Anesthesiology

General Anesthesia
Dr. Mariajose N. Miranda MD, MSc
Pathophysiology - Pathology
General Anesthesia

Many preparatory steps:

1. Pre-operative evaluation
2. Procurement and preparation of all equipment to be used, drugs to
be given, cannulate to be inserted for the infusion of the necessary
fluids
3. Monitors
4. Tools
5. Techniques needed for the establishment of an open airway
6. How to induce and maintain general anesthesia and how to ease
the patient out of the drug-unduced come.
General Anesthesia – definition

Reversible condition of comfort and quiescence for a patient within the

physiological limit of a surgical procedure that renders the patient
unaware/unresponsive to the painful stimuli.

1. loss of all modalities of sensations

2. sleep and amnesia
3. immobility or muscle relaxation
4. abolition of reflexes: somatic and autonomic

General anesthetics – produce reversible loss of all modalities of

sensation and consciousness, these are mainly inhalation or intravenous.
General Anesthesia – Induction
It is the period of time which begins with the administration of an anesthetic
upto the development of Surgical anesthesia. “the strangest journeys
of their lives”.
In short the patient will have been reduced to a physiologic organism
without his will.

General anesthesia was absent until

the mid 1800’s
• Original discoverer of general anesthetics
Crawford Long, Physician from Georgia:
1842, ether anesthesia
• Chloroform = James Simpson:1847
• Nitrous oxide = Horace Wells in 1844
Nitrous oxide/laughing gas N2O
• Colourless, odourless inorganic gas with sweet taste
• Noninflammable and nonirritating, but of low potency
• Very potent analgesic, but not potent anaesthetic
• Carrier and adjuvant to other anaesthetics
• As a single agent used wit O2 in dental extraction and in obstetrics
No good muscle relaxant
They did it for a better tomorrow
General Anesthesia – Induction
SLEEP – AMNESIA - ANALGESIA

Pre-oxygenate patients before anesthesia

Apply a face mask and select a flow of oxygen high enough. Minutes count, in 3’
the nitrogen start decreasing and usual amount of water vapor and carbon
dioxide take place and oxygen.

Ringer’s lacatate + IV anxiolytic: midazolam (1-2mg)

IV narcotic: fentanyl (50-100 ug)

Hypnotic – anesthetic and analgesic

Thiopental 3-5mg/kg or propofol 1-3mg/kg +Succinylcholine

Propofol recude the risk of post-operative nausea and vomiting and shortened
wake-up.
Thiopental
Fentanyl
Propofol
General Anesthesia – Induction
SLEEP – AMNESIA - ANALGESIA

In patients with a full stomach:

“rapid sequence induction”

Denitrogenation + thiopental
+succynilcholine + SELLICK maneuver
(press the cricoid cartilage 
compresses the esophagus therefore
intubate). Prevents regurgitation and
aspiration
General Anesthesia – Stages
Stage I – Analgesia

• Starts from beginning of anaesthetic

inhalation and lasts upto the loss of
consciousness

• Pain is progressively abolished

• Patient remains conscious, can hear and see,

and feels a dream like state

• Reflexes and respiration remain normal

• It is difficult to maintain - use is limited to

short procedures only
General Anesthesia – Stages
Stage II – Delirium and axcitemnt

• From loss of consciousness to beginning of

regular respiration
• Patient may struggle and hold his breath
• Muscle tone increases, jaws are tightly closed.
• Jerky breathing; vomiting, involuntary
micturition or defecation.
• HR and BP may rise and pupils dilate (SNS)
• No stimulus or operative procedure carried out
during this stage.
• Vomiting, laryngospasm and uncontrolled mov.

This stage is not found with modern

anaesthesia – preanaesthetic medication,
rapid induction etc.
General Anesthesia – Stages
Stage I – Surgical Anesthesia

• From onset of regular respiration to

cessation of spontaneous breathing. This has
been divided into 4 planes:

– Plane 1: Roving eye balls. This plane ends

when eyes become fixed.
– Plane 2: Loss of corneal and laryngeal
reflex.
– Plane 3: Pupil starts dilating and light
reflex is lost.
– Plane 4: Intercostal paralysis, shallow
abdominal respiration, dilated pupil.
General Anesthesia – Stages
Stage IV-Medullary/respiratory paralysis

• Cessation of breathing  failure of

circulation  death
• Pupils: widely dilated
• Muscles are totally relaxed
• Pulse is imperceptible
• BP is very low.
General Anesthesia – Maintenance

Sustaining the state of anesthesia. Usually done with an admixture

of Nitrous oxide and halogenated hydrocarbons
General Anesthesia – Recovery
At the end of surgical procedure administration of anesthetic is stopped and
consciousness regains

• Mostly through lungs in unchanged form

• Channel of absorption (lungs) become channel of elimination
• Generally, Enter and persists in adipose tissue for long periods – high lipid
solubility and low blood flow
• Muscles become intermediates in that process
• Excreted unchanged except Halothane
• Recovery may be delayed in prolonged anaesthesia for highly lipid soluble
agents.
General Anesthesia – Maintenance