1. The document discusses different types of anesthesia including general anesthesia, regional anesthesia, moderate sedation, and local anesthesia. It describes various anesthetic agents and techniques used for each type. 2. General anesthesia involves a state of unconsciousness using inhaled anesthetic gases or intravenous medications. Regional anesthesia uses local anesthetics injected near nerves to numb specific body areas. Moderate sedation reduces anxiety with sedatives while ensuring patient cooperation. Local anesthesia involves injections to numb small incision sites. 3. The document provides details on commonly used anesthetic agents for different techniques, including their advantages and disadvantages. Halothane, nitrous oxide, thiopental and propofol are discussed as general anesthetic options

1. PRACTICE TEACHING
ANESTHESIA
SUMITTED TO: SUMITTED BY:
MRS. HIMANTA S. MAGANJI MR. KAPIL SHARMA
HOD MEDICAL SURGICAL NURSING M.Sc. NSG 1st YEAR
SAIMS COLLEGE OF NURSING SAIMS COLLEGE OF NSG

2. INTRODUCTION
 From greek anaisthesis means “Not sensation”.
 When the effect of ether was discovered
“anesthesia” used as name for the new
phenomena.
 It is defined as a depressed level of
consciousness that dose not impair the patient
airway & to respond appropriately to physical
stimulation & verbal command.

4. DEFINITION
• Anesthesia is a state of narcosis (severe
central nervous system depression produced
by pharmacologic agents), analgesia, relaxation
& reflex loss. Patient loss the ability to maintain
ventilatory function and require assistance in
maintaining a patent airway.

5. HISTORY OF ANESTHESIA
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
Chloroform used as anesthetic in 1853 by Dr.
John Snow

6. ANATOMY & PHYSIOLOGY OF
NERVOUS SYSTEM
• Nervous system controls all the activities of the
body.
• It is divided into two parts.
- Central nervous system.
- Peripheral nervous system.

7. ANATOMY & PHYSIOLOGY OF
NERVOUS SYSTEM
i. CENTRAL NERVOUS SYSTEM:-
• It includes brain and spinal cord.
• It is formed by neuron and the supporting cells
called neuroglia.
• Brain is situated in the skull.
• It continued as spinal cord in the vertebral canal
through foramen magnum of the skull bone.

8. ANATOMY & PHYSIOLOGY OF
NERVOUS SYSTEM
• Brain and spinal cord are surrounding by three
layers of meninges called the outer Dura mater,
middle Arachnoid mater and inner Pia mater.
• The space between the arachnoid mater and
Pia mater is known as subarachnoid space.
• This space is filled with a fluid called
cerebrospinal fluid.

9. ANATOMY & PHYSIOLOGY OF
NERVOUS SYSTEM
ii. PERIPHERAL NERVOUS SYSTEM:-
• It consists of all the nerves outside the brain
and spinal cord.
• It is divided into two subdivisions;
• Somatic nervous system (it includes the nerves
supplying the skeletal muscles, it control the
movements of the body e.g. Skeletal muscles).

10. ANATOMY & PHYSIOLOGY OF
NERVOUS SYSTEM
• Autonomic nervous system (it concerned with
regulation of visceral or vegetative functions
e.g. cardiac muscles, smooth muscles, glands).
• It is also divided into two types 1. Sympathetic
2. Parasympathetic division.

11. TYPES OF ANESTHESIA
Anesthetic produce anesthesia because they are
delivered to the brain at a high partial pressure
that
enable them to cross the blood-brain-barrier.

12. CONTI..
1. GENERAL ANESTHESIA:-
It is a state of nacrosis, analgesia, relaxation,
and reflex loss. Patient under general
anesthesia are not arousable, not even to
painful stimuli. They loss the ability to maintain
ventilatory function and require assistance in
maintaining a patent airway. Cardiovascular
function may be impaired.

13. CONTI..
 Stages of general anesthesia-a.
STAGE I:- BEGINNING ANESTHESIA
The patient may have a ringing, roaring, or
buzzing in
the ears and though still conscious, may sense
an
inability to move the extremities easily.
b. STAGE II:- EXCITEMENT
The pupils dilate, but contract if exposed to
light,

14. CONTI..
c. STAGE III:- SURGICAL ANESTHESIA
Surgical anesthesia is reached by continued
administration of the anesthetic vapor or gas.
The
patient is unconscious and lies quietly on table.
The pupils are small but contract when exposed
to
light. Respirations are regular, the pulse rate and
volume are normal and the skin is pink or slightly
flushed.

15. CONTI..
d. STAGE IV:- MEDULLARY DEPRESSION
This stage reached when too much anesthesia
has been administered. Respirations become
shallow, the pulse is weak and thready, and the
pupils become widely dilated and no longer
contract when exposed to light. Cyanosis
develops and without prompt intervention death
rapidly follows.

18. ANESTHESTIC TECHNIQUES OF
GENERAL ANESTHESIA
 INHALATION:
Liquid anesthetics may be administered by
mixing the vapors with oxygen or nitrous
oxide-oxygen and then having the patient
inhale the mixture. The inhalation anesthetic
may also be administered through a laryngeal
mask and endotracheal tube.

19. CONTI..
o INHALATION ANESTHETIC AGENTS:-
A. LIQUID ANESTHETIC AGENTS:
a. Halothane-
• Advantages- it is useful in every type of
surgery and low incidence of post operative
nausea and vomiting. The induction is rapid
and smooth.
• Disadvantage- it require skillful administration
to prevent over dosage and require special
vaporizer for administration. It may cause liver
damage and produce hypotension.

20. CONTI..
b. Methoxyflurane-
• Advantage- it is a excellent muscles relaxation
and have a analgesic action continues several
hours after surgery.
• Disadvantage- it has unpleasant odour and
renal damage may occur.
•

22. CONTI..
B. GASES ANESTHTIC AGENTS-a.
Nitrous oxide (N2O):-
• Advantage- it’s induction and recovery rapid. it
is noninflammable and useful with oxygen for
short procedures and useful with other agents
for all type of surgery.
• Disadvantage- it is a poor relaxant & weak
anesthetic. May produce hypoxia.

23. CONTI..
 INTRAVENOUS:
o General anesthesia can also be produced by
the intravenous injection of various
substances such as barbiturates,
benzodiazepines, non-barbiturate hypnotics,
dissociative agents and opioid agents.
o An advantage
a. Onset of anesthesia is pleasant
b. No buzzing, roaring, or dizziness
c. Duration of action is brief and
d. Patient awaken with little nausea and

24. CONTI..
A. INTRAVENOUS ANESTHETIC AGENTS:
a. Tranquilizers and Sedative hypnotics-
 Benzodiazepines midazolam:-
- Advantage- it is a short acting and has
antianxiety, sedative, amnesic, and muscle
relaxant effect.
- Disadvantage- increased sensitivity to its
effects in chronic obstructive pulmonary
disease patient.

25. CONTI..
b. Opioids-
Morphine:-
- Advantage- it is not a myocardial depressant.
- Disadvantage-i.
Depress arterial blood pressure
ii. Dose not provide good amnesia

26. CONTI..
c. Barbiturates-
 Thiopental sodium-
- Advantage-i.
Low incidence of post operative nausea and
vomiting & rapid induction
ii. Requires little equipment.
- Disadvantage-i.
powerful depressant of breathing
ii. not useful for children

27. CONTI..
d. Nonbarbiturate hypnotic-
 Propofol-
- Advantage-i.
Rapid induction
ii. Antiemetic effect.
- Disadvantage-i.
Myocardial depression
ii. Hypotension
iii. Pain on injection

28. CONTI..
2. REGIONAL ANESTHESIA:-
oRegional anesthesia is a form of local
anesthesia in which an anesthetic agent is
injected around nerves so that the area
supplied by these nerves is anesthetized.
oIt is defined as “a reversible loss of
sensation in a specific area of the body”
i. Spinal anesthesia
ii. Epidural anesthesia
iii. IV Regional Blocks
iv. Peripheral Nerve Blocks

29. CONTI..
i. Spinal Anesthesia:-
A local anesthetic agent is injected into the
subarachnoid space. Spinal anesthesia is also
known as a subarachnoid block. Blocks
sensory and motor nerves, producing loss of
sensation.
Spinal anesthetic agents-a.
Procaine (Novocaine)-
- Advantage- easily administered by a physician.
- Disadvantage- Blood pressure may fall rapidly.

31. CONTI..
i. Epidural Anesthesia-
Local anesthetic agent is injected through an
inter vertebral space into the epidural space
may be administered as a one-time dose, or as
a continuous epidural, with a catheter inserted
into the epidural space to administer anesthetic
drug.
Complications of Epidural Anesthesia-
Hypotension
Inadvertent dural puncture
Inadvertent injection of anesthetic into the
subarachnoid space

32. CONTI..
iii. Peripheral nerve block-
It is achieved by injecting a local anesthetic into a
bundle of nerves (eg. Axillary plexus) or into a
single nerve to achieve anesthesia to a specific
part of body (eg. Hand or single finger).
 Brachial plexus block- Anesthesia for arms
 Para-vertebral anesthesia- which produces
anesthesia of the nerves supplying the chest,
abdominal wall, and extremities.
 Transsacral (caudal) blocks- which produces
anesthesia of the perinieum and occasionally,
the lower abdomen.

33. CONTI..
iv. Moderate sedation-o
Moderate sedation is a form of anesthesia that
involves the IV administration of sedatives or
analgesics medications to reduce patient
anxiety and control pain during diagnostic and
surgical procedure.
oThe goal is to depress a patient’s
consciousness to a moderate level to enable
surgical, diagnostic, or therapeutic procedures
to be performed while ensuring the patient’s
comfort during and cooperation with the
procedures.

35. CONTI..
oThe patient is able to maintain a patient airway,
retain protective airway reflexes, and respond
to verbal and physical stimuli.

36. CONTI..
V. Local anesthesia-
 It is the injection of a solution containing the
anesthetic agents into the tissue at the planned
incision site.
 Advantages of local anesthesia are as follows:
a. It is simple, economical, and non explosive.
b. Equipment needed is minimal.
c. Postoperative recovery is brief.
d. Undesirable effects of general anesthesia are
avoided.
e. It is ideal for short and minor surgical
procedures

37. CONTI..
 Local anesthesia is often administered in
combination with epinephrine. Epinephrine
constricts blood vessels, which prevents rapid
absorption of the anesthetic agent and thus
prolongs its local action.
 The action of the agent is almost immediate, so
surgery may begin as soon as the injections
complete. Anesthesia lasts 45 min to 3 hr.
depending on the anesthetic agent and the
simultaneous use of epinephrine.

39. CONTI..
LOCAL ANESTHETIC AGENTS:-
a. Lidocain-
- Administration-
Epidural
Spinal
Peripheral intravenous
Local infiltration.
- Advantage- It has rapid effect and longer
duration of action. Duration is 2-3 times
longer than lidocaine & free from local
irritative effect.
- Disadvantage- occasional idiosyncrasy.

40. CONTI..
b. Tetracaine-
- Administration- It is topical, infiltration, and
nerve block local infiltration.
- Advantage- long acting, produces good
relaxation.
- Disadvantage- occasionally allergic reaction.