Basics of Anaesthesia!

What does it mean? from Greek an-, "not/without" and aesthtos, "perceptible/ able to feel". Definition= reversable, drug induced, unconsciousness Drugs in Anaesthesia
he ! riad of anaesthesia"# a convenient wa$ of thinking about anaesthetic drugs A person having an anaesthetic will often have a combination from % each. Generall$# Anaesthesia depressant, surgical trauma # stimulates

% &$pnosis = unconsciousness Gaseous# volatile =''.ane"

!&alothane"# (rare in )* now+ ,soflurane / sevoflurane /-esflurane / .nflurane Given (%#/0+ with 12$gen (3405+ in air/ 6itrous o2ide .2haled unmetabolised (/4#77.80+ )nknown mechanism to cause h$pnosis'99 .ffect most organ s$stems :;< = h$potension / d$srh$thmias >< = Airwa$ refle2es / respirator$ depression / ?A :1@ ?ulmonar$ &$po2ic ;asoconstriction idal ;olume, ,ncrease >ate 6< = )nconsciousness, :an trigger Aalignant h$perp$re2ia

,ntravenous
?ropofol / hiopentone / .tomidate .ffect all organ s$stems to differing e2tents :;< = h$potension / d$rh$thmias >< = apnoea /Airwa$ refle2es / respirator$ depression G, # oesophageal sphincter tone (regurgitation+ 6< = )nconsciousness, 1ne off dose (lasts BCmins+.. vs infusions <edation (=sleep$/rela2ed but responsive+ vs anaesthesia Aetabolised b$ liver .lderl$, ill, h$povolaemic need less = greater side effects (eg cardiac arrest+ *etamine = :;< stimulant, analgesia

@ AnalgeisaD E&1 cancer analgesia ladder (shortened+= ?ain relief <$stemic ie generalised (not limited to one part of the bod$+
<imple eg paracetamol 6onsteroidal Antiinflammator$ -rugs !6<A,-<" eg diclofenac/ ibuprofen 1piods Fuick (eg alfentanil, remifentanil+ vs slow/long (eg morphine, diamorphine+

1ther >egional (eg nerve/root block+ vs central (spinal or epidural+ 1ther <$stemic eg 6@4, ramadol, reassurance, etc etc

3 ?aral$sisD competitive vs non#competitive

6ormal ?h$siolog$D at 6AG, Acet$l:holine released from nerves crosses cleft, binds to receptors on the muscle inturn releasing :a55 muscle contraction

!?aral$sis drugs"# 6euromuscular Blockers bind the Ach receptor in % of @ wa$s.. <u2amethonium 34#H4 secs on, 8#C mins off, depolarises/non#competitive, enI$mes degrade (cholinesterase+ ;ecuronium, Atracurium, others etc longer onset/offset, competitive either fall off as more A:h is made (naturall$+ or cholinesterase inhibitors

Practicalities: the conduct of general anaesthesia Also has three parts' different problems.. different solutions % ,nduction = from consciousness to the !surgical plane" of anaesthesia
.ither gaseous # slower, continuous respiration or intravenous # fast, ma$ cause apnoea, greater :;< effects Airwa$ ver$ important during induction (competent cough/gag to absent+

@ Aaintenance = during surger$

Anaesthesia is :;</>< depressant vs surgical stimulation &aemorrhage, surgical manipulation (eg vagal effect+ etc

3 .mergence = from anaesthesia to restoration of consciousness

he opposite of induction Airwa$ important again 1ther effects (:;<, pain, 6eurological etc+

Practicalities: how to do it! Preoperative visit (&2 .2 ,2 -iscussion ?lan+ Anaesthetic room + surgery considerations Airwa$D secure/definitive vs non#secure
Jacemask, gudel airwa$, Kar$ngeal Aask Airwa$ .ndotrachel tube (:1. +, racheostom$ BreathingD spontaneous vs artificial ventilation (,??;+ Ehich volatile/ carrier gas / breathing s$stem / ventilator / paral$sis :irculationD ,; Access / monitoring / fluids / drugs / blood -rugsD emergenc$ and other .FuipmentD checked and appropriate9 AnalgesiaD s$stemic (what, how much, when+ vs regional vs other ?osition and protectionD supine/ side or prone etc warmed, pressure areas etc

Complications
,mmediate/earl$/lateL Kocal or s$stemic -epends on $pe of anaesthesia (GA vs regional vs local vs central+ 5 drugs used -uration/e2tent of anaesthesia/surger$ ?reoperative medical morbidit$ / ,. what state are the$ in9 :ardiovascular, >espirator$, ,nfectious :ardiovascular scores (Ackland @4%4+ Age / other issues