ANAESTHESIA

Understanding Types,
Mehanism and Application
What is Anesthesia?
• Anesthesia is a medical practice that involves the use of drugs
or other substances to induce a state of temporary loss of
sensation or awareness.

• Anesthesia can vary in depth from mild sedation to complete

unconsciousness, depending on the type and dosage of the
anesthetic used.
Key Points
Purpose: To prevent pain during surgical or diagnostic
procedures.

Mechanism: Works by blocking nerve signals in the brain

or body.

Types: General, regional, local, and sedation.

Types of Anaesthesia
 General Anesthesia: Induces unconsciousness
Used in major surgeries

 Regional Anesthesia: Blocks pain in a larger area of the body

Includes epidural and spinal anesthesia

 Local Anesthesia: Numbs a small part of the body

Used in minor procedures

 Sedation: Relaxes and reduces pain without inducing

unconsciousness
Methods of Administration
General Anesthesia:
Inhalation
Intravenous

Regional and Local Anesthesia:

Injection
Topical application
Equipments Used in Anesthesia
Anesthesia Machine

Components and functions

Monitoring Devices: ECG, pulse oximetry, blood

pressure monitors
Components of Anaesthesia Machine
• Gas Supply:
• Oxygen (O2): Essential for patient respiration.
• Nitrous Oxide (N2O): Used for its analgesic and anesthetic properties.
• Air: Used to dilute gases and provide balance.

• Flow meters:
• Oxygen Flowmeter: Controls and measures the flow of oxygen.
• Nitrous Oxide Flowmeter: Controls and measures the flow of nitrous
oxide.
• Air Flowmeter: Controls and measures the flow of air.
Components of Anaesthesia Machine
• Vaporizers:
• Converts liquid anesthetic agents (e.g., isoflurane, sevoflurane) into vapors
• Allows precise control of the anesthetic concentration delivered to the
patient.

• Breathing Circuit:
• Inspiratory and Expiratory Valves: Ensure unidirectional flow of gases.
• Breathing Tubes: Conduct gases to and from the patient.
• Reservoir Bag: Allows manual ventilation and accommodates changes in
lung volume.
• CO2 Absorber: Removes carbon dioxide from the exhaled gases, enabling
rebreathing of anesthetic gases.
Components of Anaesthesia Machine
• Ventilator: Provides controlled or assisted ventilation to the
patient. Adjusts parameters such as tidal volume, respiratory
rate, and inspiratory/expiratory ratio.

• Scavenging System: Collects and removes excess anesthetic

gases from the operating room to prevent contamination and
exposure.
Monitoring Devices
Electrocardiogram (ECG): Monitors heart rate and rhythm.

Pulse Oximeter: Measures blood oxygen saturation levels.

Blood Pressure Monitor: Tracks patient’s blood pressure.

Capnograph: Measures end-tidal CO2 to monitor ventilation.

Gas Analyzer: Measures concentrations of gases such as oxygen,

nitrous oxide, and volatile anesthetics.
Applications of Anesthesia
• Surgery: Major and minor procedures

• Pain Management: Chronic pain, labor pain

• Diagnostic Procedures: Endoscopy, colonoscopy, Biopsy

Risk and Complications
 General Anesthesia
Minor Complications
• Nausea and Vomiting: Common post-operative side effects.
Often managed with antiemetic medications.
• Sore Throat: Caused by the insertion of a breathing tube during
surgery. Usually resolves within a few days.
• Drowsiness and Fatigue: Patients may feel groggy or tired for several
hours or even days after the procedure.
• Shivering: Post-operative shivering is common and can be managed with
warming techniques.
• Confusion and Memory Loss: More common in older adults and can last
for several days or weeks.
• Muscle Aches: Can result from muscle relaxants used during surgery.
Regional Anesthesia (e.g. Epidural, Spinal)
1.Headache:
Particularly after spinal anesthesia.
Known as a "spinal headache," it can be severe but usually resolves with proper
hydration and rest.

2.Back Pain:
Mild to moderate pain at the injection site.

3.Difficulty Urinating:
Temporary urinary retention is possible.

4.Nerve Damage (Rare):

Temporary or permanent nerve injury can occur but is extremely rare.
Local Anesthesia
1.Pain at the Injection Site:
Brief discomfort when the anesthetic is administered.

2.Bruising or Swelling:
Minor swelling or bruising can occur at the injection site.

3.Allergic Reactions:
Rare but can include symptoms like rash, itching, or difficulty
breathing.
Sedation
1.Drowsiness:
Patients may feel sleepy for several hours post-procedure.

2.Dizziness:
Lightheadedness or dizziness is common as the sedative wears off.

3.Dry Mouth:
Temporary dry mouth can occur.
Managing Side Effects
Preoperative Assessment:
• Thorough assessment to identify potential risks.

Monitoring:
• Continuous monitoring during and after the procedure.

Medications:
• Anti-nausea, pain relief, and other medications to manage side effects.

Hydration:
• Ensuring proper hydration to reduce side effects like headache and
dizziness.
General Anesthesia
1.Allergic Reactions (Anaphylaxis):
Severe, life-threatening reactions to anesthetic drugs.
Symptoms: rash, swelling, difficulty breathing, and drop in blood pressure.
Requires immediate medical intervention.
2.Respiratory Complications:
Aspiration: Inhalation of stomach contents into the lungs, leading to pneumonia
or other respiratory issues.
Breathing Difficulties: Post-operative respiratory depression, requiring
ventilatory support.
3.Cardiovascular Complications:
Arrhythmias: Irregular heartbeats that may require medication or defibrillation.
Heart Attack (Myocardial Infarction): Rare but possible, especially in patients
with preexisting heart conditions.
Stroke: Disruption of blood flow to the brain, leading to potential long-term
neurological effects.
General Anesthesia
4. Malignant Hyperthermia:
A rare genetic condition triggered by certain anesthetics.
Symptoms: rapid increase in body temperature, severe muscle
contractions.
Requires immediate treatment with dantrolene and supportive
measures.

5. Awareness During Anesthesia (Anesthesia Awareness):

Rare instances where patients become conscious during surgery
and can feel pain or discomfort.
Psychological effects: PTSD, anxiety, and nightmares.
Regional Anesthesia (e.g. Epidural, Spinal)
1. Nerve Damage:
Temporary or permanent nerve injury, resulting in numbness, weakness, or
paralysis.

2. Infection:
Infection at the injection site, which can lead to abscess formation or meningitis.

3. Bleeding:
Hematoma formation around the injection site, which can compress nerves.

4. Severe Headache:
Known as post-dural puncture headache, severe and persistent headaches that
may require medical intervention.
Local Anesthesia
1.Systemic Toxicity:
Overdose of local anesthetics leading to central nervous
system and cardiovascular symptoms like seizures,
arrhythmias, or cardiac arrest.

2.Prolonged Numbness or Weakness:

Extended duration of numbness or weakness in the affected
area.
Preventive Measures
• Thorough Preoperative Assessment:
• Identifying risk factors and patient history to tailor anesthesia
plans.

• Continuous Monitoring:
• Real-time monitoring of vital signs and oxygen levels during and
after the procedure.

• Emergency Preparedness:
• Immediate availability of emergency drugs and equipment to
manage complications.
Sedation

1.Over-Sedation:
Excessive sedation can lead to respiratory depression or airway
obstruction.

2.Allergic Reactions:
Severe allergic responses to sedative agents, similar to general
anesthesia.
Drugs Used in Anaesthesia
General Anesthesia
1.Intravenous Anesthetics:
1.Propofol:
Induces and maintains anesthesia.
Rapid onset and short duration of action.
2.Etomidate:
Used for induction of anesthesia.
Minimal cardiovascular effects.
3.Ketamine:
Provides analgesia and sedation.
Dissociative anesthesia, maintains airway reflexes.
4.Thiopental:
Barbiturate used for induction.
Rapid onset of action.
General Anaesthesia
Inhalation Anesthetics:
• Isoflurane:
• Widely used volatile anesthetic.
• Provides muscle relaxation.
• Sevoflurane:
• Commonly used in outpatient surgery.
• Pleasant smell, rapid onset, and recovery.
• Desflurane:
• Low blood-gas solubility, rapid induction, and recovery.
• Nitrous Oxide:
• Used in combination with other agents.
• Provides analgesia and sedation.
General Anaesthesia :Muscle
Relaxants
• Succinylcholine:
• Rapid-onset, short-duration muscle relaxant.
• Used for intubation.

• Rocuronium:
• Non-depolarizing muscle relaxant.
• Used for longer surgical procedures.

• Vecuronium:
• Intermediate-acting non-depolarizing muscle relaxant.
Regional Anesthesia
Local Anesthetics for Epidural and Spinal:
1.Bupivacaine:
Long-acting, provides prolonged anesthesia.

2.Lidocaine:
Intermediate-acting, commonly used for various procedures.

3.Ropivacaine:
Long-acting, similar to bupivacaine but with less cardiac toxicity.
Local Anesthesia
Topical and Injectable Local Anesthetics:
1.Lidocaine:
Widely used for minor surgical procedures and dental work.

2.Mepivacaine:
Similar to lidocaine but with a longer duration.

3.Procaine:
Short-acting, primarily used in dental procedures.

4.Benzocaine:
Used topically for surface anesthesia.
Sedation
1.Benzodiazepines:
 Midazolam:
 Provides sedation, anxiolysis, and amnesia.
 Diazepam:
 Longer-acting, used for sedation and muscle relaxation.
 Lorazepam:
1. Intermediate-acting, used for preoperative anxiety.
2.Opioids:
 Fentanyl:
 Provides analgesia and sedation.
 Short-acting, used intraoperatively.
 Morphine:
 Provides analgesia and sedation.
1. Longer duration of action.
3.Propofol:
 Used for conscious sedation in addition to general anesthesia.
 Rapid onset and short duration of action.
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