Anesthesia is a way to control pain during surgery using drugs or gases called anesthetics. It can help control blood pressure, breathing, blood flow, heart rate, and rhythm. Anesthesia is crucial during surgery as the anesthesiologist monitors the patient's vitals and administers drugs to keep the patient unconscious. The main types of anesthesia are general, which uses intravenous drugs and gases to make the patient completely unconscious; regional, which numbs a large part of the body using injections or catheters; and local, which numbs a small area. The anesthesiologist plays a vital role in patient safety during surgical procedures.

1. ANESTHESIA
DR.OMAR EL-RAJAB, MD
Anesthesia Chairman
15-09-2022

2. WHAT IS ANESTHESIA ?
Anesthesia is a way to control pain during a surgery or procedure by
using drugs or gases called Anesthetics.
Anesthesia can help:
1. Control your blood pressure
2. Control your breathing
3. Control your blood flow, heart rate, and rythm

3. WHAT IS ANESTHESIA ?
Anesthesia maybe used as well to:
1. Relax you
2. Block your pain
3. Make you sleepy or forgetful
4. Make you unconscious for your surgery

4. WHY IS ANESTHESIA CRUCIAL ?!
Anesthetists evaluate patients before an operation
Determine suitable anesthetic plans
Anesthetist is required to obtain patients’ medical history, conduct
interviews with them and order required blood for transfusion
An anesthetic plan will consider the nature and duration of the
operation, patients’ health conditions and other technical support
factors

5. WHY IS ANESTHESIA CRUCIAL ?!
During surgery, the anaesthetist continues administering anesthetic
drugs or gases to the patient to keep him or her unconscious
throughout the operation
An anesthetist also monitors the patient’s heartbeat, blood pressure,
blood glucose level and oxygen level throughout the operation
He is alert to any unexpected and life-threatening development (such
as blood loss and allergic reaction)

6. WHY IS ANESTHESIA CRUCIAL ?!
Imagine yourself doing a surgery without anesthesia ?!
Laparatomy without anesthesia..
Brain or open heart surgery without anesthesia..
THE ANESTHESIOLOGIST IS THE ONE WHO MUST WATCH WHILE
OTHERS MUST SLEEP !!

7. TYPES OF ANESTHESIA
Main 4 types of Anesthesia:
1. General Anesthesia
2. Regional Anesthesia
3. Sedation (MAC = Monitored Anesthesia Care)
4. Local Anesthesia

8. GENERAL ANESTHESIA
General anesthesia is a combination of medications that put you in a sleep-
like state before a surgery or other medical procedure
Under general anesthesia, you don't feel pain because you're completely
unconscious
General anesthesia usually uses a combination of intravenous drugs and
inhaled gasses (anesthetics)
General anesthesia is more than just being asleep, though it will likely feel
that way to you
Anesthetized brain doesn't respond to pain signals or reflexes.

9. GENERAL ANESTHESIA
Acts primarily on the brain and CNS to make the patient unconscious
and unaware
Administered via patient’s circulatory system by a combination of
inhaled gases and injected drugs
After initial induction, anesthesia is maintened with inhaled gas
anesthetics and additional drugs through an intravenous line (IV)

10. STAGES OF GENERAL ANESTHESIA

11. STAGE1 - INDUCTION - VOLUNTARY
EXCITEMENT
Stage 1 is the period between initial administration of the induction
agents and loss of consciousness.
During this stage, the patient progresses from analgesia without
amnesia to analgesia with amnesia.
Patients can carry on a conversation at this time.

12. STAGE2 - DELIRIUM - INVOLUNTARY
EXCITEMENT
Is the period following loss of consciousness and marked by excited
and delirious activity.
During this stage:
1. Respirations and heart rate become irregular.
2. Uncontrolled movements
3. Breath holding
4. Papillary Dilatation

13. STAGE2 - DELIRIUM - INVOLUNTARY
EXCITEMENT
Combination of spastic
movements + irregular breathing
= Airway Compromise
Rapidly acting drugs are used to
minimize time in this stage

14. STAGE3 - SURGICAL ANESTHESIA
During this phase:
1. Skeletal muscles relax
2. Respiratory depression occurs
3. Eye movements slow and then stop
4. Patient becomes unconscious and ready for surgery

15. STAGE4 - OVERDOSE
Too much medication given
Patient has severe brain stem or medullary depression
Cessation of respiration and potential cardiovascular collapse
Lethal Stage without cardiovascular and respiratory support

16. REGIONAL ANESTHESIA
Regional anesthesia is a type of pain management for surgery that
numbs a large part of the body, such as from the waist down.
The medication is delivered through an injection or small tube called
a catheter.
Includes:
1. Spinal anesthesia
2. Epidural Anesthesia
3. Nerve Blocks

17. SPINAL ANESTHESIA
Spinal anesthesia is a type of neuraxial anesthesia
Local anesthetic (LA) is injected into cerebrospinal fluid (CSF) in the
lumbar spine to anesthetize nerves that exit the spinal cord
Spinal anesthesia is most commonly used for anesthesia and/or
analgesia for a variety of lower extremity, lower abdominal, pelvic,
and perineal procedures

21. WHY FAILED SPINAL ?

22. SPINAL ANESTHESIA

23. SPINAL ANESTHESIA

24. EPIDURAL ANESTHESIA
An epidural is a procedure that involves injecting a medication, either
an anesthetic or a steroid into the epidural space.
The goal of an epidural procedure is to provide pain relief (analgesia)
or a complete lack of feeling (anesthesia) for one region of your body,
such as your legs or belly.

26. NERVE BLOCKS
Upper Extremity Nerve Blocks
Lower Extremity Nerve Blocks
Trunk Nerve Blocks

27. UPPER EXTREMITY NERVE BLOCKS

28. INTERSCALENE BLOCK
Anesthesia and analgesia for surgery on shoulder, distal clavicle and
proximal humerus.
Transducer placement over external jugular vein approximately 3cm
above clavicle
Brachial plexus C5 C6 C7 nerve roots

29. INTERSCALENE BLOCK

30. SUPRACLAVICULAR AND
INFRACLAVICULAR BLOCKS
Less Likely used
Anesthesia and analgesia for surgeries on humerus, elbow, forarm
and hand

31. AXILLARY NERVE BLOCK
Anesthesia nad analgesia for surgery on forearm and hand (AV
fistula, Ulna radius ORIF, hand ORIF, Carpal tunnel … )
Transducer placement perpendicular to humerus in the axillary fossa
at intersection between pectoralis and biceps muscles

32. AXILLARY NERVE BLOCK

33. LOWER EXTREMITY NERVE
BLOCKS

34. FEMORAL NERVE BLOCK
Surgery on femur, anterior thigh and knee, patella fracture,
quadriceps tendon repair.
Transducer Placement in femoral crease parallel and inferior to
inguinal ligament.
Can be done as well with nerve stimulator without ultrasound.

35. SCIATIC NERVE BLOCK
Anesthesia and analgesia for surgeries below knee
Transducer placement transverse 4-5cm above popliteal crease
Can be done as well with nerve stimulator without ultrasound.

36. SCIATIC NERVE BLOCK

37. PARAVERTEBRAL NERVE BLOCK
A paravertebral block is essentially a unilateral block of the spinal
nerve including:
1. Dorsal and ventral rami
2. Sympathetic chain ganglion.
These blocks can be performed at any vertebral level
Most commonly performed at the thoracic level because of anatomic
considerations

38. PARAVERTEBRAL NERVE BLOCK

39. PUEDENDAL NERVE BLOCK
A pudendal nerve block aims to block the nerve as it enters the lesser
sciatic foramen, 1 cm inferior and medial relative to the attachment of
the sacrospinous ligament to the ischial spine.
Different anatomical approaches are utilized to achieve successful
PNB

40. INTRAVENOUS ANESTHETICS
Benzodiazepines: Midazolam
Opioids: Fentanyl
Hypnotic: Propofol
Muscle Relaxants

41. BENZODIAZEPINES – MIDAZOLAM
(DORMICUM)
The actions of benzodiazepines are due to the potentiation of the neural
inhibition that is mediated by gamma-aminobutyric acid (GABA).
All effects of the benzodiazepines result from their actions on the ionotropic
GABA(A) receptors in the central nervous system.
The main effects of benzodiazepines are:
1. Sedation and hypnosis
2. Decreased anxiety
3. Anterograde amnesia
4. Centrally mediated muscle relaxation and anti-convulsant activity.

42. MIDAZOLAM
Benzodiazepines have a dose-dependent ventilatory depressant effect.
Cause a modest reduction in arterial blood pressure and an increase in heart
rate as a result of a decrease of systemic vascular resistance.
The benzodiazepines, widely used in clinical anaesthesia, are the agonists:
1. Midazolam
2. Diazepam
3. Lorazepam
The antagonist flumazenil

43. FENTANYL
Fentanyl, a potent lipid-soluble opioid which was first synthesized
more than 40 years ago, is still the most popular opioid used in the
perioperative period throughout the world.
Intravenous fentanyl is often used for anesthesia and to treat pain
To induce anesthesia, it is given with a sedative-hypnotic,
like propofol, and a muscle relaxant.
To maintain anesthesia, inhaled anesthetics and additional fentanyl
may be used

44. PROPOFOL
Propofol slows the activity of your brain and nervous system
Propofol is used to put you to sleep and keep you asleep during
general anesthesia for surgery or other medical procedures
It is used in adults as well as children
Propofol is also used to sedate a patient who is under critical care and
needs a mechanical ventilator (breathing machine)

45. MUSCLE RELAXANTS

47. QUESTIONS - MCQS
The antidote of benzodiazepines is :
1. Midazolam
2. Naloxone
3. Flumazenil
4. Propofol
 The mixture of fentanyl and dormicum give an:
1. Additive effect
2. Synergistic effect
3. Antagonist effect
4. No effect

48. QUESTIONS - MCQS
Axillary nerve block includes blocking all of the following nerves except:
1. Median Nerve
2. Ulnar Nerve
3. Radial Nerve
4. Saphenous Nerve
All of the following are true about epidural except:
1. Central neruaxial block
2. Faster than spinal
3. Depends on the volume of the local anesthetic given
4. Is absolutely contraindicated in septic patients

49. QUESTIONS - MCQS
The 3rd stage of general anesthesia is:
1. Excitement
2. Surgical anesthesia
3. Medullary paralysis
4. Analgesia