Types of anesthesia
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Types of anesthesia

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Lecture By: Prof.Nabil H. Mohyeddin

Lecture By: Prof.Nabil H. Mohyeddin
Anesthesiologist & Intensive Board Certified Rostock Universty Germany.

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Types of anesthesia Types of anesthesia Presentation Transcript

  • Types of AnaesthesiaProf. med. Nabil H. Mohyeddin Anesthesiologist & Intensivist Board certified University Rostock, Germany nhm1955@hotmail.com
  • Objectives Short History Definition/types of anaesthesia General anaesthesia/drugs Phases of GA Regional anaesthesia
  • Early history Ancient/Medieval period- Opium- Alcohol- Cannabis
  • History 1845- Horace Wells- N2O 1846- William Morton- Ether 1847- Simpson- Chloroform 1853-John Snow 1878- ETT 1884- Cocaine 1895-98- Spinal analgesia/anaesthesia
  • History 1921- Epidurals 1934- Thiopentone, cyclopropane 1942- Curare 1946- Lignocaine 1951- Suxamethonium 1952- IPPV 1956-Halothane
  • Definition ‘Loss of sensation’ General Regional Local
  • Triad of General anaesthesia HypnosisAnalgesia Muscle relaxation
  • Hypnosis Death Coma Hypnosis sedation AmnesiaAwake
  • Hypnotic drugs-intravenous Gold standard- thiopentone Propofol others Etomidate Benzodiazepines Ketamine
  • Inhalational anaesthetics Nitrous oxide-weak Isoflurane Sevoflurane Desflurane Halothane
  • Analgesia Good analgesia= good anaesthesia Hypnotic sparing effect Opiates Local anaesthetics NSAIDS Paracetamol
  • Analgesia-Opiates Gold standard – morphine Derivatives- diamorphine, codeine Synthetic agents- Pethidine- Fentanyl/Alfentanil-short acting- Remifentanil-ultra short acting
  • Analgesia-NSAIDS Gold standard- aspirin Ibuprofen Diclofenac Cox-2 inhibitors
  • Muscle relaxation Aids intubation Helps surgeon/surgery Surgery of long duration Reduces maintenance dose of anaesthetics agents
  • Muscle relaxants Two types Depolarising-short acting eg;suxmethonium Non-depolarising- medium/long acting- Tracurium- Vecuronium- Rocuronium
  • Prerequisites Oxygen Suction Tilting trolley Resuscitation drugs Monitoring Anaesthetist Skilled assistance Drugs and machine
  • Phases of general anaesthesia Induction Maintenance Recovery
  • Induction Intravenous- majority Inhalational- children, needle phobics Monitoring Preoxygenation Hypnotic/analgesic and or relaxant Mask/LMA/ET tube
  • Stages of anaesthesia Alcohol  General Anaesthesia1.Dizzy, delightful 1.Amnesia, analgesia2.Drunk, disorderly 2.Uninhibited3.Dead drunk response to stimuli4.Dangerously deep 3.Surgical anaesthesia 4.Vital centre depression
  • Maintenance Intravenous or inhalational Oxygen –40%-100% Nitrous oxide Muscle relaxant Analgesia
  • Recovery Turn off agent Reverse relaxation Cough reflex Extubate when awake Recovery position Monitor until discharge
  • Advantages No absolute contraindications Quick to establish Never fails to work
  • Disadvantages Polypharmacy Effects on various systems Allergic reactions Recovery profile Post operative Nausia &Vomiting Awareness
  • Regional anaesthesia Spinal/epidural- surgery below umbilicus- Provides analgesia/muscle relaxation Plexus blocks eg brachial plexus Intravenous- Bier’s block
  • Regional anaesthesiaAnalgesia Muscle relaxation
  • Local anaesthetics Lignocaine- quick/short acting Bupivacaine/levobupicvacaine- slow and long action Ropivacaine- as above Amethocaine- topical Prilocaine- intravenous
  • Advantages Effective alternative to GA Avoids polypharmacy Allergic reactions Extended analgesia Patient can remain awake Early drink/feed
  • Disadvantages Limited scope Higher failure rate Time constraints Anticoagulants/Bleeding diathesis Risk of neural injury