TYPES OF ANESTHESIA

Dr Mohammed Al-karimi
Senior Specialist in Anesthesiology
and Intensive Care Unit
1
2
 ANESTHESIA

• Greek word
• Means “without sensation”
• It is a state of:
• Controlled
• Temporary loss of sensation or awareness that is
• Induced for medical purposes.

3
 GENERAL CONSIDERATIONS

• An ideal anesthetic technique would incorporate:

• optimal patient safety and satisfaction,
• provide excellent operating conditions for the surgeon,
• allow rapid recovery, and
• avoid postoperative side effects.
• In addition, the chosen technique would be low in cost, allow
early transfer or discharge from the postanesthesia care unit.
• optimize postoperative pain control, and permit optimal
operating room efficiency, including turnover times.
4
 GENERAL CONSIDERATIONS (CONT’D)

• The anesthesia provider must evaluate the medical condition

and unique needs of each patient (Preoperative Assessment) ,
select an acceptable anesthetic technique, and make this
recommendation to the patient.
• An informed patient who has an understanding of the anesthetic
techniques available and the needs for accomplishing the
surgery is likely to be comfortable with the anesthetic technique
recommended by the anesthesia provider.
• Consent for anesthesia requires an informed patient, and
“coercion” by the anesthesiologist should not be used to obtain
consent for an anesthetic technique that the patient does not
desire. 5
 COMPONENTS OF ANESTHESIA

Analgesia

Muscle
relaxation +/- Regional
General Anesthesia
Anesthesia
Amnesia

Unconsciousnes
s

General Anesthesia also comprises: Stability and Control of the cardiovascular, respiratory 6
thermoregulatory and autonomic nervous systems.
 TYPES OF ANESTHESIA

• I- General Anesthesia
• II- Regional Anesthesia
• III- Local Anesthesia

7
 Types of Anesthesia

Local General
Regional anesthesia
anesthesia anesthesia
Total
Infiltratio
Topical Spinal Total Balanced intraveno
n
inhalational anesthesi us
anesthesia a anesthesi
Epidural a
Peripheral Nerve
block Inhalation+
Intravenous
Intravenous
Regional + Adjuncts

8
 CASE SCENARIOS
WHAT TYPE OF ANESTHESIA IS BEST ?

• An elderly patient with COPD for right hip replacement

surgery.
• An obese patient with previous history of difficult
airway management “they couldn’t pass a pipe into my
throat.
• A 4 year old child presenting for elective right tibia
fracture fixation.
• A patient with a BMI of 38, uncontrolled DM, IHD
taking ASA, Clopidogrel and Apixaban presenting for
emergent excision of an abscess involving the right
9
big toe.
 CONSIDERATIONS THAT INFLUENCE THE CHOICE
OF ANESTHETIC TECHNIQUE

• The type, site and duration of surgical procedure

• The patient’s physiologic status and stability
• NPO status
• The presence and severity of coexisting diseases ( e.g., GERD,
Asthma)
• Suspected difficult airway management
• The patient’s mental and psychologic status
• Patient’s age
• Experience of the anesthesiologist
• Preference of patient, anesthesiologist and surgeon. 10
GENERAL ANESTHESIA

11
 GENERAL ANESTHESIA

• It is a reversible drug induced state of

unconsciousness.
• In the past, inhalational anaesthesia using a single
agent (chloroform or ether) was practiced.
• Modem anaesthesia uses a combination of drugs to
provide hypnosis, analgesia and skeletal muscle
relaxation. (Balanced Anesthesia).

12
 GENERAL ANAESTHESIA IS ABSOLUTELY
ESSENTIAL IN

1. Surgeries on face, upper airways.

2. Time consuming major surgical procedures.
3. Open-heart surgery.
4. Surgery on lung and brain.
5. Uncooperative, mentally retarded patients.
6. Patient’s request for GA.
7. The presence of absolute contraindications for
regional anesthesia.
13
 STAGES OF GENERAL ANAESTHESIA

• In 1920 Guedal described the stages of anaesthesia

as follows:
1. Stage I—Stage of induction.
2. Stage II—Stage of analgesia and reflex
hyperexcitability.
3. Stage III—Stage of surgical anaesthesia.
4. Stage IV—Bulbar paralysis, respiratory arrest.

14
 TECHNIQUES OF GENERAL ANESTHESIA

• This can be achieved by:

• Intravenous route alone/ TIVA
• Inhalational route alone
• Combination of both
• Intravenous and regional anaesthesia
• Inhalational and regional anaesthesia.

15
 PHASES OF GENERAL ANESTHESIA

Maintenanc
Induction Recovery
e

16
 INDUCTION

• Intravenous – majority
• Inhalational – children, needle phobics
• Monitoring
• Preoxygenation
• Hypnotic/ analgesic and relaxant
• Airway management – Mask/laryngeal mask/
Endotracheal tube

17
 MAINTENANCE

• Inhalational with or without intravenous

• Oxygen
• Maintaining breathing ( spontaneous, controlled)
• Muscle relaxant
• Analgesia
• Monitoring
• Fluid management ( crystalloids, colloids, blood)
18
 RECOVERY

• Turn off agent

• Reverse relaxation /muscle function
• Assess for extubation (awake vs deep)
• Monitor until discharge

19
 ADVANTAGES OF GENERAL ANESTHESIA

• No absolute contraindications
• Quick to establish
• Never fails to work
• Control of gas exchange

20
 DISADVANTAGES

• Poly-pharmacy
• Effects on various systems
• Allergic reactions
• Recovery profile
• Post operative nausea and vomiting
• Awareness
• Airway-related complications
21
REGIONAL ANESTHESIA

22
 REGIONAL ANESTHESIA

• Loss of sensation over specific region of the body (arm/leg/

abdomen) with or without blocking movements .
• No unconsciousness but sedation can be provided.
• Methods of administration/types:
• Central Neuraxial block:
• Spinal block
• Epidural block
• Peripheral Nerve block:
• Plexus blocks e.g. brachial plexus
• Intravenous (IVRA) – Bier’s block 23
 ANATOMY

24
25
26
 INDICATIONS/ USES

Better intraop
Analgesia hemodynamic
control

Combined S+/-E for Intraoperative pain

RA ALONE surgeries With GA management

High risk patients Postoperative pain

with higher risk for management
GA

27
 ADVANTAGES

• Superior pain control – most important benefit

• Reduces negative physiological and psychological sequale
associated with surgical stress.
• Patient can remain awake
• Less incidence of PONV
• Allows early mobilization
• Good alternative in patients with malignant hyperthermia, COPD,
Obesity
• Less postoperative cognitive impairment, especially in the
elderly 28
 DISADVANTAGES/ RISKS

• Time constraints
• Risk of neural injury
• Toxicity
• Intravascular injection
• Respiratory/ cardiac arrest
• Block failure – with need to be supplemented or
converted to GA

29
 CONTRAINDICATIONS OF CENTRAL
NEURAXIAL BLOCKS

Absolute
• Patient refusal
• Coagulopathy: INR >1.5,
Platelet count < 80,000
• Infection at injection site
• Severe hypovolemia
• Raised ICP
• Severe aortic/mitral stenosis
• Local anesthetic allergy
Relative
• Uncooperative patient
• Sepsis
• Pre-existing neurological
defects
• Demyelinating diseases
• Severe spine deformity

30
LOCAL ANESTHESIA

31
 LOCAL ANESTHESIA

• Loss of sensation over a small and limited area of the

body (small tissue area)
• No unconsciousness,
• Method of administration/ types:
• Topical application
• Infiltration

32
 CONTRAINDICATION OF LOCAL ANESTHESIA

• Absolute contraindications:
1. Patient refusal
2. Allergy to local agents
3. Infection on the site of needle insertion

33
 REGIONAL VERSUS LOCAL ANESTHESIA
Regional Anesthesia
• Blocks nerve supply to a large
area e.g. limb, trunk
• +/- motor block
• +/- hemodynamic changes
• Contraindicated in
coagulopathy
• Site of injection near vascular
structures
• Higher possibility of drug
toxicity
Local Anesthesia
• Blocks superficial nerves of a
small part of the body
• No motor block
• No hemodynamic changes
• Can be given in coagulopathy
• Site of injection is not near to
vascular structures
• Lower possibility of toxicity
34
 CASE SCENARIOS
WHAT TYPE OF ANESTHESIA IS BEST ?

• An elderly patient with COPD for right hip replacement

surgery.
• An obese patient with previous history of difficult
airway management “they couldn’t pass a pipe into my
throat.
• A 4 year old child presenting for elective right tibia
fracture fixation.
• A patient with a BMI of 38, uncontrolled DM, IHD
taking ASA, Clopidogrel and Apixaban presenting for
emergent excision of an abscess involving the right
35
big toe.
THANK YOU

36