Introduction to
Anaesthesia
Introduction
The term anesthesia comes from the Greek meaning “loss of
sensation”.
Anaesthetic practice has evolved from a need for pain relief
and altered consciousness to allow surgery.
Early anaesthetics used plant derivatives with later
introduction of ether, inhaled gases and chloroform.
Modern anaesthesia has been developed and refined to
enable surgery, interventions, pain relief and stabilization,
and organ support.
Insensitivity to pain, especially as artificially induced by the administration
of gases or the injection of drugs before surgical operations.
Anesthesia is a medical procedure which is deliberately produced to make
a patient insensible to pain either in a part or in the whole of the body by
which diagnostic and surgical procedure are done while the patient safety
and comforts are maintained.
HISTORY OF ANESTHESIA
General anesthesia was absent until the mid- 1800s.
Ether synthesized in 1540 by Cordus
Ether used as anesthetic in 1842 by Dr. Crawford W.Long
Ether publicized as anesthetic in 1846 by Dr. William Morton.
Ether is no longer used in modern practice, yet considered to be the
first ‘ideal’ anesthetic
Chloroform used as anesthetic in 1853 by Dr. John Snow
Endotracheal tube discovered in 1878
Thiopental first used in 1934
History
1845- Horace Wells- N2O
1846- William Morton- Ether
1847- Simpson- Chloroform
1853-John Snow
1878- ETT
1884- Cocaine
1895-98- Spinal analgesia/anaesthesia
Anesthesia, risky procedure and may take the patient life in
danger, permanent organ damage and death
Although risky anesthesia is now much safer and more
pleasant than the previous period
The three phases
1. Analgesia
2. Hypnosis (amnesia) and
3. Muscle relaxation.
May be Prevention of undesirable autonomic reflex Drugs used
in anesthesia have varying effect on these three areas and to
be combined to optimize the whole process of anesthesia.
A.Hypnosis (amnesia): a state of sleep or
unconsciousness which enable the patient unaware
any events.
B. Analgesia: Insensitivity to pain + loss of
consciousness.
C. Muscle relaxation: aided by drugs which affect
skeletal muscle function and decrease the muscle
tone by which immobility and relaxation of the
skeletal muscle produced ….surgery will be
proceeded at ease.
Features of good Anaesthetic
An anesthetic procedure should:
Abolish pain
Be Completely reversible.
Be Safe...
Comfort- important
Safety - essential and must come first.
Provide good operating conditions. E.g. good
relaxation for abdominal surgery.
Types
General anesthesia
General anesthesia:- a drug-induced
reversible depression of the CNS resulting in
the loss of response to & perception of all
external stimuli.
Regional anesthesia:-(central, regional,
peripheral) -the art of rendering a part of the
body insensible for surgical operation or23
General anaesthetics
GAs are drugs which produce reversible loss of all sensations and
consciousness.
It usually involves a loss of memory and awareness with insensitivity to painful
stimuli, during a surgical procedure. General Anesthesia : General anesthesia acts
primarily on the brain and central nervous system to make the patient
unconscious and unaware.
It is administered via the patient's circulatory system by a combination of inhaled
gas and injected drugs. After the initial injection, anesthesia is maintained with
inhaled gas anesthetics and additional drugs through an intravenous line (IV).
Advantages
No absolute contraindications
Quick to establish
Never fails to work
Disadvantages
Poly-pharmacy
Effects on various systems
Allergic reactions
Recovery profile
Post operative Nausea &Vomiting
Awareness
Local Anesthesia
In this medicine given to temporarily stop the
sense of pain in a particular area of the body. A
patient remains conscious during a local
anesthetic.
For minor surgery, a local anesthetic can be
administered via injection to the site.
Regional Anesthesia
It involves injection of a local anaesthetic
(numbing agent) around major nerves or the spinal
cord to block pain from a larger but still limited
part of the body.
You will likely receive medicine to help you relax
or sleep during surgery. Major types of regional
anesthesia include:
Spinal
often used for lower abdominal,
pelvic, rectal, or lower extremity
surgery.
This type of anesthetic involves
injecting a single dose of the
anesthetic agent directly into
the spinal cord in the lower
back, causing numbness in the
lower body.
Epidural, and caudal
anesthesia: this
anesthetic is similar to
a spinal anesthetic and
also is commonly used
for surgery of the
lower limbs and during
labor and childbirth.
Nerve blocks : A local anesthetic is injected near a
specific nerve or group of nerves to block pain from
the area of the body supplied by the nerve.
Nerve blocks are most commonly used for
procedures on the hands, arms, feet, legs, or face.
Example - a Brachial Plexus block may be used by
your anesthesiologist to provide anesthesia to your
entire arm and shoulder
Intravenous regional anesthesia is appropriate for procedures,
surgeries, and manipulation of the extremities requiring
anesthesia of up to 1 hour in duration. It is most suited for
laceration repair, reduction of fractures and dislocations, burn
care, and minor soft tissue procedures in the Emergency
Department.
Intravenous regional anesthesia (IVRA) involves peripheral
injection of medication, including sympatholytics, anesthetics,
or nonsteroidal anti-inflammatory drugs into the affected
extremity.
Choice of anesthesia
The patient´s understanding and wishes regarding the type
of anesthesia that could be used
The type and duration of the surgical procedure
The patients´s physiologic status and stability
The presence and severity of coexisting disease
The patient´s mental and psychologic status
The postoperative recovery from various kinds of anesthesia
Options for management of postoperative pain Any
particular requiremets of the surgeon
Preparation for anaesthesia
Early assessment, liaison with the anaesthetist and
appropriate investigations avoid unnecessary
delays.
In any case, the anaesthetist who is to administer
the anaesthetic during the operation should assess
the patient preoperatively and temporary pacin
participate in the preparation for surgery
Preparation for anaesthesia
Investigation
Starvation before surgery
Consent for surgery and anaesthesia
Preoperative drugs and treatment
Investigations :
Investigations of the patient before surgery should be specific according
to the general history and clinical signs.
Preoperative investigations:
Blood count
Potassium sodium
Biochemical screen
Electrocardiogram
Chest radiograph
Serum for cross match
Hepatitis B antigen
Sickle cell screen
Blood gas tension
Preoperative fasting is the practice of
a surgical patient abstaining from eating or
drinking ("nothing by mouth") for some time before
having an operation. This is intended to
prevent stomach contents from getting into
the windpipe and lungs while the patient is
under general anesthesia
Consent for surgery and anaesthesia
Informed consent should be obtained by the
surgical team, prefer ably the operating surgeon,
before any sedation is given, but the anaesthetist
should still explain anaesthetic procedures,
especially regional and spinal techniques, and
discuss potential sequelae. Where added risks
pertain, the patient should be informed, for
example potential damage to vulnerable crowned
or bridged teeth
Preoperative drugs and treatment
Preoperative sedative and analgesic medication is becoming much
less common.
Heavy sedative, antiemetic, antitussive, amnesic medication was
previously used to facilitate induction of the anesthesia with older
pungent inhalational agents, which pro voked coughing and salivation.
Except for patients who are to the already in pain, opioid analgesic
agents are generally first given during induction of anesthesia,
administered intravenously for rapid onset of action prior to the start
of surgery.
For reduction of anxiety, oral short-acting benzodiazepines are now
more commonly used 1-2 hours preoperatively, especially for children.
Oral trimeprazine is also still popular for children.
For the increasing numbers of day-case procedures,
preoperative sedation is avoided so as to promote rapid
emergence from If anaesthesia and mobilization.
the anticholinergic agents atropine, glycopyrronium and
hyoscine are used to reduce respiratory and oral secretions.
They are not essential with modern anesthetic agents but
are still useful for airway surgery and endoscopy.
Hyoscine is pleasantly sedative without the cardiac effects
of atropine, but it can cause excessive sedation in infants or
the elderly.
Antithrombotic prophylaxis may be initiated preoperatively
in major surgery, commonly by subcutaneous heparin
injection.
Risk Associated With Anesthesia
These can be divided into two groups:
1. Minor: These are not life threatening and can occur even
when anesthesia has apparently been uneventful.
They include: • failed I.V. access.
• cut lip, damage to teeth, caps, crowns .
• sore throat.
• headache.
• Postoperative nausea and vomiting.
• urine retention.
2. Major Risk: These may be life-threatening
events.
They include : • aspiration of gastric contents. •
hypoxic brain damage.
• myocardial infarction.
• cerebrovascular accident
• nerve injury.
• chest infection.
• renal failure.
• death
Postoperative Complications
1. Hypoxia
2. Hypotension
3. Hypertension
4. Postoperative nausea & vomiting (PONV)
Postoperative Analgesia Postoperative pain
sequels are:
1. CVS: Tachycardia, Hypertension.
2. Respiratory: decreased of vital capacity &
tidal volume, chest infection, Basal
atelectasis.
3. GIT: nausea and vomiting.
4. other effects: urinary retention, pulmonary
embolus.
