Components of general

anesthesia

Unconsciousness

Muscle Control of
relaxation pain reflex
Drugs for general anesthesia
Inhalation agents
Hypnotics and BDZs

Unconsciousness
Unconsciousness

Muscle
Muscle Control
Controlofof Neuroleptics
relaxation pain reflex
relaxation pain reflex

Muscle relaxants Analgesic drugs

 Relaxation anesthesia
(Gray and Geddes, 1951)

Barbiturates + N2O

Unconsciousness

Muscle Control of
relaxation pain reflex
Muscle relaxants
 Neuroleptoanalgesia
(De Castro and Mundeleer, 1959)

Neuroleptics drugs

Unconsciousness

Muscle Control of
relaxation pain reflex
Muscle relaxants Analgesic drugs
 Neuroleptoanesthesia
(De Castro and Mundeleer, 1961)

Unconsciousness

Neuroleptics +
analgesics + N2O
Muscle Control of
relaxation pain reflex
Muscle relaxants
 Potentiated anesthesia
(Neff, 1947)

Barbiturates

Unconsciousness

Muscle Control of
relaxation pain reflex
Muscle relaxants Analgesic drugs
Balanced anesthesia
(Lundy, 1926)

Inhalation agents

Unconsciousness

Muscle Control of
relaxation pain reflex
Local anesthetics
Total inhalation anesthesia
Inhalation agents

Unconsciousness

Muscle Control of
relaxation pain reflex
 Total intravenous anesthesia
(Du Cailar, 1972 - Dundee, 1977 - Sear and Prys Roberts, 1979)

Hypnotics

Unconsciousness

Muscle Control of
relaxation pain reflex
Muscle relaxants Analgesic drugs
 Modern balanced anesthesia
(Little and Stevens, 1954)

Halogenated agents + N2O (+ hypnotics)

Unconsciousness

Muscle Control of
relaxation pain reflex
Muscle relaxants Analgesic
drugs
 Balanced anesthesia for
neurosurgery
• Induction:
– thiopental 5 mg/kg
– vecuronium 0.1 mg/kg
– remifentanyl 1mcg/kg
• Maintenance:
– sevoflurane 1-1.5% in O2:N2O mixture
– remifentanyl 0.1-0.2 mcg/kg/min
– vecuronium on demand
 Drugs for the control of general
anesthesia components.
UNCONSCIOUSNESS MUSCLE
MUSCLE
ANALGESIA UNCONSCIOUSNESS
RELAXATION
RELAXATION

MUSCLE
OPIOIDS HYPNOTICS RELAXANTS

BENZODIAZEPINES

NEUROLEPTICS

HALOGENATED AGENTS
Effect of 60 % of nitrous oxide
on anesthetic MAC
( from Rampil et al., 1990)

7
7
6 MAC IN O2
5 MAC 6O%
N20
4 2,83
3 1,68 2
2 0,8 0,740,29
0,57
1
0
ISO DES SEVO HALO
 Effect of 3 microg / kg
fentanyl on MAC.

Isoflurane
7 6,2 Halothane
6 Desflurane
5 Sevoflurane
4
3 1,85 2,3
2 1,21 0,78 0,81
1 0,45 0,53
0
Agent alone Agent +
Fentanyl
MAC values (in O2) for anesthesia
components control

Pain reflex control MAC BAR

2
MAC in O2
Muscle-relaxation 1,3 MAC

Unconsciousness MAC awake

 Effects of 3 mcg / kg
fentanyl on MAC.

Isoflurane
7 6,2 Halothane
6 Desflurane
5 Sevoflurane
4
3 1,85 2,3
2 1,21 0,78 0,81
1 0,45 0,53
0
Agent alone Agent +
Fentanyl
 MAC values (in N2O + fentanyl)
for anesthesia components control
2,0

Pain reflex control

MAC in N2O
+ fentanyl 1,0
Muscle relaxation

Unconscousness