment to reduce your pain. Two kind of treatment i.e farmacological or non-farmacological. The farmacological one is NSAID such as aspirin, ketorolac, and sodium diclofenac.

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How safe is anesthesia and what are the risks?

The administration of anesthesia, even to patients with serious health problems, can generally be accomplished safely without major complications and only minor side effects. However, even when carefully and competently administered, serious and potentially life-threatening complications can and do very rarely occur. During the last twenty years improved understanding of how the body reacts to anesthesia and surgery, more sophisticated monitoring devices and better anesthetic agents have dramatically improved anesthetic safety. Anesthetic mortality, as high as 1:15,000 prior to 1980, is now less than 1:200,000 for patients in good health undergoing elective procedures. The risk of anesthetic administration is determined by the patient’s health status, the nature of the surgical procedure and if the care is being provided electively or because of a surgical emergency. If you want to know more about the risk of anesthesia in your case, your anesthesiologist can make the best assessment during your pre-anesthetic evaluation. Anesthetic risk can be reduced by providing complete information about your health to your anesthesiologist and by carefully following our fasting (also called “NPO” or “nothing by mouth”) guidelines and instructions regarding any medication you are taking on a regular basis.

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What is an Anesthesiologist ?

An anesthesiologist is a physician who has completed four years of undergraduate education (college), four years of medical school and at least four years of residency training. The anesthesiologist is a physician specialist responsible for the anesthetic care, life support and pain management for patients undergoing surgery, childbirth and various medical procedures. Additionally, anesthesiologists are involved in the management of critically ill patients and patients with chronic pain syndromes. Upon completion of specialty training, the anesthesiologist becomes eligible for board certification by the American Board of Anesthesiology.

Anesthetic Agent

There are 2 kind of anesthetic induction agents, inhalation and intravenous agents. The inhalation agents are halothan, sevoflurane, enflurane, isoflurane, and desflurane. For induction, we usually use sevoflurane, that rapid onset for induction and halothan (but this agent is hepatotoxic, so the use of this agent should not repeated until minimally 6 month). The others are not common for induction because they are irritant for the airway, and slow onset. Isoflurane is the best for use in neuroanesthesia, because of the neuroprotectif feature and less toxic on renal system. Enflurane has epileptogenic effect, so it must be avoid for use on epileptic patients. The intravenous agents are barbiturat (pentothal), propofol, etomidat, ketamin, and benzodiasepin (midazolam). The features of them are same except ketamin because it has simpatetic effect, not depressed the cardiovascular system, and has broncodilator feature. Pentothal has neuroprotectif feature, so it is the best for use in neuroanesthesia. Propofol has rapid onset and short duration, but must be careful to use it because can depress cardiovasculer system. Etomidat and benzodiazepin are more safe in patient with cardiovascular compromized, but benzodiazepin has slower onset.

How to prepare patient undergoing anesthetized ?

Look general condition. Good, or bad, and the consciousness. Ask history of asthma, allergies, hypertension, diabetes mellitus, convulsion, prolong therapy of tuberculosis.
Examine “the ABCD” Airway: clear or unclear (any discharge, debris, blood, etc) Breathing: respiratory rate, pattern of breathing, additional sounds (wheezing, ronchi) Circulation: blood pressure, heart rate (regularity, quality), additional heart sounds Dissability: consciousness (GCS), pupil light reflex, pupil diameter, pupil isokor/anisokor
Do appropriate supporting examines: laboratorium, X-ray photos, CT Scan, etc.
Assess the patient condition with ASA criteria
Is the surgery being elective or emergency ? Be careful in emergency patient. All emergencies patient is full stomach, so they need special tecnique, such as rapid induction/intubation, do Sellick manuever, set the nasogastric tube.
There is no best anesthetic agent/technique but only best anestetician. Good luck

How to perform intubation ?

Prepare the instruments: endotracheal tube (ET), laryngoscope, tapes, stetoscope, spuit cuff, suction unit.
Check the light of laryngoscope.
Perform triple manuevers: jaw trust, neck extension, chin lift
Get the laryngoscope left handled, open the mouth, start from the right edge of mouth until middle tongue get the blade of laryngoscope until find eppiglottis and than plica vocalis under the epiglottis. If there is any debris, than suction
Enter the ET to the laryng.
Check the pulmo sound with stetoscope, right and left must be the same. If harder than another pull out until have the same sound.
Fixation the ET with cuffing the ballon, plaster the ET pipe on the mouth.
Connect to the breathing equipment If you have any question, or advise, please do not hesitate to contact me at this comment below