Basics Of Anaesthesia in

Surgery

Dr. Hekmatullah Nursi

House Surgeon-Surgical Unit - 2
 DEFINITION

• Anaesthesia is use of drugs

to prevent the feeling of pain
or other sensations during
surgery or other medical
procedures
that might be painful.
 ANAESTHESIA COMPONENTS
Analgesia: Insensitivity to pain.
Amnesia: state of sleep or unconsciousness which makes patient
unaware of events.
Muscle relaxation: affects skeletal muscle function and decrease
tone of muscle.
FEATURES OF GOOD ANAESTHESIA

Safe
Abolish pain
Reversible
Provides good operating
condition
TYPES OF ANAESTHESIA
 General Anaesthesia
Drug induced, reversible state characterized by triad of
amnesia, analgesia and muscle relaxation.

Phases of general anaesthesia:

Induction of anaesthesia
Maintenance of anaesthesia
Reversal and extubation
 1. Induction Of Anaesthesia
Intravenous induction:
Propofol has replaced thiopentone as most widely
used agent.
Other IV agents include, etomidate and ketamine.
Inhalational induction:
Includes gases such as isoflurane, halothane and
sevoflurane.
Useful in children, needle phobics, or in patient with
risk of pulmonary aspiration.
Sevoflurane (DOC) (rapid onset + sweet smell)
 Airway Management And Ventilation
Loss of muscle tone requires method to keep airway patent
Can be achieved by:
Jaw thrust
Laryngeal mask airway
Endotracheal intubation
Tracheostomy tube
Endobronchial tube
Once airway is secured parameters (RR, Tidal volume, PEEP)
on anaesthesia machine are adjusted and
ventilation is continued.
Suxamethonium: short acting muscle relaxant,
preventscough reflex so endotracheal intubation can be done.
different sized airways laryngeal mask airway
 2. Maintenance Of Anaesthesia
Achieved by mixture of oxygen, nitrous oxide and inhalational
agents (halothane/isoflurae).
Nitrous oxide: to keep pain free
Halothane/isoflurane: to maintain sleep
Atracurium: muscle relaxant
 3. Reversal And Extubation
Nitrous oxide and volatile agents are turned off, only oxygen is
given.
Neostigmine is given to reverse the effect of atracurium
Atropine is also given to block muscarinic receptors so max
dose of neostigmine is available at nicotinic receptors. Also
prevents bradycardia and reduces bronchial secretion.
Once patients starts coughing ETT is removed, airway is
cleaned by; suction and oxygen is given with mask till normal
breathing pattern resumes.
Total Intravenous Anaesthesia (TIVA)
Anaesthesia is achieved by IV infusion of propofol
and ultra short acting opioids.
Complications Of General Anaesthesia
Trauma
Misplacement of tube
Esophageal perforation
Pneumothorax
Atelactasis
Bronchospasm
Laryngospasm
Arrythmias
Malignant hyperpyrexia
Hypothermia
Hypoxia, hypercarbia
 Local Anaesthetics
Lignocaine (Xylocaine):
Most commonly used;
Effective for 1-2 hrs
Can be used with adrenaline;
1. its vasoconstrictive effect reduces systemic
absorption.
2. Provides bloodless field for surgery.
Dose: 3mg/kg/bodyweight without
adrenaline
7mg/kg with adrenaline
Bupivacaine:

Most potent and more toxic local anaesthetic

agent.
Effect remains for 5-7 hrs
Cardiotoxic must not be injected in to veins
Dose: 2mg/kg/body weight
Prilocaine:

Drug of choice for Bier’s block

Dose: 6mg/kg without adrenaline, 9mg/kg with
adrenaline
Overdose can cause methaemoglobinaemia
Ropivacaine:
Dose: 3-4mg/kg
Less cardiotoxic

Levobupivacaine:
Dose: 2mg/kg
Isomer of bupivacaine but
cardiotoxic
 Topical Anaesthesia
Used on skin, urethral mucosa, nasal mucosa and
cornea agents include:
lignocaine
Prilocaine
Amethocaine (well absorbed by mucosa)
Cocaine (for its vasoconstrictive properties)
 Local Infiltration
Infiltration of local anaesthetic agent may be into or around
a wound paying attention to neuroanatomical territories
and boundaries.
Contraindicated near infection:
Can spread the infection
Acidity of infection blocks the action of drug
 Plexus Block

Agent is applied to block the

whole of nerve plexus.
Brachial plexus block for
arm and hand surgery.
 Intra Venous Regional Anaesthesia
(Bier’s block)
Local anaesthetic with low toxicity profile is injected IV to
anaesthetize the limb (arm below elbow/leg below knee)
Prilocaine 0.5% (drug of choice)
Bupivacaine should never be used because of its cardiotoxicity.
 Spinal Anaesthesia

Used for limb, obstetric and pelvic surgeries

Anaesthetic agent is injected into subarachnoid space below
the level of L2 vertebrae where spinal cord ends.
2-3ml of 0.5% bupivacaine is mostly used.
Complications Of Spinal Anaesthesia
Hypotension
Injury to spinal cord
Nausea and vomiting
Paresthesia
Injury to nerve root
Spinal headache
Backache
Infection
Urinary retention
Meningitis
Disc prolapse
 Post Spinal Headache
Occurs in 1-5% of patients
Occurs due to leakage of cerebrospinal fluid
Headache is characteristically occipital
Worsens on sitting/standing position
Typically appears after 48-72/hrs
Requires bed rest along with simple analgesia and fluids
If not improved after 24/hrs epidural blood patch is
suggested.
 Epidural Anaesthesia
Anaesthesia is injected into epidural space
(a potential space between dura matter and
ligamentum flavum)
Advantage: prolong analgesia by multiple dosing
or continuous infusion
Catheter can be placed for upto 4 days.
Placement of epidural catheter in high thoracic
region provides good analgesia for upper
abdominal and thoracic procedures.
Contraindications To Spinal/Epidural
Anaesthesia
Local infection
Generalized sepsis
Bleeding diathesis
Raised intracranial pressure
Chronic backache
Hypovolemia
Difference between Spinal and Epidural
Anaesthesia
Thank you