ANESTHESIA

HISTORY OF ANAESTHESIA
Anaesthetics were administered from the early 1840s, but the impact
on general medical practice began after William Morton publically
administered ether to Gilbert Abbott on 16 ctober 1846 at
Massachusetts General !ospital, "oston#
n 1$ %ecember 1846, &rancis "oott, an American botanist who had
heard the news from "oston, watched dental surgeon 'ames (obinson
administer the first ether anaesthetic in )ngland# *wo days later,
(obert +iston operated on &rederic, -hurchill at .ni/ersity -ollege
!ospital and a medical student, William 01uire administered the
anaesthetic#
"efore anaesthesia, surgery was a terrifying last resort, a final attempt
to sa/e life# &ew operations were possible and surgeons were 2udged
by their speed# 0ome doctors had tried using alcohol, morphine and
other sedati/es to dull the pain of surgery but most patients were held
or strapped down, some luc,ily fainted from the agony# Many died#
Anaesthesia allowed surgeons to ta,e more time, be more accurate
and underta,e more comple3 procedures#
4rofessor 'ames
5oung 0impson 6by
,ind permission of
the (oyal -ollege of
4hysicians of
)dinburgh 7
ther agents soon followed# 8n 9o/ember 184:, 'ames 0impson,
4rofessor of bstetrics in )dinburgh, introduced chloroform# 8t was
more potent but could ha/e se/ere side effects such as sudden death
and late onset se/ere li/er damage# 8t became popular because it
wor,ed well and was easier to use than ether#
+ocal anaesthesia was introduced after -arl ;oller performed the first
operation using cocaine at the suggestion of 0igmund &reud in 1884#
Which in turn led to the introduction of infiltration anaesthesia, ner/e
bloc,s, spinal and epidural anaesthesia, then at the turn of the century
came control of the airway using tubes placed in the trachea to help
breathing#
"y the 1$<0=s intra/enous induction agents were introduced which
enabled patients to fall asleep 1uic,ly and pleasantly# Muscle
rela3ants were introduced in the 1$40s#
*oday, anaesthetists are highly
trained and s,illed physicians who
pro/ide a wide range of patient care#
*hey often run !igh %ependency and
8ntensi/e -are .nits# *hey are
in/ol/ed in obstetric analgesia and
anaesthesia, emergency medicine in A > ) departments, resuscitation,
ma2or accident care, pain management and patient transfers between
hospitals#
Anaesthesia is now /ery safe, with mortality of less than 1 in <?0,000
directly related to anaesthesia# 9e/ertheless with today=s
sophisticated monitoring systems and a greater understanding of
bodily functions, the anaesthetic profession will continue to stri/e for
impro/ement o/er the ne3t 1?0 years#
ANESTHESIA
*otal or partial loss of sensation to touch or pain, caused by
ner/e in2ury or disease, or induced intentionally, especially by
the administration of anesthetic drugs, to pro/ide medical
treatment#
8t is a pharmacologically induced and re/ersible state
of amnesia, analgesia, loss of responsi/eness, loss of s,eletal
muscle refle3es or decreased stress response, or all
simultaneously# *his allows patients to undergo surgery and
other procedures without the distress and pain they would
otherwise e3perience# An alternati/e definition is a @re/ersible
lac, of awareness,@ including a total lac, of awareness 6e#g# a
general anesthetic7 or a lac, of awareness of a part of the body
such as a spinal anesthetic#
Definition of Terms
ocal anesthesiaA is any techni1ue to render part of the body
insensiti/e to pain without affecting consciousness
Regional anesthesiaA is anaesthesia affecting only a large part of the
body, such as a limb#
!eneral anesthesiaA is a state of unconsciousness and loss of
protecti/e refle3es resulting from the administration of one or more
general anaesthetic agents#
"reoperati#e careA -are gi/en before surgery when physical and
psychological preparations are made for the operation, according to
the indi/idual needs of the patients#
Intraoperati#e careA -are pro/ided to a patient during surgery that
is ancillary to the surgery#
"ostoperati#e careA 4ostoperati/e care is the management of a
patient after surgery# *his includes care gi/en during the immediate
postoperati/e period, both in the operating room and the postA
anesthesia care unit 64A-.7, as well as during the days following the
surgery#
"re$operati#e me%ications
4ea, effect is desired at the time of induction# 4reAmedication is
usually gi/en at least 4? minutes before induction, some drugs
re1uires 60A$0 minutes to reach pea, effect#
"urpose
*o allay fear and an3iety
*o produce amnesia
*o decrease secretions in the respiratory tract
*o reduce refle3 irritability
*o contract some undesirable side effect to the anesthesia
*o raise the pain threshold
*o lower the body metabolism so that less anesthesia will be
used
Drugs use% & may be gi/en orally or 8M
I' Se%ati#es an% tran(uilli)ers
4roduce a calm and hypothetic state# (educes the effect of
an3ietyB amnesia helps to pro/ide comfort#
A' *en)o%ia)epines C produce e3cellent amnesia and
mild sedation sufficient to reduce an3iety and fear# *hey
cause an inhibitory effect on interneuronal transmission
to sites in the -90 associated with an3iety and fear#
Dia)epam +,AI-./ A gi/en orally for preA
medication#
*he pharmacological action of diaDepam
enhances the effect of the neurotransmitter
GA"A by binding to the benDodiaDepine site on
the GA"A
A
receptor leading to central ner/ous
system depression
to reduce tension and an3iety, and in some
surgical procedures to induce amnesia
ora)epam +ATI,AN/ A gi/en orally or 8MB has
good antiemetic action > acts more 1uic,ly than
diaDepam
+oraDepam is used for the shortAterm treatment of
an3iety, insomnia, acute seiDures including status
epilepticus and sedation of hospitaliDed patients,
as well as sedation of aggressi/e patients#
Anesthesiology
*he branch of medicine specialiDing in the use of drugs or other agents
that causes insensibility to pain# Anesthesiology may also be defined
as continuity of patient care in/ol/ing preoperati/e e/aluation,
intraoperati/e and postoperati/e care and the management of systems
and personnel that support these acti/ities# *he subspecialties within
anesthesiology include cardiothoracic anesthesiology, critical care,
neuroanesthesia, obstetrical anesthesiology, pain management,
pediatric anesthesiology, and ambulatory anesthesia#
Anesthesiologist
Anesthesiologist is a physician 6or, less often, a dentist7 who is
specialiDed in the practice of anesthesiology while an anesthetist is a
nurse or technician trained to administer anesthetics#
e#el of Anesthesia accor%ing to type of surgery
0' .inimal or ight se%ation +AN1IOSIS/
A A mild sedati/e, such as diaDepam, used for relief of an3iety#
-alled also antian3iety agent and minor tran1uiliDer#
A %rug induce state during which patients respond normally to
/erbal command, cogniti/e function and coordination may be
impaired but /entilation and cardio /ascular functions are
unaffected#
2' .o%erate se%ation3Analgesic +4ONS4IO-S SEDATION/
A %rug introduce depression of consciousness during which
patient can respond purposely to /erbal commands, either
alone or accompanied by light tactile stimulation#
A A drug or medicine gi/en to reduce pain without resulting in
loss of consciousness# Analgesics are sometimes referred to
as pain,iller medications# *here are many different types of
analgesic medications a/ailable in both prescription and o/erA
theAcounter preparation
5' Deep Se%ation +ANA!ESIA/
A %rug induce depression of consciousness during which
patient can respond purposefully after a painful stimulation#
A 0edation is the act of calming by administration of a
sedati/e# A sedati/e is a medication that commonly induces
the ner/ous system to calm#
6' Full anesthesia A drug induced loss of consciousness during
which patient cannot be roused, e/en by painful stimulation#

Types of Anesthesia
General Anesthesia
Ais the induction of a state of unconsciousness with the absence
of pain sensation o/er the entire body, through the administration of
anesthetic drugs# 8t is used during certain medical and surgical
procedures#
A -entral ner/ous system depressant used to loss pain
sensation and consciousness#
A 4ain is controlled by general insensiti/ity
A When administering general anesthetics se/eral drugs are
combined to achie/e#
"urpose
pain relief 6analgesia7
bloc,ing memory of the procedure 6amnesia7
producing unconsciousness
inhibiting normal body refle3es to ma,e surgery safe and easier
to perform
rela3ing the muscles of the body
a' Analgesia A *he inability to feel pain while still conscious# &rom
the Gree, anA, without E algesis, sense of pain#
7' -nconsciousness A +ac,ing awareness and the capacity for
sensory perceptionB not conscious#
c' Amnesia A 4artial or total loss of memory, usually resulting from
shoc,, psychological disturbance, brain in2ury, or illness#
%' Interference with un%esira7le refle8es
e' .uscle rela8ation A A contractile organ consisting of a special
bundle of muscle tissue, which mo/es a particular bone, part, or
substance of the body
Three metho%s of a%ministration
a' Inhalation A *he act of ta,ing in breath# 8nhalation results from
the negati/e pressure in the lungs caused by contraction of the
diaphragm, which causes it to mo/e downwards and to e3pand
the chest ca/ity
7' I, in9ection
c' I. C not used occasionally in pediatrics because retention >
absorption in the colon in unpredictable#
In%uction of !eneral Anesthesia
a' "re$o8ygenation A Administration of pure o3ygen prior to
induction of general anesthesia in order to eliminate nitrogen
from the lungs and body tissues#
7' oss of consciousness A A partial or complete loss of
consciousness with interruption of awareness of oneself and ones
surroundings#
c' Intu7ation A passage of a tube into a body aperture, specifically
the insertion of a breathing tube through the mouth or nose into
the trachea to ensure a patent airway for the deli/ery of
anesthetic gases and o3ygen or both
Depth of !eneral Anesthesia
4ea,
9ormal
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
Stage0 +In%uction or Analgesic Stage/
0tarts from induction of anesthesia up to the loss of
consciousness
-haracteriDed by loss of pain sensation and the patient is
still conscious and able to communicate
4atients reaction are drowsiness, diDDiness and amnesia
9ursing actionsF -lose ( doorsB ,eep room 1uite# 0tand
by to assist, initiate cricoids pressure 60ellic,Gs maneu/er7
if re1uested
Stage II +E14ITE.ENT STA!E/
0tarts from loss of consciousness up to rela3ation or light
hypnosis
4eriod of e3citement and often patient has combati/e beha/ior
with many signs os symptomatic stimulation and low probability
of recall
4atientGs reaction# May be e3cited with irregular breathing and
mo/ement of e3tremities, patients is susceptible to e3ternal
stimuli such as noise and touch#
4hysiological effects# 4upils C contracted# (espiration and pulseA
irregular and fast, "4A ele/ated#
9ursing ActionsF (estrain patients, patientGs sideB 1uietly but
ready to assist#
Stage III +S-R!I4A ANESTHERSIA OF REA1ATION/
0tarts from surgical anesthesia stage of rela3ation up to the loss
of refle3es and depression of /ital functions#
8n/ol/es rela3ation of s,eletal muscles return respirations >
progressi/e loss of eye refle3es and pupil dilation#
4atientGs reaction# (egular or steady and slow respiration and
pulse, contracted pupils, refle3es disappear, muscles rela3,
auditory sensation lost, "4 is normal#
9ursing actionF 4osition patients and prep s,in only when
anesthesiologist indicates the stage is reached under control#
Stage I, +.ED-ARY "ARAYSIS/
0tarts when the /ital functions are too depressed up to
respiratory failure and possible cardiac arrest
-haracteriDed by /ery deep -90 depression with loss of
respiratory and /asomotor center stimuli in which death occurs#
4atientGs reactionF not breathing, little or no pulse or heartbeat
9ursing actionF prepare for cardiopulmonary resuscitation
8nductionA stage 1 to H
MaintenanceA stage H to completion of surgery
(eco/eryA period from discontinuation of anesthetic until the
patient has regained consciousness mo/ement and ability to
communicate
.ost commonly use% general anesthetic agents
I' Inhalation agents
Techni(ues
0' .as: inhalationA *he in/ention describes an inhalation or
breathing mas, for therapeutic nebuliDers in which around a
connecting soc,et 4 for the therapeutic nebuliser is arranged
an e3halation /al/e consisting of e3halation openings and a
fle3ible /al/e element
2' aryngeal mas:A A laryngeal mas, of the type used to
facilitate lung /entilation and the insertion of endoAtracheal
tubes or related medical instruments through a patient=s
laryngeal opening as used during general anesthesia, intensi/e
care, or critical patient care#
5' En%otrachealA An endotracheal tube has a pro3imal end and
a distal end and includes a tracheal portion ha/ing an opening
at the pro3imal end and a bronchial portion attached at an
angle to the tracheal portion#
6' InsufflationA An insufflation system that includes a first tube
that inserts into a patient=s airway for pro/iding a primary flow
of breathing gas to such a patient#
;' Open %ropAA /olatile li1uid anesthetic is dropped into a
permeable face mas,# Iapor which is formed in contact with
the air is inhaled#
Drugs
Anesthetic !ases
ocal Anesthetic Drugs
A' Amino Ami%es CmetaboliDed more slowly in the li/er and serum
le/els of these drugs can increase and lead to to3icity#
0'*upi#acaine +.arcaine<Sensorcaine/A related chemically
and pharmacologically to the aminoacyl local anesthetics# 8t is a
homologue of mepi/acaine and is chemically related to lidocaine#
All three of these anesthetics contain an amide lin,age between
the aromatic nucleus and the amino, or piperidine group# *hey
differ in this respect from the procaineAtype local anesthetics,
which ha/e an ester lin,age#
2'Di7ucaine +Nupercainal/A belongs to a group of medicines
,nown as topical local anesthetics# 8t deadens the ner/e endings
in the s,in# *his medicine does not cause unconsciousness as
general anesthetics do when used for surgery#
5'Eti%ocaine +Duranest H4l/A a local anesthetic of the amide
type used for percutaneous infiltration anesthesia, peripheral
ner/e bloc,, and caudal and epidural bloc,#
6'e#o7upi#acaine +4hirocaine/A 8t is used for local and
regional anesthesia, for pain management, and for continuous epidural
analgesia#
;'i%ocaine +1ylocaine/A an anesthetic with sedati/e,
analgesic, and cardiac depressant properties, applied topically in the
form of the base or hydrochloride salt as a local anestheticB also used
in the latter form as a cardiac antiarrhythmic and to produce
infiltration anesthesia and /arious ner/e bloc,s#
='.epi#acaine +4ar7ocaine/A a lidocaine analogue used in the
form of the hydrochloride salt as a local anesthetic#
>'"rilocaine +4ilanest/A A local anesthetic used in its
hydrochloride form for ner/e bloc,s and in combination with lidocaine
for topical use#
?'Ropi#acaine +Naropin/A 8t is used to produce peripheral
ner/e bloc,, caudal anesthesia, central neural bloc,, and /aginal bloc,#
*' Amino esters$7ro:en %own imme%iately in the plasma 7y
pseu%ocholinesterase en)yme +plasma esterase/
0'*en)ocaine +anacane/A *he white, odorless, tasteless crystalline
ester of paraAaminobenDoate, used as a local anesthetic#
2'4ocaineA is a whitish crystalline powder that produces feelings of
euphoria when ingested#
5'4hloroprocaine +Nesacaine/A a local anesthetic with a chemical
structure similar to that of procaine#0afest local anesthetic#
6'"rocaine +No#ocain/A A white crystalline powder used in its
hydrochloride form as a local anesthetic,similar to cocaine but less
to3ic#
;'Tetracaine +"ontocaine/A a member of the procaine series of
compounds# 8t is a local and spinal anesthetic used in the form of the
hydrochloride salt# -an be administered by local in2ection but is also
useful by topical application to con2uncti/a, mucosae and s,in#