GuidelinesEML (Adult Hospital STG)
Anaesthesia, General
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition
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Intravenous Induction (and/or maintenance) Agents
INTRAVENOUS INDUCTION (AND/OR MAINTENANCE) AGENTS
- Inject intravenous induction agents over 30 seconds (> 60 seconds in the elderly).
- Titrate the dose to effect.
- Respiratory depression occurs following induction of anaesthesia and ventilation should be supported as required.
- Administer at appropriate doses, after consideration of patient factors, surgical factors and contraindications:
- Propofol is the most widely used IV induction agent but can produce hypotension.
- Etomidate or ketamine is preferred in haemodynamically unstable patients.
- Thiopentone has a rapid onset, is contraindicated in porphyria and may be
preferred for Caesarean deliveries - Propofol, IV, 1.5–2.5 mg/kg.
- 6-12 mg/kg/hour IV infusion for maintenance, if volatile agent use contraindicated.
- Etomidate, IV, 0.3 mg/kg (0.2-0.6 mg/kg)
- Ketamine, IV, 1–2 mg/kg.
- Thiopental, IV, 3–5 mg/kg.
INHALATION AGENTS
Induction
- In adults, intravenous induction is preferable.
- Inhalational induction is reserved for patients with difficult airways or severe needle phobia.
- Use only halothane or sevoflurane (isoflurane is too irritant).
- Halothane can cause hepatitis after repeated exposure within 3 months.
- Halothane sensitises the heart to catecholamines and may cause cardiac dysrhythmias, particularly if anaesthesia is too light or the patient hypercarbic.
- Sevoflurane is not associated with these problems, has a faster onset and emergence time.
- Halothane, titrated to effect.
OR
- Sevoflurane, titrated to effect.
Maintenance
- In spontaneously breathing patients, the dose of volatile agent is titrated to clinical effect.
- If a neuromuscular blocking agent has been used, the dose of the volatile agents must be adequate to prevent awareness.
- This is about 1 minimum alveolar concentration (MAC), but must be titrated according to clinical signs of awareness (e.g. tachycardia, hypertension, sweating, lacrimation).
- Isoflurane (MAC = 1.2%).
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2024 Edition