General Anesthesia
General Anesthesia
A controlled state of unconsciousness
Partial or complete loss of protective reflexes
Inability to maintain an airway and respond
purposefully to verbal commands
Four Stages of Anesthesia
Stage I - Analgesia
Stage II - Delirium
Stage III - Surgical Anesthesia
Stage IV - Medullary Paralysis
Stage I
Begins with administration of
CNS depressant drug
Ends when patient loses consciousness
eg., sedation
Stage II
Begins with loss of consciousness
Ends with entry into surgical anesthesia
eg., IV General Anesthesia
Stage II
Reflexes are hyperactive
Respiratory pattern is irregular
Risk of laryngospasm
Stage III
Surgical anesthesia, Planes 1, 2, 3, 4
Respirations regular, patient most likely
intubated
Plane 2 - most surgical procedures performed
Stage IV
Respiratory and circulatory arrest
Reversible clinical death
General Anesthesia
A progressive depression of the CNS
Controlled passage through Stage I and II to
arrive in Stage III
Advantages
Patient cooperation not absolutely essential
Unconsciousness
Amnesia
Rapid onset of action
Titration possible
Disadvantages
Loss of protective reflexes
Depression of vital signs
Advanced training required
Additional personnel required
Special equipment / setting
Disadvantages
Need for recovery room
Greater risk of intra-op complications
Post anesthetic complications
More extensive pre-op evaluation, including
lab work
Indications
Extreme anxiety and fear
Mentally and/or physically disabled adults or
children
Poor patient cooperation
Age - infants and children
Traumatic procedures - short or prolonged
Contraindications
Lack of adequate:
Training by doctor
Trained personnel
Equipment
Facilities
Medically compromised patient
(require inpatient GA)
Training Required
for General Anesthesia
Ability to secure and manage the airway is
essential
O.M.S. or anesthesia residency
Types of General Anesthesia
IV general anesthesia
Conventional O.R. type general anesthesia
Hospital same day surgery, or Surgicenter
Inpatient general anesthesia
IV General Anesthesia
Used primarily in O.M.S.
Short procedures (30 min. or less)
ASA I, selected ASA II patients
Excellent safety record (1:400,000 mortality)
NPO & escort essential
IV General Anesthesia Agents
Barbiturates
Ultra short acting
-Methohexital
Nonbarbiturates
-Propofol
Monitors
ECG
Blood Pressure
Pulse Oximeter
Pretracheal stethoscope
Capnograph
Technique-IVGeneral Anesthesia
N2O/O2 administered
IV access
Titration of sedative agents (Fentanyl/Versed)
Administration of Methohexital
- titration throughout procedure
Technique- IVGA (cont.)
Throat pack and suctioning essential
Administer local anesthetic
Surgical procedure
100% O2
Transfer to recovery area when awake
OR Type General Anesthesia
Involves tracheal intubation to secure airway
Administration of inhalational agents
May be as Outpatient or Inpatient GA
Outpatient GA
Hospital same-day surgery or Surgicenter
ASA I or II (occasional III)
For procedures of 30 mins. to 4 hrs. duration
Avoids overnight hospitalization
Inpatient GA
Hospital stay (24 hrs or more)
May be any ASA classification
Indicated for procedures that require lengthy
recovery
Less cost-effective
Armamentarium
General anesthesia machine
IV equipment
Ancillary anesthesia equipment
Monitors (incl. capnograph)
Crash cart & emergency medications
General Anesthesia Machine
Delivers O2, N2O and other anesthetic gases
Closed system, partial rebreathing
Multiple components
Components of GA Machine
Ventilator
Vaporizers
Monitors
Alarms
Ancillary Anesthesia Equipment
Suction
Face masks
Oropharyngeal & nasopharyngeal airways
Ancillary Anesthesia Equipment
Laryngoscope & blades
Magill forceps
Endotracheal tubes
Drugs for General Anesthesia
IV induction agents
Narcotics
Neuroleptic / dissociative agents
Muscle relaxants
Inhalation anesthetics
IV Induction Agents
Used to achieve Stage III rapidly
IV agents preferred to inhalation agents
Methohexital, Thiopental, Propofol
Narcotics
Used for maintenance of general anesthesia
"Balanced Technique"
Morphine, Fentanyl, Alfentanil, Sufentanil
Dissociative Agents
Ketamine
Dissociates patient from environment
Minimal depression of protective reflexes
Hallucinations are common on emergence
Muscle Relaxants
Neuromuscular blockade
Administer after Stage III obtained
Defasciculating dose /paralyzing dose
Succinylcholine, Atracrurium, Pancuronium
Inhalation Anesthetics
Produce general anesthesia
Easily titrated since pulmonary ventilation
affects uptake and elimination
Can be used for induction or maintenance
Halothane, Enflurane, Isoflurane
Technique - General Anesthesia
Pre-Op evaluation and lab work
NPO
Holding area (IV Access)
Pre-oxygenation
IV induction (Thiopental, Propofol)
Technique- GA (cont.)
Bag-mask to insure patent airway
Narcotic, muscle relaxant
Intubation
Verify placement and secure ET tube
Technique- GA (cont.)
Inhalation agent
Maintenance of Stage III
Administer local anesthetics
Surgical procedure
Technique- GA (cont.)
D/C inhalation agents, give reversal agents
Spontaneous respirations, adequate tidal
volume
Extubation
Transfer to recovery or hospital room
