Anaesthesia Techniques – Comprehensive Notes
1. Historical Background
Ancient times: Pain control achieved using alcohol, opium, cannabis, and physical
methods (compression, cooling).
1846: Dr. William T.G. Morton demonstrated the first public use of ether
anaesthesia in Boston.
1847: Sir James Young Simpson introduced chloroform.
Late 19th century: Cocaine discovered for local anaesthesia by Carl Koller.
Modern era: Safer agents like halothane, isoflurane, sevoflurane, and advanced
monitoring techniques emerged.
2. Types of Anaesthesia
1. General Anaesthesia (GA)
o Drug-induced reversible loss of consciousness and sensation.
o Achieved with inhalational or intravenous agents.
2. Regional Anaesthesia
o Numbs a specific region of the body.
o Examples: Spinal, epidural, caudal, peripheral nerve blocks.
3. Local Anaesthesia
o Loss of sensation in a small area using local agents.
o Examples: Infiltration, surface, topical.
4. Sedation / Monitored Anaesthesia Care (MAC)
o Depressed consciousness but patient is arousable.
5. Combined Techniques
o E.g., GA + nerve block for better pain control.
3. Choice of Anaesthesia
Factors influencing choice:
Patient factors: Age, medical history, allergies, airway status.
Surgical factors: Type, site, duration of surgery.
Anesthetist factors: Experience, available equipment.
Urgency of surgery: Elective vs. emergency.
Post-operative considerations: Pain control, mobility, recovery time.
4. General Anaesthesia – Indications
Long-duration surgeries.
Surgeries involving multiple body regions.
Procedures where complete muscle relaxation is required.
Patients unable to tolerate regional or local anaesthesia.
When the airway must be secured to prevent aspiration.
5. Endotracheal Intubation
Purpose:
o Maintain a secure airway.
o Deliver oxygen and anaesthetic gases.
o Protect airway from aspiration.
Types of tubes:
o Cuffed, uncuffed, reinforced (spiral), nasal, oral.
Procedure:
o Preoxygenate → Induction → Laryngoscopy → Tube insertion → Inflate cuff
→ Confirm placement (capnography, auscultation).
Complications:
o Trauma, sore throat, hypoxia, esophageal intubation.
6. General Anaesthesia Techniques
1. Inhalational Induction
o Sevoflurane, halothane, nitrous oxide.
2. Intravenous Induction
o Propofol, thiopentone, ketamine.
3. Maintenance
o Inhalational agents + muscle relaxants + analgesics.
4. Balanced Anaesthesia
o Combination of agents to reduce side effects.
7. Local Anaesthesia Techniques
Surface Anaesthesia: Eye drops, sprays for mucous membranes.
Infiltration Anaesthesia: Direct injection into tissue (e.g., suturing).
Nerve Block: Injection near a specific nerve.
Spinal Anaesthesia: Injection into subarachnoid space (L3–L4).
Epidural Anaesthesia: Injection into epidural space.
Topical Anaesthesia: Ointments, gels.
8. Blood Transfusion
Indications:
o Acute blood loss >20% of blood volume.
o Severe anemia (Hb < 7 g/dL in most cases).
o Coagulopathy.
Types:
o Whole blood.
o Packed RBCs.
o Fresh frozen plasma (FFP).
o Platelets.
Precautions:
o Cross-matching.
o Monitor for transfusion reactions.
o Warm blood if large volume given rapidly.
9. Monitoring in the Operation Theatre
Basic Monitoring:
o Pulse oximetry (SpO₂).
o Non-invasive BP (NIBP).
o ECG.
o Capnography (EtCO₂).
Advanced Monitoring:
o Invasive arterial pressure.
o Central venous pressure (CVP).
o Temperature monitoring.
o Neuromuscular blockade monitoring.
10. Positioning of Patient
Purpose:
o Optimal surgical exposure.
o Maintain physiological safety.
o Prevent nerve injury & pressure sores.
Common positions:
1. Supine – Most common, abdominal surgeries.
2. Prone – Spinal surgeries.
3. Lithotomy – Gynecological, urological surgeries.
4. Trendelenburg – Lower abdominal/pelvic surgeries.
5. Reverse Trendelenburg – Upper abdominal, head & neck surgeries.
6. Lateral – Thoracic, renal surgeries.
Precautions:
o Protect pressure points.
o Avoid excessive joint extension/flexion.
o Maintain airway access.
