The document discusses various topics related to anesthesia and pain management. It covers local anesthetics, regional blocks, general anesthesia and airway management techniques. It also discusses postoperative monitoring, risks of hypothermia, choice of anesthetic based on the procedure and patient factors. Management of different types of pain like nociceptive, neuropathic and psychogenic pain is summarized along with the WHO analgesic ladder approach. Adjuvant medications and techniques like patient controlled analgesia are also mentioned.

1. Dr. Haydar Muneer Salih

3. ■ Local anesthetic – suitable for day cases;
contraindicated in infection
■ Regional block – useful in an emergency
when the patient is not starved; gives good
postoperative pain relief
■ Spinal and epidural anesthetic – only to be
used by an anesthetist under full sterile
conditions; allows on-going postoperative
pain relief
■ General anesthetics are now safer and more
controllable

5. General anesthesia is most
frequently induced intravenously
and maintained by inhaled vapour
such as halothane
The general anesthetic triad
■ Unconsciousness
■ Pain relief
■ Muscle relaxation

6. ■ Jaw thrust – only suitable for short term
■ Guedel airway – holds tongue forwards but
does not prevent aspiration
■ Laryngeal mask – simple to insert, allows
ventilation
■ Endotracheal intubation – very secure
protection of the airway
■ Tracheostomy – used when airway needs
protecting for prolonged periods Hemostasis
and blood pressure control

12. Vasodilatation, cold infusions of fluid and
loss of body heat by radiation and fluid
evaporation from open body cavities results
in hypothermia under anesthesia
It is a particular hazard in children because
of the high ratio of body surface area to body
mass
Careful intraoperative temperature control
using warm air blowers and warming
blankets

13. Recovery from general anesthesia
should be closely supervised by trained
nursing staff skilled in airway
management in an area equipped with
the means for resuscitation and
adequate monitoring devices.

15. The choice of local anesthetic technique
depends upon its feasibility for a particular
procedure and the patient’s willingness and
ability to cooperate, as well the surgeon’s
and anesthetist's preference
The overdose manifest as depressed
conscious level, convulsions and/or cardiac
arrest (particularly bupivacaine), and may be
heralded by circumoral paraesthesia and
light-headedness.

17. The addition of adrenaline
(commonly at a concentration of 1:200
000–1:125 000) to the local anesthetic
solution hastens the onset and
prolongs the duration of action and
permits a higher dose of drug to be
used as it is more slowly absorbed into
the circulation

18. Local infiltration is contraindicated
near infection because it not only
spreads the infection but is also
ineffective, as the acidity produced by
infection blocks the action of the
drugs. It is also contraindicated in the
presence of a clotting disorder as it
may result in haemorrhage

20. Nociceptive:
Arising from stimulation of peripheral nerves
transmitted from an undamaged nervous
system;
• often described as aching in skin or deeper
tissues (account for three-quarters of pain type
in studies).
Neuropathic:
• arising from damage to the peripheral or
central nervous system;
• often described as burning or stabbing

21. Psychogenic pain.
Psychological factors play a greater or lesser
role in many chronic pain syndromes.
Whatever the primary cause may have been,
depressive illness and chronic pain may
exacerbate each other Management of
chronic pain of malignant origin
• Nociceptive pain: usually respond to
analgesics.
• Neuropathic pain: may only partially
respond to opioids. Pain control is aimed at
removing cause if possible and pain

22. Analgesia lack of pain, anesthesia lake
of sensation
Analgesia is patient control while
anesthesia controlled by specialist

24. Patient-controlled analgesia (PCA). Opioid
analgesia is injected intravenously or
through an epidural cannula.
Local anesthetic blocks.
Regular intramuscular injections
Indwelling epidural – good pain control;
opioids may depress respiration
 Continuous infusions

26. Two-thirds of patients with advanced
disease often have pain
Pain in oral cancer can be due to local
tumour infiltration causing ulceration
or infection, vascular and lymphatic
occlusion, nerve involvement, referred
pain, or treatment-related (e.g.
mucositis).

27. Step 1: non-opioids ± adjuvants:
• paracetamol 1g every 4–6h regularly, maximum 4g
over 24h;
• if this does not work after 24h move up ladder.
Step 2: weak opioids + non-opioids ± adjuvants.
Paracetamol 1g and codeine (30mg not 8mg) or
dihydrocodeine regularly every 4–6h.
Step 3: strong opioids + non opioids ± adjuvants:
• morphine 5–10mg every 4h (NB 60mg codeine equi-
analgesic with 5mg morphine every 4h);

28. Steroids: oedema pain.
Antidepressant or anticonvulsant:
neuropathic pain.
Non-steroidal anti-inflammatory drug:
inflammation.
Night sedative: if lack of sleep/reduced
pain threshold.
Muscle relaxant: cramps.
Anxiolytic: anxiety.
Antibiotics: infection