Anaesthesia

Presented by
Ashna.S
Final BAMS
Nangelil Ayurveda Medical College
Anaesthesia is a medical treatment that prevents
patients from feeling pain during procedures like
surgery, certain screening and diagnostic tests, tissue
sample removal (e.g., skin biopsies), and dental
work. It allows people to have procedures that lead
to healthier and longer lives.
From Greek anaesthesia means "Not sensation"
- Listed in Bailey's English Dictionary 1721.
- When the effect of ether was discovered"anesthesia"
used as a name for the new phenomenon.
 Basic principles of anesthesia
• Anesthesia defined as the abolition of sensation
• Analgesia defined as the abolition of pain

Triad of general
anesthesia
• need for unconsciousness
• need for analgesia
• need for muscle relaxation
 History Of
Anesthesia
• 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
• Chloroform used as anesthetic in 1853 by Dr. John Snow

• Endotracheal tube discovered in 1878

• Local anesthesia with cocaine in 1885
• Thiopental first used in 1934
• Curare first used in 1942 - opened the "Age of Anesthesia"
 TYPES OF
ANESTHESIA
 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). The components
of general anesthesia include anaesthesia (no pain), amnesia (no
recall) and muscle relaxation.
 General anesthesia

Inhaled gas IV general anesthesia

 Indication
• When the surgical procedure involves ares that
cannot be easily performed under regional
anaesthesia such as head and neck procedures
• Prolonged surgical procedures
• Extensive surgical procedures involving body
Cavities
• Surgery involving multiple parts of the body
• Hemodynamically unstable patient
 Contraindication
• Absolute contraindication- patients refusal
• If the patients general condition is poor and is at
risk of deterioration with the administration of
general anesthesia, so instead of general
anaesthesia regional anaesthesia can be given
Types of General anaesthesia
 Inhaled anaesthesia
Inhalational anaesthesia refers to the delivery of
gases or vapours to the respiratory system to produce
anaesthesia
Some inhaled anaesthesia
are,
• Ether
• Nitrous oxide
• Halothane
 Intravenous anaesthesia
• Thiopental
• Propofol
• Ketamine
• Etomidate
 Local Anaesthesia
Local anaesthetics are drugs when injected
around the nerves block impulse conduction
distal to the site of injection and produce
analgesia and anaesthesia in that area.
 Classification
Local anaesthetics consist of a hydrophilic tertiary
amine group linked to a lipophilic aromatic group.
They are classified into two main categories based
on this linking group: The aminoamides and the
aminoesters.
• Aminoesters: Procaine, chloroprocaine, tetracaine.
• Aminoamides: Lignocaine, bupivacaine,
Advantages of local Anaesthesia
• Simple technique
• Minimal equipment
• Transportable
• Minimal contraindication
• Hemorrhage could be controlled by vasoconstrictor
• No airway impairment
• Minimal postoperative care
• No need for anesthetist
• Duration could be controlled
• Co-operative patient simplify the work
Disadvantages of local anaesthesia

• Difficult to achieve co-operation

• Mechanical obstruction by large tongue or limited mouth
opening
• Failure due to anatomical variation or incomplete anesthesia
• Prolonged parasthesia
• Spread of acute infection
 Indications of local Anaesthesia
• Extraction of teeth
• Apicetomy
• Gingivectomy
• Periodontal surgery
• Pulpectomy,Pulpotomy
• Alveloplasty
• Bone grafting
• Implants
 Contraindications of local anaesthesia
• Patient refusal due to fear and apprehension
• Presence of infection
• Allergy
• Uncooperative patient as epileptic or mental
• Major surgery
• Patients with hyperthyrodism in whom local anaesthia may
precipitate a thyroid crysis
• Patients with severe renal or liver disease
How local anaesthesia is given
During the administration of local
anesthesia, a numbing medication is
either applied to the skin as a cream or
spray or injected into the area where the
procedure will be performed.
 Regional anaesthesia
It is broadly defined as a reversible loss of sensation in a
specific area or region of the body when a local anesthetic is
injected to purposefully block or anaesthetize nerve fibers in
and around the operative site.
Commonly R.A techniques include
1-Spinals (subarachnoid block)
2-Epidurals (extradural space)
3-Caudal blocks, and
 How regional anaesthesia is given
Depending on the need, the anesthesia may be
given with a needle or a needle may be used to
insert a flexible catheter line through which
anesthetics and other medications can be
administered as needed.
 Spinal anaesthesia
Spinal anesthesia is also called as spinal block or
subarachnord block (sab). SAB is a regional anesthesia
involving injection of a local anesthesia into the subarachnoid
space which extends from the foramen magnum to S2 in
adults and S3 in children. Injection of LA below LI in adults
and L3 in children helps to avoid direct trauma to the spinal
cord, (anesthetic agents acts on the spinal nerve and not on the
substance of the cord)
 Epidural anaesthesia
Epidural anesthesia is anesthesia obtained by blocking spinal
nerves in the epidural space as the nerves emerge from the
dura and then pass into the intervertebral foramina.
The anaesthetic solution is deposited out side the dura.
 Peripheral nerve block

A peripheral nerve block (PNB) is the injection of

a local anesthetic around a nerve or group of
nerves with blockade of nerve impulse conduction,
causing temporary analgesia and loss of sensory
and motor function.
 Caudal anaesthesia
• Anesthesia produced by injection of a local anesthetic into
the caudal canal, the sacral portion of the spinal canal.
• Caudal anesthesia is used to provide anesthesia and
analgesia (pain relief) below the umbilicus.
• It may be the sole anesthetic or combined with general
anesthesia.
• Also known as caudal epidural anesthesia or a caudal block.
Stages of anaesthesia
 Stage 1: Stage of analgesia
• Starts from beginning of anaesthetic inhalation and lasts up to
the loss of consciousness
• Pain is progressively abolished.
•• Reflexes and respiration
Patient remains remain
conscious, normal.
can hear and see, and feels a dream
• Some minor operations can be carried out during this stage
like state
• But it is difficult to maintain
• Therefore use is limited to short procedures
 Stage 2: Stage of excitement
• Stage starts from loss of consciousness upto gain of
rhythmical respiration
• Respiration - Irregular and large in volume
• Heart rate and BP raises
• Pupils - Large and divergent
• Muscle tone increased - jaw may be tight
• Patient may shout or struggle
• Involuntary micturation, or defecation
 Stage 3: Surgical anaesthesia
• Extends from onset of regular respiration to cessation of
spontaneous breathing.
• This has been divided into 4 planes:
• Plane 1- Roving eyeballs.
• This plane ends when eyes become fixed
• Plane 2- Loss of corneal and laryngeal reflexes.
• Plane 3- Pupil starts dilating and light reflex is lost.
• Plane 4- Intercostal paralysis
• Shallow abdominal respiration
• As anaesthesia passes to deeper planes
• Progressively-muscle tone decreases
• BP falls
• Heart Rate increases with weak pulse
• Respiration decreases in depth and later in
frequency
 Stage 4: Medullary depression
• There is cessation of breathing leading to failure
of circulation and death.
• Pupil is widely dilated
• Muscles are totally flabby
• Pulse is thready or imperceptible
• BP is very low.
Preanaesthetic Medications
Preanaesthetic medications serve to
• calm the patient, relieve pain,
• protect against undesirable effects of the
subsequently administered anesthetics or the
surgical procedure
• facilitate smooth induction of anesthesia
• lowered the required dose of anesthetic
 Preoperative Anaesthetic assessment
• Pre-operative assessment ensures that the patient is as fit
as possible for the surgery and anaesthetic
• Conducting a preoperative evaluation is based on the
history and physical examination, the appropriate
laboratory tests and preoperative consultations should be
obtained.
• Guided by the history and physical examination, the
anesthesiologist should choose the appropriate anesthetic
 Preparation of anaesthesia
• Avoid food and drinks for eight hours before you go to
the hospital unless directed otherwise.
• Quit smoking, even if it's just for one day before the
procedure, to improve heart and lung health. The most
beneficial effects are seen with no smoking for two
• Stop taking
weeks before.herbal supplements for one to two weeks
before the procedure as directed by your provider.
• Not take Viagra or other medications for erectile
dysfunction at least 24 hours before the procedure.
• You should take certain (but not all) blood pressure
medications with a sip of water as instructed by
your healthcare provider.
 Complications of anaesthesia
• Anesthetic awareness: For unknown reasons, about one
out of every 1,000 people who receive general
anesthesia experience awareness during a procedure.
• Collapsed lung (atelectasis): Surgery that uses general
anesthesia or a breathing tube can cause a collapsed
• lung.
NerveThis
damage: Althoughoccurs
rare problem rare, some
whenpeople
air sacsexperience
in the lung
nerve damage
deflate that fluid.
or fill with causes temporary or permanent
• Malignant hyperthermia: People who have malignant
hyperthermia (MH) experience a dangerous reaction to
anesthesia. This rare inherited syndrome causes fever
and muscle contractions during surgery.
• It is important to relate a personal or family history of
• MH to your physician
Postoperative delirium:anesthesiologist
Older people are before
moreyour
prone
anesthetic to avoid
to postoperative drugs that
delirium. Thistrigger this reaction.
condition causes
confusion that comes and goes for about a week.
संज्ञाहरणं
 वेदना स्थापनाद्रव्य
साल कट्फल कदम्ब पत्मक तुंग मोचरस शिरीष वज्जुल ।
एलावालुक अशोक इति दशेमानि वेदनस्थापनानि भवन्ति ।।
(cha.s
• According to Sushruta, for certain operations alcohol can be used for u.4)
anesthetic purpose. Madya, ahiphena, bhanga etc. "Madhyena mohayitwa
"and a preparation named" moha choorna" susrutha mentions in context of
certain operations. -
• According to Vagbata mathulangarasa and Madhya can be used as anesthetic
agent for the eye operation etc.
• Certain mantras and rituals performed before during the operation may have
Thank
you