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General Anesthesia
General Anesthesia
General Anesthesia
GENERAL
ANESTHETICS
INTRODUCTION
painful stimuli.
They are given systemically. They exert their main effect on the CNS.
2. Analgesia
3. Muscle relaxation
alcohol or opiate
abuse
With newer agents, the stages are difficult to characterize (rapid onset of anesthesia). G.R.
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Stages of Anesthesia
Stage 1. Analgesia Characteristics - The subject is conscious but drowsy. - Responses to painful stimuli It is pronounced with ether, N2O, but not with halothane. 2. Excitement - It is a dangerous stage. - There is loss of consciousness, delirium and violent combative behavior. - The subject does not respond to non-painful stimuli, but responds to painful ones. - Rapid respiration (irregular), irregular B.P. & preserved cough reflex In modern anesthesia, this stage cannot be distinguished. Can be avoided by thiopental. 3. Surgical anesthesia 4. Medullary paralysis - Spontaneous movement, regular respiration & marked muscle relaxation. - Severe depression of Resp. & VM centers - It starts by stoppage of respiration and ends by circulatory failure (death occurs within a few minutes).
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GENERAL ANESTHETICS:
I. Inhalation Anesthetics II. i.v. Anesthetics
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I.INHALATION
ANESTHETICS
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Common features of inhalation anesthetics 1) Non-flammable & non-explosive 2) Smooth muscle relaxation a) Cerebrovascular resistance (cerebral
Desflurane Sevoflurane
Enflurane
Methoxyflurane
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Pharmacokinetics: Very rapid absorption from the lungs (enormous surface area & efficient blood supply of the alveolar surface) G.R.
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B. Chloroform
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C. Halothane (Fluthane)
2-bromo-2-chloro-1,1,1trifluoro-ethane
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D. Enflurane
(2-chloro-1,1,2,-trifluoroethyl-difluoromethyl ether)
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peripheral & coronary v.d.) suitable for patients with ischemic heart diseases G.R.
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Malignant hyperthermia:
A pharmacogenetic disorder
It results from excessive metabolic heat production in skeletal muscle due to excessive release of Ca2+ from the sarcoplasmic reticulum a dramatic in body temp., muscle contractions & acidosis
It can be fatal unless treated promptly. Rx: dantrolene; a muscle relaxant, which blocks these Ca2+ channels
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I. Nitrous Oxide (laughing gas; N2O) Inorganic colorless, odorless, tasteless gas.
potent analgesic but weak general anesthetic usually used with another
inhaled or i.v. anesthetic for complete
anesthesia
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Inhalation of pure N2O rapid light anesthesia Induction is rapid, the patient is joyful euphoric, and consciousness is lost in 20-
30 seconds.
Continued N2O administration 2 min signs of severe anoxia (cyanosis, BP & muscle twitches)
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II.INTRAVENOUS
ANESTHETICS
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1) Anesthetics
unconsciousness in 20 sec
Ex.: ultrashort-acting barbiturates (e.g. thiopental), etomidate & propofol
2) Basal Anesthetics They act less rapidly to produce sedation prior to anesthesia the amount of inhalation anesthetics
A. Ultrashort-Acting Barbiturates
NO analgesic effect
Thiobarbiturates cross the placenta fetal resp. depression They are useful in:
1) Induction of anesthesia
2) Maintenance of short surgical procedures
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Uses: 1. Brief general anesthesia for minor operations 2. Induction of anesthesia which is then completed by another anesthetic, e.g. N2O
B. Etomidate A potent ultrashort-acting (5-10 min) nonbarbiturate anesthetic hypnotic amnesic agent
NO analgesia
Similar pharmacological properties to those of barbiturates
C. Propofol
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NO analgesia
Anesthesia may be maintained by continuous infusion of propofol combined with opioids & N2O.
D. Benzodiazepines
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dissociated from his environment, the eyes remain open and the patient appears awake
Ketamine analgesia, amnesia & paralysis of movement without actual loss of consciousness.
Neuroleptanalgesia
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A combination of a neuroleptic antipsychotic as droperidol or haloperidol ( a state of quiescence with reduced motor activity) and a potent opioid analgesic as fentanyl.
III.PREANESTHETIC
MEDICATION
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II. Analgesics
Surgical pain is often severe, and even minor preoperative pain is deleterious to smooth induction of anesthesia Opioids are frequently used i.m. 1 hour
before anesthesia
Examples: morphine, meperidine & fentanyl
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III.Antiemetics
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IV. Anticholinergics
Atropine or scopolamine is used i.m. 1 hour before anesthesia to: 1. Salivary & bronchial secretions 2. Block the reflex vagal effect on the heart 3. Counteract the respiratory depressant actions of morphine
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a preanesthetic drug:
1. Being a central depressant sedation & amnesia 2. More potent as antiemetic & antisecretory 3. It counteracts the resp. depression of morphine more efficiently
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V. Skeletal muscle relaxants: To facilitate intubation and suppress muscle tone to the required degree for
surgery
Ex.: succinylcholine, atracurium &
vecuronium
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THANK YOU
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