Introduction to anesthesia

Narrative script
Enrico P. Evangelista MD,DPBA,FPSA,MHA

A. Definition Anesthesia- Anesthesia (from Greek word “anaisthetos” which means

"without sensation") is a state of controlled, temporary loss of sensation or awareness
that is induced for medical purposes. It may include some or all of analgesia (relief from
or prevention of pain), paralysis (muscle relaxation), amnesia (loss of memory), and
unconsciousness.- Wikipedia
B. Objectives
1. To be able to apply the knowledge from this lecture in managing patients
preoperatively,intraoperatively and postoperatively.
2. To be able to apply the learnings from this lecture in using basic anesthesia equipments
intraoperatively.

C. Scope of Anesthesia –
Anesthesiologists often work as perioperative physicians with responsibilities during the
preoperative, intraoperative and postoperative periods to keep the patient comfortable
and safe. Other recognized functions within the practice of anesthesiology include
management of patients with acute and chronic pain, lead or assist in the management of
cardiopulmonary resuscitation and advanced cardiac life support and the management of
critically ill patients in intensive care units

PREOPERATIVE assessment of patients for anesthesia and surgery. The standard of care for
preoperative evaluation requires that the anesthesia provider
a. Review the patient’s medical record, visit with the patient
b. Perform a focused anesthesia history and physical exam. The patient will be
questioned about previous surgical experiences to determine if there have been any
prior anesthesia complications.
c. Inform the patient of the planned anesthetic technique and discuss methods available,
such as a peripheral nerve block and/or intravenous (IV) pain medications which
might include narcotics, for the relief of postoperative pain.
d. Risks, benefits and alternatives to the anesthesia plan are discussed to the extent of
the individual patient’s desire to know and patient questions are answered.
e. A written informed anesthesia consent is obtained from the patient or the patient’s
legal guardian.
Types of anesthesia
 General Anesthesia
- patient is unconscious
Triad
- Hypnosis
- Analgesia
- Muscle paralysis
 Regional Anesthesia
- Patient is sedated/awake
 - Spinal anesthesia
- Epidural Anesthesia
- Local Anesthesia infiltration
-Peripheral nerve block

INTRAOPERATIVELY, the anesthesia provider first

a. Apply the appropriate monitors to the patient,
b. Provide supplemental oxygen
c. Induces and maintains the planned anesthetic for the patient.
Reference: Stoelting, R.K. and Miller, R.D. (2007). Basics of Anesthesia, 5th
Edition. Churchill Livingstone.

D. Anesthesia Machine and its Parts

Essential Function of anesthesia Machine-
1. Provides O2,
2. Accurately mixes anaesthetic gases and vapours,
3. Enables patient ventilation and
4. Minimises anaesthesia related risks to patients and staff
Sinclair CM, Thadsad MK, Barker I. Modern anaesthetic machines; continuing
education in anaesthesia. Crit Care Pain. 2006;6:75–8.

Basic Parts
The early Boyle's machine had five elements, which are still present in modern machines:
(1) A high pressure supply of gases,
(2) pressure gauges on O2 cylinders, with pressure reducing valves,
(3) flow meters
(4) metal and glass vapouriser bottle for ether and
(5) a breathing system

Sinclair CM, Thadsad MK, Barker I. Modern anaesthetic machines; continuing

education in anaesthesia. Crit Care Pain. 2006;6:75–8

E. Pulse Oximetry-
Pulse oximetry is a test used to measure the oxygen level (oxygen saturation) of
the blood. It is an easy, painless measure of how well oxygen is being sent to
parts of your body furthest from your heart, such as the arms and legs. It is an
electronic device that measures the saturation of oxygen carried in your red
blood cells. Pulse oximeters can be attached to your fingers, forehead, nose,
foot, ears or toes.

Non Invasive Bp monitor

 Non-invasive BP measurement provides either intermittent or continuous
readings. Most commonly, an occluding upper arm cuff is used for
intermittent non-invasive monitoring. BP values are then obtained either manually
(by auscultation of Korotkoff sounds or palpation) or automatically

ncbi.nlm.nih.gov/pmc/articles/PMC5766655/

F. EKG
An electrocardiogram (ECG or EKG) records the electrical signal from your heart
to check for different heart conditions. Electrodes are placed on your chest to
record your heart's electrical signals, which cause your heart to beat. The signals
are shown as waves on an attached computer monitor or printer.
3 lead Placement (I, II, or III):

Monitors one of the three leads:

 RA: red electrode:

o placed under right clavicle near right shoulder, within the rib cage frame
 LA: yellow electrode:
o placed under left clavicle, near left shoulder, within the rib cage frame
 LL: green electrode:
o placed on the left side, below pectoral muscles, lower edge of left rib cage

5 lead Placement:

 RA: red electrode:

o placed under right clavicle, near right shoulder, within the rib cage frame
 LA: yellow electrode:
o placed under left clavicle, near left shoulder, within the rib cage frame
 LL: green electrode:
o placed on the left side, below pectoral muscles, lower edge of left rib cage
 V: white electrode:
o placed on the 4th intercostal space, at right sternal border
 RL: black electrode:
o place on a non muscular surface on the lower edge of the right ribcage

G. Capnograph monitor
Capnography is a non-invasive measurement during inspiration and
expiration of the partial pressure of CO2 from the airway. It provides
physiologic information on ventilation, perfusion, and metabolism, which is
important for airway management.
 Capnometry is a non-invasive monitoring technique. It allows quick and
reliable insight into aspects like: ventilation, circulation, and metabolism. In
diagnosis, monitoring, and prediction of outcome capnometry is an important
tool, especially in the pre-hospital setting.

Conditions such as pulmonary embolisms (PE's) and congenital heart disease,

affecting perfusion of the lung do not affect the shape of the curve, but have
an affect on the relationship between expired CO2 and arterial blood CO2.
Capnography can also be used to measure carbon dioxide production.
Increased CO2 production is seen during fever and shivering. Reduced
production is seen during anesthesia and hypothermia.

H. Temperature monitor
Importance of temperature monitoring

Hypothermia is a common and serious complication during anaesthesia and

surgery. It mainly results from anaesthetic-induced inhibition of
thermoregulatory control and exposure to cold operating room environment.
Perioperative hypothermia develops in three distinct phases: (1) anaesthetic-
induced vasodilation during induction of anaesthesia results in core-to-
peripheral redistribution of body heat and decreases core temperature 1–1.5°C
during the first hour of general anaesthesia; (2) subsequently core temperature
decreases linearly as heat loss to the environment exceeds metabolic heat
production; (3) after 3–5 h of anaesthesia, core temperature often stops
decreasing. This core temperature plateau results from reactivation of
thermoregulatory vasoconstriction which decreases cutaneous heat loss and
constrains metabolic heat to the core thermal compartment. Perioperative
hypothermia is associated with numerous complications such as myocardial
ischaemia, increased risk of wound infection and coagulopathy. On the other
hand temperatures only 1–3°C below normal provide substantial protection
against cerebral ischaemia and hypoxaemia in numerous animal species.
Consequently, most anaesthesiologists believe mild hypothermia is indicated
during operations likely to cause cerebral ischaemia such as carotid
endarterectomy and neurosurgery or cardiac procedures. Thermal perturbations,
therefore, deserve the same risk/benefit analysis as other medical interventions.
Fortunately, effective methods of cooling and warming surgical patients are now
available.
I. A. Kurz, Correspondence to: AK. Department of Anesthesia, Washington
University, St. Louis USA.

.
POSTOPERATIVE

Post Operative Care Unit ( PACU)- All patients are admitted to the Post-Anesthesia Care
Unit (PACU) following surgery and anesthesia. The length of your stay in the PACU
depends on several factors, including demonstrated recovery from anesthesia. If you
have had epidural or spinal anesthesia, you must be able to feel and move your legs
before being discharged from the PACU.
Pain medicine will be initiated in the PACU. Your pain control regimen may take the
form of pills, injections, or patient-controlled analgesia (PCA), sometimes called a "pain
pump".

Recovery from anesthesia is usually uneventful and routine, but a variety of physiologic
disorders that can affect multiple organ systems may present and must be diagnosed and treated
to ensure patient safety and comfort.
Physiologic disorders such as
a. upper airway obstruction
b. hypoventilation
c. hypoxemia
d. slow or fast heart rate and/or irregular heart rhythm
e. low or high blood pressure
f. agitation
g. nausea, vomiting
h. Pain

Standards of care require the anesthesiologist to perform a post anesthetic evaluation to assess
the patient’s readiness for discharge from the unit and treat any of these disorders should they
occur. After the immediate and acute effects of anesthesia and surgery have dissipated and the
patient's recovery in the PACU is complete and the patient is deemed stable by standard industry
recovery criteria that include assessing vital signs, adequacy of breathing, wakefulness and pain
control, the anesthesiologist discharges the patient to the next step-down phase of recovery
before the patient leaves the facility for home, or to the patient's hospital room.
- Reference: Stoelting, R.K. and Miller, R.D. (2007). Basics of Anesthesia, 5th Edition.
Churchill Livingstone.

The basic responsibilities of PACU staff include:

 airway management and oxygen administration for patients who have undergone
general anesthesia
 monitoring vital signs (heart rate, blood pressure, temperature, and respiratory rate)
 managing postoperative pain
 treating postoperative nausea and vomiting
 treating postanesthetic shivering
 monitoring surgical sites for excessive bleeding, mucopurulent discharge,
swelling, hematomas, wound healing, and infection
More intensive care may include:

 Preparation and education for the use of patient-controlled analgesia (PCA) units
 Preparation and administration of intravenous, epidural, or perineural infusions
 Invasive monitoring such as arterial lines, central venous lines,
and ventriculostomies