ANESTHESIA

ARTIFICIALLY INDUCED STATE OF PARTIAL

OR TOTAL OF SENSATION IN PATIENTS, WITH OR

WITHOUT LOSS OF CONSIOUSNESS

PAIN TRANSMISSION
 TYPES
• GENERAL

• REGIONAL

• LOCAL
 GENERAL
ANESTHESIA
GOALS OF GENERAL ANESTHESIA
• CAUSE LOSS OF CONSCIOUSNESS

• PREVENT OR REDUCE PAIN

• ELIMINATE NORMAL REFLEXES

• RELAX SKELETAL MUSCLES

• CAUSE AMNESIA

• MAINTAIN PHYSIOLOGIC STABILITY

STAGES OF GA
• STAGE I – ANALGESIA/ AMNESIA
• STAGE II – EXCITEMENT/ DELIRIUM
• STAGE III – SURGICAL ANESTHESIA
- PLANE I – REGULAR RESPIRATION,
ABOLISHED LID REFLEX
- PLANE II – FIXATION OF EYES, DECREASED
ACTIVITY OF INTERCOSTAL MUSCLES
- PLANE III – COMPLETE IC PARALYSIS
- PLANE IV – COMPLETE CESSATION OF
SPONTANEOUS RESPIRATION
• STAGE IV – MEDULLARY DEPRESSION
LEVELS OF SEDATION
• MINIMAL – VENTILATORY, CV FUNCTIONS
INTACT
• MODERATE – RESPONDS TO LIGHT TACTILE
STIMULATION, SPONTANEOUS
RESPIRATION AND CV FUNCTION INTACT
• DEEP – IMPAIRED VENTILATORY FUNCTION,
REDUCED CONSCIOUSNESS
• GENERAL ANESTHESIA – TOTAL LOSS OF
CONSCIOUSNESS, VENTILATION AND
NEUROMUSCULAR FUNCTION DEPRESSED
GENERAL ANAESTHETICS

INHALATIONAL INTRAVENOUS
 INHALATIONAL
• INORGANIC GAS

- NITROUS OXIDE

• VOLATILE AGENTS

- DESFLURANE

- ENFLURANE

- HALOTHANE

- ISOFLURANE
 INTRAVENOUS

• BARBITURATES

- METHOHEXITAL

- THIOPENTAL SODIUM

ENHANCE RESPONSE TO GABA,

INCREASE CHLORINE IONS IN NEURON
• NONBARBITURATES

- ETOMIDATE

- PROPOFOL

SIMILAR TO BARBITURATES
• DISSOCIATIVE AGENT

- KETAMINE

HYPNOTIC, HALLUCINOGENIC,

PRODUCE DISSOCIATION FROM SURROUNDINGS

• BENZODIAZEPINES

- DIAZEPAM

- MIDAZOLAM

INCREASE RESPONSE TO GABA AND

REDUCE RESPONSE OF BRAIN TO RAS SYSTEM

• OPIOIDS

- MORPHINE

- FENTANYL

OPIATE RECEPTOR AGONIST, INHIBIT

SUBSTANCE P RELEASE AND SLOW PAIN IMPULSE

TRANSMISSION
• NEUROMUSCULAR BLOCKERS

- DEPOLARIZING – SUCCINYLCHOLINE

- NON DEPOLARIZING – TUBOCURARINE,

ATRACURIUM

SKELETAL AND SMOOTH MUSCLE

RELAXATION
 REGIONAL ANAESTHETICS

• SPINAL / EPIDURAL ANAESTHESIA

- PROCAINE, BUPIVACAINE, LIDOCAINE,

CHLOROPROCAINE

REDUCE PERMEABILITY OF CELLS TO

SODIUM ION
 LOCAL ANAESTHETICS

• AMIDES
- LONG ACTING – BUPIVACAINE
- INTERMEDIATE ACTING – LIDOCAINE
• ESTERS
- LONG ACTING – TETRACAINE
- SHORT ACTING - CHLOROPROCAINE