When choosing anaesthesia the following factors have to be kept in mind:
Deep seated abscess
Abscess in relation to bony injuries
Most frequently seen subcutaneous abscesses, particularly located in the extremities and trunk particularly in adults may be reasonably handled under local anaesthesia
Whenever GA is used:
It is better that surgery is carried out with adequate O.T. facility.
It is very important to make sure that patient is in empty stomach before general anaesthesia is induced.
In dealing with the elderly and those with cardiac and other problems, appropriate monitoring may be required.
Use of ethyl chloride spray to incise and drain an abscess by freezing the surface is not recommended for the following reasons:
This is a highly inflammable material
The anaesthesia is inadequate
It cannot be used in locations particularly face etc.
Risk of damage due to frost bite (eyes).
It may be used to a very limited extent in fluctuating superficial abscesses where a quick procedure is possible.
Local anaesthesia : Procedure
Re-assure the patient and explain the procedure to be done; get appropriate cosultation, take adequate precautions in terms of patient, healthcare personnel etc., (AIDS, Hepatitis etc) _ universal precautions.
Requirements _ adequate lighting, clean room, surgeon and assistants to wash hands and use cap, mask and sterile gloves. Prepare the skin surface adequately with povidone iodine, use sterile drape around the abscess site.
Carefully plan and administer pre operative analgesics and sedation.
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