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GeneralAnesthesia
Acontrolledstateofunconsciousness
Partialorcompletelossofprotectivereflexes
Inabilitytomaintainanairwayandrespond
purposefullytoverbalcommands
FourStagesofAnesthesia
StageIAnalgesia
StageIIDelirium
StageIIISurgicalAnesthesia
StageIVMedullaryParalysis
StageI
Beginswithadministrationof
CNSdepressantdrug
Endswhenpatientlosesconsciousness
eg.,sedation
StageII
Beginswithlossofconsciousness
Endswithentryintosurgicalanesthesia
eg.,IVGeneralAnesthesia
StageII
Reflexesarehyperactive
Respiratorypatternisirregular
Riskoflaryngospasm
StageIII
Surgicalanesthesia,Planes1,2,3,4
Respirationsregular,patientmostlikely
intubated
Plane2mostsurgicalproceduresperformed
StageIV
Respiratoryandcirculatoryarrest
Reversibleclinicaldeath
GeneralAnesthesia
AprogressivedepressionoftheCNS
ControlledpassagethroughStageIandIIto
arriveinStageIII
Advantages
Patientcooperationnotabsolutelyessential
Unconsciousness
Amnesia
Rapidonsetofaction
Titrationpossible
Disadvantages
Lossofprotectivereflexes
Depressionofvitalsigns
Advancedtrainingrequired
Additionalpersonnelrequired
Specialequipment/setting
Disadvantages
Needforrecoveryroom
Greaterriskofintraopcomplications
Postanestheticcomplications
Moreextensivepreopevaluation,including
labwork
Indications
Extremeanxietyandfear
Mentallyand/orphysicallydisabledadultsor
children
Poorpatientcooperation
Ageinfantsandchildren
Traumaticproceduresshortorprolonged
Contraindications
Lackofadequate:
Trainingbydoctor
Trainedpersonnel
Equipment
Facilities
Medicallycompromisedpatient
(requireinpatientGA)
TrainingRequired
forGeneralAnesthesia
Abilitytosecureandmanagetheairwayis
essential
O.M.S.oranesthesiaresidency
TypesofGeneralAnesthesia
IVgeneralanesthesia
ConventionalO.R.typegeneralanesthesia
Hospitalsamedaysurgery,orSurgicenter
Inpatientgeneralanesthesia
IVGeneralAnesthesia
UsedprimarilyinO.M.S.
Shortprocedures(30min.orless)
ASAI,selectedASAIIpatients
Excellentsafetyrecord(1:400,000mortality)
NPO&escortessential
IVGeneralAnesthesiaAgents
Barbiturates
Ultrashortacting
Methohexital
Nonbarbiturates
Propofol
Monitors
ECG
BloodPressure
PulseOximeter
Pretrachealstethoscope
Capnograph
TechniqueIVGeneralAnesthesia
N2O/O2administered
IVaccess
Titrationofsedativeagents(Fentanyl/Versed)
AdministrationofMethohexital
titrationthroughoutprocedure
TechniqueIVGA(cont.)
Throatpackandsuctioningessential
Administerlocalanesthetic
Surgicalprocedure
100%O2
Transfertorecoveryareawhenawake
ORTypeGeneralAnesthesia
Involvestrachealintubationtosecureairway
Administrationofinhalationalagents
MaybeasOutpatientorInpatientGA
OutpatientGA
HospitalsamedaysurgeryorSurgicenter
ASAIorII(occasionalIII)
Forproceduresof30mins.to4hrs.duration
Avoidsovernighthospitalization
InpatientGA
Hospitalstay(24hrsormore)
MaybeanyASAclassification
Indicatedforproceduresthatrequirelengthy
recovery
Lesscosteffective
Armamentarium
Generalanesthesiamachine
IVequipment
Ancillaryanesthesiaequipment
Monitors(incl.capnograph)
Crashcart&emergencymedications
GeneralAnesthesiaMachine
DeliversO2,N2Oandotheranestheticgases
Closedsystem,partialrebreathing
Multiplecomponents
ComponentsofGAMachine
Ventilator
Vaporizers
Monitors
Alarms
AncillaryAnesthesiaEquipment
Suction
Facemasks
Oropharyngeal&nasopharyngealairways
AncillaryAnesthesiaEquipment
Laryngoscope&blades
Magillforceps
Endotrachealtubes
DrugsforGeneralAnesthesia
IVinductionagents
Narcotics
Neuroleptic/dissociativeagents
Musclerelaxants
Inhalationanesthetics
IVInductionAgents
UsedtoachieveStageIIIrapidly
IVagentspreferredtoinhalationagents
Methohexital,Thiopental,Propofol
Narcotics
Usedformaintenanceofgeneralanesthesia
"BalancedTechnique"
Morphine,Fentanyl,Alfentanil,Sufentanil
DissociativeAgents
Ketamine
Dissociatespatientfromenvironment
Minimaldepressionofprotectivereflexes
Hallucinationsarecommononemergence
MuscleRelaxants
Neuromuscularblockade
AdministerafterStageIIIobtained
Defasciculatingdose/paralyzingdose
Succinylcholine,Atracrurium,Pancuronium
InhalationAnesthetics
Producegeneralanesthesia
Easilytitratedsincepulmonaryventilation
affectsuptakeandelimination
Canbeusedforinductionormaintenance
Halothane,Enflurane,Isoflurane
TechniqueGeneralAnesthesia
PreOpevaluationandlabwork
NPO
Holdingarea(IVAccess)
Preoxygenation
IVinduction(Thiopental,Propofol)
TechniqueGA(cont.)
Bagmasktoinsurepatentairway
Narcotic,musclerelaxant
Intubation
VerifyplacementandsecureETtube
TechniqueGA(cont.)
Inhalationagent
MaintenanceofStageIII
Administerlocalanesthetics
Surgicalprocedure
TechniqueGA(cont.)
D/Cinhalationagents,givereversalagents
Spontaneousrespirations,adequatetidal
volume
Extubation
Transfertorecoveryorhospitalroom