KAMINENI INSTITUTE OF DENTAL

SCIENCES
DEPARTMENT OF MAXILLOFACIAL
SURGERY

TOPIC: STAGES OF GENERAL ANESTHESIA

Presenter: S. Shriya reddy

MODERATOR: DR Vishnu sir IV BDS
 CONTENTS
• GUEDEL’S CLASSIFICATION
• WOODBRIDGE’S CLASSIFICATION
 GUEDEL’S CLASSIFICATION

• In administering an anesthetic ,we must have signposts as guides in the

determination of depth of anesthesia .
• Guedel’s criteria were based on respiration, eyeball movement ,and
presence or absence of various reflexes .
• Gillespie added other criteria for determination of depth such as
secretions of tears ,response to skin incisions ,and evaluation of
pharyngeal and laryngeal reflexes .

STAGE 1
STAGES OF STAGE 2
ANESTHESIA STAGE 2
STAGE 4
 STAGE 1-ANALGESIA

• Analgesia lasts from the beginning of

induction until loss of consciousness .
• Respiration is quiet but often irregular.
• Reflexes are still present .
• Loss of eyelash reflex is a useful guide to the
patient’s entering stage 2.
 STAGE 2-EXCITEMENT OR DELIRIUM
• Excitement lasts from the loss of consciousness to the
onset of surgical anesthesia.
• The patient is unconscious and uncooperative.
• He or she may talk incoherently and move the limbs
gently or violently.
• Respiration is irregular
• Reflexes are active
• Retching frequently occurs and,if the stomach is not
empty vomiting may result .aspiration of vomitus in this
stage is a common complication
• The eyelid reflex (immediate closure of the
eyelid when it is gently raised )disappears
when the patient goes from stage 2 to stage
3,plane 1
 STAGE 3-SURGICAL ANESTHESIA
• Surgical anesthesia extends from the onset of
regular respiration until respiration failure
occurs from an excessive concentration of
anesthetic agent in the central nervous
system.
• This stage is divided into 4 planes.
 PLANE 1
• In plane 1 movements of extremities cease and
respiration becomes regular;eyelid reflex is lost .
• Vigorous ,incoordinate eyeball movements are
seen.
• The pharyngeal reflex disappears late in this
plane ,but the reflex is still present .
• The conjunctival reflex is lost at the bottom of
plane 1.
 PLANE 2

In plane 2 the eyes become fixed centrally ,and

pupillary size decreases .
Muscle tone is decreases ,but all muscles of
respiration still functioning .
Laryngeal reflex is abolished .
Corneal reflex is lost during plane2
 PLANE 3
• Pupillary light reflex is lost .
• There is onset of intercostal muscle paralysis.
• Respiration is largely diaphragmatic .
• Muscle relaxation is present.
 PLANE 4
• Respiration gradually becomes more
depressed with increases diaphragmatic
paralysis .
• A tracheal tug may be present.
 STAGE 4 –MEDULLARY PARALYSIS WITH RESPIRATORY
ARREST AND VASOMOTOR COLLAPSE

• In medullary paralysis ,the pupils are widely

dilated and the skin is cold and ashen.
• The blood pressure is very low and the pulse
feeble .
• Respiration is gasping and finally ceases.
• These stages are usually well defined with
either and chloroform ,but they are less clearly
marked when cyclopropane or halothane are
used.
• If anesthesia is induced with an intravenous
barbiturate, the stages become
telescoped ,and the patient passes rapidly into
stage 3, plane 2 or deeper,depending on the
dose given.
 WOODBRIDGE’S CLASSIFICATION
• Woodbridge(1958) reassesses the various levels of
anesthesia in terms od depression of central nervous
system and delineated four components of the
anesthetic state : unconsciousness
• Loss of sensation
• Loss of motor power
• And elimination of reflex activity
• Depending on what is required for the
particular procedure and for the well being of
the patient ,any desirable or combination of
these effects can be produced by varying the
anesthetic agents and drugs given.