Anesthesia is explained in Eye, Ear, Nose, Throat, Tooth along with it's explanation in Ayurveda

1. Anesthesia in
Shalakya Tantra
By Dr. Anuj Kumar Singh
1st year PG Scholar
Dept. of Shalakya Tantra
Guide- Dr. Veena Shekar
SKAMCH & RC

2. INTRODUCTION TO ANAESTHESIA
Derivation of Anaesthesia:
Aesthesis means sensation.
Anaesthesia is defined as loss of sensation.
DEFINITION
Method of bringing about loss of sensation for surgical purpose.
It is derived from 2 words :-
* Analgesia- Abolition of pain perception.
* Akinesia- Abolition of muscular contractions at the
site of injection of anaesthetic drugs.

3. ANAESTHESIA IN AYURVEDA
संज्ञाहरण-
• संज्ञा- Consciousness
• हरण- Holding
Acharya Sushruta has mentioned the use of
Madya(wine) to mitigate the pain of surgery.
(Su.Su.17/11)
AcharyaVagbhata also mentioned regarding
sangnyaharana before performing shastra karma
in sutrasthana 29/15.
Hence the concept of sangyaharana can be corelated
as anaesthesia in contemporary science.

4. संज्ञाहरण उपाय-
• In Charaka Samhita sutra sthana 4th
chapter , acharya has mentioned vedana
sthapana gana
Drugs of this gana are :
• शाल
• कदम्ब
• कट्फल
• पद्मक
• मोचरस
• तुङ्ग
• शशररष
• वञ्जुल
• एलवालुक
• अशोक

5. * Acc. to Sushruta for certain operations मद्य can be used for संज्ञाहरण purpose
i.e. “मद्येन मोहित्वं”
अशिफेन, भाङ्ग etc are also used for this purpose.

6. PRE-ANAESTHETIC CHECKUP IN EYE & E.N.T SURGERIES
• GENERAL:
• Nutritional status
• Retarded growth
• Anaemia
• Jaundice
• Cough
• Temperature.
• Oedema
• History of convulsion
RESPIRATORY SYSTEM
• Cyanosis.
• Dyspnoea
• Auscultation of lung field
AIRWAY
• Mouth opening
• Neck movement
• Dentition
CARDIOVASCULAR SYSTEM
• Pulse
• Blood pressure
• Heart sound (auscultation)
• Dependent oedema

7. INVESTIGATIONS
• ✓Full blood count
• ✓Urine analysis
• ✓Chest X-ray
• Echocardiogram (valvular disease)
OVER 40YEAR:
• Blood glucose
• ECG
• Blood urea
• S.Creatinine
OTHER
INVESTIGATIONS:
• S. electrolytes
• Liver function test
• Coagulation screening

8. NPO status
o Nil Per Oral, means nothing by mouth
o Solid food: 8 hrs before induction
o Liquid: 4 hrs before induction
o Clear water: 2 hrs before induction
o Pediatrics: stop breast milk feeding 4 hrs
before induction.

9. GENERAL ANESTHESIA
oIt means abolition of all sensations i.e. ,touch, pain, posture and temperature with
a state of reversible loss of consciousness.
CARDINAL FEATURES
ANALGESIA
AKINESIA
HYPNOSIS
LOSSOF REFLEXES

10. INDICATIONS OF GENERAL ANAESTHESIA
oInfants, Children
oAnxious patients
oNon co-operative and mentally retarded
adults
oPerforating ocular injuries
oMajor operations like exenteration.

11. CONTRAINDICATIONS OF GENERAL ANESTHESIA
o Hypersensitivity
o Acute glaucoma
o Increased intracranial pressure
o Severe asthma
o History of Cardiac issues
o Anaesthesia team with lack of experience.

12. GENERAL
ANAESTHESIA
INHALATIONAL
INTRAVENOUS

13. INHALATIONAL ANESTHESIA
o It refers to the delivery of gases or vapours to the respiratory system
to produce anesthesia.
o AGENTS USED-
1.Volatile -eg. Halothane, Isoflurane etc.
2. Non- volatile -eg. Nitrous oxide.

14. INTRAVENOUS ANESTHESIA
Anesthetic drugs are delivered through Intravenous route.
Examples-
1. Barbiturates (Thiopental)
2. Propofol
3. Ketamine
4. Benzodiazepines
5. Opioids (Fentanyl, Morphine)

15. AGENTS USED IN GENERAL ANAESTHESIA
• Inhalation anaesthetics (sevoflurane, desflurane)
• opioids (fentanyl)
• alpha-2 adrenergic agonists (clonidine and
dexmedetomidine)
• beta adrenoceptor antagonists (labetalol and
esmolol)
• Vasodilators

16. Choice of airway
• Adequate throat packing
• Flexible LMA and endotracheal tube
• Careful extubation.

17. Procedure of General anesthesia
1. Premedication for anesthesia.
2. Induction and intubation
3. Maintenance and monitoring
4. Extubation and recovery

18. COMPLICATIONS of General Anaesthesia
• Hypoxia
• Laryngospasm
• Respiratory depression
• Aspiration
• Pneumonitis
• Cardiac arrythmia
• Hypotension/ Hypertension
• Convulsion
• Restlessness

19. ANAESTHESIA FOR OCULAR SURGERY
• Local anaesthesia is more frequently employed as it has less risk and is less
dependent upon patient’s general health.
• It is easy to perform, has got rapid onset of action and provides a low
intraocular pressure with dilated pupil.

20. Preoperative sedation and analgesia
Drug Dosage Time before
operation
Diazepam 5-10mg 2 hours
Promethazine 25mg 2 hours
Barbiturates 90-180mg Night before
In India, the usually employed sedatives are
Common analgesics used pre and post operatively
are Pethidine, Pentazocine etc.

21. Classification of anesthesia in ocular surgeries
Anesthesia
Local
Infiltration
Intracameral
General
Inhalational
Topical
Intravenous

22. Advantages
Easy to administer, no need of trained anesthetist.
It does not require any special and costly
investigations.
It is less expensive.
There is no major complication of LA.
Disadvantages
 Difficult and sometimes, hazardous for the
nervous and non-co-operative patients.
 Head movements and straining, may
cause serious complications.
 Rarely, there may be globe perforation,
which is sight-threatening.
LOCAL ANESTHESIA-
Acts by producing reversible block on transmission of nerve impulses.

23. Indications
* Cataract extraction
* Pterygium
* Glaucoma surgery
* Keratoplasty
* Corneal surgeries
* Iridectomy
* Squint surgery
* Retinal Detachment
Contraindications
• Anxiety
• Tremor
• Claustrophobia
• Children
• Poor communication/
Language barrier/
Deafness
• Long operative time
• Inability to cooperate
(eg.Schizophrenia,
Dementia)

24. Types of Local anesthesia
• 1. Surface (Topical) anesthesia-
oIt is performed by instillation of 4% lignocaine, 0.5%- 1% amethocaine, or 0.5%
proparacaine thrice at an interval of 5 minutes.
oCommonly required for the removal of foreign body of cornea, tonometry or
gonioscopy.
• 2. Infiltration (Regional) anesthesia-
a. Facial block
b. Retro-bulbar block
c. Peribulbar block
d. Regional block (at selected sites)
e. Parabulbar (Sub-tenon) block
f. Frontal block

25. FACIAL BLOCK
o To block the facial nerve, or its zygomatic branch to paralyze the orbicularis
oculi muscle.
o To prevent closure and squeezing of the eyelids during operation.
Orbicularis akinesia can be achieved by blocking the facial nerve at following
branches.
Techniques-
a. Van Lint Method- Terminal branches
b. Atkinson- Superior Branches
c. Nadbath- Rehman block- Proximal trunk
d. O’ Brien technique- Proximal trunk

26. O’ Brien’s technique
At the neck of the mandible
just in front of the tragus.
Van Lint method
1cm below and behind
the lateral canthus

27. Atkinson’s block
On zygomatic arch,
superior branches of
facial nerve are blocked.
Nadbath- Rehman block
The facial nerve is blocked as it
leaves Stylomastoid foramen.

28. RETROBULBAR BLOCK
It is administered by injecting 2ml of anaesthetic solution into the muscle cone
behind the eyeball.
Retrobulbar block anesthetizes the ciliary nerves, ciliary ganglion and 3rd and
6th cranial nerves thus producing globe akinesia, anesthesia and analgesia.
Complications : Retrobulbar haemorrhage, globe perforation, optic nerve
injury and extraocular muscle palsies.

29. Effects of Retrobulbar block
• Anesthesia of the deeper intraocular structure (eg. Iris)
• Akinesia of all extraocular muscles.
• Mydriasis.
• Hypotony
• Proptosis
• Decreased oculo-cardiac reflex

30. PERIBULBAR BLOCK
o Injection of 6 to 7ml of local anaesthetic solution
in the peripherical space of the orbit, leading to
globe and orbicularis akinesia and anaesthesia.
o Administered by two injections-
• First through the upper lid (at the junction of
medial one- third and lateral two third)
• Second through the lower lid ( at the junction of
lateral one- third and medial two- third
o An intermittent pressure is given against the
closed eyelids for 10 minutes with the help of
fingers, Super pinky or Honan’s balloon.

31. Advantages of Peribulbar block
o Least chances of Retrobulbar hemorrhage, globe
perforation or optic nerve damage.
o It is less painful procedure.
o There is no need of additional facial block.
Agent-
-Lignocaine 2%
-Bupivacaine 0.75%
Along with-
- Hyaluronidase 5-7.5 IU/ml
- Adrenaline 1:200000

32. PARABULBAR (Sub-tenon block)
• Sub-Tenon's Space
Tenon's capsule:Thin layer of
connective tissue which surrounds
the globe.
Anteriorly it lies in close
apposition to the conjunctiva and
fuses with it at the level of the
limbus.
Posteriorly surrounds the globe
and fuses with the dura of the
optic nerve.

33. o The sub-Tenon's space is a virtual space between the capsule
and the sclera.
o The instillation of local anaesthetic into this space produces
analgesia and akinesia by diffusing posteriorly into the retro-
orbital space to block the traversing sensory and motor
nerves.

34. INTRACAMERAL ANESTHESIA
o New technique for ocular lidocaine administration. When local
anesthetics such as lidocaine are placed near the nerve tissue,
they penetrate the nerve sheath and block initiation and
propagation of nerve impulses by decreasing the neuronal
membrane permeability to sodium ions.
o It has rapid onset and effect stays up to 1-2 hours.

35. ANAESTHESIA IN E.N.T
OPERATIONS

36. Anesthesia
Local
Regional
General
Topical
Infiltration
Peripheral nerve block
Intravenous (regional)
Total inhalation
Total Intravenous

37. COMMONLY USED ANESTHETIC DRUGS
o 2% lignocaine with 1: 80,000 adrenaline used as infiltration in ear & nasal
surgeries.
o Packing with 4% lignocaine in nasal surgeries.
o 4% Lignocaine spray as surface anaesthesia in the pharynx and larynx
o Lignocaine in viscous form as surface anaesthesia in pharyngeal,
laryngeal and oesophageal examination.

38. TOPICAL ANESTHESIA IN EAR
o Topical use of 2% lidocaine drops or benzocaine to provide rapid pain relief in
acute otitis media.
o Topical solution of 8% tetracaine base in Myringotomy.
o Instillation of Phenol topically in Grommet insertion.

39. INFILTRATIONANESTHESIA IN EAR
Plester technique-

40. Field block-
o Approximately 10 to 20 mL of
anesthetic is injected above and below
the ear to produce a rhomboid-shaped
block.
o Caution should be used in the vicinity
of the temporal artery.
o This RING shaped block is used to
anesthetize entire auricle.
REGIONAL ANESTHESIA

41. IMPORTANT CONSIDERATIONS DURING ANESTHESIA
• Head positioning- Head-up tilt 15 to 20 degrees, slightly elevated
position of the head reduces arterial and venous pressures in
areas above the heart
• Sedation- It should produce anxiolysis, amnesia and should have
a rapid recovery. Drugs like Midazolam, Propofol, Ketamine,
Diazepam.
• Avoidance of venous obstruction
• Normocapnia
• Controlled hypotension
• Effects of nitrous oxide: The use of nitrous oxide in middle ear
surgery is particularly controversial. Use of nitrous oxide might
cause displacement of graft due to negative pressure in the
eustachian tube and middle ear spaces duringTympanoplasty.

42. ANAESTHESIA IN NASAL SURGERIES
Types of nasal surgery-
o Surgery on external aspect of nose
o Within nasal cavity
o Within nasal sinuses

43. UNDER GENERAL ANAESTHESIA UNDER LOCAL ANAESTHESIA
Rhinoplasty Anterior septum surgeries
Nasolacrimal duct surgery Septoplasty
Frontal sinus surgeries Turbinectomy
Excision of nasopharyngeal
angiofibroma
Cauterisation
Polypectomy. Polypectomy

44. Specific Preoperative evaluations
o Assessment for Obstructive sleep apnea
o Use of nasal c-pap
o Cardiovascular status
o History of NSAIDs
o Samter triad incidence.

45. TOPICAL ANESTHESIA IN NOSE
Intranasal Topical Local Anaesthetic sprays are used in nostril and oropharynx to
produce anaesthetic effect.
Example-
o Xylometazoline hydrochloride
o Lidocaine hydrochloride
oOxymetazoline
* Mostly indicated for Fibreoptic nasal endoscopy.

46. REGIONAL NERVE BLOCK
INDICATIONS-
1. Septoplasty
2. Rhinoplasty
3. Sub Mucous Resection of nasal
septum
4. Nasal fracture repair
5. Caldwell- Luc operation

47. Anaesthesia ForThroat Surgery
oTonsillectomy
oAdenoidectomy
oPalatal Surgery
oLaryngeal Procedures
oBenign, Malignant Lesions surgery
oAirway Endoscopy
o Laser Surgery.

48. PREOPERATIVE ASSESSMENT
o Same as other surgeries.
o Patients with Obstructed sleep apnoea
o Loose teeth
o Vulnerable dental implants
o Bleeding disorders
o Anaemia.

49. DENTAL ANAESTHESIA
INDICATIONS
o Wisdom tooth removal
o Placement of dental implants
o Non- cooperative patient due to anxiety.
o To reduce pain.

50. Dental
Anesthesia
Local
Sedation
General
Example
Lidocaine
Bupivacaine
Example
Midazolam
Diazepam
Example
Ketamine
Isoflurane

51. NERVE BLOCK IN DENTAL ANAESTHESIA

52. CONCEPT OF जालन्धर बन्ध​
o In िठ योग प्रदीशपका (3/70) the procedure of tooth
extraction has been mentioned by a special
method called जालन्धर बन्ध (Chin lock)
o This procedure is practiced to extract the tooth
without causing much pain to the patient.

53. DISCUSSION
oOur acharyas have explained various surgeries in ShalakyaTantra like in
Linganasha,Tundikeri,Vartmarbuda,Vartmasharkara, Klishtavartma,
Anjananaamika etc. but methods of anesthesia in these Shastra karmas are not
clearly specified in Samhitas.
oAcharya Sushruta explained SangnaharanaUpayas like usage of Bhanga,
Ahiphena, Madya etc and Charaka acharya enlisted Vedanasthapana gana dravyas
for anaesthesia but the effect of those drugs are only partial or incomplete.
oThe effect of those drugs told in Ayurveda found to be not sufficient as per the
requirement.

54. oThe extracted derivatives of Bhanga (cannabis derivatives), Ahiphena
(Fentanyl,Thiopentone) are being used for analgesic action.
oThe various forms of alcohol like Ether, Propofol etc. are used in general
anesthesia which proves that the action of the anesthetics depend upon
specific form of the drug for it’s usage.

55. CONCLUSION
* The drugs used for Sangnaharana purpose are seem to be outdated as their effect does not
fulfil the purpose of anaesthesia during surgery.
* The partial effect of anaesthesia can create discomfort for patient as well as surgeon.
* The side effects and sometimes complications of anesthesia are inevitable which has to be
managed accordingly whereas the complications due to anaesthesia withAyurveda drugs is quite
less.

56. * The concept of Jalandhara bandha though not directly mentioned as regional anaesthetic
but its mode of action can be understood as it nullifies the pain in particular area for a duration
of time.
* The well planned and highly efficient anaesthetic methods are told in modern era which
make us to rely on them to avoid complications.
* In ShalakyaTantra, Surgery is an important line of management and anesthesia being an
integral part of surgery cannot be neglected here so detailed methods of anaesthesia in
modern era can be followed as an alternative to perform a successful surgery.