General and regional anaesthesia.pptx
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This document outlines the principles of local, regional, and general anesthesia. It discusses the history of anesthesia, including the first successful demonstrations in the 1840s. It defines the types of anesthesia as general, which causes amnesia, analgesia, and muscle relaxation, and regional, which provides anesthesia and analgesia through nerve blocks. The key principles of general anesthesia are outlined as a reversible state of unconsciousness achieved through IV drugs and inhalational agents. Regional anesthesia techniques include central neuraxial blocks like spinal and epidural as well as peripheral nerve blocks. The mechanisms and properties of local anesthetic agents are also summarized.
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The document outlines the key steps and objectives of pre-anaesthetic consultation:
- Evaluate the patient's medical condition and optimise any risk factors.
- Determine the anaesthetic technique and perioperative care plan.
- Obtain informed consent from the patient after discussing anaesthesia and the procedure.
- The assessment may involve medical history, physical exam, and targeted lab/imaging tests to evaluate risk.
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DEFINITION
PHASES
STAGES
INDICATIONS & CONTRAINDICATIONS
CLASSIFICATION
ADVANTAGES & DISADVANTAGES
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General anaesthetics (GAs) are drugs which produce reversible loss of all sensation and consciousness.
The cardinal features of general anaesthesia are:
• Loss of all sensation, especially pain.
• Sleep (unconsciousness) and amnesia
• Immobility and muscle relaxation
• Abolition of somatic and autonomic reflexes.
GA was absent until the mid 1800’s
Original discoverer of GA
-Crawford long, physician from Gerogia(1842),
ETHER ANESTHESIA
. NITROUS OXIDE
- Horace wells(1844)
. GASEOUS ETHER by William T.G. Morton(1846)
. CHLOROFORM introduced by
- James simpson (1847)
METHODS OF ADMINISTRATION OF INHALATIONAL GENERAL ANAESTHETICS
OPEN METHOD: This is a simple method of administering a volatile anaesthetic.
A simple mask covered with six to ten layers of gauze, which does not fit the contour of the face is held on the face and an anaesthetic like ether, or ethyl chloride is poured on it in drops. The anaesthetic vapour, diluted with air, is inhaled through the gap between the mask and the face.
SEMI-OPEN METHOD: This method is similar to open method but the dilution with air is prevented by using either a well-fitting mask like Ogston’s mask or layers of gauze between face and the mask. A small carbon dioxide build-up occurs with this method.
SEMI-CLOSED METHOD: This method allows some rebreathing of the anaesthetic drug with the help of a reservoir but in addition, part of the volume of each succeeding inspiration is a new portion from an anaesthetic mixture. This method involves accumulation and rebreathing of carbon dioxide.
• CLOSED METHOD: This method employs the chemical agent soda lime to absorb the carbon dioxide present in the expired air. It requires the use of a special apparatus but is particularly useful when the anaesthetic agent is potentially explosive
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Guedel, in 1920 outlined the four stages of general anaesthesia :
• Stage I: Stage of analgesia
• Stage II: Stage of delirium
• Stage III: Stage of surgical anaesthesia
• Stage IV: Stage of respiratory paralysis
Inadequate anaesthesia is indicated by:
Signs of ANS overactivity, such as tachycardia, rise of BP, sweating and lacrimation.
Grimacing;
Other muscle activity.
Surgical anaesthesia is indicated by:
Loss of eyelash (lid) reflex
Development of rhythmic respiration.
Deep anaesthesia is suggested by :
Depression of respiration.
Hypotension
Asystole
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The document outlines the key steps and objectives of pre-anaesthetic consultation:
- Evaluate the patient's medical condition and optimise any risk factors.
- Determine the anaesthetic technique and perioperative care plan.
- Obtain informed consent from the patient after discussing anaesthesia and the procedure.
- The assessment may involve medical history, physical exam, and targeted lab/imaging tests to evaluate risk.
- The goals are to ensure patient safety and provide preoperative counselling and risk assessment.
Cardiac risk index
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1 Goldman Risk Index
2 Revised Cardiac Risk Index
3 Canadian Cardiovascular Grading Scale
4 NYHA Classification
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DEFINITION
PHASES
STAGES
INDICATIONS & CONTRAINDICATIONS
CLASSIFICATION
ADVANTAGES & DISADVANTAGES
General anesthesia
General anaesthetics (GAs) are drugs which produce reversible loss of all sensation and consciousness.
The cardinal features of general anaesthesia are:
• Loss of all sensation, especially pain.
• Sleep (unconsciousness) and amnesia
• Immobility and muscle relaxation
• Abolition of somatic and autonomic reflexes.
GA was absent until the mid 1800’s
Original discoverer of GA
-Crawford long, physician from Gerogia(1842),
ETHER ANESTHESIA
. NITROUS OXIDE
- Horace wells(1844)
. GASEOUS ETHER by William T.G. Morton(1846)
. CHLOROFORM introduced by
- James simpson (1847)
METHODS OF ADMINISTRATION OF INHALATIONAL GENERAL ANAESTHETICS
OPEN METHOD: This is a simple method of administering a volatile anaesthetic.
A simple mask covered with six to ten layers of gauze, which does not fit the contour of the face is held on the face and an anaesthetic like ether, or ethyl chloride is poured on it in drops. The anaesthetic vapour, diluted with air, is inhaled through the gap between the mask and the face.
SEMI-OPEN METHOD: This method is similar to open method but the dilution with air is prevented by using either a well-fitting mask like Ogston’s mask or layers of gauze between face and the mask. A small carbon dioxide build-up occurs with this method.
SEMI-CLOSED METHOD: This method allows some rebreathing of the anaesthetic drug with the help of a reservoir but in addition, part of the volume of each succeeding inspiration is a new portion from an anaesthetic mixture. This method involves accumulation and rebreathing of carbon dioxide.
• CLOSED METHOD: This method employs the chemical agent soda lime to absorb the carbon dioxide present in the expired air. It requires the use of a special apparatus but is particularly useful when the anaesthetic agent is potentially explosive
STAGES OF ANAESTHESIA
Guedel, in 1920 outlined the four stages of general anaesthesia :
• Stage I: Stage of analgesia
• Stage II: Stage of delirium
• Stage III: Stage of surgical anaesthesia
• Stage IV: Stage of respiratory paralysis
Inadequate anaesthesia is indicated by:
Signs of ANS overactivity, such as tachycardia, rise of BP, sweating and lacrimation.
Grimacing;
Other muscle activity.
Surgical anaesthesia is indicated by:
Loss of eyelash (lid) reflex
Development of rhythmic respiration.
Deep anaesthesia is suggested by :
Depression of respiration.
Hypotension
Asystole
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- Pre-anaesthetic evaluation and selection of anaesthetic technique based on factors like operative site and patient risk.
- Acute and chronic pain management with a focus on multimodal approaches using analgesics like opioids, NSAIDs, and local anaesthetics.
- Special considerations for pain control in malignant diseases and chronic pain conditions.
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Regional anesthesia is a technique that induces loss of sensation in part of the body using local anesthetics. It has benefits like lower costs, high patient satisfaction, and decreased risks of DVT and PE compared to general anesthesia. However, it requires skills and may cause issues like hypotension. The main types are topical, intravenous, peripheral nerve blocks, plexus blocks, and neuro-axial blocks. Regional anesthesia can provide anesthesia for surgery, post-op analgesia, or chronic pain treatment. Factors like the anesthetic used, patient position, and injection speed affect its spread. Spinal and epidural blocks involve injecting anesthetic into the subarachnoid or epidural space and have risks like anaphyl
SPINAL ANAESTHESIA
This document provides information on spinal anaesthesia. It discusses the history of spinal anaesthesia, indications, contraindications, anatomy, procedure, positions, techniques, drugs used, mechanism of action, adjuvants, and factors affecting block height. The key points are:
- Spinal anaesthesia involves injecting local anaesthetic into the subarachnoid space to block nerve impulses and provide anaesthesia or analgesia.
- Common indications include surgeries of the lower body and patients with medical comorbidities. Contraindications include infection, coagulopathies, and increased intracranial pressure.
- Proper patient positioning, sterile technique, identification of spinal landmarks, and slow injection
Anesthesia for Total Knee replacement 4-3-2017
This document discusses anesthesia considerations for total knee replacement (TKR) surgery. It covers preoperative evaluation of cardiopulmonary and musculoskeletal systems, anesthesia techniques including spinal, epidural, peripheral nerve blocks and general anesthesia, intraoperative monitoring and tourniquet use, postoperative care including pain management, and complications associated with TKR such as blood loss, infection and venous thromboembolism. Regional anesthesia techniques are preferred due to advantages like less blood loss, better pain control and early mobilization, though patient factors and surgical needs determine the best option.
Anaesthesia
This document provides an overview of anaesthesia. It begins with definitions of anaesthesia and a brief history highlighting key developments. It then outlines the major steps of anaesthesia including induction, maintenance and recovery.
The document discusses the pharmacology of various anaesthetic agents including intravenous and inhalation anaesthetics. It explains their mechanisms of action, focusing on interactions with ion channels and receptors in the brain and spinal cord. Minimum alveolar concentration is introduced as a measure of comparing agent potency.
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Pharmacology of anesthesia
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General Anesthetics
General anesthetics are drugs that induce reversible loss of consciousness and sensations during surgery. They work by depressing the central nervous system in stages, starting with cortical centers and ending with the medulla. There are two main types - inhalational gases administered through masks or intravenous drugs given through injections. A balanced anesthesia approach uses multiple drugs to induce unconsciousness, amnesia, analgesia, and muscle relaxation. Precise drug combinations and dosages are tailored for each patient and procedure type. The goal is to smoothly induce and rapidly recover from anesthesia with minimized risks and side effects.
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Anesthetics and its side affect Mechanism of action
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General and regional anaesthesia.pptx
- 1. Enumerate the Principles of Local, Regional and General Anesthesia Batch 2019 Dr. Ankita Singh Assistant Professor Department of Surgery
- 2. Learning objectives • History • Types & Meaning of Regional & General anaesthesia • Principles • Agents • Advantage and disadvantages
- 3. History • First successful demonstration of anaesthesia • William Morton (1846)- Ether • Other incidents use of • Nitrous oxide • Chloroform
- 4. Types of anaesthesia • General anaesthesia (GA) • Amnesia, Analgesia, Muscle relaxation • Regional anaesthesia • Provide: Anaesthesia & Analgesia • Sole agent • Adjunct to GA • Techniques • Topical • Local infiltration • Regional nerve blocks • Central neuroaxial blocks
- 5. Key principles of anaesthesia • Multidisciplinary collaboration
- 6. Principles of General anaesthesia • Reversible state of unconsciousness • 4 components: • Amnesia • Analgesia • Inhibition of noxious reflexes • Skeletal muscle relaxation • Achieved by combination of • IV anesthetics & analgesics • Inhalational anesthetics, and • Frequently muscle relaxants
- 9. Principles of General anaesthesia.. • 3 Phases: • Induction • Maintenance- inhalational or intravenous infusion • Reversal • Indications: • Major intra-abdominal and thoracic procedures • Most neurosurgical operations • Any procedure in which airway protection and mechanical ventilation are required
- 10. Principles of General anaesthesia.. • The drugs used cause both desirable & undesirable effects • Thus pharmacological effects must be matched to pathophysiology of patient’s comorbidities • Major adverse changes • Respiratory depression • Cardiovascular depression • Loss of airway maintenance and protection • Important complications: • Hypoxemia, hypotension, cardiac arrest, aspiration of gastric contents
- 11. Principles of Regional anaesthesia • First produced with cocaine (1800s) • Temporary block nerve by injecting LA agent • Includes: • Central Neuraxial blocks: • Spinal • Epidural • Caudal • Peripheral Nerve blocks • Truncal: Abdominal wall B (TAP, Rectus,Ii-Ih, Ql blocks), paravertebral, intercostal • Plexus: Brachial plexus B, Lumbar plexus B, Cervical plexus B • Distal: Wrist B, Ankle B, Median nerve B, Ilio inguinal nerve B • Field & topical block
- 12. Local anaesthetic agent • 2 classes most commonly used: • Esters & Amides • Mechanism of action of drugs- • dose dependent blockade of sodium current in nerve fibers • Different physiochemical characteristics- • pKa- lower value: faster onset; commonly used agents: relatively high value • protein binding- duration of action • degree of hydrophobicity- proportional to potency
- 14. Local anaesthetic agent.. • Caution- toxicity • Symptoms- numbness/ tingling of tongue and lips, metallic taste, light headedness, tinnitus, visual disturbance, slurred speech, disorientation, seizures, cardio vascular collapse • Prevention • Aspiration before injecting • Knowledge of safe dose • Addition of epinephrine • Treatment • Oxygenation & airway support • BZP/thiopental • Cardio vascular support
- 15. Spinal Anesthesia • a/k/a Subarachnoid block • Indications- below umbilicus procedures • Urologic, lower abdominal, perineal, lower extremity surgery • Provides excellent • Sensory + motor blockade below level of block • Technique • Position & site • Induced by injection of Local anesthetic ± opiates into subarachnoid space • Rapid & Predictable onset
- 17. Spinal Anesthesia.. • Factors determining level, speed of onset and duration of spinal blockade • Local Anesthetic agent • Volume and dose of drug: cephalad spread • Patient position and baricity of drug • Vasoconstrictors • Addition of opioids • Anatomical and physiologic factors
- 18. Spinal Anesthesia.. • Advantages: • No manipulation of airway • Avoidance of side effects of GA • Several types of surgeries with good post-operative analgesia • Awake patient: monitor for assessment • Limitation: • Single bolus injection-limited duration • Complications: • Hypotension, bradycardia, postdural puncture headache (PDPH), transient radicular neuropathy, backache, urinary retention, infection, epidural hematoma, excessive cephalad spread leading to cardiorespiratory compromise.
- 19. Spinal Anesthesia.. • Limitation: • Absolute contraindication • Sepsis, bacteremia, infection at site of injection, severe hypovolemia, coagulopathy, therapeutic anticoagulation, increased ICP, patient refusal
- 20. Epidural Anesthesia • Induction by injection of local anesthetics ± opiates into lumbar or thoracic epidural space • Generally catheter is placed • Advantages: controlled anesthesia, repeated dosing, post operative analgesia • Indications- same as spinal anesthesia, adjunct to GA • Special advantages: thoracic, peripheral vascular and gastrointestinal surgery • Superior pain control, less sedation, better pulmonary function, less ileus • Complications and limitations- similar to SA • Caution: catheter care and removal, consideration with anticoagulation • Epidural hematoma- back pain, sensory & motor dysfunction, bladder & bowel abnormalities.
- 21. Peripheral Nerve Blocks • Types • Truncal: Abdominal wall B (TAP), paravertebral, intercostal • Plexus: Brachial plexus B, Lumbar plexus B, Cervical plexus B • Distal: Wrist B, Ankle B, Median nerve B, Ilio inguinal nerve B • Field & topical block • Advantages • Reduced physiological stress, avoidance of airway manipulation & side effects of GA • Safety profile • Limitations- cooperative patient, complications of LA agent.
- 26. What have we learnt? • Types of anesthesia and classification • Advantages and disadvantages • Basic principles