ANE601 — Anaesthesia Lectures: Lecture Note

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la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Course code: ANE 601 Course title: Anaesthesia Lectures Course credit load: 3 Unit Series 1: Applied Basic Sciences and Pharmacology for Anaesthesia • Part 1.1: Applied Anatomy for Anaesthesia o Sub Part 1.1.1: Anatomy of the upper airway o Sub Part 1.1.2: Anatomy of the lower airway and lungs o Sub Part 1.1.3: Anatomy of the peripheral nervous system relevant to anaesthesia • Part 1.2: Common Diseases and Emergencies Including Trauma o Sub Part 1.2.1: Common diseases relevant to anaesthetic practice o Sub Part 1.2.2: Airway and respiratory emergencies o Sub Part 1.2.3: Trauma and its anaesthetic implications • Part 1.3: Applied Physiology of Respiration and the Cardiovascular System o Sub Part 1.3.1: Physiology of respiration o Sub Part 1.3.2: Cardiovascular physiology relevant to anaesthesia o Sub Part 1.3.3: Interaction between respiratory and cardiovascular physiology under anaesthesia • Part 1.4: Applied Physiology of the Nervous and Neuromuscular Systems o Sub Part 1.4.1: Autonomic nervous system physiology o Sub Part 1.4.2: Neuromuscular junction physiology o Sub Part 1.4.3: Central nervous system considerations relevant to anaesthesia • Part 1.5: Applied Biochemistry and Pharmacological Principles o Sub Part 1.5.1: Electrolyte and acid-base physiology o Sub Part 1.5.2: Ionisation of drugs and its clinical relevance o Sub Part 1.5.3: Nutrition and basic pharmacological principles in anaesthesia Introduction

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Every safe anaesthetic ultimately rests on a genuinely thorough working knowledge of the patient's own underlying anatomy and physiology, since the anaesthetist deliberately manipulates consciousness, airway reflexes, respiratory drive, and cardiovascular stability all at once, and doing so safely requires knowing precisely what normal looks like before attempting to control it. This opening Series of ANE 601: Anaesthesia Lectures builds that essential foundation, working through applied airway and peripheral nervous system anatomy, the common diseases and emergencies, including trauma, that anaesthetists routinely encounter, the applied physiology of respiration, the cardiovascular system, and the nervous and neuromuscular systems, and, finally, the basic biochemistry and pharmacological principles underlying safe, informed drug administration. The aim of this Series is to equip you with a thorough understanding of the basic anatomy of the airway and peripheral nervous system, common diseases and emergencies including trauma, basic physiology of respiration, the cardiovascular, nervous, and neuromuscular systems, and basic biochemistry of electrolytes, acid-base disorders, drug ionisation, and nutrition. This Series begins with applied anatomy for anaesthesia, before turning to common diseases and emergencies including trauma, applied physiology of respiration and the cardiovascular system, and applied physiology of the nervous and neuromuscular systems. It concludes with applied biochemistry and pharmacological principles. Series Learning Outcomes At the end of this Series, you should be able to: • SLO 1.1: describe the applied anatomy of the airway and peripheral nervous system relevant to anaesthesia • SLO 1.2: describe common diseases, airway and respiratory emergencies, and trauma relevant to anaesthetic practice • SLO 1.3: describe the applied physiology of respiration • SLO 1.4: describe applied cardiovascular physiology and its interaction with respiratory physiology under anaesthesia • SLO 1.5: describe the applied physiology of the autonomic nervous system and neuromuscular junction • SLO 1.6: describe central nervous system considerations relevant to anaesthesia • SLO 1.7: describe applied electrolyte and acid-base physiology • SLO 1.8: explain the ionisation of drugs and its clinical relevance • SLO 1.9: describe nutrition as it relates to anaesthetic practice, and • SLO 1.10: describe basic pharmacological principles underlying drug use in anaesthesia.

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS 1.1 Applied Anatomy for Anaesthesia 1.1.1 anatomy of the upper airway Structures directly relevant to airway management The upper airway, extending from the nares and lips through the pharynx to the larynx, comprises structures of direct, immediate relevance to every anaesthetic encounter, since the anaesthetist must repeatedly assess, manipulate, and, where necessary, instrument this specific anatomical region to establish and maintain a patent airway throughout the perioperative period. The larynx, discussed in relation to its cartilaginous framework, marks the transition between the upper and lower airway, with the vocal cords and glottic opening representing the narrowest point an endotracheal tube must successfully pass through during intubation, meaning detailed familiarity with laryngeal anatomy directly underpins safe, confident airway instrumentation technique. Fill in the blank: The upper airway extends from the nares and lips through the pharynx to the larynx, comprising structures of direct, immediate relevance to every anaesthetic ________. 1.1.2 anatomy of the lower airway and lungs The tracheobronchial tree and respiratory unit The trachea, continuing from the larynx, bifurcates at the carina into the right and left main bronchi, with the right main bronchus following a characteristically more vertical, direct course, a detail of genuine practical relevance since it explains why an inadvertently advanced endotracheal tube preferentially enters the right main bronchus, producing recognisable, asymmetric ventilation. Beyond the major airways, discussed earlier in this sub-Part, the lungs themselves comprise progressively branching bronchioles terminating in alveoli, the functional gas exchange unit, with pleural anatomy and the lungs' segmental organisation carrying further practical relevance to positioning, one-lung ventilation, and recognition of complications such as pneumothorax during anaesthetic care. Fill in the blank: The trachea bifurcates at the carina into the right and left main bronchi, with the right main bronchus following a characteristically more vertical, direct ________.

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS 1.1.3 anatomy of the peripheral nervous system relevant to anaesthesia Nerve pathways underlying regional technique and monitoring The peripheral nervous system, comprising the spinal and cranial nerves and their branches, provides the essential anatomical basis for every regional anaesthetic technique, discussed further in a later Series of this course, since accurate, confident nerve blockade depends directly on detailed knowledge of individual nerve course, relations, and the specific dermatomal or myotomal territory each nerve supplies. This peripheral anatomy, discussed earlier in this sub-Part, additionally underpins neuromuscular monitoring during anaesthesia, discussed further later in this course, since peripheral nerve stimulation, generally applied to the ulnar or facial nerve, provides the essential clinical means of assessing neuromuscular blockade depth throughout a general anaesthetic. Fill in the blank: Accurate, confident regional nerve blockade depends directly on detailed knowledge of individual nerve course, relations, and the specific dermatomal or myotomal territory each nerve ________. Figure 1.1: A diagram illustrating the upper and lower airway anatomy relevant to airway management, from the larynx through the tracheobronchial tree. Pilot questions 1.1

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS 1. Describe the structures comprising the upper airway. (Linked to SLO 1.1) 2. Explain the clinical relevance of laryngeal anatomy to intubation. (Linked to SLO 1.1) 3. Describe the anatomy of the tracheobronchial tree at the carina. (Linked to SLO 1.1) 4. Explain why an inadvertently advanced endotracheal tube preferentially enters the right main bronchus. (Linked to SLO 1.1) 5. Explain the relevance of peripheral nervous system anatomy to regional anaesthesia and neuromuscular monitoring. (Linked to SLO 1.1) 1.2 Common Diseases and Emergencies Including Trauma 1.2.1 common diseases relevant to anaesthetic practice Comorbidity shaping anaesthetic risk and planning Anaesthetists routinely encounter patients with significant coexisting disease, including hypertension, diabetes mellitus, sickle cell disease, and chronic respiratory or cardiac conditions, discussed further in relation to specific disease-modified anaesthetic technique in a later Series of this course, each carrying genuine implications for perioperative risk assessment and anaesthetic planning. Recognising these common comorbidities, discussed earlier in this sub-Part, before proceeding with anaesthesia allows appropriate, individualised modification of anaesthetic technique, monitoring intensity, and perioperative management plan, meaning a genuinely thorough preoperative assessment, discussed further later in this course, remains foundational to safe anaesthetic practice regardless of the specific procedure planned. Fill in the blank: Anaesthetists routinely encounter patients with significant coexisting disease, each carrying genuine implications for perioperative risk assessment and anaesthetic ________. 1.2.2 airway and respiratory emergencies Time-critical events demanding immediate recognition Airway emergencies, including complete or partial airway obstruction, laryngospasm, and bronchospasm, represent genuinely time-critical events requiring immediate recognition and skilled intervention, since even brief delay in restoring adequate airway patency or ventilation risks rapid, potentially catastrophic patient deterioration. Further recognised respiratory emergencies, discussed earlier in this sub-Part, include aspiration of gastric contents, particularly relevant to the full-stomach patient discussed further in a later

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Series of this course, and acute hypoxaemia from a range of underlying causes, each demanding a systematic, well rehearsed emergency response from the anaesthetic team. Fill in the blank: Airway emergencies represent genuinely time-critical events requiring immediate recognition and skilled intervention, since even brief delay risks rapid, potentially catastrophic patient ________. 1.2.3 trauma and its anaesthetic implications A population demanding specific additional caution The trauma patient, discussed throughout this Part, presents genuinely specific additional anaesthetic considerations, including the presumption of a full stomach regardless of reported fasting status, discussed further in relation to full-stomach technique in a

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