GENERAL ANAESTHESIA

COMES FROM A
GREEK WORD WORD COINED BY
MEANING OLIVER WENDEL
ABSENCE OR LOSS HOLMES.
OF SENSATION.

ANESTHESIA
 LOCAL

• WHAT WE HAVE LEARNT SO FAR ALONG WITH

• SPINAL – REGIONAL ANESTHESIA
• INJECTION OF A LOCAL ANESTHETIC INTO THE SUBARACHNOID SPACE
• HYPERBARIC LIGNOCAINE HYDROCHLORIDE
• EPIDURAL ANESTHESIA

• GENERAL
TYPES OF 1. GENERAL ANESTHESIA :-
GENERAL ANESTHESIA IS THE INDUCTION OF A STATE OF
ANESTHESIA UNCONSCIOUSNESS WITH THE ABSENCE OF PAIN SENSATION
OVER THE ENTIRE BODY THROUGH ADMINISTRATION OF
ANESTHETIC DRUGS.
2. REGIONAL ANESTHESIA :-
BLOCKING THE NERVE SUPPLY TO PART OF THE BODY, SUCH
AS AN ARM, LOWER LIMB ETC. SO THE PATIENT CAN’T FEELS
PAIN IN THAT AREA.
3. LOCAL ANESTHESIA :-
LOCAL ANESTHETIC AROUND THE AFFECTED AREA TO MAKE
IT PAIN FREE.
 General anaesthetics (GAs) are drugs which produce reversible loss of all
sensation and consciousness.

The cardinal features of general anaesthesia are:

• Loss of all sensation, • Sleep (unconsciousness) • Immobility and muscle • Abolition of somatic
especially pain and amnesia relaxation and autonomic reflexes.
PHYSIOLOGIC
HOMEOSTASIS ANALGESIA

MUSCLE
AMNESIA RELAXATION
These modalities are
achieved by using
combination of inhaled
and i.V. Drugs, each drug
for a specific purpose
 THEORIES OF ACTION OF GA

• UNITARY HYPOTHESIS
• AGENT SPECIFIC THEORY
 STAGE OF ANALGESIA : Patient experiences
analgesia or loss of pain sensation but remains
conscious.

STAGE OF EXCITEMENT: Patient may experience

delerium or become violent. Respiration becomes
STAGES irregular and respiratory rate increases.
OF GA SURGICAL ANALGESIA: The skeletal muscles
relax, respiration becomes regular, eye
movements stop.

MEDULLARY PARALYSIS : Apnea occurs

STAGES
OF GA
 HOW GENERAL ANESTHESIA WORKS

BY ALTERING THE FLOW OF SODIUM MOLECULES INTO NERVE

CELLS (NEURONS) THROUGH THE CELL MEMBRANE.

BUT WHEN THE SODIUM MOLECULES DO NOT GET INTO THE

NEURONS, NERVE IMPULSES ARE NOT GENERATED.

THE BRAIN BECOMES UNCONSCIOUS, DOES NOT STORE

MEMORIES, DOES NOT REGISTER PAIN IMPULSES DOES NOT
CONTROL INVOLUNTARY REFLEXES.
 COMPONENTS OF ANAESTHESIA
THE FAMOUS COMPONENTS OF GENERAL ANESTHESIA ARE

1. UNCOSCOUSNESS.
2. ANALGESIA
3. MUSCLE RELAXATION.

BUT THE TRIAD IS MODIFIED AS

• UNCONSCIOUSNESS REPLACED BY AMNESIA OR LOSS OF AWARENESS
• ANALGESIA REPLACED BY NO STRESS AUTONOMIC RESPONSE
• MUSCLE RELAXATION REPLACED BY NO MOVEMENT IN RESPONSE TO SURGICAL STIMULI
 STEPS

• PREOPERATIVE EVALUATION
• INTRAOPERATIVE MANAGEMENT
• POSTOPERATIVE MANAGEMENT
 PREOPERATIVE EVALUATION

• MEDICAL ASSESSMENT OF THE PATIENT.

• DECIDE THE TYPE OF ANESTHESIA.
• ESTABLISH RAPPORT WITH THE PATIENT.
• ALLAY ANXIETY AND DECREASE PAIN.
• OBTAIN INFORMED CONSENT.
• ASK FOR FURTHER INVESTIGATION.
• DECIDE RISK VERSUS BENEFIT .
• PRESCRIBE MEDICATIONS.
 GENERAL HEALTH STATUS

• CLASS I - A NORMALLY HEALTHY INDIVIDUAL

• CLASS II - A PATIENT WITH MILD SYSTEMIC DISEASE
• CLASS III - A PATIENT WITH SEVERE SYSTEMIC DISEASE THAT IS NOT INCAPACITATING
• CLASS IV - A PATIENT WITH INCAPACITATING SYSTEMIC DISEASE THAT IS A CONSTANT THREAT
TO LIFE
• CLASS V - A MORIBUND PATIENT WHO IS NOT EXPECTED TO SURVIVE 24 H WITH OR
WITHOUT OPERATION
• CLASS E - ADDED AS A SUFFIX FOR EMERGENCY OPERATION
AIRWAY ASSESSMENT
 PREOPERATIVE MEDICATION

• NPO
• REDUCE SECREATIONS
• ATROPINE

• REDUCE ANXIETY
• DIAZEPAM

• REDUCE NAUSEA/ VOMMITTING

• PROMETHAZINE
 TOOLS OF ANAESTHESIA

1. ANESTHETIC MACHINE.
2. MONITORING SYSTEM
3. BREATHING CIRCUITS AND MASKS
1. ENDOTRACHEAL TUBES
2. NASO / ORO PHARYNGEAL AIRWAYS
 ANAESTHETIC MACHINE

1. OXYGEN GAS SUPPLY.

2. NITROUS OXIDE GAS SUPPLY.
3. FLOW METER
4. VAPORIZER SPECIFIC FOR EVERY AGENT
5. MECHANICAL VENTILATOR
6. TUBES FOR CONNECTION.
Anesthesia
Machine –
Boyle’s
apparatus
 MONITORING

1. PULSE, ECG
2. BLOOD PRESSURE
3. OXYGEN SATURATION. BASIC
4. END TIDAL CO2
5. URINE OUTPUT
6. TEMPERATURE
7. URINE OUTPUT, ADVANCED
8. CVP, EEG, ECHO, IBP.
 DRUGS IN ANESTHESIA

• PREMEDICATION
• INDUCTION
• MUSCLE RELAXATION
• INTUBATION

• MAINTAINENCE
• REVERSAL
• EXTUBATION
 INDUCTION

• VOLATILE ANESTHETICS:
• ETHER, TRICHLOROETHYLENE, HALOTHANE, ENFLURANE, ISOFLURANE, SEVOFLURANE.

• GASEOUS ANESTHETICS:
NITROUS OXIDE
• INTRAVENOUS ANESTHETICS:
• THIOPENTONE, KETAMINE, PROPOFOL

• OXYGEN
 MUSCLE RELAXANTS

• DEPOLARIZING MUSCLE RELAXANTS

• SUXAMETHONIUM CHLORIDE (SCOLINE):

• NONDEPOLARIZING MUSCLE RELAXANTS

• TUBOCURARINE:
• PANCURONIUM BROMIDE
• VECURONIUM BROMIDE:
 REVERSAL

• NEOSTIGMINE – DIRECTLY REVERSES EFFECTS OF NON DEPOLARISING MUSCLE RELAXANT

• ATROPINE – ADDED TO PREVENT THE MUSCARNIC EFFECTS OF NEOSTIGMINE LIKE

BRADYCARDIA, HYPOTENSION, BRONCHOSPASM ETC
 CONDUCT OF GENERAL ANESTHESIA

IV ACCESS :-

• PREOXYGENATION

• INDUCTION AGENT

• MUSCLE RELAXANT TO FACILITATE INTUBATION

• LARYNGOSCOPY INTUBATION
 OROTRACHEAL INTUBATION

TECHNIQUE

 HEIGHT OF THE TABLE

 POSITION OF THE PATIENT

 PILLOW UNDER THE OCCIPUT - FLEXION OF THE HEAD

 EXTENSION AT THE ATLANTO OCCIPITAL JOINT

MASK VENTILATION

HOLD THE MASK WITH THE THUMB AND FIRST FINGER OF LEFT HAND.

LIFT THE MANDIBLE WITH OTHER THREE FINGERS.

DIRECT LARYNGOSCOPY

Hold the laryngoscope in the

left hand
Open the mouth with the right
hand.
Insert the blade to the right
side of tongue. Tongue pushed
to left as the blade is advanced
until the epiglottis is seen.
 INSERT THE TUBE THROUGH THE RIGHT SIDE OF THE MOUTH. PASS IT
GENTLY THROUGH THE LARYNX UNTIL
THE CUFF PASSES BELOW THE VOCAL CORDS.

CHECKING POSITION OF TUBE

AUSCULTATION.
DETECTION OF EXPIRED CO2 – WITH A CAPNOGRAPH
Laryngoscopy – Endotracheal Intubation
Laryngeal Mask Airway
Oropharyngeal and Nasopharyngeal Airways
COMPLICATIONS

KINKING OF THE TUBE.

BLOCKAGE OF THE TUBE.

ACCIDENTAL EXTUBATION.

OBSTRUCTION BY INFLATED CUFF

ENDOBRONCHIAL INTUBATION.
RECOVERY OF THE PATIENT

• REVERSAL

• SUCTION OF THE THROAT

• DEFLATION OF THE CUFF + REMOVAL OF THE TUBE

• 100% .02 WITH MASK FOR 10 MTS

• SHIFT TO RECOVERY ROOM

• NASAL 02
• MONITORING
 COMPLICATIONS OF ANAESTHESIA

(A) RESPIRATORY DIFFICULTIES.

(B) CARDIO VASCULAR COMPLICATIONS

(C) AIR EMBOLISM

(D) VOMITING REGURGITATION.

(E) NEUROLOGICAL COMPLICATION

.
(F) CONVULSIONS
G. DELAYED RECOVERY FROM ANAESTHESIA

H. PERIPHERAL NERVE INJURIES

I. AWARNESS OF SURGERY DURING GENERAL ANAESTHESIA.

J. ACCIDENTAL HYPOTHERMIA

K. LONG OPERATION. EG VASCULAR SURGERY WITH MASSIVE

BLOOD TRANSFUSION.
 THANK YOU

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