GENERAL ANAESTHESIA

Means abolition of all sensations, i.e, touch, pain, posture & temperature with a state
of reversible loss of sensation & consciousness.

TRIAD OF GA

CLINICAL FEATURES
✓ Loss of sensation
✓ Muscle relaxation
✓ Diminished reflexes
✓ Unconsciousness.

TYPES
1. Inhalation of nitrous oxide, ether.
2. Intravenous → thiopentone, ketamine.

TECHNIQUES
Open drop method or Nitrous oxide through Boyle’s apparatus.

INSTRUMENTS
1. Boyle’s apparatus:
It consists of:
 Cylinders for N2O & O2.
 Pressure gauge – to know the amount of gas remaining.
 Pressure regulator – to regulate the pressure of gas used.
 Rotameter – to know the flow of gas.
 Vaporizer.

2. Endotracheal tube 2 3
3. Magill’s forceps
4. Mouth gag
5. Laryngoscope
6. Connectors
7. Laryngeal mask airway (LMA)
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 7
4 5
.

ADVANTAGES
 Does not require laryngoscope for insertion.
 Does not cause irritation of airway.
 Less incidence of laryngospasm.
 In case of inability to intubate can save the life of the patient.

CONTRAINDICATIONS
Ø Pharyngeal pathology
Ø Full stomach as it can cause aspiration.
Ø Bronchospasm.

DISADVANTAGES
► BP may increase
► Teratogenic effect.

DRUGS FOR GA
1. Anesthetic agents

Volatile anesthetics Gaseous anesthetics Intravenous anesthetics

Ether: Nitrous oxide:
⸙ Colorless volatile
liquid.
⸙ Muscle relaxation is
good so used in all
abdominal surgeries.
⸙ Safe.
⸙ Irritant.
⸙ Unpleasant.
⸙ Flammable.
⸙ Disadvantages:
Vapors are highly
irritative to URT,
causes nausea & Cyclopropane:
vomiting, increases
secretions of all
glands.
Enflurane & isoflurane:
♦ Non-inflammable.
♦ Non-explosive.
Thiopentone:
ꟹ Laughing gas. ♯ Ultrashort acting barbiturate.
ꟹ Non-inflammable. ♯ Causes hypnosis during
ꟹ Non-irritant. induction of anesthesia.
ꟹ Good analgesic but ♯ No analgesic effect.
weak anesthetic agent. ♯ Non-irritant to lungs.
ꟹ Safest. ♯ Causes hypotension,
ꟹ Better smelling. respiratory depression, less
ꟹ Administered with 30- nausea & vomiting.
50% of oxygen. ♯ Rapid muscle relaxation.
ꟹ Post OP ♯ Disadvantages:
complications less. Shock may occur due to fall in
BP.
Respiratory depression.
⸛ Highly inflammable. Recovery period is long.
♯ Dose: 4-7mg/kg.
Ketamine:
♣ Good analgesic.
♣ It causes dissociative
anesthesia.

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 ♦ Non-irritant. ♣ Good for repeated use.
♦ Stable. ♣ Respiration not depressed.
♣ Used on dressing of burn,
incision & drainage.
♣ It can lead to hypertension,
apnea, laryngospasm.
♣ Dose: 2 mg/kg.

2. Oxygen
⁜ Given through Boyles apparatus.
⁜ In high concentration is respiratory depressant & also affects eyes.
⁜ Available in black & white colored cylinder.

3. Muscle relaxants
 During abdominal surgeries or in fracture reduction process, in addition to
anesthetic drugs muscle relaxants are also used.
 Scoline (Suxamethonium chloride) 50-70 mg → action for 5min.
 Flaxedil 80-120mg → action for 30 min.
 Curare 15-18mg IV → action for 45 min.
 Pavulon 6mg → action for 60 min.
 Neostigmine 2.5mg → antidote for curare.

COMPONENTS OF GA
♠ Premedication
♠ Induction
♠ Maintenance
♠ Recovery

Premedication
⁂ Given 1 hour before surgery.
⁂ For sedation & relief of anxiety:
→ Pethidine 50mg
→ Morphine 10mg
→ Diazepam 10mg
→ Midazolam 1-2.5mg.
⁂ To suppress vagal activity → atropine 0.6mg IM.
⁂ To reduce vomiting → promethazine (phenargan) 12.5mg.

Induction
☺ Patient is preoxygenated with 100% oxygen for 3 minutes then induced with IV
thiopentone, given 4-5mg/kg.
☺ Patient less consciousness → induction is maintained by 67% nitrous oxide & 33%
oxygen.
☺ Scoline as IV → to relax muscles to facilitate endotracheal intubation.

Postoperative care
⁘ Immediate postoperative period is important & critical.
⁘ Patient may not fully conscious.

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 ⁘ Patient should be kept in recovery room until he/she recovers from anaesthesia.

1. Care of respiratory system:

⁕ Oxygen supplement through mask, observation, proper positioning.
2. Hypercarbia.
3. Circulatory problems → Hypotension, arrhythmias, hypertension, cardiac arrest.
4. GIT → Vomiting, regurgitation, Mendelson’s syndrome.
5. Renal problems.
6. Other problems → restlessness, shivering, pain.

Monitoring of postoperative patient

 Pulse, temperature, BP chart.
 Breathing type.
 Level of consciousness.
 Urine output.
 Oxygen saturation & heart rate using pulse oximeter.
 Checking & encouraging limb movements.
 Skin-tongue colour for adequacy of oxygenation.
 Tongue for hydration.
 Cardiac monitor.
 Blood gas analysis in case of patient on ventilator.
 Serum electrolytes assessment.

STAGES OF ANESTHESIA
1. Stage of Analgesia
2. Stage of Excitement
3. Stage of Surgical anaesthesia
4. Stage of respiratory paralysis

Stage of analgesia
• Stage is from giving of anaesthetic drugs up to loss of consciousness.
• Pain is diminished.
• Respiration & reflexes are normal.
• Used for minor operations like labor & for incision & drainage.

Stage of excitement
o Stage from loss of consciousness to regular respiration.
o Patient gets excited, involuntary movements occur, pupils are dilated, blood pressure
& heart rate increases.

Stage of surgical anaesthesia

▪ In this stage there will be shift of respiration from regular to irregular.
▪ BP goes down, muscle tone decreases.
▪ This stage is divided into 4 planes:-
1. Roving eye balls.
2. Loss of corneal & laryngeal reflexes.
3. Pupils starts dilating & light reflex loss.
4. Intercostal paralysis, shallow abdominal respiration.

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Stage of respiratory paralysis
Irregular respiration.
BP drops down.
Pupils fully dilate.
Finally patient may die if situation is not treated properly.

COMPLICATIONS
$ Hypertension or hypotension.
$ Intra-arterial injection of the drug.
$ Myocardial depression & cardiac arrest.
$ Respiratory depression, airway obstruction, bronchospasm.
$ Nausea & vomiting
$ Hepatic or renal failure.
$ Hypoxia.
$ Drowsiness.

Dr.GEETHU V.S.BAMS, MS(Ay)