Types of Anaesthesia

Prof. med. Nabil H. Mohyeddin

Anesthesiologist & Intensivist
Board certified
University Rostock, Germany
nhm1955@hotmail.com

Objectives

Short History
Definition/types of anaesthesia
General anaesthesia/drugs
Phases of GA
Regional anaesthesia

Early history

Ancient/Medieval period
Opium
Alcohol
Cannabis

History

1845- Horace Wells- N2O

1846- William Morton- Ether
1847- Simpson- Chloroform
1853-John Snow
1878- ETT
1884- Cocaine
1895-98- Spinal analgesia/anaesthesia

History

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

Definition
Loss of sensation
General
Regional
Local

Triad of General
anaesthesia
Hypnosis

Analgesia

Muscle relaxation

Hypnosis
Death

Coma
Hypnosis
sedation
Amnesia
Awake

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

Inhalational anaesthetics

Nitrous oxide-weak
Isoflurane
Sevoflurane
Desflurane
Halothane

Analgesia

Good analgesia= good anaesthesia

Hypnotic sparing effect
Opiates
Local anaesthetics
NSAIDS
Paracetamol

Analgesia-Opiates

Gold standard morphine

Derivatives- diamorphine, codeine
Synthetic agents
Pethidine
Fentanyl/Alfentanil-short acting
Remifentanil-ultra short acting

Analgesia-NSAIDS

Gold standard- aspirin

Ibuprofen
Diclofenac
Cox-2 inhibitors

Muscle relaxation

Aids intubation
Helps surgeon/surgery
Surgery of long duration
Reduces maintenance dose of
anaesthetics agents

Muscle relaxants

Two types
Depolarising-short acting
eg;suxmethonium
Non-depolarising- medium/long acting
Tracurium
Vecuronium
Rocuronium

Prerequisites

Oxygen
Suction
Tilting trolley
Resuscitation drugs
Monitoring
Anaesthetist
Skilled assistance
Drugs and machine

Phases of
general anaesthesia

Induction
Maintenance
Recovery

Induction

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

Stages of anaesthesia
Alcohol
1.Dizzy, delightful
2.Drunk, disorderly
3.Dead drunk
4.Dangerously deep

General Anaesthesia
1.Amnesia, analgesia
2.Uninhibited
response to stimuli
3.Surgical anaesthesia
4.Vital centre
depression

Maintenance

Intravenous or inhalational
Oxygen 40%-100%
Nitrous oxide
Muscle relaxant
Analgesia

Recovery

Turn off agent

Reverse relaxation
Cough reflex
Extubate when awake
Recovery position
Monitor until discharge

Advantages

No absolute contraindications
Quick to establish
Never fails to work

Disadvantages

Polypharmacy
Effects on various systems
Allergic reactions
Recovery profile
Post operative Nausia &Vomiting
Awareness

Regional anaesthesia

Spinal/epidural
surgery below umbilicus
Provides analgesia/muscle relaxation
Plexus blocks eg brachial plexus
Intravenous- Biers block

Regional anaesthesia

Analgesia

Muscle relaxation

Local anaesthetics

Lignocaine- quick/short acting

Bupivacaine/levobupicvacaine- slow
and long action
Ropivacaine- as above
Amethocaine- topical
Prilocaine- intravenous

Advantages

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

Disadvantages

Limited scope
Higher failure rate
Time constraints
Anticoagulants/Bleeding diathesis
Risk of neural injury