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General Anaesthesia

General anesthesia involves the reversible depression of the central nervous system through the use of intravenous or inhalation agents. It is characterized by a lack of pain sensation and unconsciousness during surgery. Ideal general anesthetic agents produce fast induction and recovery without side effects. Common agents include volatile gases like sevoflurane, intravenous drugs like propofol, and nitrous oxide. The stage of anesthesia depends on the concentration of the agent in the brain. Precautions are needed due to potential side effects involving various organ systems.

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45 views21 pages

General Anaesthesia

General anesthesia involves the reversible depression of the central nervous system through the use of intravenous or inhalation agents. It is characterized by a lack of pain sensation and unconsciousness during surgery. Ideal general anesthetic agents produce fast induction and recovery without side effects. Common agents include volatile gases like sevoflurane, intravenous drugs like propofol, and nitrous oxide. The stage of anesthesia depends on the concentration of the agent in the brain. Precautions are needed due to potential side effects involving various organ systems.

Uploaded by

halayehiah
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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General Anesthesia

It is a controllable and reversible depression of CNS characterized by lack of


perception of all sensations during surgery.

Characters general Anesthesia:


•Unconsciousness.
•Absence of pain sensation.
•Amnesia (short term memory loss).
•Decrease autonomic responses (HR, BP).

NB. Local anestheties:


They are agents applied locally they block nerve conduction and abolish sensation in a
limited area of the body with
no loss of Consciousness.
Types of general Anesthesia:

A- Intravenous:

•They are agents injected directly to blood →BBB →brain.

•Used for induction.

B- Inhalation :

•Agents inspired with oxygen and absorbed from


lung alveoli → blood →pass the BBB → brain.
•Volatile liquids or gases and are delivered using
an anaesthesia machine.
•Used for maintenance.
Elimination:
•Volatile anaesthetics are eliminated in the terminal phase via the lungs.

•Some anaesthetics are metabolized by the liver, and their metabolites are often toxic

e.g. chloroform (old anesthesia NOT used now).


Characters of an ideal general anesthetic agent: It should be:

•Produces fast rate of induction.

•Produces analgesia.

•Produces skeletal muscle relaxing effect.

•Produces no respiratory and no myocardial depression.

•Inert (no interaction with other agents).

•Produces no post anesthesia complications.

•Inexpensive.
Effect of general anesthetics on CNS:

Mechanisms of Action :

•They alter the excitation of the neuronal membrane → Modify the impulse
conduction → ↓ sodium influx→ ↓ initiation of action potential.

•Reduce neuronal activity by increasing their threshold to fire.

•General anesthetics may act on thalamus, cortex, hippocampus and at higher


concentration it affects all brain regions.
Physco-chemical therories of GA.

1- Overton-Mayer theory:

GA are lipid soluble drugs. ↑↑Lipid solubility→↑↑ BBB →↑↑ GA effect
GA dissolves in the membrane lipids and results in membrane fluidization.

membrane fluidization.

GA dissolves in the lipid layer of the


neuronal membrane →↑ fluidity of the
membrane → prevent or reduce ion
conduction.
2- Modern theories:

•Activation of GABA receptors. - inhibition of NMDA receptors→ ketamine.

GABA is considered an inhibitory Glutamate is the main


neurotransmitter because it blocks, or excitatory neurotransmitter with
inhibits, certain brain signals and several types of receptors (e.g:
decreases activity in the nervous NMDA)
system Block NMDA → ↓↓excitation
Stages of anesthesia:

These stages are due to ↑↑concentrations of the anesthetic agent in the brain.

Stage I: (Analgesia)

There is loss of sensation → ↓ Responses to painful stimuli.


The patient is conscious but drowsy.

Stage II: (Excitement or Delirium)

It is a dangerous stage.


The patient begins to lose consciousness.
Responses are exaggerated to painful stimuli.
Cough reflex, gagging response may be present.
Stage III: (Surgical anaesthesia)

Spontaneous movement stops


Respiration become regular
All reflexes are disappeared (in deep anesthesia)

Stase IV: (Medullary paralysis)

Is the toxic effect of general anesthesia.


Stop respiration
The blood pressure and heart rate are severely reduced.
Inhaled anesthetics.

A- liquid agent :
Isoflurane
Sevoflurane Most commonly used
Desflurane
Enflurane
Halothane
B- gas agent :
Nitrous oxide - Mainly used for maintenance of anesthesia.
- Rapidly eliminated from the body.
Adjuvant (not used alone) - No post operative respiratory depression.
Pharmacokinetics of Inhaled anesthetics.
agents inspired with oxygen and absorbed from lung alveoli → blood →pass the
BBB → brain.
Diffusion from lung alveoli to blood depend on:
1- Partial pressure between alveolar air and blood
→↑ Partial pressure →↑ anesthetics in blood
2- Partition coefficient
Blood/gas (must be low)
Brain/ gas (must be high)
3- Cardiac output
side effects of Inhaled anesthetics.

1-Malignant hyperthermia: (high body temp, muscle contractions).


this can be treated with Dantrolene.
2- CNS: Increase intracranial pressure
3- CVS: hypotension and bradycardia
4- Respiratory : bronchodilation (no problem with asthma) except :
Desflurane bronchoconistriction.(C.I in asthma)
5- Liver: hepatotoxicity esp with Halothane
6- Uterus: relaxation …..(note: after delivery postpartum bleeding)
Halothane Enflurane
-Widely used potent one  Less potent
-Non explosive -It has SMR effect
-Non irritant -It has analgesic
-Not analgesic -Less respiratory &cvs depression.
Used: for pediatrics.
S.E: S.E:
1. hepatotoxicity 1. Nephrotoxic
2. Resp.depression 2. Malignant hyperthermia.
3. hypotension 3. Seizure
4. bradycardia
5. Malignant hyperthermia Rapid induction and rapid recovery.
6. Relax the uterus.
Isoflurane Methoxyflurane

Most widely used More potent with slow recovery


Little toxicity. S.E:
-No seizure 1. CVS depression
2. Resp.depression
3. No uterine effect
1. Expensive
2. Hypotension
3. Respiratory Irritant
4. Coronary V.D
Nitrous oxide
--Used for dental, labor.
-Produces fast induction with laughing
and euphoria.

N.B.
NO CVS depression
NO Resp.depression
No Hepatotoxicity
Strong analgesic effect.
Intravenous anethesics

- used for rapid induction.


-unsatisfactory for producing maintenance.
-All are lipid soluble drugs (phase 1and 2 dist) Highly lipid
soluble
-IV bolus→ induction
-Can be used for maintenance?
-Yes……. when given IV infusion
Propofol
Thiopental
 Ketamine
Etomidate
Midazolam
Propofol

- Most commonly used


Uses:
-For day case surgeries
- For maintain surgical Anesthesia without the
need of inhalation agents

Thiopental

S.E:
-Myocardium depress.
-Hypotension.
-respiratory depress.
Etomidate

S.E:
-nausea and vomiting
-suppression of adrenal cortex

Midazolam

Medazolam is used for short procedures


(endoscopy).
Ketamine
produces Dissociated anesthesia.
Slow onset (2-5 mm).

-↑heart rate, ↑blood Pressure


No respiratory depression
Uses:
For short procedure in young patients.
- Ketamine can be used for short operations alone.

Dissociated anesthesia. (Hallucination, Disorientation, amnesia,


analgesia, rigidity, paralysis of movements, without loss of
consciousness).
Pre-anesthetic medications.

•Diazepam to sedate and reduce anxiety.

•Opiates to relieve pain. Fentanyl


•Succinyicholine to facilitate intubation.

•Atropine to reduce salivation and prevent bradycardia during surgery.

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