Anesthesia signs and stages:

General anesthetics cause total loss of sensation and complete loss of

consciousness in the patient.
They are administered by inhalation of certain gases or vaporized
liquids, intravenous infusion, or rectal induction.
Early pioneers in the field of anesthesia such as John no!, Arthur
Guedel recognized that there is a progression of predictable
physiological changes produced during anesthesia.
The igns and stages of "iethyl ether anesthesia !ith increasing depth
!ere characterized by Guedel as follo!s:
tage# is called the stage of Amnesia or $nduction
$t begins !ith induction of anesthesia and ends !ith the loss of
consciousness % !e can &ne! it by loss of eyelid refle'.
"uring this period, the patient e'periences dizziness, a sense of
unreality, and a lessening sensitivity to touch and pain. At this stage,
the patient(s sense of hearing is increased, and responses to noises are
intensified.
)ain perception threshold during this stage is not lo!ered.
tage * is the stage of e'citement.
"uring this period, there is a variety of reactions involving muscular
activity and delirium. This stage characterized by uninhibited
e'citation. Agitation, delirium, irregular respiration and breath holding
are commonly seen.
)upils are dilated and
Eyes are divergent.
)otentially dangerous responses to no'ious stimuli can occur during
this stage, including vomiting, laryngospasm, hypertension,
tachycardia, and uncontrolled movement. $ts important to remember
that during this stage the patient may respond violently to very little
stimulation.
tage + is called the surgical or operative stage.
,haractherized by central gaze, constricted pupils
And regular respiration.
Target depth of anesthesia is sufficient !hen painful stimulation does
not elicit somatic refle'es or deleterious autonomic responses.
There are - levels of consciousness .also called planes to this stage. $t
is the responsibility of the anesthesiologist to determine !hich level is
optimal for the procedure. The determination is made according to
specific tissue sensitivity the individual and the surgical site. Each
successive plane is achieved by increasing the concentration of
anesthetic agent in the tissue.
)hase # is also called the phase of sleep and analgesia.
)atient unresponsive to surgical stimulations. )upils constricted and
eyes moist. $ntercostal ventilation ..arterial blood concentration /
#00mg1#00ml2
3n )hase *.
)upils dilate and eyes dry. $n this phase, the intercostal paralysis its
going to occurred, !ith increased diaphragmatic ventilation.
3n phase + there is increasing s&eletal muscle rela'ation
"iaphragmatic ventilation predominates in this phase, instead of
intercostal ventilation !hich predominate on phase #. 3n this phase
also Tidal volume !ill falls. ,orneal rele'es absent !ith pupil dilated.
.Arterial blood concentration / #+0mg1#00ml2
3n phase - there is onset of complete intercostal paralysis.
4hich ends !ith diaphragmatic paralysis. ,irculatory depression
occurred. )upils ma'imally dilate. This -
th
level of consciousness of
stage + is demonstrated by cardiovascular impairment that results
from diaphragmatic paralysis. $f this phase is not corrected
immediately, stage - quic&ly ensues..Arterial blood concentration /
#-0 to #50 mg1#00ml2
This stage .stage -2 is called the to'ic or danger stage. 3bviously, this
is never a desired stage of anesthesia.
At this point, ,ardiopulmonary failure and death can occur. 3nce
surgical anesthesia has been obtained, the anesthesiologist must
e'ercise care to control the level of anesthesia. This stage is
commonly referred to as 6too deep7
E'plained the table..
Although evaluation of the patient anesthetized !ith diethyl ether is
rather straightfor!ard, ne!er more potent anesthetics !ith lo!er
solubilities pass through these various phases faster. $n addition the
overall pharmacological effects are some !hat different, although the
end result is similar.
8asically the ne!, more rapid anesthetics can be categorized into t!o
stages: the stage of analgesia and delirium and the stage of surgical
anesthesia. This latter stage is divided into light, moderate and deep.
4ith progressive deepening of surgical anesthesia there are parallel
diminustions in ventilation and circulatory integrity.
"eath can occur from medullary paralysis and circulatory arrest in the
absence of hypo'ia !ith overdosage of potent anesthetics.