OUTLINE

Definition
 PRINCIPLE
Method of s anesthesia
Awarness
Balanced anesthesia
Responsibility
hx
 definition

 From greek word(anaisthisis)=not sensation.

 loss of awareness(vague defn)
 provition of combination of (drug induced
reversible)
amnesia, analgesia(pain control)and muscl
relaxation(allow performance of surgery and
interventional procedure)
Pre-1846 Foundation of Anesthesia
 anesthesia

local GENERAL REGIONAL

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Inhalational hypnotic drugs
 Balanced anaesthesia
(multimodal aneshesia)

This is an important concept. It views general

anaesthesia as comprising three parts:
Anaesthesia (i.e. being asleep)
Analgesia (i.e. pain relief)
Muscle relaxation (which may or may not be
necessary
 Awareness

The problem of awareness= ( patient is awake or

partially conscious during surgery, when thought to
be fully anaesthetised)
a preventable problem
 the anaesthetist must ensure that the patient is not
aware under general anaesthesia.
 features of a good anaesthesia
(Principle of anesthesia)
The first object of anaesthesia is the abolition of pain
It must be completely reversible.
It must be as safe as possible.
It should provide good operating conditions. For
example, good relaxation for abdominal surgery or
lowered intracranial pressure for neurosurgery.
It should be acceptable to the patient.
METHODS OF SURGICAL ANAESTHESIA

Anaesthesia may be achieved with either:

Regional anaesthesia alone e.g. spinal anaesthesia,
arm block
General anaesthesia
A combination of regional and general
Regional anaesthesia with sedation
 Local or regional anaesthetic techniques

The conduction of painful impulses from the site of

injury to the brain can be interrupted at one of
many points, giving us:
Surface anaesthesia
Infiltration anaesthesia
Nerve block/plexus block
Epidural anaesthesia
Spinal anaesthesia
 General anaesthetic techniques

1 Mask anaesthesia (including laryngeal mask)

Induction either intravenous or inhalational
Maintenance during surgery with the patient
breathing spontaneously using an air/O2/
inhalational agent
+/– IV analgesia
 2 Endotracheal anaesthesia

 Induction either intravenous or inhalational

Intubation using an IV muscle relaxant or an
inhalational agent
 Maintenance during surgery either with
spontaneous respiration as for mask anaesthesia or
intermittent positive pressure ventilation (IPPV) using
a long acting muscle relaxant in addition to
air/O2/inhalational agent
+/– IV analgesia
Reversal of the muscle relaxation at the end of surgery
 Responsibilities of the anaesthetist

Responsibility, for the anaesthetist, starts and finishes in the

ward
. Anaesthetised patients can be compared to people setting out
on a journey –in this case a journey into unconsciousness and
back – and it is the anaesthetist who steers the course.
Anaesthetists must therefore know as much as possible about
their patients –how they are made and how they function.
They must assess each patient carefully before the journey.
They must know how to modify techniques to compensate for
pre-existing problems and for when unexpected problems
occur. The journey must be as safe as possible.
 Reference

Safe anesthesia
Lecture note in clinical anesthesia
Miller anesthesia 8th edition
Morgan,clinical anesthesia 4th edition
thank you