General anesthesia is a controlled, reversible state characterized by amnesia, analgesia, akinesia, and reflex blockade achieved through a combination of drugs. It is indicated for patients who cannot cooperate for procedures, extreme anxiety, or significant medical conditions, but presents risks such as impaired protective reflexes and the need for specialized assistance. Various theories explain its mechanism, with the membrane expansion theory being widely accepted, alongside considerations for preoperative evaluation, patient preparation, and the use of specific anesthetic agents.

1. GENERAL ANAESTHESIA
Dr Alvi Fatima
Jr II
Dept. of Pedodontics and
Preventive Dentistry

2. Introduction
• General anaesthesia = Hypnosis + Analgesia +
Relaxation
• Hypnosis = suppression of consciousness
• Analgesia = suppression of physiological responses to pain
stimuli
• Relaxation = suppression of muscle tone and relaxation
2

3. • A controlled reversible state of:
– Amnesia (with loss of consciousness)
– Analgesia
– Akinesia (skeletal muscle relaxation)
– Autonomic and sensory reflex blockade
• Called the “4 A’s” of General Anaesthesia.
• In practice these effects are produced with a combination of
drugs rather than with a single anaesthetic agent.

4. DEFINATION- AAPD 2017
• General anesthesia: a drug-induced loss of
consciousness during which patients are not
arousable, even by painful stimulation.
• The ability to independently maintain ventilatory
function is often impaired.

5. • Patients often require assistance in maintaining a
patent airway, and positive pressure ventilation may
be required because of depressed spontaneous
ventilation or drug-induced depression of
neuromuscular function.
• Cardiovascular function may be impaired.

6. Theories of mechanism of action of general
anesthesia
• Still now exact mechanism not known.
• Various theories have been proposed. They are:
– Lipid/water partition theory
– Surface tension theory
– Theory of inhibition of energy production/ utilization
– Clathrates formation theory
– Membrane expansion theory
– Membrane fluidization/ perturbation theory
6

7. 1. LIPID/WATER PARTITION THEORY
Meyer and Overton in 1901
• A direct parallelism exists between lipid water
partition co efficient of drugs and their anesthetic
potency.
• The minimum alveolar concentration (MAC) shows
excellent correlation with oil/gas partition coefficient
of inhalation anesthetics.
7

8. 2. SURFACE TENSION THEORY.
• General anesthetics reduce surface tension at all cell
membrane and thus affect its permeability, electrical
and /or enzymatic properties.
• This theory is generally not accepted.
8

9. 3. THEORY OF INHIBITION OF ENERGY PRODUCTION /
UTILIZATION.
• This theory states that general anesthetics decreases
the production of action potential in the brain.
• Decrease in energy production In the brain is
probably an effect rather than the cause of general
anesthesia.
9

10. 4. CLATHRATES FORMATION THEORY
Pauling & Millerin 1961
• Water has a crystal like molecular arrangement.
• General anesthetics are believed to fill up the spaces between
micro crystals (clathrates) and make water structured. They plug
the pores and impede ionic fluxes.
• However this behavior is also dependant on hydrophobicity.
• But there is no evidence of clathrate formation at body
temperature.
10

11. 5. MEMBRANE EXPANSION THEORY
• The general anesthetics occupy the space in the nerve
membrane in the brain and expand it disproportionately
(about 10 times their molecular volume).
• This causes increased surface pressure in the membrane,
there by closing ionic channels.
• This theory in much widely accepted.
11

12. ASA PHYSICAL STATUS CLASSIFICATION SYSTEM:
• In 1962 the American Society of Anesthesiologists
adopted the ASA physical status classification system.
• It is a method by which a doctor can estimate the
medical risk to a patient who is scheduled to receive
anesthesia for a surgical procedure.
• The classification is as follows:
12

13. ASA Classification
13

14. American Society of Anesthesiologists
[ASA-Physical Health Status]
Allman K, Wilson I. Oxford Handbook of Anaesthesia.

15. ADVANTAGES OF GENERAL ANAESTHESIA
1. Patients cooperation in not absolutely essential for
the success of GA.
2. Patient is unconscious.
3. Patient does not respond to pain.
4. Amnesia is present.
5. GA may be the only technique that will prove
successful for certain patients.
6. Rapid onset of action.

16. DISADVANTAGES OF GENERAL ANAESTHESIA
1. The patient is unconscious.
2. Protective reflexes are depressed.
3. Advanced training is required.
4. An ‘‘anaesthesia team’’ is required.
5. Special equipment is required wherever general
anaesthesia.
6. A recovery area must be available for the patient.

17. 7. Post-anesthetic complications are more common
following general anaesthesia.
8. The patient receiving general anaesthesia must
receive nothing by mouth for 6 hours before the
procedure.
9. Patients receiving general anaesthesia must be
evaluated more extensively preoperative.

18. INDICATIONS FOR GENERAL ANESTHESIA
1. Patients too young to co-operate for routine dental
procedures.
2. Extreme anxiety and fear.
3. Adults or children who have mental or physical
disabilities, senile patients, or disoriented patients.
4. Short, traumatic procedures.
5. Prolonged traumatic procedures.
6. Children in whom procedural sedation becomes
unsuccessful because of psychological or medical
factors.

19. 7. Healthy patients aged 24 to 60 months , who require
more than 3 treatment visits with procedural sedation.
8. Patients in whom LA is proved unsuccessful or is unlikely
to be completely effective because of the extent of
surgery or the presence of infection.
9. Patients with coagulopathies and blood dyscrasias
requiring multiple extractions.
10. Children with extensive orofacial trauma.

20. CONTRAINDICATIONS FOR GENERAL ANAESTHESIA
1. A young child with incipient carious lesions.
2. Non- compliance with NIL PER ORAL instructions.
3. Unwilling parents

21. REQUIREMENT TO OBTAIN HOSPITAL STAFF
PRIVILAGES
• EDUCATION
• TRAINING

22. PRE ANAESTHETIC PREPARATION
AND PRE MEDICATION

23. Objectives
– Reduce anxiety and fear.
– Reduce secretions
– Enhance the hypnotic effect of GA agents.
– Reduce post op nausea and vomiting
– Produce amnesia.
– Reduce the volume and pH of gastric contents
– Attenuate vagal reflexes
– Attenuate sympatho adrenal responses.
23

24. Pre operative evaluation
• Purpose:
1. To obtain pertinent information about the patients medical history
and physical as well as mental condition.
2. To determine the need for a medical consultation and the kind of
investigations required.
3. To educate the patient about anesthesia, per operative care, pain
treatment, in the hope of reducing anxiety and thereby facilitating
recovery.
4. To choose the anesthesia plan to be followed, guided by the risk
factors, uncovered by the medical history.
5. To obtain an informed consent.
24

25. Contd..
• History
– Current problems.
– Other known problems
– Treatment/ medications for the problem.
– Current drug use.
– use of tobacco, alcohol etc
– drug allergies.
– Prior anesthetic exposure.
– General health of the patient And
– Review of systems.
• Physical examination:
– Vital signs
– Airway.
– Heart.
– Lungs.
25

26. Preoperative instructions
PARENT COUNSELLING
DIETARY INSTRUCTIONS
• Intake of food and liquids should be limited prior to
treatment.

27. Fasting guidelines – NIL PER ORAL guidelines
• Clear liquids – 2 hours
• Breast milk – 4 hours
• Infant formula – 6 hours
• Non – human milk – 6 hours
• Solids – 6 hours

28. DRUGS USED FOR PREMEDICATION.
• BENZODIAZEPINES:
– E.g.: Diazepam, Midazolam, Oxazapam, Lorazepam.
– Produces anxiolysis, sedation and amnesia
28

29. • OPIOD ANALGESICS:
– E.g.: Morphine, Fentanyl, Pethidine, Pentozocaine etc
– It produces sedation and analgesia.

30. • ANTICHOLINERGIC AGENTS:
– E.g.: Atropine, Glycopyrolate, Scopolamine
– Dosage
• Atropine- 0.12 mg/kg
• Glycopyrolate- 0.44mg/kg

31. Contd..
• ANTICHOLINERGIC AGENTS:
– Increases the heart rate by blocking the action of acetylcholine on muscarinic
receptors in SA node.
– Very useful in preventing intraoperative bradycardias resulting from stimulation of
carotid sinus or vagal stimulation.
– Antisialagouge action
• Glycopyrolate is more potent and long acting drying agent and is likely to increase the heart
rate.
• Scopolamine is more effective Antisialagouge than atropine.
– Sedation and amnesia:-
• Glycopyrolate doesn't cross blood brain barrier and hence doesn't cause sedation/ amnesia.
• Scopolamine has good sedative and amnesic effect.
• Atropine cause delirium in elderly individuals, so glycopyrolate is better than atropine for
elderly individuals
31

32. STAGES OF ANAESTHESIA
[Guedel 1920 -with ether]

33. GUEDEL’S
1937

34. GUEDEL OBSERVATIONS
Character of
the
respiration
Eyeball
activity
Pupillary
changes
Eyelid reflex
(presence or
absence)
Swallowing or
vomiting

37. MINIMUM ALVEOLAR CONCENTRATION
[MAC]
– The amount of drug used to produce lack of reflex response to
skin incision in 50% of patients.
– Factors which decreases the MAC.
• Sedative drugs such as pre medication agents, analgesics
• N20.
• Increasing age
• Drug which affect the neurotransmitter release such as
methyldopa, pancuronium, clonidine
• Higher atmospheric pressure.
• Hypocapnia
37

38. –Factors which increases the MAC.
• Decreasing age
• Pyrexia
• Induced sympathoadrenal stimulation E.g.:
hypercapnia.
• Thyrotoxicosis
• Chronic alcohol ingestion
38

39. HALOTHANE [fluothane]
• MAC 0.75%
• Colorless volatile liquid with sweet odour.
• Non irritant and non inflammable.
• This is 4 to 5 times more potent anesthetic
agent than ether.
39

40. • Actions:
– BP falls in proportion to the concentration of the vapors inhaled.
– Hypotension
– Respiratory depression in proportion to the concentration of
halothane inhaled.
– Breathing: shallow and depressed.
– Increases the CSF pressure.
– Causes moderate relaxation of skeletal muscles.
– Post op nausea and vomiting not severe as in ether.
– Shivering.
40

41. ETHER
• Highly volatile and colorless liquid.
• It is inflammable in air and explosive with oxygen,
• About 85 to 90% of the drug will get excreted
through the lungs.
• Stimulates the sympathetic system yielding to
increase in heart rate and to depress the vagus
nerve.
• BP falls in the deeper planes of anesthesia
41

42. • Respiratory movements first increase due to stimulation of
respiratory centre and later on it decreases as the anesthesia
deepens.
• Stimulates salivation, so atropine pre medication is advised.
• Irritant to respiratory tract and produces cough and laryngeal
spasm.
• On induction it induces analgesia followed by-excitement and then
anesthesia.
• Increases CSF pressure and blood glucose levels.
• Produces post operative nausea and vomiting in 50 % of patients
42

43. ENFLURANE
• MAC 1.68%
• Non inflammable
• Non irritant
• Strong anesthetic agent with pungent odour
43

44. • ACTIONS
– Depresses the cardiovascular system.
– Heart rate remains relatively stable.
– Increases the BP
– As the depth of the anesthesia increases, respiratory
system will be depressed.
– Induction and recovery slower compared to Halothane.
Produces brief clonic seizures at deeper levels if respiration
is not assisted.
– Contraindicated in Epileptics .
44

45. ISOFLURANE
• MAC 1.15%
• Non inflammable,
• Mild pungent smell.
• Actions:
– Rapid onset and reversal.
– Profound respiratory depression with decreased tidal volume
– Depresses the cardiovascular system.
– Decreases the BP as the dosage increases.
– Produces good muscle relaxation.
– Increases the intra cranial pressure secondary to increased cerebral
blood flow (vasodilatation).
45

46. INTRAVENOUS ANAESTHETICS.

47. THIOPENTONE SODIUM.
• Dosage: 3-5mg/kg
• Ultra short acting barbiturate
• Highly soluble in water
• Produces unconsciousness in 15-20 seconds
• Produces CNS depression which persists for> 12 hours.
• Poor analgesic and weak muscle relaxant
• Respiratory depression with inducing doses of
thiopentone is generally transient, but with large dose
it will be severe.
47

48. – Bp falls immediately after injection but recovers
rapidly.
– Cardiovascular collapse may occur if hypovolemia,
shock or sepsis are present.
– Adverse effects:-
• Laryngospasm
• Shivering and delirium during recovery.
• Pain in the post operative period.
48

49. METHOHEXITAL SODIUM
• Dosage:
– 1-1.5mg/kg.
• 3 times more potent than thiopentone.
• Quicker and brief actions.
• Unconsciousness is usually induced in 15-30 seconds.
• Consciousness will regain within 2-3 minutes.
• Actions:
– Less hypotensive compared to thiopentone.
– Causes slight increase in heart rate.
– Moderate hypoventilation
– Short period of apnea may be seen after iv injection.
– This drug is contraindicated in epileptic patients.
49

50. PROPOFOL
• Phenol derivative.
• Oil in water emulsion
• pH between 7.0 and 8.5.
• Dosage:
– G.A Induction: 2 to 2.5 mg/kg titrated over 20 to 3.0
seconds.
– Maintenance: 25% of the induction dose.
– Sedation: 3mg/kg/hr in an infusion pump.
50

51. • Action
– Rapid onset: 45 seconds.
– Average duration of anesthesia: 10 minutes.
– Antiemetic property is present. So post op nausea and
vomiting less.
– Decreases arterial pressure by 30%.
– No heart rate change.
Cardiac output decreases minimally.
– Incidence of phlebitis is 0.6%.
– Pain at the injection site.
51

52. DIAZEPAM BENZODIAZEPINE GROUP
• Dosage:
– 0.2 to O.5 mg/kg.
• Site of action: Thalamus, hypothalamus at gamma-
aminobutyric acid (GABA) receptors
• Action:
– Mild decrease in BP by decreasing anxiety and causing muscle
relaxation.
– Antiemetic property is present.
– Produces amnesia which increases as the dose increases .
– Produces emotional responses in adolescent females.
52

53. MIDAZOLAM [1-5mg/ml]
• Onset of action: 1 minute.
• Given slowly, 1 mg over 2 minutes.
• Soluble in water.
• Less chance of thrombophlebitis.
• Respiratory depression may occur at higher dose.
• Faster acting.
• Short clinical action than diazepam.
• Half life 2.5 hours.
53

54. KETAMINE {100mg and 500mg/10ml injection }
• Produces 'dissociative' anesthesia
• Profound analgesia, immobility, amnesia with light sleep
and feeling dissociation from ones own body and
surroundings.
• Primary site of action:
– cortex and sub cortical area.
• Muscle tone increases.
• Heart rate, cardiac output and BP are elevated due to
sympathetic stimulation
54

55. • Dosage:
– 1 to 4 mg/kg IV or 6.5 to 15 mg/kg IM
• Onset of action: within 1 to 3 minutes
• Recovery starts after 10 - 15 minutes, but the patient
remains amnesic for 1 to 2
hours.
• Delirium, hallucinations and involuntary movements
occurs in 50% patients.
• Children tolerate the drug well.
55

56. • Recommended for
– Surgeries on the head and neck
– Asthmatic patients (relieves bronchospasm)
– Hypovolemic patients.
• Contraindicated in:
– Hypertensive patients
– Ischemic heart diseases.
– Unmarried females
• As it causes lucid dreams
56

57. FENTANYL- DROPERIDOL COMBINATION.
• Fentanyl is a short acting (30 to 50 minutes) potent
opioid analgesic.
• Droperidol is a rapidly potent neuroleptic. When this
combination is given IV a state of
'neuroleptanalgesia' is produced.
• This state lasts for 30 to 40 minutes
57

58. • Dosage:
• Fentanyl 0.5 mg+ Droperidol 2.5mg/ml
• 4 to 6 ml is diluted in 5% dextrose sol and infused over 10 minutes .
• Supplemental doses of Fentanyl can be given at 30 minutes intervals.
– Patient remains drowsy but conscious.
– Respiratory depression present.
– Slight fall in BP.
– Heart rate increases.
– Recovery is slow,
58

59. –Abnormal movements can be seen.
–Psychomotor function remains depressed
for many hours.
–Can be converted to 'neuroleptanesthesia'
by administering 65% N20 and 35% 02.
59

60. The advantages and disadvantages
Inhalation anaesthesia
Intravenous anaesthesia
Advantages - controllable reversibility
(duration of action can be controlled)
- fast induction
Disadvantages - relatively slow induction
- irritation of airways
- claustrophobic feeling
- duration of action can not be
controlled
(termination of action require biotransformation or
excretion processes over which the anesthetist has
no control)
60

61. Reversal agents:
• Physostigmine.
– dosage: 0.5 to 2 mg slow IV
• Flumazenil
– dosage: 0.1 to 1mg IV.
• Neostigmine
– dosage: 0.05 to 0.07 mg/kg IV
61

62. • Naloxone- 0.4mg initially followed by 0.1mg-0.2mg
every 2-3min for children under 20 kg and dose for
children over 20 kg is 2mg.

63. STANDARDS OF
GENERAL ANESTHESIA
STANDARDS FOR GENERAL ANESTHESIA COMPRISES OF:-
I. Anesthetic team
II. General anesthetic armamentarium
III. Facility operating requirements

64. • Physicians, dentists and other personnel in a
non-hospital general anesthetic facility should
be instructed in and familiar with proper
anesthetic protocol, and their responsibilities.
I. ANAESTHETIC TEAM
• All clinical staff must be trained in basic life support (BLS) and duties in
anesthetic emergencies must be well defined.
• The presence of a female staff member is recommended at all times.

65. Team includes :-
A. Anesthetist
B. Operating Dentist
C. Operative Assistant
D. Recovery Supervisor
E. Office Assistant (Receptionist)

66. 1. Qualifications
• The anesthesia care provider must
be a licensed medical practitioner
with current state certification to
independently administer deep
sedation / general anesthesia in a
dental office.
2. Responsibilities
i. PAC of the patient and
determine the appropriate
anesthetic management.
ii. Administer the anesthesia.
iii. Monitor and support the vital
organ systems during the
anesthetic period.
iv. Post-anesthetic management
of the patient.
v. Provide resuscitation or
emergency care, if necessary.
A. ANAESTHETIST

67. • Must be familiar with the use of this
modality of anaesthesia including
indications, contraindications,
patient evaluation, patient selection,
pharmacology of relevant drugs, and
management of potential adverse
reactions.
• Significant pediatric training
B. OPERATING DENTIST
• Selected by the operating
dentist.
• The operative assistant must
be appropriately trained.
C. OPERATIVE ASSISTANT

68. • The office assistant's function is
to attend to office duties so that
the anesthetic team is not
disturbed.
• Primary duties and responsibilities
are supervising and monitoring
patients in the recovery area.
E. OFFICE ASSISTANT
(RECEPTIONIST)
D. RECOVERY SUPERVISOR

69. II. GENERAL ANAESTHETIC
ARMAMENTARIUM
• All necessary equipment, drugs and
supplies comprising the general
anesthetic armamentarium must be
readily available and in proper working
order, including emergency equipment
for resuscitation and life support.
• The practitioner administering the general anesthesia must be
familiar with these Practice Standards, and the facility’s current
list of general anesthetic equipment.

70. PAEDIATRIC ANAESTHETIC EQUIPMENT
Pediatric equipment should:
• Have minimal resistance to airflow
• Have minimal dead space
• Be light weight
• Be easy to use and reliable
• Able to conserve heat and moisture.

71. Pediatric airway equipments includes the following:
Anesthesia machine Nasopharynx Air Ways
Endotracheal tubes (ETT)
The formula for calculating the
length of the tube form the
teeth to mid-trachea:
• Age / 2 + 12 for oral tube
• Age / 2 + 15 for nasal tube
In children the epiglottis is
floppy and large, it can get
folded
Laryngoscope blades

72. 2. Venipuncture
• Intravenous equipment and supplies must
include the following:
 Catheters
 Cannulas (needles)
 Administration sets (adult/pediatric)
 For smaller children, mini-drip sets (60 drops/cc) with burettes
 IV stand
 IV solutions (choice to be determined by anesthetist)

73. • Emergency equipment and drugs must be available at all times.
Emergency equipments:
i. Portable apparatus for intermittent positive pressure breathing
(IPPB)
ii. Bag-valve-mask, face masks, connectors.
iii. Portable, battery powered light source.
iv. Apparatus for emergency tracheostomy.
v. Electrocardiogram monitor and defibrillator.
3. EMERGENCY ARMAMENTARIUM

74. • A dentist may need to provide the following basic equipment if it is not available at the hospital:
1. A suitable x- ray unit or intra oral radiographs.
2. Equipment that enables development of dental radiographs.
3. A self contained dental unit equipped with its own compressor and /or powered from
compressed air tanks
4. Portable dental cabinets for supplies and equipment
5. An extension for the operating room table
6. Physical restraints
7. Mouth – stabilizing devices
Dental Equipments For Hospital Procedures

75. A. ANESTHETIC PREPARATION OF THE CHILD
1. Preoperative preparation immediately before surgery
• In children, because they dislike needles, anesthesia is commonly induced by
inhalation of a halogenated volatile anesthetic via a face mask.
• The patient will be brought into the operating room and transferred to the operating
table from the mobile cart.
• The anesthesiologist and staff will attend to the patient.
• After the anesthesiologist has the established monitoring devices and Intravenous
route, induction begins.

76. • Special care is taken to protect child’s eye
Place ophthalmic ointment in the eyes and
then tape them shut to prevent
conjunctivitis and foreign bodies in the
eyes.
• A shoulder roll is place, head is stabilized,
heating or cooling blankets are used as
needed and the safety belt.

77. Obtaining diagnostic radiographs.
Notice the use of protective lead gloves, gown, and apron.
• Before scrubbing dentist should obtain necessary preoperative radiographs
• Digital radiographs are advantageous because radiation exposure is reduced and
image feedback is immediate

78. 2. Perioral Cleaning, Draping, And Placement Of
Pharyngeal Throat Pack
Special care must be taken during perioral cleaning to prevent
materials from entering the oral cavity.
Perioral Cleaning
• Before the dental procedure is begun, the
perioral area is cleansed with sterile 4 × 4-
inch gauze pads.
• The first gauze pad is saturated with a
bacteriostatic cleansing agent (betadine
)and the second with sterile water.

79. Draping
• A surgical sheet is then positioned over the remainder of the child’s body.
• Maintains body temperature and provides a clean field during the procedure.
• The head is draped with three towels arranged to form a triangular access space
for the mouth.
• The towels are secured in place with towel clamps or hemostats.
• The mouth should be fully exposed.
• The nasotracheal tube remain exposed for
monitoring.

80. Operating room positions of the staff
while performing the necessary
dental procedures.
(Dental assistant, dental surgeon,
anesthesiologist, assistant dental
surgeon, and circulating nurse. )
Sitting position in operating room.
(Dental surgeon and dental
assistant)

81. Positioning of a mouth prop.
Special care is taken not to impinge on the lips or tongue with
the prop.
Placement Of Pharyngeal Throat Pack

82. Placement of the pharyngeal throat pack
• The mouth is thoroughly aspirated.
• The pharyngopalatine area is sealed off with a strip of moist 3-inch sterile gauze
approximately 12 to 18 inches long.
• The gauze should be tightly packed for a good seal and once the pack is in place, a
thorough intraoral examination is performed

83. B. RESTORATIVE DENTISTRY
IN THE OPERATING ROOM
• Instruments used for restorative dental procedures in the operating room are
the same as those for procedures in the dental operatory.
• Local anesthesia may be used to minimize pain and bleeding and can decrease
the anesthetic requirements or need for
postoperative opiate analgesia and thus
decrease postoperative side effects such
as nausea.
• The use of quadrant isolation
with a rubber dam is preferred.

84. C. COMPLETION OF THE PROCEDURE
• The anesthesiologist should be notified 10 minutes before the completion of the
procedure so that the child can begin to be aroused and preparations can be made for
Extubation.
• The recovery room preparations done for the child.
• On completion of the dental procedure, the oral cavity is thoroughly debrided, and the
throat pack is removed carefully to prevent aspiration of any materials that might be
lodged against it.

85. 1. After treatment, the first drink should be sips of
plain water, sweet drinks can be given next.
2. Food or drinks are preferred in small quantities at
frequent intervals rather in large quantities at one
time.
3. Aerated drinks should not be given in first 24 hours.
4. For elevated body temp- antipyretics and fluids can
be given.

86. 5. Patients should seek advice if there is persistent vomiting
beyond 4 hours, increased temp above 101F i.e 38°C ,
difficulty in breathing , excessive drowsiness, any matter
of concern.
6. 24 hour contact number of dental surgeon/ pedodontist
should be given to parents.
7. Emphasize on checkup on the following day and
essentials of regular follow up.

87. Discharge criteria
1. Cardiovascular function is satisfactory and stable.
2. Airway patency is uncompromised and satisfactory.
3. Patient is easily arisable and protective reflexes are intact.
4. State of hydration is adequate.
5. Patient can talk, if applicable.
6. Patient can sit unaided, if applicable.
7. Patient can ambulate, if applicable, with minimal assistance.
8. If the child is very young or disabled, incapable of the usually
expected responses, the presentation level o f responsiveness or
the level as close as possible f or that child has been achieved.
9. Responsible individual is available.

88. COMPLICATIONS OF GENERAL ANESTHESIA.
• DURING ANESTHESIA
– Respiratory depression and hypercarbia.
– Increased salivation, respiratory secretions.
– Cardiac arrhythmias, asystole
– Fall in BP.
– Aspiration of gastric contents, acid pneumonitis.
– Laryngospasm, asphyxia
– Delirium, convulsions.
88

89. AFTER ANESTHESIA.
– Nausea, vomiting
– Persisting sedation; impaired psychomotor function
– Pneumonia
– Liver / kidney damage
– Nerve palsies- due to the faulty positioning
– Delirium
– Malignant hyperthermia
• Stop surgery! 100% oxygen; Dantrolene Sodium and ice to cool
89

90. Post-operative shivering
• Causes –
– Is per- operative hypothermia secondary to
anaesthetic induced inhibition of thermoregulation.
– Causes both cutaneous vasodilation and reduction in
the thresholds for activation of vasoconstriction and
shivering.
– In turn this results in redistribution of body heat from
core to periphery with subsequent rapid hypothermia
during anaesthesia.
90

91. • Prevention
– Increasing the ambient temperature in theatre,
– Using conventional or forced warm air blankets
– Using warmed intravenous fluids.
91

92. THANKYOU