Professional Documents
Culture Documents
GA/LA
Rabindra Adhikary
ravinems@iom.edu.np
M.Optom, 1st Batch
Tilganga Institute of Ophthalmology
Pokhara University
Types
• General
• Regional
• Local
• Topical
GA
• Combination of drugs causes generalized loss of
consciousness & muscle movements
– Reversible & doesn’t jeopardize pt health
– Fasting Rule:
• Water/clear fluids: 2 hours
• Solid food: 6 hours
• Breast milk: 4 hours
– Drugs
• Barbiturates
• Ketamine
• Etomidate
• Propofol
Stages of GA
• STAGE I: Induction
– Consciousness to unconsciosness
• STAGE II: Excitement
– Excitement of inhibitory neurons of CNS
– Involuntary movement of muscle
– Heart rate, BP and respiration increases
• STAGE III: Surgical Anesthesia
– Loss of muscle tone and reflexes
– Ideal stage for surgery
• STAGE IV: Medullary Paralysis
– Respiratory or cardiovascular failure death
– Overdose
– Careful monitoring in stage 3.
Common General Anesthetics [GAs]
• Nitrous Oxide
– Commonly called laughing gas with a formula N2O
– Colorless, non-inflammable, slightly sweet odor and
taste in room temperature
– Most used gaseous anesthetic in the world
– Other uses: food additive as propellant, fuel additive
for higher combustion, respiratory inhalant for
euphoric pleasures, refrigerant
– Due to its weaker anesthetic and muscle relaxant
properties, it is always supplemented with other
agents to increase the potency
Dosage and administration
• For the maintenance of anaesthesia, nitrous
oxide must always be mixed with at least 30%
oxygen. This is usually accomplished using a
compressed-gas anaesthetic machine.
• For analgesia, a concentration of 50% nitrous
oxide with 50% oxygen usually suffices
• Mode of administration: Inhalation
• Indication of Nitrous Oxide
– Surgical anesthesia, analgesia, pain
• Renal excretion accounts for >70%
• Side effects:
– Nausea, vomitting
– Paresthesia, lack of concentration
– Peripheral neuropathy, atonia
– Hypoxia [in overdose]
Halothane
• volatile inhalational anesthetic agent
• colourless, volatile, non-irritant liquid with a
sweet odour
• In anaesthetic dosage it depresses both cerebral
function and sympathetic activity and produces
little, if any, preliminary excitement
• surgical anaesthesia can be produced in 2-5
minutes.
• The recovery time is rapid and the incidence of
postoperative nausea and vomiting is low.
• Side effects
– Cardio-depressant
– Hepatitis
– Respiratory and vasomotor depression
• Administered through specially calibrated vaporizer
• Concentrations of 0.5-1.5% are usually adequate
for adults and children
• Recovery is fast, but also depends upon the
dosage
– Shivering is seen during recovery cover with warm
blankets
• Contra-indications
– Raised CSF pressure
– Family h/o malignant hyperthermia
– Jaundice/hepatitis
• Halothane should be stored in tightly closed
amber-glass containers protected from light,
below 25°C. Thymol is added as a stabilizing
agent to commercially produced supplies at a
concentration of 100 micrograms/ml.
Ketamine HCL
• Non-barbiturate general anesthetic
administered IM or IV
• 2 –(0-chlorophenyl)-2-(methylamino)
cyclohexanone hydrochloride
• Rapidly acting Gawith profound analgesia
• Best suited for short procedures, used in
conjunction with other drugs for long
procedures
• Initial dose administered intravenously may range from
1mg/kg to 4.5mg/kg. The average amount to produce 5-10
minutes of surgical anesthesia has been 2mg/kg
• Intramuscular dose ranges from 6.5 to 13mg/kg. A dose of
10mg/kg produces 12-25 min surgical anesthesia
• Given over a period of 60 secs
• Side effects may include:
– Respiratory depression
– Cardiac decompensation
– Systemic hypertension
– Diplopia and nystagmus
– Slightly Raised IOP
Propofol
• 2,6-Bis(1-methylethyl) phenol
• C12H18O
• Vulnerable to microbial contamination
– Strict aseptic technique should be applied
• Mode of administration:
– IV infusion
– IV injection
Indication
• Induction and maintenance of GA
• Conscious sedation for diagnostic and surgical
procedures
• Sedation during intensive care
• GA for 3 year or above
• Contraindications
– Who has cardiovascular depression/hypotension
– Not be used for ICU sedation for pt who have fat
metabolism disorder
– Epilepsy: various manifestation of seizures have been
reported, so, not indicated to epileptic pts.
– Pregnancy, labor and delivery
Propofol Dose