ANAESTHESIA

PRESENTED BY : Divya Patil

GUIDED BY : Dr.Veeresh sir
INTRODUCTION
Anesthesia is a state of controlled, temporary loss of sensation
or awareness that is induced for medical or veterinary
purposes.

The word anaesthesia means ‘loss of sensation’. People under

anaesthetic will ‘lose’ feelings of pain and other sensations.

Anesthesia is sometimes used to numb the feelings of the

specific part of the human body and sometimes make you
unconscious completely so that the surgery or treatment can
be done without giving any pain to the patient.
ANAESTHESIA IN AYURVEDA
[SANGYAHARANA]
The anaesthesia was used widely during Samhita period as surgery was at peak
during Sushruta period.Various references from different acharyas are given
regarding anaesthesia is as follows;
1. Madhya paan:
Sushruta mentioned Madhya for some operations. It is even advocated by
Charaka to relieve pain of labor & during extraction of foreign body
2. Shantvaitva:
Means consoling, the most of operations were advocated to be conducted just
by soothing & counselling the patients with sweet words, happy conversations,
fomentation, applying digital pressure on root of sensory nerves etc.
3. Samgnya sthapana dravyas: Samgnya sthapana means group of medicinal
plants used to restore the consciousness. They are… • Hingu • Kaitarya • Irimeda
• Vacha • Choraka • Vayastha • Golomi • Jatila • Palankasha • Rohinya.

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4. Aaptairdrudham grahitasya: Holding & caressing by relatives.
5. Vedana sthapana dravyas:
Vedana sthapana means group of medicinal plants used to subside the pain.
They are…
• Shala• Katphala• Kadamba• Padmaka• Tumba• Mocharasa• Shirisha• Vanjula•
Elavaluka• Ashoka

6. Sammoha churna:
A preparation as a moha churna is vigorously used as for the head
surgeries in king Bhoja kingdom.
7. Reversal of unconscious:
Reference available in Valmika Ramayana, where sanjeevani was
used to revive Lakshman who was badly injured in battle
8. Acc to Vagbhatta:
Matulunga rasa & Madhya can be used as anesthetic agent for eye
operations etc.
9. Drugs:

Bhavaprakasha says Ahiphena, Bhaanga possess the quality

moha & madkari which is used in the management of pain

10. Mantra:

Certain mantra & rituals were being performed before

conducting the operations whit probably may have super
natural or hypnotic effect on patient.

11. Bandhas:
Jalandhara bandha in tooth extraction etc
 DEFINITION
A drug or agent used to abolish the sensation of pain, to achieve adequate muscle
relaxation during surgery, to calm fear and allay anxiety, and to
produce amnesia for the event.

TYPES
1.Local Anaesthesia
2.Regional Anaesthesia
3.General Anasthesia
4.Dissociative Anasthesia

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 1. Local anesthesia inhibits sensory perception within a specific location on the
body, such as a tooth or the urinary bladder.

2. Regional anesthesia renders a larger area of the body insensate by blocking

transmission of nerve impulses between a part of the body and the spinal cord. Two
frequently used types of regional anesthesia are Spinal anesthesia and Epidural
anesthesia.

3. General anesthesia refers to inhibition of sensory, motor and sympathetic nerve

transmission at the level of brain, resulting in unconsciousness and lack of sensation.

4. Dissociative anesthesia uses agents that inhibit transmission of nerve impulses

between higher centers of the brain (such as the cerebral cortex) and the lower
centers, such as those found within the limbic system.

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 LOCAL ANAESTHESIA
Local anesthesia is any technique to induce the absence of sensation in a specific
part of the body, generally for the aim of inducing local analgesia, i.e. local
insensitivity to pain, although other local senses may be affected as well. It allows
patients to undergo surgical and dental procedures with reduced pain and distress.

Types of local anesthesia:

1. Surface anesthesia
2. Infiltration anesthesia
3. Nerve block
4. Field block

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 1. Surface anesthesia: it is defined as
superficial loss of sensation in conjunction mucus
membranes or skin produce by direct application of
local anesthetic solutions, ointments, gels, or sprays.
Drugs used are xylocaine 4% solution, ethyl chloride
spray etc.
It is commonly used in laryngoscopy and
bronchoscopy,incision of quinsy (tonsilitis),cystoscopy,
urethral dilatation etc.

2. Infiltration anesthesia:
Subcutaneously ,drug is injected through as few
needles pricks as possible.
Drugs used are xylocaine 2% used in lipoma, polyp,
tooth extraction etc.

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 3. Nerve block:
The local anesthesia solution is deposited in close proximity
to the main nerve trunk supplying the operative field.
Drugs used: lidocaine, bupivacaine etc.
Common nerve blocks are
a. Brachial block → block shoulder, upper arm, elbow and
forearm
b. Digital block → block complete finger

4. Field block:
Local anesthetic is infiltered in circumferential pattern
around the border of the surgical field, leaving the operative
area undisturbed.
Used in midline incision, in operation for hernia, in excision
of benign tumour of skin & subcutaneous tissue.

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ROUTE OF LOCAL ANAESTHESIA

TOPICAL : 5min
INTRAMUSCULAR : 5-10 min
SUBCUTANEOUS : 30-90 min

Drugs used
Procain:Low potency with short acting
Lidnocaine : Intermittent potency with duration
Bupivacaine : High potency and long duration

COMPLICATIONS
Needle breakage
Pain,Infection,Oedema
Burning sensation
Regional anesthesia / Spinal anesthesia:
The spinal tracts are blocked by injecting local anesthetic
drug in sub arachnoid space.

Position:
Lateral decubitus position with head, hips and knee being
fully flexed to open the interlaminar spaces. Highest point
of Iliac crest corresponds top 4th lumbar vertebra.

Useful drugs in spinal anesthesia:

Lignocaine
Bupivacaine
Tetracaine
Cinchocaine / Nupercaine

Types of Spinal Anaesthesia:

1. Caudal (Up to L₂) 2. Low spinal (Up to L₁)
3. Mid spinal (Up to T10) 4. High spinal (Up to T)
5. Unilateral spinal
Indications:
Surgeries below the umbilicus (lower abdominal) and perinea

Advantages:
1. Economical
2. Hypotension reduces the bleeding
3. Adequate relaxation is achieved.
4. Respiratory complications are less.

Disadvantages:
1. High incidence of post operative headache 2. Hypotension
3. Dural puncture 4. Meningitis

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Materials required:
• Lumbar puncture needle
• 2cc & 5cc disposable syringes
• 23/24 number injectable needle
• Towel
• Sponge holding & artery forceps
• Glows and anesthetic drugs

PRE-OPERATIVE

1.Light & liquid diet

2.lumbar region shaving or cleaning
3.Inj diazepam iv
TECHNIQUE
SPINAL NEEDLE PASSES FOLLOWING STRUCTURES:

1. SKIN
2. SUBCUTANEOUS TISSUE
3. SUPRA SPINAL LIGAMENT
4. INTER SPINAL LIGAMENT
5. LIGAMENTUM FLAVUM
6. EPIDURAL SPACE
7. DURAMATER
8. SUB ARACHNOID SPACE

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 COMPLICATIONS
• Immediate • LATE

• Bleeding • Vomiting
• Severe headache • Restlessness
• Backache • Paralysis
• Soothing pain • Nerve damage
• Shock

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 GENERAL ANAESTHESIA
DEFINITION:
General anesthesia is a medically induced coma and loss of protective reflexes
resulting from the administration of one or more general anesthetic agents.
Types:
1. Intravenous
2. Inhalation

INTRAVENOUS
Intravenous therapy is a medical technique that administers fluids, medications and nutrients directly into a
person's vein.
• Pentotheal sodium: Sodium 5gm in 10ml distilled water
• Ketamine Hcl : 2gm/kg of body weight
• Propofol
• Cocktail anaesthaesia
COCKTAIL ANAESTHESIA
Cocktail anesthesia is a type of anesthesia that combines oral
medications and nerve-blocking injections to alleviate discomfort
during surgery.
Different sedative drugs like fortwin,calmpose,phenargan,largactile
injection are given in combinations of 3 or 4 in very little dose.
This is administered in operations of short duration like fracture
reduction, D & C, Vasectomy etc.

INHALATION
An inhalational anesthetic is a chemical compound possessing
general anesthetic properties that can be delivered via inhalation.
Gaseous: Nitrogen oxide
Liquid : Chloroform,ether,ethyl chloride
Rapid acting : Thiopentone, Propofol
Slower acting : Ketamine,Benza diazepine
Boyle’s apparatus is used mainly’

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Premedication:
It is the term given to the administration of certain medications prior to anesthesia. Their
objectives are as follows;
1. To allay anxiety: Tab Diazepam. 0.1-0.2 mg/kg or Tab Lorazepam 2-4 mg orally or
Triclofos syrup 100 mg/kg, one hour prior to surgery (children)
2. To relieve pain: Morphine 0.1 mg/kg or Pethidine 0.5 mg/kg or Tramadol 0.5-1 mg/kg IM
3. To dry secretions: Anti-cholinergic drugs like Glycopyrrolate 0.2 mg IV
4. To help anesthesia induction
5. To blunt baroreceptor reflux: small dose of beta blocker or clonidine
6. To reduce gastric volume & acidity: Metoclopramide 10 mg or Ranitidine 150 mg or
Pantaprazole 40 mg orally.

Investigations: All investigations are depending upon condition of patient and disease.
Some common are

• Routine blood • Urine routine • ESR • BT, CT

• HIV 1 & 2 • HbsAg • ECG • Chest X-ray
 SUBDIVISION:
LIGHT ANAESTHESIA DEEP ANAESTHESIA
 Diaphragmatic respiration with intercostal paralysis
Respiration is regular,full,deep & thoraco-abdominal
Roving eyeball  Dialated pupil & ,abolition of papillary corneal
Eyelid reflux is lost reflux ,light reflux is abolished
Swallowing reflux disappears  BP falls
Incomplete relaxation of skeletal muscles  Complete muscle relaxation

SURGICAL ANAESTHESIA PROFOUND ANAESTHESIA

 Eyeballs are fixed o Complete paralysis of intercoastal muscles
 Corneal and laryngeal reflux disappears o Pupils will dialate, muscles become flaccid,shallow
 Gradual depression of respiration abdominal respiration
 Adeqyate relaxation of skeletal muscles o Further drop in BP

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Monitoring during anesthesia:
• Inspiratory oxygen concentration
• Oxygen saturation by pulse oxymeter
• Expiratory oxygen tension measurement
• BP
• ECG
• Hourly observation of urine output via urinary catheter
Airway management:
During the state of GA, patient has unable to maintain spontaneous respiration and require
support by their anesthesiologist, to maintain an open airway and regulate breathing within
acceptable parameters. It involves placement of either an endotracheal tube or a supraglottic
airway (Device that sits above the vocal cards). Both devices allow for adequate delivery of
oxygen and anesthetic gasses.
Positioning of tongue and jaw:
The anesthetist thrusts the jaw forward from behind the temporomandibular joints, thereby
lifting the tongue off the posterior pharyngeal wall, which may also be achieved by inserting
an artificial oropharyngeal airway such as the Guedel. The anesthetic gases are given through
a face mask.
Complications of GA:
• Myocardial depression & cardiac arrest • Hypertension
• Laryngeal & bronchial spasm • Cardiac arrhythmias
• Respiratory failure • ARDS (Acute Respiratory Distress Syndrome)
• Hypoxia • Pneumothorax
• Hypothermia
Mode of action of GA:
1. Drugs → depression of brain center → unconsciousness muscle relaxation → sensory loss
→ motor loss → muscle relaxation
2. More drug use → fully depression of brain centers → respiratory failure → death

Commonly used drugs:

Chloroform:
• 1-5 minutes loss of sensation
• Increases respiratory secretions
• Decreases temperature, BP, heart rate, function of liver & blood supply of kidney

Nitrous oxide (N₂O):

• Laughing gas
• Quick induction (1-2 minutes)
• Colour of cylinder: Black body with blue shoulder
• When stops its administration, patient comes in conscious within 2-3 minutes
• If it administered without oxygen then patient undergo unconscious within half
minute
• Nonirritant to patient, pleasant to inhale and post operative complication is less
• No muscle relaxant, no increase in respiration
• Increases BP & pulse

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Ethyl ether:
• It quick evaporate & fire also, so kept in cold & dark room
• Killed organisms & act as LA , Relax the muscles
• Increases secretions in respiratory system & glucose level
• Decreases intestinal movements & secretions, blood supply to kidney & liver function

Halothane:
• Anaesthesia is rapid, smooth and with fast recovery, Dilatation of blood vessels
• Made heart to sensitive towards adrenalin
• Contraindicated in shock & delivery ,most costly and it has no analgesic properties.
• Decreases BP & pulse
• It has got hepatotoxic effect such as hepatitis that is why it should not be given to
patient who has previously taken halothane anesthesia within 4 weeks.

Ketamine:
• It is also known as "Dissociative (Sudden temporary alteration) anesthesia
• Good for repeated uses, useful for burn dressing and I & D
• Reflexes are not abolished
• It elevates heart rate, cardiac output, and BP due to sympathetic stimulation • It is
dangerous for IHD patients

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THANK YOU