Types of Anesthesia used for different surgeries. A Brief look.

1. Types of
Anaesthesia
PPT PREPARED BY
DR RAJESH T EAPEN
ATLAS HOSPITAL
RUWI

2. Sushruta 800B.C.
wrote first Surgery textbook

3. Anesthesiology
Making
Surgery
Painless

4. Anesthesia
 From Greek anaisthesis means
not sensation
 Listed in Bailey´s English
Dictionary 1721.
 When the effect of ether was
discovered anesthesia” used as a
name for the new phenomenon.

5. Oxford dictionary
definition
 insensitivity to pain, especially
as artificially induced by the
administration of gases or the
injection of drugs before
surgical operations

6. World Anesthesia Day 16th Oct

7. HISTORY OF ANESTHESIA
• General anesthesia was absent until the mid-
1800s.
• Ether synthesized in 1540 by Cordus
• Ether used as anesthetic in 1842 by Dr. Crawford
W.Long
• Ether publicized as anesthetic in 1846 by Dr.
William Morton.
• Ether is no longer used in modern practice, yet
considered to be the first ‘ideal’ anesthetic
• Chloroform used as anesthetic in 1853 by Dr. John
Snow
• Endotracheal tube discovered in 1878
• Thiopental first used in 1934

8. Pre 1846 - The Foundations of
Anaesthesia
……..so the Lord God caused him to fall
into a deep sleep. While the man
was sleeping, the Lord God took out
one of his ribs. He closed up the
opening that was in his side……...
Genesis 2:21 NIrV

9. Primitive Anesthesia
 Ancient civilizations- opium poppy,
coca leaves, mandrake root,
alcohol
 Regional anesthesia in ancient
times- compression of nerve
trunks or the application of cold
(cryoanalgesia)

10. World Anaesthesia Day
 On 16 October 1846,
John Collins Warren
removed a tumor from
the neck of a local
printer,Edward Gilbert
Abbott. Warren
reportedly quipped,
"Gentlemen, this is no
humbug.
 MGH Boston

11. Regional
Anaesthesia
 1884 Sigmund Freud
physiology actions
cocaine
 Carl Koller cocaine
ophthalmological
surgery

12. Birth of modern Anaesthesia
 1913,Chevalier Jackson-use of direct
laryngoscopy as a means to intubate
the trachea
 Sodium Pentathal - first used in humans
on 8 March 1934 by Ralph M. Waters

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

15. Types Of Anesthesia

16. Types
.

17. Triad of General
anaesthesia
Hypnosis
Analgesia Muscle relaxation

18. CLASSIFICATION:
18
General
anaesthetics
Inhalational Intravenous

19. INTRODUCTION
• General anaesthetics (GAs) are drugs which produce
reversible loss of all sensations and consciousness. It usually
involves a loss of memory and awareness with insensitivity to
painful stimuli, during a surgical procedure
General anesthesia
need for
unconsciousness
‘Amnesia-hypnosis’
need for analgesia
‘Loss of sensory and
autonomic reflexes’
need for muscle
relaxation

20. General anesthetics

21. Amnesia
sedation
Hypnosis
Coma
Death
Awake
Hypnosis

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

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

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

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

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

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

28. Muscle relaxants
 Two types
 Depolarising-short acting
e.g.; suxmethonium
 Non-depolarising-
medium/long acting
- Tracurium
- Vecuronium
- Rocuronium
- Cisatracurium (NIMBEX)

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

30. The 21 st century-digital
revolution

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

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

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

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

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

37. Disadvantages
 Poly-pharmacy
 Effects on various systems
 Allergic reactions
 Recovery profile
 Post operative Nausea &Vomiting
 Awareness

38. Providing operative conditions

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

40. 40
Spinal Block - Position

41. Regional anaesthesia
Analgesia Muscle relaxation

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

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

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

45. Patient is more important
than our ego; call for help,
whenever patient is in
danger
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46. Slide master
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47. Choice of anesthesia
 The patient´s understanding and wishes regarding the type of
anesthesia that could be used
 The type and duration of the surgical procedure
 The patients´s physiologic status and stability
 The presence and severity of coexisting disease
 The patient´s mental and psychologic status
 The postoperative recovery from various kinds of anesthesia
 Options for management of postoperative pain
 Any particular requiremets of the surgeon
 There is major and minor surgery but only major
anesthesia

48. Types of anesthesia care
General Anesthesia
 Reversible, unconscious state is
characterised by amnesia (sleep,
hypnosis or basal narcosis),
analgesia (freedom from pain)
depression of reflexes, muscle
relaxation
 Put to sleep

49. Types of anesthesia care
Regional Anesthesia
 A local anethetic is injected to
block or ansthetize a nerve or
nerve fibers
 Implies a major nerve block
administered by an
anesthesiologist (such as spinal,
epidural, caudal, or major
peripheral block)

50. Types of anesthesia care
Monitored anesthesia care
 Infiltration of the surgical site with a local
anesthesia is performed by the surgeon
 The anasthesiologist may supplement the
local anesthesia with intravenous drugs
that provide systemic analgesia and
sedation and depress the response of the
patient´s autonomic nervous system

51. Types of anesthesia care
local anesthesia
 Employed for minor procedures in which the
surgical site is infiltrated with a local anesthetic
vital signs
 May injsuch as lidocaine or bupivacaine
 A perioperative nurse usually monitors the
patient´s ect intravenous sedatives or analgesic
drugs

53. Thank
you
Macintosh noted: “for the
surgeon the spinal ends
with the injection of the
agent; for the anesthetist it
begins with the injection of
the agent.”