Introduction to Anaesthesia

for Medical Students

Dr Ron Glick
Department of Anaesthesiology and
Perioperative Medicine
r.glick@alfred.org.au
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Learning Objectives

Define consciousness and anaesthesia

Outline the importance of pre-operative

assessment

Describe the types and physiological effects

of anaesthesia

Understand the WHO analgesic ladder

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What is Anaesthesia?

GREEK

“an” – without
anaisthēsia Anaesthesia
“aisthēsis” – sensation

Modern Definition:

Drug induced reversible loss of consciousness

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What do you see?

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What do you see?

(hint: there are two correct answers)

Concept of Consciousness:

Your individual interpretation of the physical world.

All the colour, sound, touch, motion and sense of awareness
we experience.
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Balanced Anaesthesia
“Triad of Anaesthesia”

Hypnosis

Analgesia Muscle
relaxation
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Pre-operative Assessment

Assessment:
- History and Examination
- Investigations

Optimisation:
- Comorbidities (CVS, Resp, Diabetes)
- Medications
- Smoking cessation

Determine suitability (“fitness for surgery”):

- Risk assessment
- Shared decision making
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Airway assessment
 Surgical Risk Assessment
ASA Physical Definition Mortality %
Status
1 Healthy patient 0.1%

2 Mild systemic disease 0.7%

3 Severe systemic disease 3%

4 Severe systemic disease that is a 18%

constant threat to life

5 Moribund patient who is not 60%

expected to survive without the
operation

riskcalculator.facs.org/
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Safety briefing and checklists

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Phases of General Anaesthesia

Induction
Intravenous hypnotic drugs
+/- muscle relaxation
Airway management

Maintenance
Volatile or Intravenous anaesthesia
Depth depends on surgical stimulus
Analgesia

Emergence
Reversal of muscle relaxation
Return of spontaneous ventilation
Extubation (removing airway)
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Physiological effects of anaesthesia

A – obtund reflexes, airway obstruction

B – hypoventilation, apnoea

C – vasodilation, hypotension, bradycardia

D – loss of consciousness, analgesia, amnesia

E – hypothermia

F – fluid shifts, insensible losses, vomiting

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Haemodynamic effects of propofol bolus

MAP = CO x SVR

Hua et al 2017
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Regional Anaesthesia
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Regional anaesthesia – peripheral nerve block

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Regional anaesthesia – neuraxial Block

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Postoperative Care

Postoperative Analgesia (Acute Pain Service)

Fluid and electrolytes

DVT prophylaxis

Antibiotic prophylaxis

Early post-operative complications

- Hypoxia
- Hypotension
- Tachycardia
- Delirium
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Post-operative Analgesia

Examples:
+/- Morphine /
oxycodone

+/- Tapentadol /
pregabalin

Paracetamol
+ NSAIDS
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Learning Task – 3rd Year Students CCS

Aim
To understand the principles and processes involved in the perioperative
anaesthetic care of a patient having surgery
Guidelines
Choose a surgical patient undergoing major surgery and follow their
perioperative journey (pre-operative assessment, surgery, post-operative
recovery)
Report
Prepare a 1-2 page report outlining the issues that arise during your
patient’s perioperative journey
Tutorial
Contact el.cawson@alfred.org.au to organise a tutorial for the last week
of your rotation
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Summary – Introduction to anaesthesia

Anaesthesia (like consciousness) not an all-or none

phenomenon

Preoperative planning is the key to safe anaesthesia

and surgery

Understand the principles of general and regional

anaesthesia

Understand how to apply the WHO analgesic ladder