Karolina Doskocz gr2B

Basics of anesthesia
Anesthesia refers to the practice of administering medications either by injection
or by inhalation (breathing in) that block the feeling of pain and other
sensations, or that produce a deep state of unconsciousness that eliminates all
sensations, which allows medical and surgical procedures to be undertaken
without causing undue distress or discomfort.
Classification of anesthesia

Classified into 2 major types.

They are :
1. General anesthesia. 2. Local & regional anesthesia.
1. General Anesthesia
General anesthesia is a medically induced state of unconsciousness with loss of
protective reflexes, resulting from the administration of one or more general
anesthetic agents. It is carried out to allow medical procedures that would
otherwise be intolerably painful for the patient or where the nature of the
procedure itself precludes the patient being awake. A variety of medications
may be administered, with the overall aim of ensuring unconsciousness,
amnesia, analgesia, loss of reflexes of the autonomic nervous system, and in
some cases paralysis of skeletal muscles. The optimal combination of drugs for
any given patient and procedure is typically selected by an anesthetist, or
another provider such as a physician assistant or nurse anesthetist (depending on
local practice), in consultation with the patient and the surgeon, dentist or other
practitioner performing the operative procedure.
Purpose
Purpose of General anesthesia has includes:
1. Analgesia (loss of response to pain)
2. Amnesia (loss of memory)
3. Immobility (loss of motor reflexes)
4. Hypnosis (unconsciousness)
5. Paralysis (skeletal muscle relaxation)

Side effects of general anesthesia

 Side effects of general anesthesia include -
 Confusion and memory loss - (more common in the elderly)
 Dizziness
 Difficulty passing urine.
 Bruising or soreness from the IV drip.
 Nausea and vomiting (Most common)
 Shivering and feeling cold.
 Sore throat (due to the breathing tube).
Advantages of general anesthesia
 Reduces intra-operative patient awareness and recall.
 Allows proper muscle relaxation for prolonged periods of time.
 Facilitates complete control of the airway, breathing, and circulation.
 Can be used in cases of sensitivity to local anesthetic agent.
 Can be administered without moving the patient from the supine position.
 Can be adapted easily to procedures of unpredictable duration or extent.
 Can be administered rapidly and is reversible.
Disadvantages of general anesthesia
  Requires increased complexity of care and associated costs.
 Requires some degree of preoperative patient preparation.
 Can induce physiologic fluctuations that require active intervention.
 Associated with less serious complications such as nausea or vomiting,
sore throat,
 headache, shivering, and delayed return to normal mental functioning.
 Associated with malignant hyperthermia, a rare, inherited muscular
condition in
 which exposure to some (but not all) general anesthetic agents results in
acute and
 potentially lethal temperature rise, hypercarbia, metabolic acidosis, and
hyperkalemia

2. Local & regional anesthesia

Local anesthesia is the reversible loss of sensation in a defined area of the body
and is achieved by the topical application or injection of agents that block the
generation and/or journey of nerve impulses in tissue.
Regional anesthesia is essentially local anesthesia but covering a larger area of
subcutaneous tissue or larger peripheral nerves. Chemically they are weak bases
formed of lipophylic group connected to ionizable hydrophilic group by an
intermediate chain. Local anesthesia is used in many dermatological procedures
and surgical operations. The aim is to minimise pain and suffering and maximise
patient comfort.
Mechanism of action local anesthesia
- They act from inside the nerve & inhibit Na influx (membrane stabilization)
- Fibers are affected in this sequence (Sensory, cold, touch, pressure & lastly
motor) & unmyelinated before myelinated.
- Recovery occurs in the reverse direction
Classification of local anesthesia
According to their chemical structure they are classified into 2 types,
Amides
 Lidocaine (most frequently used)(effective, acts rapidly)
 Dibucaine
 Prilocaine
  Mepivacaine
 Bupivacaine
Esters
 Cocaine
 Procaine
 Tetracaine
 Benzocaine
According to their solubility and therapeutic application they are classified into
3 types,
Soluble L.A suitable for injection:
 Lidocaine
 Dibucaine
 Procaine
 Tetracaine
All these can produce surface anesthesia except Procaine which is effective only
by injection.
Soluble L.A used only topically:
 Cocaine
 Phenacaine
 Butacaine
Mainly used to produce topical anesthesia of the Eye.
Insoluble L.A:
 Benzocaine
 Orthoform
Used as surface anesthetics in the form of powders and ointments for wounds.
Methods of administration
1. Surface anesthesia
 By direct application for skin & mucous membrane
2. Infiltration anesthesia
 By S.C injection to reach fine nerve branches and sensory nerve
terminals.
3. Nerve block anesthesia
 By injection close to the appropriate nerve trunks (Brachial
plexus) to produce a loss of sensation peripherally.
4. Sympathetic block
 It is injected around sympathetic ganglion.
5. Para vertebral block
 It is injected around spinal roots as they emerge from the
paravertebral foramina.
6. Epidural anesthesia
 The LA is injected in the epidural space,between the dura &
bony spinal canal containing fat & connective tissue.
 It can be performed in sacral hiatus (Caudal anesthesia)
7. Spinal
 The LA is injected in the subarachnoid space in the lumbar region
 The level of spinal anesthesia depends upon:
 Posture of the patient.
 Specific gravity of the injected solution.

Side effects / Complications of local anesthetic

Local side effects such as bruising and a temporary sensation of stinging or
burning are common.
When administered correctly the chances of more serious side effects occurring
are minimal.
Signs and symptoms of systemic toxicity include:
 Severe numbness or tingling
 Dizziness and drowsiness
 Tinnitus (ringing in the ears)
 Slurred speech
 Metallic taste in mouth
 Mental status change
  Muscle twitching

Advantages of Local anesthetic

 During local anesthesia the patient remains conscious.
 Patient maintains own airway.
 Aspiration of gastric contents unlikely.
 Recovery is smooth as it requires less skilled nursing care as compared to
other anesthesia like general anesthesia.
 Postoperative analgesia.
 There is reduction surgical stress.
 Earlier discharge for outpatients.
 Expenses are less.
Disadvantages of Local anesthetic
 Sometimes patient may prefer to be asleep.
 It needs a practiced and skilled person for the best results.
 Some blocks require up to 30 min or more to be fully effective.
 It is also possible that analgesia may not always be totally effective. May
be the patient requires additional analgesics, IV sedation, or a light
general anesthetic.
 Sometimes toxicity may occur if the local anesthetic is injected
intravenously or if the overdose is given Operation like thoracotomies is
not suitable for local anesthetics.