1.
Prof. S.D.Khimich
Vinnitsa National Medical University
 LECTURE:
 GENERAL, LOCAL
AND REGIONAL
ANESTHESIA

2.
Anesthesiology is a science
about the protection of
organism from operative
trauma
 All kinds of anesthesia divided on
general (narcosis) and local
anesthesia

3.
Narcosis is an artificial reversible
state of the human organism
characterized with inhibition of
CNS (absence of consciousness)
loss of sense, muscular relaxation
& absence of some reflexes.

4.
Anesthesia is produced by progressively
increasing the amount of the anesthetic
in the inspired air and thus in the blood
and brain. Unconsciousness is one of its
primary conditions

5.
Relaxation of skeletal
muscles,
essential for carrying out certain
operations, may be achieved by deep
anesthesia but only for a short time
since such narcosis is dangerous.

6.
Preparing to the operation
(preanesthetic medication)
 Anesthesiologist must examine of patient before
each operation. The tasks of examination are:
 · General condition estimation;
 · Peculiarities of anamnesis, connected with
anesthesia;
 · Clinical and laboratory data estimation;
 · Determination of degree of operational and
narcosis risk;
 · Method of anesthesia selection;
 · The character of premedication determination.

7.
Premedication (preanaesthetic
medication) –is introduction of
medicinal substances before
operation for decreasing of
intraoperation and postoperation
complications’ frequency.
 The main medicinal substances for premedication
are:
 · Opiates;
 · Sedatives;
 · Neuroleptics;
 · Antihistamines;
 · Narcotic drug;
 · Anticholinergic drug.

8.
The main schemes of
premedication are:
 Before the urgent operation the narcotic
drug and atropine (promedol 2% - 1,0,
atropine – 0,01 mg/kg) are introduced;

9.
Classification of narcosis
 Inhalation narcosis – through respiratory ways
the pharmaceutical substances are introduced.
Aperture-mask, endotracheal and endobronchial
narcosis are distinguished. In modern time
usually the endotracheal narcosis is used.

10.
Classification of narcosis
 Noninhalation narcosis – the preparation
are introduced not through respiratory
ways, but intravenously (mainly) or
intramuscularly.
 Electroanesthesia
 Combined anesthesia

11.
Medicines for inhalative
narcosis:
 1.nitrous oxide (N2O) – colorless gas without
smell, is kept as a fluid under pressure 50
atmospheres in black gas-bags.
 2.Ethyl ether (anesthetic ether).
 3.Methoxyfluran (penthran, inhalan).
 4.Cyclopropane etc.

12.
The administration of
anesthetic results in progressive
depression of the CNS , which
may be preceded by varying
degrees of excitation.
These drugs first depress the
cerebral cortex via the RAS
(reticular activating system) and
the basal ganglia and cerebrum.

13.
Stages (or phase) of
anesthesia:
 1. Stage of analgesia
 2. Stage of excitement
 3. Surgical stage
 4. Agonal stage (or period of recovery )

14.
The I stage (analgesia)
 – begins in 3-8 min after inhalation of ether &
last 3-5 min and characterized by partial
unconsciousness and diminution of sensitivity
to pain.

15.
The II stage (excitation,
delirium)
 – last 1-5 min and is characterized with the
activation of all physiological processes – the
patient is excited, breathing is deep and rare,
uncontrolled motor-speech excitation occurs
(patient try to run anywhere, to jump, to talk
to anybody).

16.
The III stage (surgical anesthesia)
– the phase of surgical sleep is
divided into 4 levels.
 - The first level (III1) is characterized by
superficial anesthesia – loss of sensitivity to
pain, easy sleep begins…
 - The second level (III2) – the level of corneal
reflex and develops as the anesthesia
deepens.

17.
The III stage (continue)
 - The third level (III3) – the level of pupil
dilation. The pupils are slightly dilatated and
their reaction to light is weakened.
Anesthesia is conducted in this level when
relaxants are employed.
 The fourth level (III4) – the level of
diaphragmatic respiration – is characterized
with the inhibition of physiological functions.
This level may transform to agony with the
following death.

18.
The IV stage
 – the phase of awakening – is characterized
with the reverse development of all the
clinical symptoms.

19.
Regional (Local) Anaesthesia
Regional anaesthesia implies reversible
blockade of pain perception or
transmission by local anesthetic drugs,
although physical agents such as cold or
pressure can act similarly.

20.
Topical anaesthesia is results
from the application of certain
local anesthetics to skin or
mucous membranes
(conjunctiva, oral, nasal, and
anal).

21.
Local Anesthetic Agents:
 Cocaine Hydrochloride
 Procaine Hydrochloride (Novocain)
 Tetracaine (Pontocaine Hydrochloride)
 Lidocaine (Xylocaine)
 Dibucaine (Nupercaine Hydrochloride)
 Piperocaine (Metycaine Hydrochloride)

22.
Local anesthesia (LA) is a
blockade in the zone of surgical
intervention.
 Regional anesthesia (RA) is the stopping of
the painful impulsation proximal the field of
operation.

23.
Indications for conducting of
local anesthesia:
1. Ambulatory surgical operations;
2. Small on volume surgical interventions;
3. In old and extreme age people with
diseases of cardiac-vascular and respiratory
systems.
4. In case of contra-indication to general
anesthesia (narcosis).

24.
Contra-indications for conducting
of local anesthesia:
 1. Raised sensitiveness of organism to anesthetic;
 2. Mental affections;
 3. Sharp nervous excitement;
 4. Early child age (till 10 years);
 5. The urgent surgical interventions, connected
with acute bleeding;
 6. Expressed fibrous changes of soft tissues;
 7. Long-term operations on body cavities;
 8. The refusal of the patient from local anesthesia.

25.
Complications of local
anesthesia (I):
 Local: the damage by needle of anatomic
formations or internal organs (nervous trunks,
vessels, spinal cord, organs of pectoral or
abdominal cavities), infectivity of soft tissues,
bleeding, hematoma, inflammatory infiltrates,
paresis, paralyses, peritonitis, etc.

26.
Complications of local
anesthesia (II):
 General – connected with overdoses of anesthetic or raised
sensitiveness of organism to it.
 1. Light degree – vasomotor discords (dizziness, pallor, cold
sweat, general weakness, tachycardia, nausea).
 2. Middle degree – stinging of central nervous system
(impellent flustering, hallucinations, cramps, vomit).
 3. Heavy degree – violation of activity of life important
organs and systems (collapse, stop of breathing and cardiac
activity).
 Allergic reactions are nettle rash, Kvinke’s swollen,
bronchospasm, anaphylactic shock.

27.
TYPES OF LOCAL AND
REGIONAL ANESTHESIA
 - Terminal;
 - Infiltrative;
 - Conduction;
 - Intraosseous;
 - Intravenous under tourniquet;
 - Epidural;
 - Spinal.

28.
Terminal anesthesia is a simple and
accessible method. It is realized by bringing
the solution of anesthetic on mucous by the
way of smearing, dispersion, dropping.
 For terminal anesthesia anesthetics of
amides group are used: 2% solution of
piromecaine, 5% solution of lidocaine
hydrochloride (xycain), trymecaine, marcaine.

29.
Infiltrative anesthesia is made layer by layer
introduction of the solution of anesthetic on
each next operation stage.
 For the infiltrative
anesthesia often
we are using
0,25-0,5% of
solution of
Novocain.
 Fig.1. Infiltration anesthesia

30.
Conductive anesthesia – method of regional
analgesia, when the solution of the local anesthesia is
put into the nervous trunk or interning proximally from
the field of operation.
 Recommended anesthetics are: 1-2%
solution of lidocaine hydrochloride (xycaine),
trymecaine, and marcaine. Rarely: 0,25%
solution of dicaine, 1-2% solution of
Novocain.

31.
Professor Lukashewich (1886) from Kyiv tested the
action of the solution of cocaine on himself and
volunteers for conducting anesthesia on fingers
(150 cases), made 36 surgical interventions in the
cases whitlow.
 Today this
anesthesia is
famous as
anesthesia after
Lukashewich-
Oberst (fig.3).
Anesthesia by Lukashewich-Oberst fig. 3)

32.
Intraosseous and intravenous
regional anesthesia
Fig.4. Technique of intraosseous
regional anesthesia
 Fig.5. Technique of
intravenous regional
anesthesia

33.
Epidural and spinal anesthesia is the method of
conducting anesthesia, at which the analgesia
with the help of local anesthetics is reached on the
level of spinal radices (rootlets).
Fig.6. Spinal anesthesia.

34.
The solution of anesthetic is deposits in space,
between hard cerebral membrane and clear space
covering an osseous spinal channel.
 Analgesic matters diffuse through the hard cerebral
membrane and membrane of the spinal nerves into
spinal fluid, then spreads through the intervertebral
communications realizes paravertebral blockade of
nerves.
 The puncture of epidural space is made as a rule
from the middle (between spinous processes or
paramedial access), laterally on 1,5-2 cm, on the
level of III – IV lumbar vertebra.

35.
Complications of epidural
anesthesia:
 - Vascular collapse by the reason of
paralysis of vasoconstrictors, redistribution of
blood;
 - Total spinal block is arises in the case of
puncture of hard cerebral membrane, when
the anesthetic in high concentration is
reached the spinal bulb. The collapse
breathing paralysis is coming.

36.
Спасибо за внимание
Thank for attention