In the name of Allah

Definition of Anesthesia

Anesthesia literally means “no sensation”

sensation
Derived from the Greek verb for “to
perceive”

Oliver Wendell Holmes suggested the name "Anesthesia"

History of Anesthesia 18th
Century Surgery

Original in the Royal College of Surgeons of England, London.

Historical Review

1771-Joseph Priestly
- discovery of 02

1772-Joseph Priestly - discovery of

N20

Late 1700's-Pneumatic Medicine

Historical Review

1798- Sir Humphrey Davies first mention of

inhalational properties of N20 ( relief of pain
caused by an erupting wisdom tooth) but
clinicians overlooked his suggestion
1846- Horace Wells :observed significant leg
injury without pain , next day received N2O for
extraction of one his teeth

Early 1800's - recreational use ether frolics

 History of Anesthesia

1540 : A flammable ,volatile liquid synthesized by Cordus

(sweet vitriol)

1740 : Frobenius named it Ether (from the greek word for

ignate or blaze)

1842 Used as anesthetic , publicized as anesthetic in 1846 by

Dr. William Morton

Chloroform used as anesthetic in 1853 by Dr. John Snow

 One of the most significant events in the history of
medicine
Oct. 16, 1846 - Ether Day : First demonstration of
the use of ether in anesthesia at Mass. Gen.
Hosp.( Ether dome ) -Dr. William T.G. Morton
( First anesthesia specialist)
Historical Review
1850’s - Chloroform/Ether - multiple deaths

1863 - N20 reintroduced by Colton

1887 - The first anesthesia machine - N20/02

1953- Fluorinated anesthetics

1954- Halogenated drugs; Halothane (more pleasant odor,

higher potency, favorable pharmacokinetic, nonflammability& low
toxicity)
1960:Enflurane,Isoflurane,desflurane,Sevoflurane

Xenon : inert gas ,under investigation

History of Anesthesia Operation Under Ether -
1852

“The effect of the gaseous inhalation in

neutralizing the sentient faculty was made
perfectlyMassachusetts
distinct to my mind..”
General Hospital, Boston
 Anesthesia
Now covers :
1. OR
2. PACU
3. PREOP. CLINIC
4. RESP. CARE
5. ICU (gen.surg.,cardiac surg.,Tx.)
6. PAIN CLINIC (acute & chronic pain services)
7. OPIOD DETOXIFICATION
8. TRAUMA team
9. EMERGENCY DEPT.
10. CPCR
Types of Anesthesia
Local Anesthesia: loss of sensory perception over a small area
of the body

Regional Anesthesia: loss of sensation over a specific region

of the body (e.g. lower trunk)

Monitored Anesthesia Care (MAC) :conscious sedation +

observation & management of complications

General Anesthesia: loss of sensory perception of the entire

body
 loss of response
General Anesthesia (defenition)
to & perception of all external stimuli

Components of General Anesthesia:

1. Unconsciousness
2. Analgesia (most GA’s are poor analgesics)
3. Amnesia
4. Anexiolysis
5. Areflexia
6. Attenuation of autonomic responses to painful stimuli
 General Anesthetics
Inhalational Parenteral

Gas Volatile liquids* Barbiturates

(nitrous oxide) (halothane (thiopental)
isoflurane,
desflurane,
sevoflurane) Opioids
Benzodiazepines (fentanyl)
(midazolam)

Misc.
(etomidate,
propofol)
 Anesthetic Techniques

Inhalation anesthesia
Total intravenous anesthesia
Inhalation plus intravenous (“Balanced
Anesthesia”)
Most common
 Phases of General Anesthesia

Induction- initial entry to surgical anesthesia

Maintenance- continuous monitoring and medication

Maintain depth of anesthesia, ventilation, fluid balance, hemodynamic
control, hoemostasis

Emergence- resumption of normal CNS function

Extubation, resumption of normal respiration
 Inhalation Anesthetics

Gas enters the blood

plasma but rapidly leaves
it in preference for a lipid
environment such as cell
membranes/ the brain

Inhaled and Aveoli Blood Tissues,

exhaled gases including
Brain
The “Old Theory” of General Anesthesia
Induction
Patient wakes up

Anesthetic molecules
partition into lipid bilayers
The exact opposite of the non-
specific miracle occurs….
A non-specific miracle occurs….
(Δ cell lipid bilayer (some GA’s produce
physical properties?) stereospecific effects!?)
Unconsciousness

Remove anesthetic
 Receptors Possibly Mediating CNS
Effects Of Inhaled Anesthetics

Potentiation of Inhibition of
inhibitory ‘receptors’ excitatory ‘receptors’
GABAA NMDA (glutamate)
Glycine AMPA (glutamate)
Potassium channels Nicotinic acetylcholine
Sodium channels
 Inhalation Anesthetics

Applying a gas rather than a solid or a liquid

special set of terms:

Concentration –µg/litre or µM is possible but
difficult because of the volatility of the drug

MAC – minimum alveolar concentration (as a

percentage) to induce pain insensate
anesthesia
Minimum alveolar concentration
Alveolar concentration required to
prevent movement in 50% of subjects
in response to skin incision
standard stimulus Agent MAC
represents brain concentration
consistent within and between species Nitrous oxide 104
additive Desflurane 6.6
Sevoflurane 1.8
Enflurane 1.63
Isoflurane 1.17
Halothane 0.75
Factors increasing MAC
Hyperthermia
Chronic ETOH abuse
Hypernatremia
Increased CNS transmitters
MAOI
Amphetamine
Cocaine
Ephedrine
L-DOPA
Factors decreasing MAC
Increasing age
Narcotics
Hypothermia
Ketamine
Hyponatremia
Benzodiazepines
Hypotension (MAP<50mmHg)
Pregnancy α2 agonists
Hypoxemia (<38 mmHg) LiCO3
O2 content (<4.3 ml O2/dl) Local anesthetics
Metabolic acidosis ETOH (acute)
And many more
Factors with no influence on MAC
Duration of anesthesia
Sex
Alkalosis
PCO2
Hypertension
Anemia
Potassium
Magnseium
Intravenous anesthesia
Intravenous Anesthetic Agents

1656 : First attempt at intravenous anesthesia by Wren

-- opium into his dog

1934 : Use in anesthesia with thiopental

Many ways to meet requirements-- muscle relaxants,

opoids, nonopoids

Appealing, pleasant experience

Narcotic agonists (opioids)
Used for years for analgesic action-- civil war for wounded
soldiers
Predominant effects are analgesia, depression of sensorium
and respirations
Mechanism of action is receptor mediated
Muscle Relaxants
Neuromuscular Junction
Local Anesthetics
Mechanism of action is by reversibly blocking
sodium channels to prevent depolarization
Anesthetic enters on axioplasmic side and attaches to
receptor in middle of channel
Anesthesia subspecialities
Intensive care medicine
Anesth. For thoracic surg.
Anesth. For cardiac & vascular surg.
Neurosurgical anesth.
Organ transplant
Anesth. For hepatobil. & genitourinary sys.
Anesth. For OB & laparoscopic surg.
Ped. & geriatric anesth.
Anesth. For robotic & LASER surg.
Anesth.for trauma
Anesth. For Ophth. & ENT operations
CPCR
Thank you!