General Anaesthetics

GENERAL ANAESTHETICS Definition General anesthesia is the induction of a state of unconsciousness with the absence of pain sensation over the entire body, through the administration of anesthetic drugs. It is used during certain medical and surgical procedures. Objectives or states of General Anaesthetics o Analgesiaacts on Substantia Gelatinosa of the spinal cord. o Amnesiaacts on the Hippocampus of the cerebral cortex. o Loss of consciousnessacts on the reticular activating system. o Inhibition of sensory and autonomic reflexes (by inhibiting the effects on polysynaptic reflexes) o Muscle relaxation (by inhibiting the effects on polysynaptic reflexes) Stages of anaesthesia The Guedel's classification by Arthur Ernest Guedel described four stages of anaesthesia in 1937. Despite newer anaesthetic agents and delivery techniques, which have led to more rapid onset and recovery from anaesthesia, with greater safety margins, the principles remain. Stage 1 Stage 1 anaesthesia, also known as the "induction", is the period between the initial administration of the induction agents and loss of consciousness. During this stage, the patient progresses from analgesia without amnesia to analgesia with amnesia. Patients can carry on a conversation at this time. Stage 2 Stage 2 anaesthesia, also known as the "excitement stage", is the period following loss of consciousness and marked by excited and delirious activity. During this stage, respirations and heart rate may become irregular. In addition, there may be uncontrolled movements, vomiting, breath holding, and pupillary dilation. Since the combination of spastic movements, vomiting, and irregular respirations may lead to airway compromise, rapidly acting drugs are used to minimize time in this stage and reach stage 3 as fast as possible. Stage 3 Stage 3, "surgical anaesthesia". During this stage, the skeletal muscles relax, vomiting stops , and respiratory depression occurs . Eye movements slow, then stop, the patient is unconscious and ready for surgery. It has been divided into 4 planes: 1. 2. 3. 4. eyes initially rolling, then becoming fixed loss of corneal and laryngeal reflexes pupils dilate and loss of light reflex intercostal paralysis, shallow abdominal respiration

Stage 4 Vaageswari college of Pharmacy, Karimnagar

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Stage 4 anaesthesia, also known as "overdose", is the stage where too much medication has been given relative to the amount of surgical stimulation and the patient has severe brain stem or medullary depression. This results in a cessation of respiration and potential cardiovascular collapse. This stage is lethal without cardiovascular and respiratory support. Mechanism (at gross level) o At low concentration the anaesthetics acts on the SGR (Substantia Gelatinosa Ronaldi) present on the tip of the dorsal horn of the spinal cord and produces a block in the synaptic transmission of pain carriage at the SGR, so there is analgesia. o At slight higher concentration anaesthetics act on the hippocampus of the brain and non-functioning hippocampus produces loss of memory resulting in amnesia. o When the concentration rises further in the brain there is inhibition of the golgy type-II neurons and there is inhibition of the inhibitory neurons. So, there is excitation. o Then the concentration of anaesthetics rises further in the brain, there is block of transmission of the RAS fibers in the midbrain resulting in drowsiness, loss of alertness and ultimately unconsciousness. o Further increase of concentration affects medulla, when vital center of the medulla like VMC (vasomotor center) and respiratory center depresses resulting in stoppage of respiration and severe fall of BP. Mechanism (at molecular level) According to the Mayer Overton principleany substance can behave as narcotic-anaesthetic provided, it attained a sufficient molar concentration in the CNS neuronal membrane. Because cell membrane are made up of mostly by phospholipids is oily in nature. So substances which are lipid soluble therefore can enter the oily cell membrane from the ECF and attain sufficient molar concentration to produce anaesthesia. More a substance is lipid soluble; more is its potency and anaesthetic irrespective of its chemical structure. When the molecules of anaesthetic have appeared within the cell membrane, they exert a pressure which tends to obliterate the sodium channels of the cell membrane. Therefore the sodium channels fail to open properly, there is insufficient flow of Na+ from ECF to ICF. So there is no development of action potential resulting in non-responsiveness of the cell and this will block the normal transmission.

CLASSIFICATION General anaesthesia Vaageswari college of Pharmacy, Karimnagar

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Intravenous Inhalational

Inducing agents

Slow Acting
Ether Halothane Enflurane Isoflurane Desflurane Sevofluran e

Volatile liquids

Gas
Thiopentone sod. Methohexitone sod. Propofol Etomidate

Nitrous oxide

Dissociative anaesthesia

Opoid Analgesics

Benzodiazepine s

Diazepam Ketamine Fentanyl Morazepa m Midazolam

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Fentanyl

ketamine

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