The document provides a comprehensive overview of the types and history of anaesthesia, including significant historical milestones and the development of various anaesthetic agents. It outlines the definitions and classifications of general, regional, and local anaesthesia while discussing the phases and procedures involved in general anaesthesia. Additionally, the document highlights the advantages and disadvantages of each anaesthesia type, mentioning key drug classes and their applications.

1. Types of Anaesthesia
Prof. med. Nabil H. Mohyeddin
Anesthesiologist & Intensivist
Board certified
University Rostock, Germany
nhm1955@hotmail.com

2. Objectives
 Short History
 Definition/types of anaesthesia
 General anaesthesia/drugs
 Phases of GA
 Regional anaesthesia

3. Early history
 Ancient/Medieval period
- Opium
- Alcohol
- Cannabis

4. History
 1845- Horace Wells- N2O
 1846- William Morton- Ether
 1847- Simpson- Chloroform
 1853-John Snow
 1878- ETT
 1884- Cocaine
 1895-98- Spinal analgesia/anaesthesia

5. History
 1921- Epidurals
 1934- Thiopentone, cyclopropane
 1942- Curare
 1946- Lignocaine
 1951- Suxamethonium
 1952- IPPV
 1956-Halothane

6. Definition
‘Loss of sensation’
 General
 Regional
 Local

7. Triad of General
anaesthesia
Hypnosis
Analgesia Muscle relaxation

8. Hypnosis
Death
Coma
Hypnosis
sedation
Amnesia
Awake

9. Hypnotic drugs-intravenous
 Gold standard- thiopentone
 Propofol
others
 Etomidate
 Benzodiazepines
 Ketamine

10. Inhalational anaesthetics
 Nitrous oxide-weak
 Isoflurane
 Sevoflurane
 Desflurane
 Halothane

11. Analgesia
 Good analgesia= good anaesthesia
 Hypnotic sparing effect
 Opiates
 Local anaesthetics
 NSAIDS
 Paracetamol

12. Analgesia-Opiates
 Gold standard – morphine
 Derivatives- diamorphine, codeine
 Synthetic agents
- Pethidine
- Fentanyl/Alfentanil-short acting
- Remifentanil-ultra short acting

13. Analgesia-NSAIDS
 Gold standard- aspirin
 Ibuprofen
 Diclofenac
 Cox-2 inhibitors

14. Muscle relaxation
 Aids intubation
 Helps surgeon/surgery
 Surgery of long duration
 Reduces maintenance dose of
anaesthetics agents

15. Muscle relaxants
 Two types
 Depolarising-short acting
eg;suxmethonium
 Non-depolarising- medium/long acting
- Tracurium
- Vecuronium
- Rocuronium

16. Prerequisites
 Oxygen
 Suction
 Tilting trolley
 Resuscitation drugs
 Monitoring
 Anaesthetist
 Skilled assistance
 Drugs and machine

17. Phases of
general anaesthesia
 Induction
 Maintenance
 Recovery

18. Induction
 Intravenous- majority
 Inhalational- children, needle phobics
 Monitoring
 Preoxygenation
 Hypnotic/analgesic and or relaxant
 Mask/LMA/ET tube

19. Stages of anaesthesia
 Alcohol  General Anaesthesia
1.Dizzy, delightful 1.Amnesia, analgesia
2.Drunk, disorderly 2.Uninhibited
3.Dead drunk response to stimuli
4.Dangerously deep 3.Surgical anaesthesia
4.Vital centre
depression

20. Maintenance
 Intravenous or inhalational
 Oxygen –40%-100%
 Nitrous oxide
 Muscle relaxant
 Analgesia

21. Recovery
 Turn off agent
 Reverse relaxation
 Cough reflex
 Extubate when awake
 Recovery position
 Monitor until discharge

22. Advantages
 No absolute contraindications
 Quick to establish
 Never fails to work

23. Disadvantages
 Polypharmacy
 Effects on various systems
 Allergic reactions
 Recovery profile
 Post operative Nausia &Vomiting
 Awareness

24. Regional anaesthesia
 Spinal/epidural
- surgery below umbilicus
- Provides analgesia/muscle relaxation
 Plexus blocks eg brachial plexus
 Intravenous- Bier’s block

26. Regional anaesthesia
Analgesia Muscle relaxation

27. Local anaesthetics
 Lignocaine- quick/short acting
 Bupivacaine/levobupicvacaine- slow
and long action
 Ropivacaine- as above
 Amethocaine- topical
 Prilocaine- intravenous

28. Advantages
 Effective alternative to GA
 Avoids polypharmacy
 Allergic reactions
 Extended analgesia
 Patient can remain awake
 Early drink/feed

29. Disadvantages
 Limited scope
 Higher failure rate
 Time constraints
 Anticoagulants/Bleeding diathesis
 Risk of neural injury