Anesthesia

1) Terminologies
a) Amnesia: loss of memory
b) Analgesia: lessening of or insensibility of pain
c) Anesthesia: the partial or complete loss of sensation of pain with or without loss of consciousness
d) Emergence: return of sensation and reflexes , to regain consciousness following general anesthesia
e) Induction: the period from the beginning of administration of anesthetic until the patient losses consciousness
f) Pain threshold: an individual’s tolerance for pain
g) Reflex irritability: the reflex stimulation of the vital centers in the brain from the application of stimuli to peripheral
sensory area which may be manifested by alteration in blood pressure or in respiratory or cardiac action.
2) Pre-Operative Medication
a) Time: preoperative drugs should be given from 45 minutes to one hour prior to when the patient will be wheeled
into the operating room or waiting are to allow the medication to reach it’s optimum effect
b) Objective:
i) To allay fear or anxiety
ii) To produce some amnesia
iii) To decrease secretion in the respiratory tract
iv) To reduce reflex irritability
v) To counteract some undesirable side effects of the anesthesia
vi) To raise pain threshold
vii) To lower the body metabolism so that less anesthesia will be used.
c) Medications: any of which may be given orally or intramuscularly
i) Sedatives and Tranquilizers: sedation reduces the effect of anxiety. Amnesia helps to provide comfort;
produces a calm, hypnotic state.
(1) Benzodiazapines: produces excellent amnesia and mild sedation sufficient to reduce anxiety and fear.
They cause inhibitory effect on the interneuronal transmission to sites in the central nervous system
associated with anxiety and fear.
(a) Diazepam (Valium): given orally
(b) Lorazepam (Ativan): given orally than IM, has a good anti-emetic effect
(c) Midazolam (Domicum): given IM for pre-op med and slow IV for conscious sedation
(2) Barbituates: usually given the evening and or the morning before the surgery to promote restful sleep
(3) Anti-emetic/Antinauseants: to minimize nausea and vomiting, usually used in combination with other
drug...eg. Promethiazine hydrochloride (Phenargen)
ii) Narcotics:
(1) Natural alkaloids of opium (optiated/opiods)
(2) Produce analgesia by acting an opiate receptors on CNS
(3) Effectively raise the pain threshold and lower metabolic rate, moderately decreasing the amount of
anesthetic to be used.
(4) Should not be given to asthmatic clients and those with cardiopulmonary disease.
(5) Cause circulatory depression and hypotension
(a) Meperidine hydrochloride (Demerol)
(b) Fentanyl (Sublimaze)
(c) Nalbuphine (Nubain) produce analgesia and relieve severe to moderate pain
iii) Antimuscarinics/Anticholinergics: for sedation and decreases secretion thereby preventing laryngospasms…
eg. Atrophine sulfate
3) Factors that Determines the Choice of Drugs
i) Physical and mental condition
ii) Age and weight of the patient
iii) Operative procedure
iv) Choice of anesthetic
4) Considerations for choice of anesthetics: determined by surgeon and anesthesiologist
i) Patient’s physical condition
ii) Patient’s age
iii) Medications taken
iv) Type and probable duration of operation
v) Laboratory findings
vi) Any known idiosyncracies
vii) Patient’s preference
5) Classification of Anesthesia
a) General Anesthesia: association pathway are broken in the cerebral cortex to produce some loss of sensory
perception and motor discharge. Unconsciousness is produced when blood circulating to the brain contains an
adequate amount of anesthetic agent. General anesthesia results in an immobile, quiet patient who does not recall
the procedure.
b) Methods of Administration:
i) Inhalation: gases and vapors can be delivered via face mask or endotracheal tube.
 (1) Mask inhalation: anesthetic gas or vapor of a volatile liquid is inhaled through a face mask attace to an
anesthesia machine by breathing tubes. The mask must fit the face tightly to minimize th escape of gases
into the environment.
(2) Endotracheal Administration: anesthetic vapor or gas is inhaled directly into trachea through a nasal or
oral tube inserted between vocal cords by direct or blind laryngoscopy. The tube must be fixed in place to
minimize tissue trauma. The patient is given oxygen before and after suctioning. Intubation, insertion of
tube directly into the trachea and extubation or the removal of tube.
ii) Intravenous : a drug that produce hypnosis, sedation, amnesia, and or analgesia that is injected directly into
the circulation, usually via the peripheral vein.
c) Complications of General Anesthesia
i) Cardiopulmonary Complications
(1) Cardiac arrythmias
(2) Cardiac arrest
(3) Bronchospasm and laryngospasm
(4) Respiratory obstruction and failure
(5) Vomiting and aspiration
(6) Shock and hypertension
ii) Cerebral Complications
(1) Cerebrovascular accident
(2) Convulsions
iii) Renal Complications
(1) Renal ischemia
d) Regional Anesthesia: depresses superficial nerves and interfere with the condition of pain impulses from certain
area or region. The sensory nerve are the first affected. The patient remains conscious.
i) Advantages:
(1) A non-explosive anesthetic agents
(2) Use of minimal, simple equipment, economic
(3) No loss of consciousness
(4) Suitable for ambulatory patients
ii) Disadvantages:
(1) Not practical for all types of surgery
(2) Individual variations---pain threshold
(3) Too rapid absorption of drug into the blood can cause server, fatal reaction
(4) Apprehension-patient is conscious
iii) Contraindications:
(1) Local infection or malignancy
(2) Septicemia ( may open new lymph channels, thereby causing new foci and local abscess formation from
the perforation of small vessels and exit of bacteria.)
(3) Allergic sensivity of the patient to local drug
(4) Highly nervous patient.