ANAESTHESIA
DEF : An anaesthetic is a drug or agent that produces a complete or partial loss
of feeling. There are three kinds of anaesthetic: general, regional and local.
TYPES OF ANAESTHESIA :
1. General Anaesthesia
2. Regional Anaesthesia
3. Local Anaesthesia
General Anaesthetic:
induces a temporary, reversible state of unconsciousness, analgesia, and
muscle relaxation. It is used for major surgeries and involves inhalation of
anesthetic gases or intravenous medications.
A qualified anaesthetist administers the general anaesthetic (intravenously or by
gas mask, or both).
PROCEDURE:
● After a few seconds the client becomes unconscious.
● The anaesthetist then inserts a small tube connected to a ventilator into
the airway (an endotracheal tube is usually used) or a laryngeal mask.
● The anaesthetist controls the length of time patient is asleep, and
constantly monitors pulse, breathing and blood pressure.
● If necessary, the anaesthetist will administer intravenous fluids before,
during and after surgery.
● Once the surgery is over other drugs may be injected that will reverse
the effect of the anaesthetic and any other drugs used during the
operation (such as muscle relaxant).
Regional Anaesthetics:
Depending on the type of surgery, alternatives to general anaesthetic can include:
Regional anaesthetic –
Eg : ‘nerve block’- Blocking nerve transmission in a larger area, like a limb or below
the waist, commonly used for surgeries and pain management. Examples include spinal
blocks, epidurals, and nerve blocks. , spinal and abdominal surgeries ,thoracic
surgeries.
eg, a woman giving birth by caesarean section may have an epidural (an
injection into the spine that numbs the body from the waist down).
LOCAL ANAESTHETICS :
Local anaesthetic – anaesthetic is injected into the immediate area to be operated
on. Numbness of a small, specific area of the body, often used for minor procedures
and injections
eg a dentist may inject local anaesthetic into the gum before removing a tooth.
Eg: NSAIDS injected into painful joint for pain relief.
Implications for Physiotherapy:
● Pre-operative Assessment:
Physiotherapists can assess patients' respiratory function, mobility, and pain
levels before anesthesia to establish a baseline and identify potential risks.
● Post-operative Management:
Understanding the effects of anesthesia, such as muscle weakness, respiratory
depression, and pain, allows physiotherapists to tailor rehabilitation programs to
address these specific challenges.
● Early Mobilization:
Physiotherapists play a vital role in promoting early mobilization and preventing
complications like deep vein thrombosis and pneumonia after surgery.
● Pain Management:
Physiotherapy techniques like manual therapy, exercise, and modalities can be
used to manage pain related to anesthesia and surgery.Anaesthesia and pain
management is a specialised area of medicine that controls pain during and after surgery. It
is important to control pain during surgery, so the patient does not experience discomfort.
After surgery, it is essential to control pain so the patient can recover quickly and without
complications.
Causes of chronic pain :
Some causes of chronic pain include:
● Arthritis: Arthritis is a condition that causes inflammation and pain in the joints. There are
numerous types of arthritis, each of which can cause different symptoms.
● Back pain: Back pain is one of the most common. Various things, including muscle strain,
herniated discs, and degenerative disc disease, can cause it.
● Cancer pain: Cancer pain can be caused by cancer itself, by the treatment of cancer, or by
the side effects of the treatment.
● Headaches: Headaches can be caused by some different things, including tension,
migraines, and cluster headaches.
● Neuropathic pain: Neuropathic pain is caused by damage to the nervous system. Diabetes,
nerve injuries and certain medications can cause it.
● Patient Education:
Physiotherapists can educate patients about the effects of anesthesia, the
importance of rehabilitation, and strategies for managing pain and discomfort.
EFFECTS OF ANAESTHESIA :
SHORT TERM EFFECTS :
● Nausea and vomiting
● Sore throat
● Confusion and disorientation
● Itching
● Pain at the injection site
● Muscle aches
● Headache
● Fatigue
● Dry mouth
● Shivering and chills
● Difficulty urinating.
LONG TERM EFFECTS :
● Nerve damage
● Post operative cognitive dysfunction
● Allergic reactions
● Infection
● Malignant hyperthermia
ROLE OF PHYSIOTHERAPIST :
Pre-operative and post-operative care, including monitoring for side
effects and administering appropriate medications, is crucial to minimize
the risk of complications.
Open communication between the patient, surgeon, and anesthesiologist
is essential to ensure a safe and comfortable surgical experience.
The specific side effects and their severity can vary depending on the type
of anesthesia used, the individual's health, and the type of surgery
performed.
INDICATIONS NEEDED GENERAL ANAESTHESIA:
1. heart surgery or organ transplants
2. long surgeries like some back surgeries.
3. Uncooperative patients
4. Patient preference
5. thoracic or abdominal procedures
6. Major surgeries, including open-heart surgery, organ transplants, and complex
cancer surgeries, often require general anesthesia to allow for a deeper level of
relaxation and control over the patient's vital signs.
INDICATIONS NEEDED REGIONAL ANAESTHESIA:
● Orthopedic: Extremity surgeries (arms, legs, hands, feet).
● Gastrointestinal/Hepatic: Abdominal surgeries.
● Gynecological: Reproductive surgeries, including cesarean section.
● Urological: Procedures involving the bladder and urinary tract.
● Thoracic: Chest surgery.
● Ophthalmology: Eye surgeries.
● Abdominal/Leg Surgery: Various procedures, including hernia repair,
appendectomy.
INDICATIONS NEEDED LOCAL ANAESTHESIA:
Local anesthesia is indicated for a wide variety of procedures, primarily to block pain and allow for
safe and comfortable medical interventions.
Used for minor surgeries.
1. Dental surgeries
2. Eye surgeries
3. Orthopaedic
4. Vaginal or C section
5. Rectal or vaginal examination
6. Skin biopsies .
CONTRA INDICATIONS NEEDED ANAESTHESIA:
ABSOLUTE :
1. Patient refusal
2. Infection at injection site
3. severe hemodynamic instability (shock),
4. active psychosis due to interaction with anaesthesia medications with in last year
5. unstable angina
6. severe pulmonary disease
7. CHF
8. significant airway problems
9. morbid obesity
10. obstructive sleep apnea
11. a history of malignant hyperthermia.
RELATIVE :
1. Coagulopathies
2. certain medications (anticoagulants)
3. Diabetes can increase the risk of infection and other complications.
4. Obesity can make intubation more difficult and increase the risk of respiratory
complications.
5. Extremes of age (very young or very old) can pose unique challenges.
6. Smoking can negatively impact lung function and increase the risk of
complications.
7. Patients with bleeding disorders or those taking anticoagulants may be at risk for
excessive bleeding.
8. active psychosis or certain other mental health conditions may be a
contraindication or require specific management.
Potential Post operative Complications and risk factors :
GENERAL , REGIONAL ,LOCAL ANAESTHESIA:
● Vomitings
● Chest complications
● Thrombosis of leg veins
● CO2 retention
● Cyanosis
● Pain
● Toxic effects
SPINAL ANAESTHESIA :
● Fall in BP due to inaction of sympathetic nervous system .
● Headaches
● Meningitis
● Vomiting
● Toxic reactions
● Neurological complications
● Nausea and vomiting
● Itching
● Pain at the injection site
● Muscle aches
● Head achae
● Fatigue
