Types of Anaesthesia

Prof. med. Nabil H. Mohyeddin

Anesthesiologist & Intensivist
Board certified
University Rostock, Germany
nhm1955@hotmail.com
 Objectives
Short History
Definition/types of anaesthesia
General anaesthesia/drugs
Phases of GA
Regional anaesthesia
 Early history
Ancient/Medieval period
- Opium
- Alcohol
- Cannabis
 History
1845- Horace Wells- N2O
1846- William Morton- Ether
1847- Simpson- Chloroform
1853-John Snow
1878- ETT
1884- Cocaine
1895-98- Spinal analgesia/anaesthesia
 History
1921- Epidurals
1934- Thiopentone, cyclopropane
1942- Curare
1946- Lignocaine
1951- Suxamethonium
1952- IPPV
1956-Halothane
 Definition
Loss of sensation
General

Regional

Local
 Triad of General
anaesthesia

Hypnosis

Analgesia Muscle relaxation

 Hypnosis

Death

Coma
Hypnosis
sedation
Amnesia
Awake
Hypnotic drugs-intravenous
Gold standard- thiopentone
Propofol

others
Etomidate

Benzodiazepines

Ketamine
 Inhalational anaesthetics
Nitrous oxide-weak
Isoflurane
Sevoflurane
Desflurane
Halothane
 Analgesia
Good analgesia= good anaesthesia
Hypnotic sparing effect
Opiates
Local anaesthetics
NSAIDS
Paracetamol
 Analgesia-Opiates
Gold standard morphine
Derivatives- diamorphine, codeine
Synthetic agents
- Pethidine
- Fentanyl/Alfentanil-short acting
- Remifentanil-ultra short acting
 Analgesia-NSAIDS
Gold standard- aspirin
Ibuprofen
Diclofenac
Cox-2 inhibitors
 Muscle relaxation
Aids intubation
Helps surgeon/surgery
Surgery of long duration
Reduces maintenance dose of
anaesthetics agents
 Muscle relaxants
Two types
Depolarising-short acting
eg;suxmethonium
Non-depolarising- medium/long acting
- Tracurium
- Vecuronium
- Rocuronium
 Prerequisites
Oxygen
Suction
Tilting trolley
Resuscitation drugs
Monitoring
Anaesthetist
Skilled assistance
Drugs and machine
 Phases of
general anaesthesia
Induction
Maintenance
Recovery
 Induction
Intravenous- majority
Inhalational- children, needle phobics
Monitoring
Preoxygenation
Hypnotic/analgesic and or relaxant
Mask/LMA/ET tube
 Stages of anaesthesia
Alcohol General
1.Dizzy, delightful Anaesthesia
2.Drunk, disorderly 1.Amnesia, analgesia
3.Dead drunk 2.Uninhibited
4.Dangerously deep response to stimuli
3.Surgical anaesthesia
4.Vital centre
depression
 Maintenance
Intravenous or inhalational
Oxygen 40%-100%
Nitrous oxide
Muscle relaxant
Analgesia
 Recovery
Turn off agent
Reverse relaxation
Cough reflex
Extubate when awake
Recovery position
Monitor until discharge
 Advantages
No absolute contraindications
Quick to establish
Never fails to work
 Disadvantages
Polypharmacy
Effects on various systems
Allergic reactions
Recovery profile
Post operative Nausia &Vomiting
Awareness
 Regional anaesthesia
Spinal/epidural
- surgery below umbilicus
- Provides analgesia/muscle relaxation
Plexus blocks eg brachial plexus
Intravenous- Biers block
Regional anaesthesia

Analgesia Muscle relaxation

 Local anaesthetics
Lignocaine- quick/short acting
Bupivacaine/levobupicvacaine- slow
and long action
Ropivacaine- as above
Amethocaine- topical
Prilocaine- intravenous
 Advantages
Effective alternative to GA
Avoids polypharmacy
Allergic reactions
Extended analgesia
Patient can remain awake
Early drink/feed
 Disadvantages
Limited scope
Higher failure rate
Time constraints
Anticoagulants/Bleeding diathesis
Risk of neural injury