2. Anaesthesia : A clinical and philosophical concept
It is in the Hippocratic Corpus, that the word ‘anaesthesia’
was used for the first time in a medical context as reversible
loss of sensation and unconsciousness, when Hippocrates
writes:
“For when they [breaths] pass through the flesh and puff it
up, the parts of body affected lose the power of feeling
[‘anaestheta’]”.
Anaesthesia : Aclinical and philosophical concept
It is in the Hippooatic Corpus, that the word 'anaesthesia'
was usedfor theftrst time in a medical context as reversible
loss of sensation and unconsciousness, when Hippocrates
writes:
"For when they[breaths]pass through theflesh andpuffit
up, the parts ofbody gfected lose the power of
feeling
['anaestheta']'.'
3. What was done to a patient before an operation ?
It was the custom then, as for centuries afterward, to bind the patient to
the table with ropes or straps. His screams were disregarded, but if he
struggled too Violently, assistants grasped his arms and legs.
Whatwas done to a patient b+re an operation ?
Wellcorne Irnages
It was the custom then, as for centuries afterward, to bind the patient to
the table with ropes or straps. His screams were disregarded, but if he
struggled oo Violently, assistants grasped his arms and legs.
4. • Pain had not prevented surgery in the past, but it had made it
almost an unbearable, excruciating agony.
• In January 1843, George Wilson, a medical student who
underwent surgery to amputate an infected leg, described his
experience of surgery without anaesthesia and analgesia.
• “Of the agony it occasioned, I will say nothing. Suffering so great
as I underwent cannot be expressed in words. ... The particular
pangs are now forgotten;but the black whirlwind of emotion, the
horror of great darkness, and the sense of desertion by God and
man, bordering close upondespair, which swept throughmy
mind and overwhelmed my heart, I can never forget ...”
Pain had not prevented surgery in the past, but it had made it
almost an unbearable, excruciating agony.
' n January 1843, George Wilson, a medical student who
nderwent surgery to amputate an infected leg, described his
xperience of surgery without anaesthesia and analgesia.
"Ofthe agony it occasioned, I will say nothing. Suffering so great
as I underwent cannot be expressed in words. The particular
pangs are nowforgotten;but the blackwhirlwind ofemotion, the
horror ofgreat darkness, and the sense ofdesertion by God and
man, bordering close upon despair, which swept through my
ind and overwhelmed my heart, I can neverforget
5. By the early1840s successive cultural and medical changes
basedon newerhumanistic standards had resultedin the view
that physical painis purposeless.
This new concept regardingpain prevention and its relief is the
social scenery for the discovery of modern ‘anaesthesia’ during
the middle of the 19thcentury.
By the early 1840s successive cultural and medical changes
based on newer humanistic standards had resulted in the view
that physical pain is purposeless,
This new concept regarding pain prevention and its reli# the
soul sceneryfor the discovoy ofmodern 'anaesthesia 'during
the middle ofthe 19th centuy,
6. • The word “Anaesthesia“ was
coined by Oliver Wendell
Holmes in 1846.
• It originates from the Greek an
- "without” and “aisthēsis”
refers to the inhibition
of sensation.
Oliver Wendell Holmes
(1809–1894)
The word "Anaesthesia" was
coined by Oliver Wendell
Holmes in 1846.
It originates from the Greek an
'without" and "aisthésis
refe s the inhibition
to
Ofs nsation.
Oliver Wendell Holmes
(1809-1894)
7. In a letter to William T. G. Morton, the first practitioner
to publicly demonstrate the use of ether during surgery,
he wrote:
"Everybody wants to have a hand in a great
discovery. All I will do is to give a hint or two as to
names—or the name—to be applied to the state
produced and the agent. The state should, I think, be
called 'Anaesthesia.' This signifies insensibility—more
particularly ... to objects of touch.“
In a letter to William T. G. Morton, the first practitioner
to publicly demonstrate the use of ether during surgery,
he wrote:
"Everybody wants to have a hand in a great
discovery. All I will do is to give a hint or two as to
names or the name to be applied to the state
produced and the agent. The state should, I think, be
called 'Anaesthesia.' This signifies insensibility more
particularly ... to objects of touch."
9. • Attempts at producing a state of general anaesthesia can be
traced throughout recorded history.
• The Renaissance saw significant advances
in anatomy and surgical technique. However, despite all this
progress, surgery remained a treatment of last resort.
• An appreciation of the germ theory of disease led rapidly to the
development of antiseptic techniques in surgery reducing the
overall morbidity and mortality of surgery to a far more
acceptable rate.
Attempts at producing a state of general anaesthesia can be
raced throughout recorded history.
he Renaissance saw significant advances
in anatomy and surgical technique. However, despite all this
prog ess, surgery remained a treatment of last resort.
' An a preciation of the germ theory of disease led rapidly to the
devel pment of antiseptic techniques in surgery reducing the
overa I morbidity and mortality of surgery to a far more
acceptable rate.
10. • Concurrent with these developments were the significant
advances in pharmacology and physiology which led to the
development of general anesthesia and the control of pain.
• In the 20th century, the safety and efficacy of general anesthesia
was improved by the routine use of tracheal intubation and other
advanced airway management techniques.
• Significant advances in monitoring and new anesthetic
agents with improved pharmacokinetic and pharmacodynamic
characteristics also contributed to this trend.
Concurrent with these developments were the significant
dvances in which led to the
pharmacology and physiology
development of general anesthesia and the control of pain.
, In the 20th century the safety and efficacy of general anesthesia
was improved by the routine use of tracheal intubation and other
adva ced airway management techniques.
Signi Icant advances in monitoring and new anesthetic
agent with improved pharmacokinetic and pharmacodynamic
charac eristics also contributed to this trend.
11. TIMELINE OF
ANESTHESIA
• Antiquity
• Middle ages and Renaissance
• 18th Century
• 19th Century
• 20th Century
• 21st Century
TIMELINE OF
ANESTHESIA
' Antiquity
' Middle ages and Renaissance
' 18th Century
' 19th Century
' 20th Century
' 21st Century
12. Antiquity
Antiquity saw the dawn of anesthesia.
This era saw the uses of poppy,
mandrake, Indian hemp, cocaine and
carotid compression.
Antiquity
Antiquity saw the dawn of anesthesia.
This era saw the uses of poppy,
mandrake, Indian hemp, cocaine and
carotid compression.
14. Opium, is a very popular ancient pain relieving and euphoria
inducing remedy.
It is first said to have been cultivated in lower mesopotamia
(Southwest Asia) in 3400 BC.
Sumerians referred it as “hul-gil” which means “joy plant”
Sumerians passed this “miracle drug” to the Assyrians who in
turn passed opium to the Babylonians and then to the
Egyptians.
3400 BC
3400 BC
is a very popular ancient pain relieving and euphoria
Opium
inducing remedy.
is first said to have been cultivated in lower mesopotamia
(Southwest Asia) in 3400 BC.
Sunlerians referred it as which means
hul-gil joy plant
Sumerians passed this "miracle drug" to the Assyrians who in
turn passed opium to the Babylonians and then to the
Egy tians.
15. • The knowledge and use of opium
passed on from Egypt across
Mediterranean Sea trade routes to
various civilizations including the
Phoenicians and the Greeks.
• Later, around 330 BC, Alexander the
Great and his armies introduced
opium to the people of India, Persia
and other eastern and Middle Eastern
kingdoms.
The knowledge and use of opium
passed on from Egypt across
Mediterranean Sea trade routes to
various civilizations including the
Phoenicians and the Greeks.
La er, around 330 BC, Alexander the
Gre t and his armies introduced
opi m to the people of India, Persia
and other eastern and Middle Eastern
king oms.
2
16. Prior to the introduction of opium to ancient India and China,
these civilizations pioneered the use of cannabis incense and
aconitum. By the 8th century AD, Arab traders had brought
opiumto India and China.
Prior to the introduction ofopium to ancient India and China,
these civilizations pioneered the use of cannabis incense and
aconituwu By the 8th centuty AD, Arab traders had brought
opium to India and China
17. • Pictographs showing practice of
Acupuncture in China on bone
and Tortoise shells with
inscriptions dating from the time
of Shang dynasty have been
found, and it is thought that
these were used for divination in
the art of healing.
1600 BC
1600 BC
ictographs showing practice of
puncture in China on bone
and Tortoise shells with
inscr•ptions dating from the time
of Shang dynasty have been
foun , and it is thought that
these were used for divination in
thea of healing.
18. • Sushruta in Sushruta
Samhita advocated the use of
wine with incense
of cannabis for anaesthesia.
• The use of henbane and
of Sammohini and Sanjivani
are reported at a later period
600 BC
600 BC
in
Sushruta
Susruta
(600 BC)
Sushruta
Samhita advocated the use of
wme with incense
o, cannabis for anaesthesia.
The use of henbane and
of ammohini and Sanjivani
are r ported at a later period
19. • Assyrians and Egyptians used
carotid compression to produce
brief unconsciousness before
circumcision or cataract surgery.
• In a passage in
History of Animals, Aristotle says of the jugular veins: “If these
veins are pressed externally, men, though not actually choked,
become insensible, shut their eyes, and fall flat on the ground."
400 BC
400 BC
Assyrians and Egyptians used
carotid compression to produce
rief unconsciousness before
circumcision or cataract surgery.
Ina assage in
roti
artery
Hist ry ofAnimals, Aristotle says of the jugular veins: "If these
veins are pressed externally, men, though not actually choked,
become insensible, shut their eyes, and fall flat on the ground. "
20. • Pedanius Dioscorides, a Greek
surgeon in the Roman army of
Emperor Nero, recommended
mandrake boiled in wine to
"cause the insensibility of those
who are to be cut or cauterized.”
in his writings in De Materia
Medica
C. 64 BC
C. 64 BC
a Greek
Pedanius Dioscorides
surgeon in the Roman army of
Emperor Nero, recommended
I iandrake boiled in wine to
"cause the insensibility of those
who are to be cut or cauterized."
in his writings in De Materia
Me ica
21. • Hua Tuo of China used to perform surgery
under anesthesia using a formula he had
developed and called mafeisan.
• The word mafeisan probably means
something like "cannabis boil powder".
• The exact composition of mafeisan, similar to all of Hua Tuo's clinical
knowledge, was lost when he burned his manuscripts, just before his
death.
CA 160
cA 160
' H a Tuo of China used to perform surgery
u der anesthesia using a formula he had
developed and called mafeisan.
The word mafeisan probably means
something like ' cannabis boil powder O Wood Library:Musau
The exact composition of mafeisan, similar to all of Hua Tuo's clinical
knowled e, was lost when he burned his manuscripts, just before his
death.
24. Origin
• The compound may have been created by Jābir ibn Hayyān in
the 8th century .
• Alchemist Ramon Llull has also been credited with
discovering diethyl ether in 1275, althoughthere is no
contemporary evidence of this.
Origin
' The compoundmay have been created byJäbir ibnHayyän in
the 8th century.
' Alchemist Ramon Llull has also been creditedwith
discovering diethyl ether in 1275, although there is no
contemporat•y evidence ofthis,
25. • Paracelsus (1493–1541) isolated
substances that resulted from interaction of
alcohol and vitriol and demonstrated its
action in chickens.
• He noted chickens enjoy sweet vitriol
[ether] - after which they "undergo
prolonged sleep, awake unharmed".
• However, he did not extend this discovery
from farm animals to people.
1525
1525
Paracelsus (1493-1541) isolated
s bstances that resulted from interaction of
Icohol and vitriol and demonstrated its
action in chickens.
He noted chickens enjoy sweet vitriol
[ether after which they "undergo
prolonged sleep, awake unharmed".
Howe r, he did not extend this discovery
from fa animals to people.
26. • German physician Valerius Cordus
(1515–1544), is widely credited
with developing a method for
synthesizing ether.
• He synthesized diethyl ether by
distilling ethanol and sulphuric acid
into what he called by the poetic
Latin name oleum dulci vitrioli, or
"sweet oil of vitriol”
1540
1540
erman physician Valerius Cordus
( 515—1544), is widely credited
ith developing a method for
synthesizing ether.
He ynthesized diethyl ether by
distill ng ethanol and sulphuric acid
into hat he called by the poetic
Latin name oleum dulci vitrioli or
"swee of vitriol"
27. • The name ether was given to the substance in 1729 by August
Sigmund Frobenius.
• WilliamT. G. Morton was First in the worldto publicly and
successfully demonstrate the use of ether anesthesia for
surgery.
' Thename ether was givento the substance in 1729 byAugust
Sigmund Frobenius,
' William T, G, Mortonwas First intheworldto publiclyand
successfully demonstrate the use ofether anesthesiafor
surgoy,
28. Developments in 18th century
pmentsin18thcenboy
Develo
OF GAS.
Tcu: Nitrous Oxide. or Gas.
It is of equivalent
it by au'tracti"',.• pret of tLe Oxygen ft-ota thet Nitrie Oxide.
Oxygen angi Nitr€:gen. of Sir i)avy. it was
30. • Joseph Priestley (1733–1804) was an
English chemist who discovered nitrous
oxide (1772), nitric oxide, ammonia,
hydrogen chloride and oxygen(1774).
• He originally named nitrous oxide as "nitrous air, diminished”,
on account of his preparative method of allowing NO to
standing in contact with moist iron filing
.
1771-1786
1771-1786
' Joseph Priestley (1733—1804) was an
English chemist who discovered nitrous
oxide (1772), nitric oxide, ammonia,
hydrogen chloride and oxygen(1774).
11774
Discovny OF
He riginally named nitrous oxide as nitrous air, diminished
on ccount of his preparative method of allowing NO to
stan ing in contact with moist iron filing
32. • Priestley was clearly perplexed as to the nature of his diminished
nitrous air.
• A candle burnt with an increased brightness in the gas. When
mice were placed in a bell-jar of N2O their liveliness was
reduced and they soon died.
• In contrast they seemed livelier if they respired oxygen, which
Priestley subsequently discovered.(1774).
• But general anaesthesia by the inhalation of nitrous oxide wasn't
demonstrated for over 40 years till December 1844 by US
dentist Horace Wells.
Priestley was clearly perplexed as to the nature of his diminished
nitrous air.
A candle burnt with an increased brightness in the gas. When
mice were placed in a bell-jar of N20 their liveliness was
reduced and they soon died.
' Inhcontrast they seemed livelier if they respired oxygen, which
Prie tley subsequently discovered.(1774).
But eneral anaesthesia by the inhalation of nitrous oxide wasn't
dem nstrated for over 40 years till December 1844 by US
dentist Horace wells
34. JULY, 1800
Even though N2O was discovered by
Joseph Priestley it Humphry Davy who
spotted its medical potential
In 1798, Humphry Davy was appointed
laboratory superintendent of the Pneumatic
Institute in Bristol, UK. This was an
establishment founded on the belief that
the recently discovered gases might have
curative applications
JULY, 1800
Eve though N20 was discovered by
Jos ph Priestley it who
Humphry Davy
spo ted its medical potential
In 1798, Humphry Davy was appointed
laboratoyy superintendent of the Pneumatic
Institute in Bristol, UK. This was an
establishment founded on the belief that
the rece tly discovered gases might have
curative ap lications
35. • Curiously, the use of this gas in therapy is barely mentioned: a
couple of accounts of its use on paralysed patients, and that's about
the extent.
• It is at the end of this book “the history, chemistry, physiology and
recreational use of nitrous oxide” that he makes his off-repeated
statement about the possible use of nitrous oxide in surgery:
"As nitrous oxide in its extensive operation appears capable of
destroying physical pain, it may probably be used with advantage
during surgical operations in which no great effusion of blood takes
place."
Curiously, the use of this gas in therapy is barely mentioned: a
ouple of accounts of its use on paralysed patients, and that's about
he extent.
It is at the end of this book "the history, chemistry, physiology and
recreational use of nitrous oxide" that he makes his off-repeated
state ent about the possible use of nitrous oxide in surgery:
"As nitrous oxide in its extensive operation appears capable of
destroying physical pain, it may probably be used with advantage
during surgical operations in which no great effusion of blood takes
place,"
36. • Henry Hill Hickman (1800–1830)
experimented with the use of carbon
dioxide as an anesthetic in the 1820s.
• He would make the animal insensible,
effectively via almost suffocating it
with carbon dioxide, then determine
the effects of the gas by amputating
one of its limbs.
.
1824
1824
(1800-1830)
Henry Hill Hickman
experimented with the use of carbon
dioxide as an anesthetic in the 1820s.
He ould make the animal insensible,
effectively via almost suffocating it
wit
the
one
carbon dioxide, then determine
ffects of the gas by amputating
f its limbs.
37. • In 1824, Hickman submitted the results of his research to
the Royal Society in a short treatise entitled Letter on
suspended animation: with the view of ascertaining its
probable utility in surgical operations on human subjects.
• The response was an 1826 article in The Lancet titled
'Surgical Humbug' that ruthlessly criticized his work.
• Hickman died four years later at age 30. Though he was
unappreciated at the time of his death, his work has since been
positively reappraised and he is now recognized as one of the
fathers of anesthesia
' In 1824, Hickman submitted the results of his research
the Royal Society in a short treatise entitled Letter
suspended animation: with the view of ascertaining
probable utility in surgical operations on human subjects.
to
on
its
The response was an 1826 article in The Lancet titled
'Surgical Humbug' that ruthlessly criticized his work.
Hic man died four years later at age 30. Though he was
unappreciated at the time of his death, his work has since been
posit•vely reappraised and he is now recognized as one of the
fathe of anesthesia
38. • Crawford W. Long had observed in the
ether frolics gatherings, that some
participants experienced bumps and
bruises, but afterward had no recall of
what had happened.
• He postulated that that diethyl ether
produced pharmacologic effects similar to
those of nitrous oxide.
• On 30 March 1842, he administered
diethyl ether by inhalation to a man named
James Venable, in order to remove a cysts
from the man's neck.
1842
1842
had observed in the
rawford W. Long
ether frolics gatherings, that some
articipants experienced bumps and
ruises, but afterward had no recall of
what had happened.
He postulated that that diethyl ether
prodåced pharmacologic effects similar to
those of nitrous oxide.
On 0 March 1842, he administered
dieth ether by inhalation to a man named
James Venable, in order to remove a cysts
from t e man's neck.
CRAWCOROW LONG
39. • Dr. Horace Wells (1815-1848) volunteered to inhale nitrous
oxide for his own dental extraction back in December of 1844.
• Wells then began to administer nitrous oxide to his patients,
successfully performing several dental extractions over the next
couple of weeks.
1845
1845
, Dr. orace wells (1815-1848) volunteered to inhale nitrous
oxide for his own dental extraction back in December of 1844.
Wells then began to administer nitrous oxide to his patients,
succe sfully performing several dental extractions over the next
couple of weeks.
40. • In spite of these convincing results being reported by Wells to the
medical society in Boston already in December 1844, this new
method was not immediately adopted by other dentists.
• The reason for this was most likely that Wells, in January 1845 at
his first public demonstration to the medical faculty in Boston, had
been partly unsuccessful, leaving his colleagues doubtful
regarding its efficacy and safety the partial anesthetic was judged
as a "humbug."
spite of these convincing results being reported by Wells to the
edical society in Boston already in December 1844, this new
ethod was not immediately adopted by other dentists.
The reason for this was most likely that Wells, in January 1845 at
his first public demonstration to the medical faculty in Boston, had
been partly unsuccessful, leaving his colleagues doubtful
regar ing its efficacy and safety the partial anesthetic was judged
as a "humbug."
42. • On October 16,1846 William T. G. Morton (1819-1868)
became first in the world to publicly and successfully
demonstrate the use of ether anesthesia for surgery. This occurred
at what came to be called "The Ether Dome," at Massachusetts
General Hospital.
1846
1846
On ctober 16,1846 (1819-1868)
William T. G, Morton
beca e first in the world to publicly and successfully
demo strate the use of ether anesthesia for surgery. This occurred
at whåt came to be called at Massachusetts
The Ether Dome
Genera Hospital.
43. The Ether Dome is a surgical operating amphitheater in
the Bulfinch Building at Massachusetts General
Hospital in Boston.
It was the site of the first public demonstration of the use of
inhaled ether as a surgical anesthetic on 16 October 1846.
The ether Dome is a surgical operating amphitheater in
the Bu finch Building at Massachusetts General
Hospital in Boston.
It was t e site of the first public demonstration of the use of
inhaled ether as a surgical anesthetic on 16 October 1846.
44. • Crawford Long, had previously administered ether in 1842,
but this went unpublished until 1849.
• The Ether Dome event occurred when William T. G. Morton,
used ether to anesthetize Edward Gilbert Abbott.
• John Collins Warren, the first dean of Harvard Medical
School, then painlessly removed part of a tumor from Abbott's
neck.
• After Warren had finished, and Abbott regained consciousness,
Warren asked the patient how he felt.
had previously administered ether in 1842,
' Crawford Long
but this went unpublished until 1849.
The Ether Dome event occurred when William T. G, Morton,
used ether to anesthetize Edward Gilbert Abbott.
the first dean of Harvard Medical
' Joi n Collins Warren
School, then painlessly removed part of a tumor from Abbott's
neck.
Afte Warren had finished, and Abbott regained consciousness,
Warren asked the patient how he felt.
45. • Reportedly, Abbott said, "Feels as if my neck's been
scratched". Warren then turned to his medical audience and
uttered "Gentlemen, this is no Humbug".
• This was presumably a reference to the unsuccessful
demonstration of nitrous oxide anesthesia by Horace Wells in
the same theater the previous year, which was ended by cries
of "Humbug!" after the patient groaned with pain..
Reportedly, Abbott said, "Feels as if my neck's been
scratched". Warren then turned to his medical audience and
uttered "Gentlemen, this is no Humbug",
This was presumably a reference to the unsuccessful
de onstration of nitrous oxide anesthesia by Horace Wells in
the ame theater the previous year, which was ended by cries
of" umbug!" after the patient groaned with pain..
47. • Chloroform was discovered independently
in 1831 by the USA's Samuel Guthrie,
France's Eugène Soubeiran, and
Germany's Justus von Liebig.
• Prof. James Y. Simpson (1811-1870)-
Scottish obstetrician begins administering
chloroform to women for pain during
childbirth.
• Chloroform quickly became a popular
anesthetic for surgery and dental
procedures as well.
1847
1847
Chloroform was discovered independently
in 1831 by the USA's Samuel Guthrie,
Soubeiran, and
France's Eugene
Germany's Justus von Liebig.
James Y. Simpson (1811-1870)-
Scottish obstetrician begins administering
chloroform to women for pain during
chilåbirth.
Ch oroform quickly became a popular
anesthetic for surgery and dental
proc dures as well.
48. • Dr. John Snow (1813-1858) who was a
fulltime anesthetist since 1847,
popularized obstetric anesthesia by
chloroforming Queen Victoria for the
birth of Prince Leopold (1853) and
Princess Beatrice (1857).
1853 & 1857
1853 & 1857
Dr. John Snow (1813-1858) who was a
fulltime anesthetist since 1847,
popularized obstetric anesthesia
chloroforming Queen Victoria for
bi h of Prince Leopold (1853)
Princess Beatrice (1857).
by
the
and
John Snow
The First Anaesthetist
49. • Knowledge of the narcotic effect of chloroform spread rapidly,
but very soon reports of sudden deaths mounted.
• The first fatality was a 15-year-old girl called Hannah Greener,
who died on January 28, 1848.
• Between 1864 and 1910 numerous commissions in UK studied
chloroform, but failed to come to any clear conclusions.
• The reservations about chloroform could not halt its soaring
popularity. Between about 1865 and 1920, chloroform was
used in 80 to 95% of all narcoses performed in UK and
German-speaking countries.
Knowledge of the narcotic effect of chloroform spread rapidly,
but very soon reports of sudden deaths mounted.
The first fatality was a 15-year-old girl called Hannah Greener,
who died on January 28, 1848.
Between 1864 and 1910 numerous commissions in UK studied
chloroform, but failed to come to any clear conclusions.
The reservations about chloroform could not halt its soaring
pop larity. Between about 1865 and 1920, chloroform was
use in 80 to 9500 of all narcoses performed in UK and
German-speaking countries.
50. History of Cocaine
History ofCocaine
cocam
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51. • Dr. Karl Koller (1857-1944)-Viennese
ophthalmologist and colleague of
Sigmund Freud, introduced cocaine as
an anesthetic for eye surgery.
• Koller recognized its tissue-numbing capabilities, and in 1884
demonstrated its potential as a local anaesthetic to the medical
community.
1884
1884
(1857-1944)-Viennese
Dr. Karl Koller
ophthalmologist and colleague of
Sigmund Freud, introduced cocaine as
an anesthetic for eye surgery.
Koll r recognized its tissue-numbing capabilities, and in 1884
dem nstrated its potential as a local anaesthetic to the medical
community.
52. • Koller's findings were a medical
breakthrough. Prior to his discovery,
performing eye surgery was difficult
because the involuntary reflex
motions of the eye to respond to the
slightest stimuli.
• Later, cocaine was also used as a
local anaesthetic in other medical
fields such as dentistry
Koller's findings were a medical
breakthrough. Prior to his discovery,
performing eye surgery was difficult
because the involuntary reflex
motions of the eye to respond to the
slightest stimuli.
Lat r, cocaine was also used as a
loca anaesthetic in other medical
field such as dentistry
aCOCAINE(
'OCHLORIDE Topical
t Coeæt-e
53. • Dr. August Bier (1861-1949) was a
German surgeon.
• On 16 August 1898, Bier performed
the first operation under spinal anesthesia at the Royal Surgical
Hospital of the University of Kiel.
• The subject was scheduled to undergo segmental resection of
his left ankle, which was severely infected with tuberculosis.
1898
1898
Dr. August Bier (1861-1949) was a
German surgeon.
' On 16 August 1898, Bier performed
the Irst operation under spinal anesthesia at the Royal Surgical
Ho ital of the University of Kiel.
The subject was scheduled to undergo segmental resection of
his I t ankle, which was severely infected with tuberculosis.
54. • But Bier dreaded the prospect of general anesthesia because he had
suffered severe adverse side effects during multiple previous
operations. Therefore, Bier suggested "cocainization" of the spinal
cord as an alternative to general anesthesia.
• Bier injected 15 mg of cocaine intrathecally, which was sufficient
to allow him to perform the operation. The subject was fully
conscious during the operation, but felt no pain.
B t Bier dreaded the prospect of general anesthesia because he had
su ered severe adverse side effects during multiple previous
op rations. Therefore, Bier suggested "cocainization" of the spinal
co d as an alternative to general anesthesia.
Bier injected 15 mg of cocaine intrathecally, which was sufficient
to allo him to perform the operation. The subject was fully
conscious during the operation, but felt no pain.
55. • Two hours after the operation, the subject complained
of nausea, vomiting, severe headache, and pain in his back and
ankle.
• The vomiting, back and leg pain improved by the following day,
but the headache was still present.
• Bier performed spinal anesthetics on five more subjects for
lower extremity surgery, using a similar technique and achieving
similar results
wo hours after the operation, the subject complained
f nausea, vomiting, severe headache, and pain in his back and
nkle.
The vomiting, back and leg pain improved by the following day,
butthe headache was still present.
Bier
lowe
simil
performed spinal anesthetics on five more subjects for
extremity surgery, using a similar technique and achieving
r results
57. The 20thcentury saw the transformation of the practices of
tracheotomy, endoscopy and non-surgical tracheal intubation
fromrarelyemployed procedures to essential componentsof the
practices of anesthesia, critical care medicine, emergency
medicine, gastroenterology, pulmonology and surgery.
The 20th centuyy saw the transformation ofthe practices of
tracheotomy, endoscopy and non-surgical tracheal intubation
fromrarely employdprocedures to essential components ofthe
practices ofanesthesia, critical care medicine, emergency
medicine, gastroenterolou, pulmonolog and surgety.
59. In 1902, Hermann
Emil Fischer (1852–
1919) and Joseph von
Mering (1849–1908)
discovered that
diethylbarbituric
acid was an
effective hypnotic
agent.
In 1902, Hermann
Emil Fischer (1852—
1919) andJosephvon
Mering (1849—1908)
discovered that
diethylbarbituric
acid was an
effective hypnotic
agent.
60. • Also called barbital or Veronal, the trade name assigned to it
by Bayer Pharmaceuticals, this new drug became the first
commercially marketed barbiturate.
• It was used as a treatment for insomnia from 1903 until the
mid-1950s.
Also called barbital or Veronal, the trade name assigned to it
by Bayer Pharmaceuticals, this new drug became the first
commercially marketed barbiturate.
It as used as a treatment for insomnia from 1903 until the
mid 1950s.
61. • Barbitone was prepared by
condensing diethylmalonic ester
with urea in the presence of sodium
ethoxide, and then by adding at least
two molar equivalents of ethyl iodide
to the silver salt of malonylurea or
possibly to a basic solution of the
acid. The result was an odorless,
slightly bitter, white crystalline
powder.
Barbitone
condensing
prepared by
was
diethylmalonic ester
with urea in the presence of sodium
ethoxide, and then by adding at least
wo molar equivalents of ethyl iodide
to the silver salt of malonylurea or
pos ibly to a basic solution of the
acid. The result was an odorless,
slig tly bitter, white crystalline
POW er.
hlemal'
62. • Alfred Einhorn (1857-1917)-
German chemist develops
procaine and names the substance
"Novocain.“ from the Latin nov-
(meaning new) and -caine, a
common ending for alkaloids used
as anesthetics.
• It was introduced into medical use
by surgeon Heinrich Braun.
1905
Alfred
German
1905
(1857-1917)-
Einhorn
chemist develops
procaine and names the substance
"Novocain." from the Latin nov-
eaning new) and -caine, a
common ending for alkaloids used
as anesthetics.
s introduced into medical use
by surgeon Heinrich Braun
At
63. • Arthur Guedel publishes his eye signs of
Ether anesthesia in the American Journal of
Surgery.
• He also described 4 stages of ether anaesthesia dividing the
stage III into 4 planes
• His Guedel (oral) airway is still used today.
• He has been memorialized by the Arthur E. Guedel Memorial
Anesthesia Center, San Francisco.
1920
1920
Arthur Guedel publishes his eye signs of
Ether anesthesia in the American Journal of
Surgery.
He also described 4 stages of ether anaesthesia dividing the
stage Ill into 4 planes
His Guedel (oral) airway is still used today.
He as been memorialized by the Arthur E. Guedel Memorial
Ane hesia Center, San Francisco.
64. HISTORY OF SODIUM THIOPENTAL
Who cares about
your consent or
Supreme Court's
verdict on
Narco Tests
HISTORY OF SODIUMTHIOPENTAL
65. • Sodium thiopental, the 1st IV
anesthetic, was synthesized in
1934 by Ernest H. Volwiler &
Donalee L. Tabern , working
for Abbott Laboratories.
• In the mid 1930s, Volwiler and Tabern spent three years
screening over 200 candidate compounds in search of a
substance which could be injected directly into the blood
stream to produce unconsciousness
the 1st IV
Sodium thiopental
anesthetic, was synthesized in
1934 by Ernest H, Volwiler &
, working
Donalee L. Tabern
for Abbott Laboratories.
' In he mid 1930s, Volwiler and Tabern spent three years
screening over 200 candidate compounds in search of a
sub tance which could be injected directly into the blood
strea to produce unconsciousness
66. •It was first used in humans on
8 March 1934 by Ralph M. Waters in
an investigation of its properties,
which were short-term anesthesia and
surprisingly little analgesia.
•Three months later, John Silas Lundy started a clinical trial of
thiopental at the Mayo Clinic at the request of Abbott
Laboratories.
' t was first used in humans on
8 arch 1934 by Ralph M. Waters in
a investigation of its properties,
w ich were short-term anesthesia and
suprisingly little analgesia.
•Three months later, John Silas Lundy started a clinical trial of
thiopental at the Mayo Clinic at the request of Abbott
Labora ories.
67. • Volwiler and Tabern were awarded U.S. Patent No. 2,153,729 in
1939 for the discovery of thiopental, and they were inducted into
the National Inventors Hall of Fame in 1986.
• The popularity of thiopental-as a swift-onset intravenous agent
for inducing general anesthesia- paved the way for other totally
unrelated intravenous induction agents, such as ketamine,
etomidate, and propofol.
Volwiler and Tabern were awarded U.S. Patent No. 2,153,729 in
939 for the discovery of thiopental, and they were inducted into
he National Inventors Hall of Fame in 1986.
The popularity of thiopental-as a swift-onset intravenous agent
for 1 ducing general anesthesia- paved the way for other totally
unrelated intravenous induction agents, such as ketamine,
etom date, and propofol.
68. • On 23 January 1942 Griffith and his resident Enid Johnson
administered curare to a young man undergoing
appendicectomy..
Dr. Harold Griffith (1894-1985) & Enid Johnson (1909-2001)
1942
1942
Dr Harold Griffith (1894-1985) & Enid Johnson (1909-2001)
' On 23 January 1942 Griffith and his resident Enid Johnson
administered curare to a young man undergoing
app ndicectomy..
69. The credit for introducing curare to anaesthetics belongs to Griffith.
Griffith and Johnson reported their use of curare in July 1942, and
the introduction to their report is memorable: ‘Every anaesthetist
has wished at times that he might be able to produce rapid and
complete muscular relaxation in resistant patients under general
anaesthesia”
The credit for introducing curare to anaesthetics belongs to Griffith.
GrTfith and Johnson reported their use of curare in July 1942, and
th introduction to their report is memorable: 'Every anaesthetist
has wished at times that he might be able to produce rapid and
complete muscular relaxation in resistant patients under general
anaesthesia "
70. • Many new intravenous and inhalational
anesthetics were developed and brought
into clinical use during the second half of
the 20th century.
• Paul Janssen (1926–2003), the founder of Janssen Pharmaceutica, is
credited with the development of over 80 pharmaceutical
compounds.
• Janssen synthesized nearly all of the butyrophenone class
of antipsychotic agents, beginning with haloperidol (1958)
and droperidol (1961).
Many new intravenous and inhalational
anesthetics were developed and brought
into clinical use during the second half of
the 20th century.
Paul Janssen (1926—2003), the founder of Janssen Pharmaceutica, is
credited with the development of over 80 pharmaceutical
com ounds.
Jans en synthesized nearly all of the butyrophenone class
of ntipsychotic agents, beginning with haloperidol (1958)
and d operidol (1961).
71. • These agents were rapidly integrated into the practice of
anesthesia.
• In 1960, Janssen's team synthesized fentanyl, the first of
the piperidinone-derived opioids.
• Fentanyl was followed by sufentanil (1974), alfentanil
(1976), carfentanil (1976), and lofentanil (1980). Janssen and
his team also developed etomidate (1964),a potent intravenous
anesthetic induction agent.
These agents were rapidly integrated into the practice of
anesthesia.
' In 1960, Janssen's team synthesized fentanyl, the first of
the piperidinone-derived opioids.
' Fen anyl was followed by sufentanil (1974), alfentanil
(19 6), carfentanil (1976), and lofentanil (1980). Janssen and
his eam also developed etomidate (1964),a potent intravenous
anes hetic induction agent.
72. 1956 - UK's Dr. Michael Johnstone clinically introduces
halothane, the first modern-day brominated general
anesthetic.
1963 - Dr. Edmond I. Eger, II described minimum alveolar
concentration (MAC), later characterized as "the
concentration of inhaled anesthetic producing immobility in
50% of patients subjected to a noxious stimulus."
1 56 - UK's Dr.
the
halothane,
anesthetic.
Michael Johnstone
first modern-day
clinically introduces
brominated general
1963 - Dr. Edmond 1. Eger, 11 described minimum alveolar
later characterized as "the
entration (MAC)
entration of inhaled anesthetic producing immobility in
con
of patients subjected to a noxious stimulus."
500
73. 1964- Dr. Günter Corssen et al. begin human trials of the
dissociative intravenous anesthetic ketamine.
1966- Dr. Robert Virtue et al. begin human trials of the inhalational
anesthetic enflurane.
1972- Isoflurane is clinically introduced as an inhalational
anesthetic.
1992- Desflurane is clinically introduced as an inhalational
anesthetic.
1994- Sevoflurane is clinically introduced as an inhalational
anesthetic.
1 64- Dr. Günter Corssen et al. begin human trials of the
dissociative intravenous anesthetic ketamine.
19 6- Dr. Robert Virtue et al. begin human trials of the inhalational
nesthetic enflurane,
is clinically introduced as an inhalational
1972- Isoflurane
anesthetic.
is clinically introduced as an inhalational
1992- esflurane
anest etic.
is clinically introduced as an inhalational
1994- roflurane
anesthetic.
75. • Among the most widely used drugs are Propofol, Etomidate,
Barbiturates such as methohexital and thiopentone,
Benzodiazepines such as midazolam and Ketamine.
• The "digital revolution“ of the 21st century has brought newer
technology to the art and science of tracheal intubation.
• Several manufacturers have developed video laryngoscopes
' Among the most widely used drugs are Propofol, Etomidate,
Barbiturates such as methohexital and thiopentone,
Benzodiazepines such as midazolam and Ketamine.
The "digital revolution" of the 21st century has brought newer
tec nology to the art and science of tracheal intubation.
Sev ral manufacturers have developed video laryngoscopes
76. • Xenon has been used as a general anesthetic. Although it is
expensive, anesthesia machines that can deliver xenon are
about to appear on the European market, because advances in
recovery and recycling of xenon have made it economically
viable.
• New agents based on benzodiazepine, etomidate, and propofol
structures are being developed.
Xenon has been used as a general anesthetic. Although it is
expensive, anesthesia machines that can deliver xenon are
about to appear on the European market, because advances in
recovery and recycling of xenon have made it economically
viable.
' Ne
stru
agents based on benzodiazepine, etomidate, and propofol
tures are being developed.
77. Conclusion
• Surgery learned many lessons through the ages, but never was
it able to banish Pain.
• More than a century ago, a vapor in the operating-room of the
Massachusetts General Hospital blotted out sufferrings from
surgery.
• It was the most beneficent change in the history of surgery,
and has since been one of the greatest gift to mankind.
• However, the history of anaesthetics will remain an unfinished
work, until some one is able to synthesize a drug that will have
all of the desirable properties of the ideal anaesthetic.
Conclusion
Surgery learned many lessons through the ages, but never was
it able to banish Pain.
More than a century ago, a vapor in the operating-room of the
Massachusetts General Hospital blotted out sufferrings from
surgery.
It as the most beneficent change in the history of surgery,
and has since been one of the greatest gift to mankind.
Ho ever, the history of anaesthetics will remain an unfinished
wor , until some one is able to synthesize a drug that will have
all o the desirable properties of the ideal anaesthetic.
81. † Dioscorides first used the term
anesthesia in first century AD
„ To describe the narcotic-like effects
† As “a defect of sensation” in Bailey’s
An Universal Etymological English
Dictionary (1721)
Dioscoridesfirstusedtheterm
o
anesthesiainfirstcenturyAD
Todescribethe narcotic-likeeffects
As"adefectofsensation"inBailey's
o
An Universal Etymological English
(1721)
Dictionary
82. † Oliver Wendell Holmes used its
present meaning (1846)
„ means the sleeplike state
„ makes possible painless surgery
OliverWendellHolmes usedits
o
(1846)
presentmeaning
annakes possible painless surgery
83. History of Anesthesia
† In ancient time, people used
„ Opium poppy, coca leaves, mandrake
root, alcohol, phlebotomy
† Ancient Egyptians used the
combination of opium poppy and
hyoscyamus morphine and
scopolamine
Historyof Anesthesia
Inancienttime,people used
o
Opium poppy,cocaleaves, mandrake
o
root,alcohol,phlebotomy
AncientEgyptians usedthe
o
combinationofopium poppyand
hyoscyamus
scopolamine
morphineand
84. Ether
† Prepared in 1540 by Valerius
Cordus
† Used as sedative in
„ tuberculosis
„ asthma and whooping cough
„ remedy for toothache
† Crawford W. Long and William
Clark used it on patients in 1842
Ether
Prepared in1540 byValerius
o
Cordus
Usedassedative in
o
tuberculosis
o
asthmaand whoopingcough
o
remedyfortoothache
o
Crawford W.LongandWilliam
o
Clarkusediton patients in1842
85. William Morton
(1819-1868)
† The first succesful
surgical
anesthesia, 1846,
Boston
William Morton
(1819-1868)
Thefirstsuccesful
surgical
anesthesia,1846,
Boston
86.
87. 3
7
1. Newspaper repotlet
2. John call Dalton
3. William Williamson
Wellington
4. Abel Lawrence Peitson
5. Char es Hosea Hildreth
6. William Tt'aoma•s
Green Mctlon
7. Jonathan Mason
Warren
B. Gilbert Abbott
g. John Collins Warren
10. H.
11 Charles
Frederick Heywood
12. HeneryJacob Bigelow
13. Augustus Addison
Gould
14. Salomon Davis
88.
89. Professor James Young
Simpson (1811-
1870)
† found chloroform to
be efficacious and
reasonably safe
† used for Prince
Leopold’s and
Princess Beatrice’s
birhts
Chloroform
Chloroform
ProfessorJamesYoung
Simpson(1811-
1870)
foundchloroformto
o
be efficaciousand
reasonablysafe
usedforPrince
o
Leopold'sand
Princess Beatrice's
birhts
90. Nitrous oxide (N2O)
† Produced by Joseph Priestly
1772,
† Humphrey Davy first noted
its analgesic properties in
1800.
† Horace Wells first used it in
humans for anesthesia in
1844
† Less popular in tree agents
„ Low potency
„ Tendency to cause asphyxia H. Davy
(N20)
Nitrousoxide
Produced byJoseph Priestly
1772,
HumphreyDavyfirstnoted
itsanalgesic properties in
1800.
I-Horace Wells firstused itin
humansforanesthesiain
1844
Less popularintreeagents
Low potency
Tendencytocause asphyxia H.Davy
91. Intravenous Anesthesia (IVA)
† Pierre Cyprien Ore
„ Pioneer of IVA
„ Chloral hydrate in
1872
† Barbiturates were
synthesized 1903
„ For induction of
anesthesia
IntravenousAnesthesia(lVA)
Pierre Cyprien Ore
o
Pioneerof1VA
Chloralhydratein
1872
Barbiturates were
o
synthesized1903
Forinductionof
anesthesia
ANGIOCATHS
92. Regional Anesthesia
† In 1860, Albert Niemann isolated
crystalized alcoloids of coca.
† Karl Koller used cocain for eye block in
1884
† In 1885, first epidural block
† In 1898, first spinal anesthesia by
August Bier
† Second local anesthetic agent (prilocain)
was founded in 1904
† Lidocain was founded in 1946
RegionalAnesthesia
o
o
o
o
In1860,AlbertNiemannisolated
crystalizedalcoloids ofcoca.
Karl Kollerusedcocainforeyeblockin
1884
In1885,firstepidural block
I n 1898,firstspinalanesthesiaby
AugustBier
Secondlocalanestheticagent(prilocain)
wasfounded in1904
Lidocainwasfoundedin1946
93. Evolution of the specialty
†The development of the
indepented medical specialty
of anesthesiology would not
occur until the early 20th
century.
Evolutionofthe specialty
Thedevelopmentofthe
indepented medicalspecialty
ofanesthesiologywouldnot
occuruntiltheearly20th
century.
94. † In England, in 1893, the first
organization of physician specialists in
anesthesia, “The Society of
Anesthetists”
† In the United States, the first
organization of physician anesthetists
was formed in 1911.
In England,in1893,thefirst
o
organizationofphysicianspecialistsin
anesthesia,"TheSocietyof
Anesthetists"
Inthe UnitedStates,thefirst
o
organizationofphysiciananesthetists
was formed in1911.
95. † invented an inhaler
for ether
† published the first
book on general
anaesthesia:On the
Inhalation of Ether
John Snow
the father of anaesthesia
aninhaler
forether
publishedthefirst
o
bookongeneral
anaesthesia : Onthe
InhalationofEther
John Snow
the fatherofanaesthesia
96. History of Anesthesia in Turkey-1
† The first publications belong to surgeons
† They made great contributions to
anesthesia in Turkey
† Publication of Miralay Ahmet Bey
„ includes the information about the use of
ether
† Ether anesthesia was first used in
Gülhane Askeri Hospital in 1898 by
Rieder Paşa
Historyof AnesthesiainTurkey-1
Thefirst publications belongtosurgeons
Theymadegreatcontributionsto
anesthesia inTurkey
Publication ofMiralayAhmetBey
o
the use of
ether
Etheranesthesia wasfirstusedin
o
GülhaneAskeriHospitalin1898 by
Ri ed e r Pasa
97. History of Anesthesia in Turkey-2
† Dr. Sadi Sun is the
first anesthesiologist
in Turkey
† The first endotracheal
entubation was
performed by Dr Sun
† In 1955, anesthesia
was accepted as a
medical specialty by
Ministry of Health
Historyof AnesthesiainTurkey-2
Dr.SadiSunisthe
firstanesthesiologist
inTurkey
Thefirstendotracheal
entubationwas
performed by DrSun
In1955,anesthesia
wasacceptedasa
medicalspecialtyby
MinistryofHealth
98. What is Anesthesiology?
†Practice of medicine
dedicated to the relief of
pain and total care of the
surgical patient before,
during and after surgery.
What isAnesthesiology?
Practiceofmedicine
o
dedicatedtothereliefof
painandtotalcareofthe
duri ngandaftersurgery.
99. †Anesthesiologists are a
physician who complete a six
years of medical school and
four more year anesthesiology
residency training program.
Anesthesiologistsarea
o
physician whocompleteasix
yearsofmedicalschooland
fourmore yearanesthesiology
residencytrainingprogram.
100. † Anesthesiologist is the perioperative
physician
† Provides medical care to each patient
„ Evaluating the patient before surgery
(preoperative)
„ Consulting with the surgical team
„ Providing pain control
„ Supporting of life functions during
surgery (intraoperative)
„ Supervising care after surgery
(postoperative)
Anesthesiologististhe perioperative
o
physician
Provides medicalcaretoeachpatient
o
Evaluatingthe patientbefore surgery
(preoperative)
Consultingwiththe surgicalteam
Providing paincontrol
Supporting oflifefunctionsduring
surgery(intraoperative)
Supervisingcareaftersurgery
(postoperative)
101. In the operating room
† The role of anesthesiologist is to provide
continual medical assessment of the
patient
„ Monitor and control the patient’s vital
functions
† Heart rate, rhythm, breathing, blood pressure,
body temperature, fluid balance
† Immediately diagnose and treat any medical
problems during surgery or recovery period
„ Control pain and level of unconsciousness
Intheoperatingroom
The roleofanesthesiologististo provide
continualmedicalassessmentofthe
patient
patient'svital
functions
IHeartrate,rhythm,breathing,blood pressure,
bodytemperature,fluid balance
Immediately diagnose andtreatany medical
o
problemsduringsurgery orrecovery period
Controlpainand levelofunconsciousness
102. In the postanesthesia care unit
† Patients are
transferred to recovery
room after surgery
„ Allowing them to emerge
fully from the anesthetics’
effects
† They are observed by
skilled nursing
personnel
„ After stabilization
sufficiently, transferred to
regular room or home
Inthe postanesthesiacareunit
Patientsare
transferredtorecovery
roomaftersurgery
Allowingthem to emerge
fully fromtheanesthetics'
effects
Theyare observed by
skillednursing
personnel
Afterstabilization
sufficiently,transferredto
regularroomorhome
103. What is Scope of Anesthesiologist?
† Anesthesiologists work in ICU
What isScopeof Anesthesiologist?
Anesthesiologists work inlCU
104. † Sedation and providing anesthesia outside
the operating room
„ Magnetic resonance imaging, cardiac
catheterization etc.
† Pioneers in cardiopulmonary resuscitation
† In childbirth, anesthesiologists manage the
care of two persons
† Anesthesiologists are also involved in pain
management,
„ to diagnose and treatment of acute and chronic
problems.
Sedationandprovidinganesthesiaoutside
o
theoperatingroom
Magnetic resonanceimaging,cardiac
catheterizationetc.
Pioneersincardiopulmonaryresuscitation
o
Inchildbirth,anesthesiologists managethe
o
careoftwo persons
Anesthesiologistsare alsoinvolvedin pain
o
management,
to diagnoseandtreatmentofacute andchronic
problems.
106. Types of
Anaesthesia
PPT PREPARED BY
DR RAJESH T EAPEN
ATLAS HOSPITAL
RUWI
Types of
Anaesthesia
PPTPREPARED BY
DR RAJESH TEAPEN
ATLAS HOSPITAL
RUWI
109. 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.
Anesthesia
From Greek anaisthesis means
not sensation
Listed in Bailey's English
Dictionary 1721.
the effect Of ether was
discovered anesthesia" used as a
name for the new phenomenon.
110. Oxford dictionary
definition
insensitivity to pain, especially
as artificially induced by the
administration of gases or the
injection of drugs before
surgical operations
Oxford dictionary
definition
insensitivity to pain, especially
as artificially induced by the
administration of gases or the
injection of drugs before
surgical operations
112. 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
HISTORY OF ANESTHESIA
General anesthesia was absent until the mid-
800s.
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
onsidered 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
113. 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
Pre 1846 - The Foundations of
—Anaesthesia
so the Lord God caused him to fa//
into a deep sleep, While the man
was s/eeping, the Lord God took out
one ofhis ribs. He closed up the
opening that was in his side
Genesis 2:21 /V1rV
114. 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)
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)
115. 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
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.
NIGH Boston
116. Regional
Anaesthesia
1884 Sigmund Freud
physiology actions
cocaine
Carl Koller cocaine
ophthalmological
surgery
Regional
Anaesthesia
1884 Sigmund Freud
physiology actions
cocaine
Carl Koller cocaine
ophthalmological
surgery
117. 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
Birth of modern Anaesthesia
Chevalier Jackson-use of direct
-1 13,
laryngoscopy as a means to intubate
the trachea
Sodium Pentathal - first used in humans
on 8 March 1934 by Ralph M. Waters
118. Slide master
Your Text here
"Ether Day, 1846" Pictured are Gilbert Abbott (the patient), John Collins Warren,
MD (the surgeon), William T. G. Morton (the anesthetist) and Henry J. Bigelow. MD (the junior
surgeon).
119. 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
1845- Horace wells- N20
1846- William Morton- Ether
1847- Simpson-
1853-John Snow
1878- ETT
1884- Cocaine
1895-98- Spinal
analgesia/anaesthesia
124. 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
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
need for
unconsciousness
'Amnesia-hypnosis'
General anesthesia
need for analgesia
'Loss of sensory and
autonomic reflexes'
need for muscle
relaxation
132. Muscle relaxation
Aids intubation
Helps surgeon/surgery
Surgery of long duration
Reduces maintenance dose of
anaesthetics agents
Muscle relaxation
Aids intubation
Helps surgeon/surgery
Surgery oflong duration
Reduces maintenance dose of
anaesthetics agents
139. Recovery
Turn off agent
Reverse relaxation
Cough reflex
Extubate when awake
Recovery position
Monitor until discharge
Recovery
Turn offagent
Reverse relaxation
Cough reflex
Extubate when awake
Recovery position
Monitor until discharge
140. SAMPLE USE ONLY
@ 2009 Nucleus Medical Art All Rights Reserved.
nucleus
MEDICAL
141. Advantages
No absolute contraindications
Quick to establish
Never fails to work
Advantages
No absolute contraindications
Quick to establish
Neverfails to work
142. Disadvantages
Poly-pharmacy
Effects on various systems
Allergic reactions
Recovery profile
Post operative Nausea &Vomiting
Awareness
Disadvantages
Poly-pharmacy
Effects on various systems
Allergic reactions
Recovery profile
Post operative Nausea &Vomiting
Awareness
147. Local anaesthetics
Lignocaine- quick/short acting
Bupivacaine/levobupicvacaine
- slow and long action
Ropivacaine- as above
Amethocaine- topical
Prilocaine- intravenous
Local anaesthetics
- quick/short acting
/levobupicvacaine
- slow and long action
Ropivacaine- as above
Amethocaine- topical
j'
Prilocaine- intravenous
148. Advantages
Effective alternative to GA
Avoids polypharmacy
Allergic reactions
Extended analgesia
Patient can remain awake
Early drink/feed
Advantages
Effective alternative to GA
Avoids polypharmacy
Allergic reactions
Extended analgesia
Patient can remain awake
Early drink/feed
150. Patient is more important
than our ego; call for help,
whenever patient is in
danger
Your Text here
Patient is more important
than our ego; call for help,
whenever patient is in
000
"Nurse, get on the internet, go to SURGERY.COM,
scroll down and click on the 'Are you totally lost?'
icon.
151. Slide master
Your Text here
THE IDEAL ANESTHETIST
Reader
Seoee &
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cardiae
Free
foot fast
Counter
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FieJd Eye
Gas Eye
.anaeoev.y
4
4
block
anesthetics
Srnag
Storn•ch
Met* Bats
droppiro beetles
AB Blood
Table
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Pacifier
& chest
Shovel
Ernergerwy
152. 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
hoice 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 minorsurgery but only major
anesthesia
153. 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
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
154. 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)
Types Of anesthesia care
Regional Anesthesia
A local anethetic is injected to
block or ansthetize a nerve or
nerve fi
Implies a major nerve block
administered by an
anesthesiologist (such as spinal,
epidural, caudal, or major
peripheral block)
155. 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
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
156. 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
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
157.
158. 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.”
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."
Thank
you
159. Types of Anaesthesia
Prof. med. Nabil H. Mohyeddin
Anesthesiologist & Intensivist
Board certified
University Rostock, Germany
nhm1955@hotmail.com
Types ofAnaesthesia
Prof. med, Nabil H, Mohyeddin
Anesthesiologist &Intensivist
Board certified
University Rostock, Germany
nhm1955@hotmail.com
160. Objectives
Short History
Definition/types of anaesthesia
General anaesthesia/drugs
Phases of GA
Regional anaesthesia
Objectives
Short History
Definition/types ofanaesthesia
General anaesthesia/drugs
Phases ofGA
Regional anaesthesia
161. Early history
Ancient/Medieval period
- Opium
- Alcohol
- Cannabis
Early history
Ancient/Medieval period
Opium
Alcohol
Cannabis
162. 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
1845- Horace Wells- N20
1846- William Morton- Ether
1847- Simpson-
1853-John Snow
1878- ETT
1884- Cocaine
1895-98- Spinal analgesia/anaesthesia
172. Muscle relaxation
Aids intubation
Helps surgeon/surgery
Surgery of long duration
Reduces maintenance dose of
anaesthetics agents
Muscle relaxation
Aids intubation
Helps surgeon/surgery
Surgery oflong duration
Reduces maintenance dose of
anaesthetics agents
179. Recovery
Turn off agent
Reverse relaxation
Cough reflex
Extubate when awake
Recovery position
Monitor until discharge
Recovery
Turn offagent
Reverse relaxation
Cough reflex
Extubate when awake
Recovery position
Monitor until discharge
180. Advantages
No absolute contraindications
Quick to establish
Never fails to work
Advantages
No absolute contraindications
Quick to establish
Neverfails to work
181. Disadvantages
Polypharmacy
Effects on various systems
Allergic reactions
Recovery profile
Post operative Nausia &Vomiting
Awareness
Disadvantages
Polypharmacy
Effects on various systems
Allergic reactions
Recovery profile
Post operative Nausia &Vomiting
Awareness
185. Local anaesthetics
Lignocaine- quick/short acting
Bupivacaine/levobupicvacaine- slow
and long action
Ropivacaine- as above
Amethocaine- topical
Prilocaine- intravenous
Local anaesthetics
- quick/short acting
/levobupicvacaine- slow
and long action
Ropivacaine- as above
Amethocaine- topical
Prilocaine- intravenous
186. Advantages
Effective alternative to GA
Avoids polypharmacy
Allergic reactions
Extended analgesia
Patient can remain awake
Early drink/feed
Advantages
Effective alternative to GA
Avoids polypharmacy
Allergic reactions
Extended analgesia
Patient can remain awake
Early drink/feed
189. Autonomic
Nervous
system
S. Parasuraman, M.Pharm., Ph.D.,
Associate Professor,
Faculty of Pharmacy, AIMST University
The Autonomic Nervous System
Sympathetic
NorEpi
mydriasis
reduced saliva flow
increased SV & HR
vasoconstriction
reduced peristalsis & secretion
glycogen* glucose
inhibition of bladder contraction
Parasympathetic
ACh
Ganglia (N)
miosis
Sympathetic
ganglia (N)
epinephrine
release
132 bronchodilation
(not innervated)
stimulated saliva flow
decreased HR
Vagal
bronchoconstriction
nerve
stimulates peristalsis
& secretion
stimulates bile release
bladder contraction
Autonomic
Nervous
system
S. Parasuraman, M.Pharm., Ph D
Associate Professor,
Faculty of Pharmacy, AIMST University
190. Learning Outcomes
• At the end of this session, the student would be able to:
– Briefly describe Sympathetic and parasympathetic
outflow and its functions.
– List the differences between Sympathetic and
Parasympathetic division.
– Explain the adrenergic and cholinergic receptors
Learning Outcomes
' At the end of this session, the student would be able to:
— Briefly describe Sympathetic and parasympathetic
outflow and its functions.
— List the differences between Sympathetic and
Parasympathetic division.
— Explain the adrenergic and cholinergic receptors
191. Nervous System
Central nervous
system
Peripheral
nervous system
Afferent division
(Sensory)
Efferent division
(Motor)
Somatic system
(voluntary)
Autonomic nervous
(involuntary)
Sympathetic system
(thorcolumbar outflow)
Come from the thoracic
and lumbar regions (T1
to L2/3) of the spinal
cord
Parasympathetic system
(craniosacral outflow)
Come from brainstem
(Cranial Nerves III, VII, IX, X)
or the sacral spinal cord (S2,
S3, S4)
Enteric nervous
system
Nervous System
Central nervous
system
Peripheral
nervous system
Afferent division
(Sensory)
Efferent division
(Motor)
Somatic system
(voluntary)
Sympathetic system
(thorcolumbar outflow)
Come from the thoracic
and lumbar regions (Tl
to L2/3) of the spinal
cord
Autonomic nervous
(involuntary)
Parasympathetic system
(craniosacral outflow)
Enteric nervous
system
Come from brainstem
(Cranial Nerves Ill, VII, X)
or the sacral spinal cord (S2,
192. Spinal nerves
• There are 31 pairs of
spinal nerves
– 8 cervical
– 12 thoracic
– 5 lumbar
– 5 sacral
– 1 coccygeal
The human spinal column is made
up of 33 bones.
• 7 - cervical region
• 12 - thoracic region
• 5 - lumbar region
• 5 - sacral region
• 4 - coccygeal region
Ci (Atlas)
Os sacrum
Coccyx
Spinal nerves
The human spinal column is made
up of 33 bones.
7 - cervical region
12 - thoracic region
5 - lumbar region
5 - sacral region
4 - coccygeal region
' There are 31 pairs
spinal nerves
Cervical nerves
Thoracic nerves
Lumbar nerves
— 8 cervical
— 12 thoracic
— 5 lumbar
— 5 sacral
— 1 coccygeal
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
9
10
11
12
1
2
3
Spinal cord
End of spinal cord
—Cauda equina
Sacral and coccygeal nerves
4
5
1
2
3
4
5
Filum terminale
193. Peripheral Nervous System
• Most of the nerves of the peripheral nervous system
are composed of sensory nerve fibres conveying
afferent impulses from sensory end organs to the
brain and motor nerve fibres conveying efferent
impulses from the brain through the spinal cord to
the effector organs.
Peripheral nervous system
Efferent division
(Motor)
Afferent division
(Sensory)
Somatic system
(voluntary)
Autonomic nervous
(involuntary)
Peripheral Nervous System
' Most of the nerves of the peripheral nervous system
are composed of sensory nerve fibres conveying
afferent impulses from sensory end organs to the
brain and motor nerve fibres conveying efferent
impulses from the brain through the spinal cord to
the effector organs.
Peripheral nervous system
Afferent division
Sensor
Efferent division
(Motor)
Somatic system
(voluntary)
Autonomic nervous
(involuntary)
194. Somatic Nervous System
• The somatic nervous system (SNS or voluntary nervous
system) is the part of the peripheral nervous system.
• The somatic nervous system includes both sensory
(afferent nerves) and motor (efferent nerves) neurons.
• Sensory neurons convey input
from receptors for somatic
senses (tactile, thermal, pain,
and proprioceptive sensations)
and from receptors for the
special senses (sight, hearing,
taste, smell, and equilibrium)
Somatic Nervous System
' The somatic nervous system (SNS or voluntary nervous
system) is the part of the peripheral nervous system.
' The somatic nervous system includes both sensory
afferent nerves) and motor (efferent nerves) neurons.
' Sensory neurons convey input
from receptors for somatic
(tactile, thermal, pain,
senses
and proprioceptive sensations)
and from receptors for the
(sight, hearing,
special senses
taste, smell, and equilibrium)
SKIN
AFFERENT NERVE
SPINAL CORD
MUSCLE
EFFERENT NERVE
195. Autonomic Nervous System
• The autonomic nervous system is involved in a
complex of reflex activities, which depend on
sensory input to the brain or spinal cord, and
on motor output.
• The majority of the organs of the body are
supplied by both sympathetic and
parasympathetic nerves which have opposite
effects that are finely balanced to ensure the
optimum functioning of the organ.
Autonomic Nervous System
' The autonomic nervous system is involved in a
complex of reflex activities, which depend on
sensory input to the brain or spinal cord, and
on motor output.
' The majority of the organs of the body are
supplied by both sympathetic and
parasympathetic nerves which have opposite
effects that are finely balanced to ensure the
optimum functioning of the organ.
196. Autonomic Nervous System
• The autonomic nervous system (ANS) is a complex set
of neurons that mediate internal homeostasis
without conscious intervention or voluntary control.
• The ANS maintains blood pressure, regulates the rate
of breathing, influences digestion, urination, and
modulates sexual arousal.
• There are two main branches to the ANS – the
sympathetic nervous system and the
parasympathetic nervous system.
The effects of autonomic control are rapid and essential for homeostasis
Autonomic Nervous System
' The autonomic nervous system (ANS) is a complex set
of neurons that mediate internal homeostasis
without conscious intervention or voluntary control.
' The ANS maintains blood pressure, regulates the rate
of breathing, influences digestion, urination, and
modulates sexual arousal.
' There are two main branches to the ANS — the
sympathetic and the
system
nervous
parasympathetic nervous system
The effects of autonomic control are rapid and essential for homeostasis
197. Sympathetic nervous system
• Sympathetic nervous system otherwise called as
thoracolumbar system.
• Sympathetic stimulation prepares the body to deal
with exciting and stressful situations, e.g.
strengthening its defences in danger. sympathetic
stimulation mobilises the body for 'fight or flight'.
• Neurones convey impulses from their origin in the
hypothalamus, reticular formation and medulla
oblongata to effector organs and tissues. The first
neurone has its cell body in the brain and its fibre
extends into the spinal cord.
Sympathetic nervous system
' Sympathetic nervous system otherwise called as
thoracolumbar system.
prepares the body to deal
' Sympathetic stimulation
with exciting and stressful situations
strengthening its defences in danger sympathetic
stimulation mobilises the body for 'fight or flight
Neurones convey impulses from their origin in the
hypothalamus, reticular formation and medulla
oblongata to effector organs and tissues. The first
neurone has its cell body in the brain and its fibre
extends into the spinal cord.
198. Sympathetic nervous system
• Structure of the Sympathetic Division
– Pathway from Spinal Cord to Sympathetic Trunk Ganglia
– Organization of Sympathetic Trunk Ganglia
– Pathways from Sympathetic Trunk Ganglia to Visceral
Effectors
Sympathetic nervous system
• Structure of the Sympathetic Division
— Pathway from Spinal Cord to Sympathetic Trunk Ganglia
Organization of Sympathetic Trunk Ganglia
— Pathways from Sympathetic Trunk Ganglia to Visceral
Effectors
199. Structure of the sympathetic division of the autonomic nervous system
Trachea and bronchi: Bronchodilation
Liver: Glycogen glucose conversion increased
Iris muscle: Pupil dilated
Blood vessels in heart : Vasoconstriction
Heart: Rate and force of contraction
increased
Salivary glands: Secretion inhibited
Stomach: Peristalsis reduced
Sphincters closed
Intestines: Peristalsis and tone decreased
Vasoconstriction
Kidney: Urine secretion decreased
Bladder: Smooth muscle wall relaxed
Sphincter closed
Sex organs: Generally Vasoconstriction
SYUPAtHEOC DIVISION
(thoracolumbar) pretar*i to rtuscle
of blood a' ttueo organs
Preganglionic new-ons
PostP"91ionÉ nouroru
SINEtg1Äi
Iris muscle: Pupil dilated
Lactrr•l
Salivary glands: Secretion inhibited
Wjcous rnernbrar,o
oc and palate
gland
Blood vessels in heart : Vasoconstriction
Atrial muscle titers
Sweat
Hair
smooth
(each
trurü
tho
Sympathetic
trunk gan#
cte
TtO
712
cervical
gan•ion
Uiddle
interior
cervical
Selan&
Crdiac plexus
Greater
speanehnie /
-z Celiae
ganglion
Aorticore
splanchnié
Odon
Heart
SA'AV
enuscle
Spleen
Heart: Rate and force of contraction
increased
Trachea and bronchi: Bronchodilation
Liver: Glycogen glucose conversion increased
Stomach: Peristalsis reduced
Sphincters closed
Intestines: Peristalsis and tone decreased
solanchnic
meent«ic
ganglion
Renal
ganglions
Lumbar
splanchnic Interior
mesenterie
ganglion
Preverte&al
Rectum
Uret•e
(hsad
gangUa
Urnary 'External
Hypogastric
p&xus
Vasoconstriction
Kidney: Urine secretion decreased
Bladder: Smooth muscle wall relaxed
Sphincter closed
Uton.n /
Sex organs: Generally Vasoconstriction
Structure of the sympathetic division of the autonomic nervous system
200. Parasympathetic nervous system
• Parasympathetic nervous system otherwise called as
craniosacral outflow.
• Parasympathetic stimulation has a tendency to slow
down body processes except digestion and
absorption of food and the functions of the
genitourinary systems. Its general effect is that of a
'peace maker' allowing restoration processes to occur
quietly and peacefully.
• Cell bodies of parasympathetic preganglionic neurons
are found in nuclei in the brain stem.
Parasympathetic nervous system
' Parasympathetic nervous system otherwise called as
craniosacral outflow.
' Parasympathetic stimulation has a tendency to slow
down body except digestion and
processes
absorption of food the functions of the
and
Its general effect is that of a
genitourinary systems
peace maker allowing restoration processes to occur
quietly and peacefully.
' Cell bodies of parasympathetic preganglionic neurons
are found in nuclei in the brain stem.
201. Parasympathetic nervous system
• Structure of the Parasympathetic Division
– The cranial parasympathetic outflow consists of
preganglionic axons that extend from the brain stem in four
cranial nerves. The cranial outflow has four pairs of ganglia
and the ganglia associated with the vagus (X) nerve.
– The sacral parasympathetic outflow consists of
preganglionic axons in anterior roots of the second through
fourth sacral spinal nerves.
Parasympathetic nervous system
• Structure of the Parasympathetic Division
— The cranial parasympathetic outflow consists of
preganglionic axons that extend from the brain stem in four
cranial nerves. The cranial outflow has four pairs of ganglia
and the ganglia associated with the vagus (X) nerve.
parasympathetic outflow consists of
— The sacral
preganglionic axons in anterior roots of the second through
fourth sacral spinal nerves.
202. Structure of the parasympathetic division of the autonomic nervous system
Trachea and bronchi: Bronchoconstriction
Liver: Blood vessels dilated
Secretion of bile increased
Iris muscle: Pupil constricted
Heart: Rate and force of contraction
decreased
Salivary glands: Secretion increased
Stomach: Secretion of gastric juice and
peristalsis increased
Intestines: Digestion and absorption
increased
Kidney: Urine secretion increased
Bladder: Muscle of wall contracted
Sphincters relaxed
Sex organs: Male: erection;
Female: variable
PARASYMPATHETIC DIVES'ON Koy-,
Preganglionic t'ieurms
neurons
OcüotnDtOt (Ill)
ganglia
Facsai (VIV, Ciliary
to
and giards 01 otgat%:
Iris muscle: Pupil constricted
Eye
and
Trans•ars.o
Ascending
Lacnmal q
Salivary glands: Secretion increased
Mcnous
an
Parotxi .
ganglion
Pterygopalatine
ganglion
Submandibular
ganglion
Glossopharynpaj (tX)
Otic
ganglion
Vagus (X
tto
T12
Pelvic
nerves
Coccygeal
Atnai
rmscle ibers
SAiAVnodes
Trac*E0
Bronchi
aro bie du
Stomact
Unnary Extern* Ute
Structure of the parasympathetic division o
Heart: Rate and force of contraction
decreased
Trachea and bronchi: Bronchoconstriction
Liver: Blood vessels dilated
Secretion of bile increased
Stomach: Secretion of gastric juice and
peristalsis increased
Intestines: Digestion and absorption
increased
Kidney: Urine secretion increased
Bladder: Muscle of wall contracted
Sphincters relaxed
Sex organs: Male: erection;
Female: variable
t e autonomic nervous system
205. Autonomic Motor Pathways
• Each division of the ANS has two motor neurons
(preganglionic and postganglionic neuron).
• Preganglionic Neurons
– In the sympathetic division (thoracolumbar division/
thoracolumbar outflow), the preganglionic neurons have
their cell bodies in the lateral horns of the gray matter in
the 12 thoracic segments and the first two (and sometimes
three) lumbar segments of the spinal cord.
– In the parasympathetic division (craniosacral division/
craniosacral outflow), the preganglionic neurons have their
cell bodies in in the nuclei of four cranial nerves in the brain
stem (III, VII, IX, and X) and in the lateral gray matter of the
second through fourth sacral segments of the spinal cord.
Autonomic Motor Pathways
' Each division of the ANS has two motor neurons
(preganglionic and postganglionic neuron).
' Preganglionic Neurons
sympathetic division (thoracolumbar division/
— In the
thoracolumbar outflow) the preganglionic neurons have
their cell bodies in the lateral horns of the gray matter in
the 12 thoracic segments and the first two (and sometimes
three) lumbar segments of the spinal cord.
parasympathetic division (craniosacral division/
— In the
craniosacral outflow) the preganglionic neurons have their
cell bodies in in the nuclei of four cranial nerves in the brain
stem (Ill, VII, IX, and X) and in the lateral gray matter of the
second through fourth sacral segments of the spinal cord.
206. Autonomic Motor Pathways
Preganglionic Neurons
• Autonomic Ganglia
– There are two major groups of autonomic ganglia
• sympathetic ganglia
• parasympathetic ganglia
• Sympathetic Ganglia:
– The sympathetic ganglia are the sites of synapses between
sympathetic preganglionic and postganglionic neurons.
– There are two major types of sympathetic ganglia:
• sympathetic trunk ganglia (also called vertebral chain
ganglia or paravertebral ganglia)
• prevertebral ganglia (collateral)- Five types of
prevertebral ganglia are celiac ganglion, superior
mesenteric ganglion, inferior mesenteric ganglion,
aorticorenal ganglion and renal ganglion.
Autonomic Motor Pathways
Preqanqlionic Neurons
' Autonomic Ganglia
— There are two major groups of autonomic ganglia
' sympathetic ganglia
' parasympathetic ganglia
' Sympathetic Ganglia
— The sympathetic ganglia are the sites of synapses between
sympathetic preganglionic and postganglionic neurons.
— There are two major types of sympathetic ganglia:
(also called vertebral chain
' sympathetic trunk ganglia
ganglia or paravertebral ganglia)
(collateral)- Five types of
' prevertebral ganglia
prevertebral ganglia are celiac ganglion, superior
mesenteric ganglion, inferior mesenteric ganglion,
aorticorenal ganglion and renal ganglion.
207. Autonomic Motor Pathways
Preganglionic Neurons
• Autonomic Ganglia
– There are two major groups of autonomic ganglia
• sympathetic ganglia
• parasympathetic ganglia
• parasympathetic ganglia:
– Preganglionic axons of the parasympathetic division
synapse with postganglionic neurons in terminal
(intramural) ganglia. They are the ciliary ganglion,
pterygopalatine ganglion, submandibular ganglion, and otic
ganglion
Autonomic Motor Pathways
Preqanqlionic Neurons
Autonomic Ganglia
— There are two major groups of autonomic ganglia
' sympathetic ganglia
' parasympathetic ganglia
' parasympathetic ganglia
— Preganglionic axons of the parasympathetic division
synapse with postganglionic neurons in terminal
(intramural) ganglia. They are the ciliary ganglion,
pterygopalatine ganglion, submandibular ganglion, and otic
ganglion
208. Autonomic Motor Pathways
Postganglionic Neurons
• Once axons of sympathetic preganglionic
neurons pass to sympathetic trunk ganglia,
they may connect with postganglionic
neurons.
• A single sympathetic preganglionic fiber has
many axon collaterals (branches) and may
synapse with 20 or more postganglionic
neurons.
Autonomic Motor Pathways
Postqanqlionic Neurons
' Once axons of sympathetic preganglionic
neurons pass to sympathetic trunk ganglia,
they may connect with postganglionic
neurons.
single sympathetic preganglionic fiber has
many axon collaterals (branches) and may
synapse with 20 or more postganglionic
neurons Dendrites covered
with dendritic spines
Cytoplasm of
Schwann cell
Synaptic terminals
Axon
Cell body collateral
Nucleus
Axon Nodes of
Ranvier
Axon
Nucleus
Myelin
sheath
Schwann Terminal
cell branches
209. Autonomic Motor Pathways
Postganglionic Neurons
• Axons of preganglionic neurons of the
parasympathetic division pass to terminal
ganglia near or within a visceral effector. In the
ganglion, the presynaptic neuron usually
synapses with only four or five postsynaptic
neurons, all of which supply a single visceral
effector, allowing parasympathetic responses
to be localized to a single effector.
Autonomic Motor Pathways
Postqanqlionic Neurons
' Axons of preganglionic neurons of the
parasympathetic division pass to terminal
ganglia near or within a visceral effector. In the
ganglion, the presynaptic neuron usually
synapses with only four or five postsynaptic
all of which supply a single visceral
neurons
effector, allowing parasympathetic responses
to be localized to a single effector.
![Anaesthesia : A clinical and philosophical concept
It is in the Hippocratic Corpus, that the word ‘anaesthesia’
was used for the first time in a medical context as reversible
loss of sensation and unconsciousness, when Hippocrates
writes:
“For when they [breaths] pass through the flesh and puff it
up, the parts of body affected lose the power of feeling
[‘anaestheta’]”.
Anaesthesia : Aclinical and philosophical concept
It is in the Hippooatic Corpus, that the word 'anaesthesia'
was usedfor theftrst time in a medical context as reversible
loss of sensation and unconsciousness, when Hippocrates
writes:
"For when they[breaths]pass through theflesh andpuffit
up, the parts ofbody gfected lose the power of
feeling
['anaestheta']'.'](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)