In this episode, we discuss induction, the stage of general anesthesia that encompasses the onset of sedation, amnesia, analgesia, and sometimes akinesia. The anesthesiologist’s goals are to achieve induction smoothly and safely, maintaining the patient’s hemodynamic stability throughout.
Step 1: Place monitors on patient (see Episode 2 show notes for a list of the CAS’ required monitors).
*Clinical tip: take a moment to double-check that all monitors are attached to the patient and showing up correctly on the screen. Run some fluids through the patient’s IV for a few seconds to check that it is functioning reliably.
Step 2: Surgical timeout.
*Clinical tip: The patient needs to be awake for this step, so hold off on giving any sedatives or psychoactive medications until after the timeout.
Step 3: Pre-oxygenation.
*Clinical tip: Aim for an end-tidal oxygen concentration (EtO2) of >0.8.
Step 4: Administer induction agents (intravenous or inhalational, depending on the type of induction). Typical IV induction agents may include an opioid, a benzodiazepine, an induction agent (sedative), and a neuromuscular blocker.
*Clinical tip: propofol and some other induction agents can cause hypotension, so keep an eye on the patient's blood pressure readings after administering your medications.
Step 5: Assess the depth of anesthesia before proceeding with airway management.
*Clinical tip: you can check the orbicularis oculi reflex by lightly brushing the patient's eyelashes with your finger.
Link to Canadian Anesthesiologists' Society (CAS) Guidelines (2020): https://bit.ly/34srKo8
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