Anesthesia
Local anesthesia: is a reversible loss of
sensation induced by a local anesthetic agent
• Advantages:
– Short preoperative preparation
– Can be used when general anesthesia is not
available
– No need for postoperative observation of the
patient
• Used for outpatient surgeries
• Used when general anesthesia is
contraindicated
• Local anesthetic agents:
– Novocain, Procaine, Lidocain, xylocain etc.
• Contraindications for local anesthesia:
– Allergy for anesthetic agent
– Concurrent psychiatric disease
– Scarring (may interfere infiltration of the anesthetic
drug)
– Profuse internal bleeding
– Thoracic surgeries
Novocain (Procain): Infiltration
5-10%, 0.25-0.5%, 1-2%, Intravenous
1-3% Block
Spinal
Peridural
intraosseous
Lidocain (xylocain): Superficial
1-10%, 0.25-0.5%, 1-2% Infiltration
Block
Epidural
intravenous
• Complications:
• Allergic reactions:
• Skin rash
• Itching
• Edema
• Laryngo- and bronchospasm
• Overdose :
• Anxiety, skin hyperemia, tachycardia, hypertension
• In severe cases: respiratory or cardiac arrest or even
coma
Infiltration anesthesia
• This way of anesthesia combines positive aspects of
both infiltration and block anesthesia
• Method is based on the features of fascicular
structures
• The anesthetic that is given under pressure into
fascicular compartment spreads to engulf and
penetrate the nerve and nerve ending
• Tense infiltrates of novocain trickle along the fascial
covering and converge with each other and allows
for hydrous dissection of the tissue
Ex.: Thyroid surgery
Block anesthesia
• Types of block anesthesia:
– Anesthesia of the neural trunks
– Anesth. of the neural plexuses
– Anesth. of a group of the nerve ganglia
(paravertebral anesthesia)
– Spinal anesthesia
– Epidural anesthesia
Block anesthesia of the finger
• Indications: abscess, trauma, tumors
• 1-2% of novocain is used
• Tourniquet is applied to the base or proximal
part
• Novocain is injected directly onto the nerves
Intercostal nerve block
• Used in rib fractures
• A few cm away from fracture skin is anesthetized
• Novocain is injected in the perpendicular direction
• Then the needle is pulled back for about 2-3mm
and is directed to the lower end of the rib along the
lower surface and novocain is injected
Anesthesia of the brachial plexus
• Used in operations on upper extremities
• Supine position
• Head turned to opposite direction
• After infiltration of the skin needle is pushed
laterally from the site of the arterial pulsation
and sliding along the upper end of the rib
toward the spine (T1-T2)
Blocking of the arm, forearm, thigh and leg
• 0.25% of novocain is used
• Thin needle is used to anesthetize the skin
• Novocain is injected into the fascial pouches
of the flexors and extensors
Retromammary block
• Used in treatment of mastitis, in sectoral
resection, incision and drainage
• At the base of the breast in three points (upper,
lower and lateral aspects) novocain is injected
intradermally
• Then with the long deedle novocain is injected
into retromammary space
• No resistance should be felt during injection
• After removing the syringe novocain should not
flow back
Paranephral lumbar block
• Method is used in ileus, renal or hepatic colic
• The patient is lying on the intact side with a folded
sheet under the waist
• The point of injection lies 1 - 1,5cm of the angle
between the 12th rib and the latissimus dorsi muscle
• On crossing lumbar fascia resistance will be felt
• Needle must arrive to the paranephric fat
• If blood appears in the syringe, it must be
withdrawn
The latter spreads into the retroperitoneal fat engulfing the
kidney, adrenal glands, solar plexus and celiac nerves
Intraosseous anesthesia
• Type of local anesthesia
• Drug is given into the bone which enters the
venous system
a. Into the humeral condyle
b. Ansethesia into the ankle
c. Inadequate application of tourniquet results in anesthetic escape
Spinal and epidural anesthesia
• Spinal anesthesia is a nerve block type anesthesia
• Injected into the subarachnoid space of the spinal
cord
• Indications:
– Indicated for surgeries below the diaphragm (stomach,
intestine, liver and bile ducts, spleen and the pelvic
organs)
• Lumbar puncture is usually performed between L3-
L4 or L4-L5
• Lumbar spine L4 is used as the hallmark of the line
joining the superior posterior spine of the iliac bones
• Appearance of colorless fluid suggests
successful puncture
• If there is no fluid needle must be rotated
around its axis
• If still no fluid or blood appears the needle
must be withdrawn and repeated from
different place
• After successful puncture 2 ml of 2% lidocain is
injected into the cerebrospinal canal
• Contraindications for spinal anesthesia:
– Traumatic shock
– Severe intoxication as a result of peritonitis
– Concurrent hypotension
– Myocarditis
– Skin infections on the spine
– Vertebral column deformities
• Complications:
– Fall in blood pressure (due to block to sympathetic
nerve fibers)
– Block the innervation to the intercostal muscles,
can affect breathing or can lead to respiratory
arrest
– Headaches, lower limb paresis or meningitis can
occur
Peridural (Epidural) anesthesia
• Anesthetic is given into the peridural space
between the dura matter and the periosteum
of the vertebra
• Results in the block of spinal nerve roots
• Puncture can be performed at any level
• !!! Dura mater can easily be punctured, which
will facilitate entering the drug into the
subarachnoid space with resultant serious
complications
• Peridural anesthesia is used:
– In traumas and orthopedic surgeries on lower
limbs
– Abdominal and pelvic surgeries
– For old patients
– For patients with CV diseases, respiratory
diseases, obesity, diabetes mellitus
• Contraindications are same with spinal
anesthesia
• Complications are rare
– Hypotension and respiratory problems
– Nausea
– Vomiting
– Seizzures can occur
1. Epidural space
2. Subdural space
3. Needle in the epidural space
4. Needle in the subdural space
• Thank you for your attention!!!
