The document discusses the history and types of anesthesia, from ancient civilizations using plants for pain management to the development of modern general anesthesia with ether and chloroform in the 1800s. It also covers regional anesthesia techniques like spinal blocks and local infiltration, as well as the different classes of drugs used for induction, maintenance, analgesia, and muscle relaxation during general anesthesia. The choice of anesthesia depends on factors like the procedure, patient health, and surgeon requirements.

1. Types of
Anaesthesia
PPT PREPARED BY
DR RAJESH T EAPEN
ATLAS HOSPITAL
RUWI

2. Sushruta 800B.C.
wrote first Surgery textbook

3. Anesthesiology
Making
Surgery
Painless

4. Anesthesia
 From Greek anaisthesis means
not sensation
 Listed in Bailey´s English
Dictionary 1721.
 When the effect of ether was
discovered anesthesia” used as a
name for the new phenomenon.

5. Oxford dictionary
definition
 insensitivity to pain, especially
as artificially induced by the
administration of gases or the
injection of drugs before
surgical operations

6. World Anesthesia Day 16th Oct

7. HISTORY OF ANESTHESIA
• General anesthesia was absent until the mid-
1800s.
• Ether synthesized in 1540 by Cordus
• Ether used as anesthetic in 1842 by Dr. Crawford
W.Long
• Ether publicized as anesthetic in 1846 by Dr.
William Morton.
• Ether is no longer used in modern practice, yet
considered to be the first ‘ideal’ anesthetic
• Chloroform used as anesthetic in 1853 by Dr. John
Snow
• Endotracheal tube discovered in 1878
• Thiopental first used in 1934

8. Pre 1846 - The Foundations of
Anaesthesia
……..so the Lord God caused him to fall
into a deep sleep. While the man
was sleeping, the Lord God took out
one of his ribs. He closed up the
opening that was in his side……...
Genesis 2:21 NIrV

9. Primitive Anesthesia
 Ancient civilizations- opium poppy,
coca leaves, mandrake root,
alcohol
 Regional anesthesia in ancient
times- compression of nerve
trunks or the application of cold
(cryoanalgesia)

10. World Anaesthesia Day
 On 16 October 1846,
John Collins Warren
removed a tumor from
the neck of a local
printer,Edward Gilbert
Abbott. Warren
reportedly quipped,
"Gentlemen, this is no
humbug.
 MGH Boston

11. Regional
Anaesthesia
 1884 Sigmund Freud
physiology actions
cocaine
 Carl Koller cocaine
ophthalmological
surgery

12. Birth of modern Anaesthesia
 1913,Chevalier Jackson-use of direct
laryngoscopy as a means to intubate
the trachea
 Sodium Pentathal - first used in humans
on 8 March 1934 by Ralph M. Waters

13. Slide master
Your Text here

14. History
 1845- Horace Wells- N2O
 1846- William Morton- Ether
 1847- Simpson- Chloroform
 1853-John Snow
 1878- ETT
 1884- Cocaine
 1895-98- Spinal
analgesia/anaesthesia

15. Types Of Anesthesia

16. Types
.

17. Triad of General
anaesthesia
Hypnosis
Analgesia Muscle relaxation

18. CLASSIFICATION:
18
General
anaesthetics
Inhalational Intravenous

19. INTRODUCTION
• General anaesthetics (GAs) are drugs which produce
reversible loss of all sensations and consciousness. It usually
involves a loss of memory and awareness with insensitivity to
painful stimuli, during a surgical procedure
General anesthesia
need for
unconsciousness
‘Amnesia-hypnosis’
need for analgesia
‘Loss of sensory and
autonomic reflexes’
need for muscle
relaxation

20. General anesthetics

21. Amnesia
sedation
Hypnosis
Coma
Death
Awake
Hypnosis

22. Hypnotic drugs-
intravenous
 Gold standard- thiopentone
 Propofol
others
 Etomidate
 Benzodiazepines
 Ketamine

23. Inhalational
anaesthetics
 Nitrous oxide-weak
 Isoflurane
 Sevoflurane
 Desflurane
 Halothane

24. Analgesia
 Good analgesia= good
anaesthesia
 Hypnotic sparing effect
 Opiates
 Local anaesthetics
 NSAIDS
 Paracetamol

25. Analgesia-Opiates
 Gold standard – morphine
 Derivatives- diamorphine,
codeine
 Synthetic agents
- Pethidine
- Fentanyl/Alfentanil-short
acting
- Remifentanil-ultra short
acting

26. Analgesia-NSAIDS
 Gold standard- aspirin
 Ibuprofen
 Diclofenac
 Cox-2 inhibitors

27. Muscle relaxation
 Aids intubation
 Helps surgeon/surgery
 Surgery of long duration
 Reduces maintenance dose of
anaesthetics agents

28. Muscle relaxants
 Two types
 Depolarising-short acting
e.g.; suxmethonium
 Non-depolarising-
medium/long acting
- Tracurium
- Vecuronium
- Rocuronium
- Cisatracurium (NIMBEX)

29. Prerequisites
 Oxygen
 Suction
 Tilting trolley
 Resuscitation drugs
 Monitoring
 Anaesthetist
 Skilled assistance
 Drugs and machine

30. The 21 st century-digital
revolution

31. Phases of
general anaesthesia
 Induction
 Maintenance
 Recovery

32. Induction
 Intravenous- majority
 Inhalational- children, needle
phobics
 Monitoring
 Preoxygenation
 Hypnotic/analgesic and or
relaxant
 Mask/LMA/ET tube

33. Maintenance
 Intravenous or inhalational
 Oxygen –40%-100%
 Nitrous oxide
 Muscle relaxant
 Analgesia

34. Recovery
 Turn off agent
 Reverse relaxation
 Cough reflex
 Extubate when awake
 Recovery position
 Monitor until discharge

36. Advantages
 No absolute contraindications
 Quick to establish
 Never fails to work

37. Disadvantages
 Poly-pharmacy
 Effects on various systems
 Allergic reactions
 Recovery profile
 Post operative Nausea &Vomiting
 Awareness

38. Providing operative conditions

39. Regional anaesthesia
 Spinal/epidural
- surgery below umbilicus
- Provides analgesia/muscle
relaxation
 Plexus blocks eg brachial plexus
 Intravenous- Bier’s block

40. 40
Spinal Block - Position

41. Regional anaesthesia
Analgesia Muscle relaxation

42. Local anaesthetics
 Lignocaine- quick/short acting
 Bupivacaine/levobupicvacaine
- slow and long action
 Ropivacaine- as above
 Amethocaine- topical
 Prilocaine- intravenous

43. Advantages
 Effective alternative to GA
 Avoids polypharmacy
 Allergic reactions
 Extended analgesia
 Patient can remain awake
 Early drink/feed

44. Disadvantages
 Limited scope
 Higher failure rate
 Time constraints
 Anticoagulants/Bleeding
diathesis
 Risk of neural injury

45. Patient is more important
than our ego; call for help,
whenever patient is in
danger
Your Text here

46. Slide master
Your Text here

47. Choice of anesthesia
 The patient´s understanding and wishes regarding the type of
anesthesia that could be used
 The type and duration of the surgical procedure
 The patients´s physiologic status and stability
 The presence and severity of coexisting disease
 The patient´s mental and psychologic status
 The postoperative recovery from various kinds of anesthesia
 Options for management of postoperative pain
 Any particular requiremets of the surgeon
 There is major and minor surgery but only major
anesthesia

48. Types of anesthesia care
General Anesthesia
 Reversible, unconscious state is
characterised by amnesia (sleep,
hypnosis or basal narcosis),
analgesia (freedom from pain)
depression of reflexes, muscle
relaxation
 Put to sleep

49. Types of anesthesia care
Regional Anesthesia
 A local anethetic is injected to
block or ansthetize a nerve or
nerve fibers
 Implies a major nerve block
administered by an
anesthesiologist (such as spinal,
epidural, caudal, or major
peripheral block)

50. Types of anesthesia care
Monitored anesthesia care
 Infiltration of the surgical site with a local
anesthesia is performed by the surgeon
 The anasthesiologist may supplement the
local anesthesia with intravenous drugs
that provide systemic analgesia and
sedation and depress the response of the
patient´s autonomic nervous system

51. Types of anesthesia care
local anesthesia
 Employed for minor procedures in which the
surgical site is infiltrated with a local anesthetic
vital signs
 May injsuch as lidocaine or bupivacaine
 A perioperative nurse usually monitors the
patient´s ect intravenous sedatives or analgesic
drugs

53. Thank
you
Macintosh noted: “for the
surgeon the spinal ends
with the injection of the
agent; for the anesthetist it
begins with the injection of
the agent.”