General

Anesthesia
VALERIE BLANCAFLOR, RPH
Anaesthesia

▶ It is a reversible blocking of pain feeling in whole body or in a part of it

using pharmacology or other methods

DIVISIONS
▶ Local - regional anesthesia, patient is conscious or sedated
▶ General - anesthesia interact with whole body, function of central
nervous
system is depressed:
– Intravenous
– Inhalation (volatile)
– Combined, balanced
 GENERAL ANESTHETICS

▶ Drugs which causes reversible loss of all sensation

and consciousness
Cardinal features:
1. Loss of all sensation, especially pain.
2. Sleep (consciousness) and amnesia
3. Immobility and muscle relaxation
4. Abolition of somatic and autonomic reflexes
Parts of General Anesthesia

▶ Hypnosis – pharmacological sleep, reversable lack

of consciousness
▶ Analgesia – pain management
▶ Areflexio – lack of reflexes
▶ Relaxatio musculorum – muscle relaxation,
pharmacological reversable neuromuscular blockade
Parts of General Anesthesia

Hypnosis
(anesthesia) Analgesia

Lack of reflexes (muscle

relaxation)
STAGES OF GENERAL
ANESTHESIA

I. Analgesia and sedation stage

II. Delirium & Excitation stage
III. Surgical Anesthesia
IV. Medullary/Respiratory
Paralysis
I. ANALGESIA
STAGE
▶ From beginning of anesthesia to loss of consciousness
▶ Patient is conscious (dream state)
▶ Pain is abolished
▶ Spontaneous respiration
▶ Reflexes and respiration are normal
▶ Difficult to maintain  short procedures only
Ex. Small surgery procedures (dressing change in
burns)
 II. DELIRIUM & EXCITATION
STAGE
▶ From LOC to beginning of automatic breathing
▶ Eyelash reflex disappear
▶ No stimulus or operative procedure are carried out during
this stage
Excitement:
patient may shout, struggle, and hold his
breath Delirium:
 Muscle tone increases, jaws are tightly close
 Breathing is jerky (vomiting, uncontrolled
movement)
 III. SURGERICAL ANESTHESIA

▶ From onset of spontaneous respiration to respiratory paralysis

▶ This has been divided into 4 planes:
Plane 1: Roving eyeballs. This plane ends hen eyes become
fixed.
Plane 2: Loss of corneal and laryngeal reflexes
Plane 3: Pupil starts dilating and light reflex s lost.
- This was the desired phase of surgery when muscle relaxants are not used.

Plane 4: Intercostal paralysis, shallow abdominal

respiration, dilated pupil.
IV. Medullary/Respiratory Paralysis

▶ Cessation of breathing (failure of circulation  death)

▶ Pupils (widely dilated)
▶ Muscles are totally flabby
▶ Pulse is imperceptible
▶ BP is very low
General Anesthetics: Classification

▶ Inhalation Gas: Nitrous oxide

▶ Volatile Liquid: Halothane, Enflurane,
Isoflurane, Desflurane, Sevoflurane
▶ Intravenous
Inducing agent: Thiopental, Propofol, Etomidate
Slower acting drugs: Benzodiazepines
(Diazepam,
Lorazepam, Midazolam)
Routes of Administration

▶ ENTERAL
- Oral
- Rectal
▶ PARENTERAL
- Sublingual
- Intranasal
- Intramuscular
- intravenous
VOLATILE / INHALATIONAL
ANESTHETIC USES
Inhalational anesthetic
Nitrous - non-flammable, non-irritating but of low potency
as anesthesia
oxide/Laughing gas - Very potent analgesic
- Single agent used in dental extraction and
obstetrics
Halothane - Potent anesthetic
- 2-4% induction dose
- 0.5-1% for maintenance
- D/A: special apparatus, cardiac arrhythmias
Enflurane - Non-flammable
- Similar action with Halothane
- Induce seizure in deep anesthesia and is therefore
no longer used.
Isoflurane - Isomer of enflurane but more potent
- 1.5-3% inductions dose
- 1-2% maintenance dose
Individual
inhalational
anesthestics
DIETHYL
ETHER
CHLOROFORM
DIETHYL ETHER

▶ The most important member of the ether family

PROPERTIES:
▶ Colorless, highly volatile liquid, highly flammable liquid,
sweet solvent-like odor (produces irritating vapours)
▶ Important solvent in the production of cellulose acetate &
other
cellulose-based polymers
PHARMACOKINETICS
- 85-90% is eliminated through lung and others are
through skin,
urine, milk, sweat
USES

▶ Starter fluid for diesel and gasoline (combined

with petroleum distillates) engines
▶ Solvent for Grignard reagent
▶ Used extensively in chemical industry as
aerosol propellant
▶ General anesthetic (former)
▶ Recreational drug to cause intoxication
PRODUCTION PROCESS

▶ Prepared in industrial laboratories by

acid ether synthesis
▶ Ethanol + strong acid (ex. H2SO4)
▶ This strong acid dissociates in aqueous
environment producing H30+
(hydronium ions)
DIETHYL ETHER

ADVANTAGES DISADVANTAGES
▶ Can be used without complicated ▶ flammable and explosive
apparatus
▶ Slow induction and slow
▶ Potent anesthetic and good analgesic recovery
▶ Muscle relaxation ▶ Cardiac arrest
▶ Wide safety of margin
▶ Convulsions in children
▶ Does not sensitize the heart
to adrenaline ▶ Cross tolerance – ethyl alcohol
▶ No cardiac arrhythmias
▶ Less likely to be hepatotoxic
or
nephrotoxic
Chloroform

Trichloromethane
ORGANIC COMPOUND (CHCl3)

▶ Synthesized independently by two groups in 1831

▶ Liebig carried out the alkaline cleavage of chloral
▶ Soubeirain obtained the compound by the action
of chlorine bleach on both ethanol and acetone
▶ 1835 – Dumas prepared the substance by
alkaline cleavage of trichloroacetic acid
 Physical
properties
▶ Clear, colorless, volatile liquid, pleasant-sweet odor
SOLUBILITY:
▶ Practically insoluble in water
▶ Soluble in alcohol, ether, benzene, petroleum ether
HIGH VAPOR PRESSURE  evaporates readily
▶ Non-flammable (but vapors may burn with green flame)
▶ Brings temporary unconsciousness when vapours are
inhaled for sufficient time
Routes of Exposure and Health
Effects
▶ Suspected human carcinogen and reproductive
toxin
▶ Affects the central nervous system (depressant)

ROUTES OF EXPOSURE:
▶ Inhalation
▶ Skin absorption
▶ Eyes
▶ Ingestion
Routes of Exposure:
INHALATION

▶ Potent anesthetic
▶ Irritates respiratory tract
▶ CNS effects: headache, drowsiness, dizziness
▶ Liver injury and blood disorders
▶ Removes natural oils from skin
▶ At higher conc.  unconsciousness, death
Routes of Exposure: INGESTION

▶ Kidney and liver disorders

▶ Skin irritation resulting in redness and pain
▶ Vapors  pain and irritation to the eyes
▶ Severe burning in mouth and throat
▶ Pain in the chest and vomiting
▶ Prolonged exposure may lead to death due to
irregular heartbeat
STORAGE AND HANDLING

Containers of Chloroform should be:

▶ stored away from direct sunlight
▶ Kept in a cool, dry, well-ventilated area
▶ Should not be made of aluminum
▶ PURE CHLOROFORM IS UNSTABLE. Check to find if it
has been stabilized with ethanol or amylene.
INTRAVENOUS ANESTHETICS

▶ For induction (rapid) & maintenance

▶ Not used alone – supplemented with analgesics and
muscle
relaxants
INTRAVENOUS
- Inducing agents: Thiopental, Propofol, Etomidate, BZDs
- Dissociative anaesthesia (Ketamine)
- Neurolept anaesthesia (Fentanyl)
Inducing agent
Thiopentone Na - Ultra short-acting barbiturate
- 3-5mg/kg IV (onset: 15-
20 seconds)
- CNS depression persist
for >12 h
Propofol - replaced thiopentone
- Oily liquid, 1% emulsion
- Onset: 15-45 seconds and
lasts for 5-10 mins
Induction: 2mg/kg IV bolus
Maintenance: 9mg/kg/hr IV
 KETAMINE

▶ Dissociative anaesthesia
- A state characterized by immobility, amnesia, and
analgesia with light sleep and feeling of
dissociation from ones own body, mind and the
surroundings.
▶ Phencyclidine derivative
▶ Dose: 5-10mg/kg IM or 1-2mg IV
Fentanyl (Droperidol
®)
▶ Neurolept analgesia (opioid)
▶ 4-acylanilino derivative
▶ DOA: 30-50 mins.
USES:
 Combination with Diazepam for diagnostic,
endoscopic and angiographic procedures
 Adjunct to spinal and nerve block anesthesia
Complications of Anaesthesia
DURING
▶ Respiratory depression
▶ Salivation
▶ Cardiac arrhythmias
▶ Fall in BP
▶ Aspiration
▶ Laryngospasm and
asphyxia
▶ Delirium and convulsion
AFTE
R
▶ Nausea and vomiting
▶ Persisting sedation
▶ Pneumonia
▶ Organ damage (liver,
kidney)
▶ Nerve palsies
▶ Emergency delirium
▶ Cognitive defects
Pre-
anaesthetic
medication
- the use of drugs prior to the
administration of an
anaesthetic agent to make
anesthesia safer and more
agreeable to the patient.
AIM:
 Relief of anxiety
 Amnesia for pre and
post operative events
 Analgesia
 Decrease secretions
 Antiemetic effects
 Decrease acidity and
volume of gastric
juice
Pre-anaesthetic medications

6A’s
▶ Anxiolytics: Sedatives (diazepam, lorazepam,
midazolam)
▶ Amnesia: Lorazepam
▶ Anticholinergic: Atropine
▶ Antacids: H2 blockers
▶ Anti-emetics: Metoclopramide, Domperidone
▶ Analgesia: Morphine