Anesthesia is the term given to the loss of feeling or sensation.

In medical terms, it is the

method of decreasing sensitivity to pain in a patient so that a medical procedure may be
performed. Anesthesia may be accomplished without the loss of consciousness, or with
partial or total loss of consciousness.

Anesthesiology is the branch of medicine dealing with anesthesia and anesthetics.

Anesthetics can be administered by doctors (called anesthesiologists) or by specially
trained nurses (called CRNAs, certified registered nurse anesthetists) working under a
doctor's guidance. The development of modern anesthesia has made possible complex
operations such as open heart surgery.

Types of Anesthesia
Anesthesia involves the use of medicines to block pain sensations (analgesia) during
surgery and other medical procedures. Anesthesia also reduces many of your body's
normal stress reactions to surgery.

The type of anesthesia used for your surgery depends on:

• Patient’s medical history, including other surgeries the patient have had and any
conditions she/he may have (such as diabetes). They will also be asked whether
they have had any allergic reactions to any anesthetics or medicines or whether
any family members have had reactions to anesthetics.
• The results of their physical examination. A physical exam will be done to
evaluate the patient’s current health and identify any potential risks or
complications that may affect anesthesia care.
• Tests such as blood tests or an electrocardiogram (EKG, ECG), if needed.
• The type of surgery the patient will be having.
o The patient needs to be able to lie still and remain calm during surgery
done with local or regional anesthesia.
o Young children usually cannot stay still during surgery and need general
anesthesia.
o Adults who are extremely anxious, in pain, or have muscle disorders also
may have difficulty remaining relaxed and cooperative.
o Some surgical procedures require specific positions that may be
uncomfortable for long periods if the patient remains awake.
o Some procedures require the use of medicines that cause muscle relaxation
and affect the patient’s ability to breathe on his/her own. In such cases, the
patient’s breathing can best be supported if general anesthesia is used.

Based on the patient’s medical condition, his/her anesthesiologist may prefer one type of
anesthesia over another for the surgery. When the risks and benefits of different
anesthesia options are equal, the anesthesiologist may let the patient choose the type of
anesthesia.
Anesthesia methods

There are several ways that anesthesia can be given.

• Local anesthesia involves injection of a local anesthetic (numbing agent) directly

into the surgical area to block pain sensations. It is used only for minor
procedures on a limited part of the body. The patient may remain awake, though
he/she will likely receive medicine to help him/her relax or sleep during the
surgery.
1. Topical Application—the anesthetic
is applied directly to a mucous membrane, to a serous surface, or into an
open wound. A topical agent is often applied to the respiratory passages to
eliminate laryngeal reflexes and cough, for insertion of airways before
induction or during light general anesthesia. It is also used in the urethral
meatus for cystoscopy. The duration of anesthesia is 20 to 30 minutes.
(example: Emla Cream, Cathejell, Alcaine eye drops [proparacaine HCl])
2. Simple Local Infiltration—the agent
is injected intracuatenously and subcutaneously into tissues at and around
incisional site to block peripheral sensory nerve stimuli at their origin. It is
used before suturing superficial lacerations or excising minor lesions.
(Example: Marcaine, Xylocaine)
• Regional anesthesia involves injection of a local anesthetic (numbing agent)
around major nerves or the spinal cord to block pain from a larger but still limited
part of the body. The patient will likely receive medicine to help him/her relax or
sleep during surgery. Major types of regional anesthesia include:
o Peripheral nerve blocks. A local anesthetic is injected near a specific nerve
or group of nerves to block pain from the area of the body supplied by the
nerve. Nerve blocks are most commonly used for procedures on the hands,
arms, feet, legs, or face.
o Epidural and spinal anesthesia. A local anesthetic is injected near the
spinal cord and nerves that connect to the spinal cord to block pain from
an entire region of the body, such as the abdomen, hips, or legs. For
injection, the patient is placed in the position desired by the
anesthesiologist, depending on patient condition, solution baricity, and
level of anesthesia to be produced; it is either lateral position or sitting
position. Spinal anesthesia produces a circulatory depressant effect:
hypotension,and stasis of blood as a result of interference with venous
return from motor paralysis and arteriolar dilation in the lower extremities.
Complications include spinal headache, auditory and ocular disturbances,
meningitis, cauda equine syndrome (failure to regain use of the legs or
control of urinary and bowel functions. The anesthesia machine, oxygen
and IV line must be in readiness before injection. Constant vigilance of
respiration and circulation is critical. The blood pressure and heart rate are
monitored and maintained at normal levels. For epidural anesthesia, the
drug diffuses slowly through the dura mater into CSF. Anesthesia is
prolonged while the drugs is absorbed from CSF to the bloodstream. An
 epidural approach may be used for lower extremity, abdominal, urologics,
anorectal, vaginal or perineal procedures. Epidural narcotic anesthesia
may provide sustained post operative relief or control of pain in patients
with intractable or prolonged pain.
• General anesthesia is given into a vein (intravenously) or is inhaled. It affects the
brain as well as the entire body. The patient is completely unaware and does not
feel pain during the surgery. Pain is controlled by general insensibility. In
addition, general anesthesia often causes forgetfulness (amnesia) right after
surgery (postoperative period). Basic elements include loss of consiousness,
analgesia, interference with undesirable reflexes, and muscle relaxation.

I. Administration techniques:

1. Mask inhalation—anesthetic gas or vapor of a volatile liquid is inhaled

through a facemask attached to the anesthesia machine by breathing tubes.
The mask must fit snugly to minimize escape of gases into room air.
Significant leakage occurs around an ill-fitting mask, particularly in the
area above the nose. Several sizes should be available.
2. Laryngeal Mask—an airway can be maintained by inserting a laryngeal
mask into the larynx. This flexible tube has an inflatable silicone ring and
cuff. When the cuff is inflated, the mask fills the space around and behind
the larynx to form a seal between the tube and the trachea. The method
does not protect against regurgitation and aspiration.
3. Endotracheal administration—anesthetic vapor and gas is inhaled directly
into the trachea through a nasal or oral tube inserted between the vocal
cords by direct laryngoscopy. The tube is securely fixed in place to
minimize tissue trauma. The patient is given oxygen before and after
suctioning of a tracheal tube.

II. Inhalation anesthetic Agents

Inhalation is the most controllable method of administration because

uptake and elimination of anesthetic agents are accomplished mainly by
pulmonary ventilation.

1. Isoflurane—a more potent muscle relaxant and

protects the heart against cathecolamin-induced dysrythmia. Isoflurane is
used for the induction and maintainance in a wide spectrum of procedures
except routine obstetrics. Isoflurane reduces uterine relaxation.
2. Sevoflurane—a volatile liquid and non flammable
and non explosive. Noted for its rapid induction and rapid emergences
 qualities, it is commonly used for induction and maintenance of general
anesthesia. It is rapidly eliminated by the lungs.

III. Intravenous anesthetic agents

A drug that produces hypnosis, sedation, amnesia, and/or analgesia is

injected directly into the circulation, usually via a peripheral line in the
arm. Oxygen is always given during IV and inhalation anesthesia.

1. Propofol (Diprivan, Fresofol,

Lipuro)—A sedative-hypnotic that produces anesthesia. It is used for rapid
induction and maintenance of anesthesia for short procedures. It can be
used also in combination with inhalation agents or opioids for prolonged
anesthesia. Propofol is supplied in a sterile, milky soybean, oil-in-water
emulsion. In low doses, it produces sedation. Continued IV administration
leads to hypnosis and unconsciousness. Propofol is used for general
anesthesia for ambulatory surgery patients and for maintenance of
sedation during local and regional anesthesia. It is used in caution in
geriatric, debilitated, and hypovolemic patients. It is not recommended for
pediatrics, obstetrics, and some neurosurgical procedures.
2. Ketamine Hydrochloride (Ketalar,
Ketaject)—General anesthesia may be produced by a phenycyclidine
derivative to produce a state referred to as dissociative anesthesia. The
drug acts by selectively interruption associative pathways of the brain
before producing sensory blockage. This permits a surgical procedure on a
patient who appears to be awake but who is anesthetized. Ketamine is
used mainly in children between the ages of 2 and 10 years and in adults
younger than 30 years, for short procedures not requiring skeletal muscle
relaxation, for plastic and eye procedures when combined with local
agents, for diagnostic procedures, as an induction agent before other
general agents are used.

III. Adjunctive Drugs Used in Anesthesia

Many drugs are used to supplement halogenated inhalation agents, and IV

drugs to maintain amnesia and analgesia, control hypertension, attenuate the
extent of postoperative respiratory depression, or maintain or control other
effects of general anesthesia.

1. Narcotics—Natural opiates
and synthetic opioids have been given to produce analgesia and sedation
preoperatively and postoperatively. In addition, they are used intra-
operatively as supplemental agents and/or in combination with oxygen for
complete anesthesia for short procedures and in patients with little
cardiovascular reserve. The most popular narcotics for general anesthesia
 are the opioids fentanyl (sublimaze) and meperidine hydrochloride
(Demerol) and the opiate morphine sulfate.
2. Narcotic reversal (Narcotic
Antagonist)—a narcotic antagonist neutralizes or impedes the action of
another drug. An example is Naloxone hydrochloride (Narcan). It reverses
respiratory depression caused by narcotics.
3. Muscle relaxants—skeletal
muscle relaxant drugs, referred to as neuromuscular blockers, facilitate
muscle relaxation for smoother endotracheal intubations and working
conditions during the surgical procedure.
a. Atracrium besylate
(Tracrium)—with duration of action of about 30 minutes,
atracrium metabolizes more quickly than the other blockers, which
may be an advantage in patients with liver or renal disease.
b. Succinylcholine
chloride (Anectine, Quelicin)—an ultra-short acting synthetic drug
with an onset of action in seconds, succinylcholine produces
paralysis for up to 20 minutes. It is used primarily for endotracheal
intubations.
4. Muscle relaxant reversal agents (Cholinergics)—An example is
neostigmine methylsulfate (prostigmin). It inhibits the destruction of
acetylcholine released from parasympathetic nerves. Use with care in
patients with bronchial asthma, bradycardia, seizure disorders, coronary
artery disease, and hyperthyroidism. It is not for use in patients with
peritonitis or bowel or urinary obstruction.

For some minor procedures, a qualified health professional who is not an anesthesia
specialist may give some limited types of anesthesia, such as procedural sedation.
Procedural sedation combines the use of local anesthesia with small doses of sedative or
analgesic agents (painkillers) to relax you.

Medicines used for anesthesia

A wide variety of medicines are used to provide anesthesia. Their effects can be complex,
and they can interact with other medicines to cause different effects than when they are
used alone. Anyone receiving anesthesia-even procedural sedation-must be monitored
continuously to protect and maintain vital body functions. The complex task of managing
the delivery of anesthesia medicines as well as monitoring your vital functions is done by
anesthesia specialists.

Medicines used for anesthesia help you relax, help relieve pain, induce sleepiness or
forgetfulness, or make you unconscious. Anesthesia medicines include:
 • Local anesthetics, such as lidocaine (Xylocaine) or bupivacaine (Marcaine), that
are injected directly into the body area involved in the surgery.
• Intravenous (IV) anesthetics, such as sodium thiopental (Pentothal), midazolam
(Versed), propofol (Diprivan), or fentanyl (Sublimaze), that are given through a
vein.
• Inhalation anesthetics, such as isoflurane and nitrous oxide, that you breathe
through a mask.

Other medicines that are often used during anesthesia include:

• Muscle relaxants, which block transmission of nerve impulses to the muscles.

They are used during anesthesia to temporarily relax muscle tone as needed.
• Reversal agents, which are given to counteract or reverse the effects of other
medicines such as muscle relaxants or sedatives given during anesthesia. Reversal
agents may be used to reduce the time it takes to recover from anesthesia.