WHAT IS ANAESTHESIA ?

DR RAJESH T EAPEN ATLAS HOSPITAL MUSCAT

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WHAT IS ANAESTHESIA ?
absence

of sensation, especially artificially induced inability to feel pain. implies AMNESIA (loss of memory), ANALGESIA (insensibility to pain), HYPNOSIS (artificially produced sleep) and RELAXATION (rendering a part of the body less firm or less rigid). 26/06/2013 2

Different types of anesthesia

local,

regional and general anesthesia these three types of anesthesia interrupt pain signals at specific points in the nervous system.

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Local anesthesia

The numbed nerves do not allow the 'pain signal' from the foot to be sent through the nervous system. It is as if the phone is 'off the hook' and the phone message cannot be sent. Different types: -TOPICAL ANESTHESIA-This is accomplished by applying or spraying a local anesthetic agent (e.g. lignocaine) on to the area to be anesthetised. Used in short surgical procedures in the nose, throat e.g. Upper GI endoscopy, bronchoscopy, DL scopy. -INFILTRATION ANESTHESIA-Injection of the anesthetic drug directly into the area to be incised or manipulated. Used for minor procedures like I&D. 26/06/2013 4

Regional anesthesia :
to

eliminate pain in a larger part of the body by temporarily blocking large groups of nerves or the spinal cord so that the pain signal cannot reach the brain. If a telephone cable broke, all the phones in one area of the office would temporarily stop operating and no messages from that entire area could be sent to the switchboard.
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Regional anesthesia : contd..

SPINAL ANESTHESIA Epidural block Caudal anesthesia NERVE BLOCK

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SPINAL ANESTHESIA

Injection of a local anesthetic drug into the subarachnoid space which contains the spinal fluid. used for surgeries of lower limb, perineum, lower abdomen, and sometimes surgery of upper abdomen. Following SA the patients vital parameters like BP, Pulse, Respiration must be monitored strictly. Hypotension and bradycardia are common side effects of SA. Post-spinal headache is a complication of SA and if it occurs can be treated with strict bed rest, plenty of oral & IV fluids, and caffeine-paracetamol tablets.
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Epidural block :

drug is injected into the epidural space and affects a band around the body depending on the area of the vertebral column and the dose of the drug. can be performed at the lumbar, thoracic or cervical levels. widely used for operative anesthesia, obstetric analgesia, postoperative pain control and chronic pain management. used as a single dose technique or with a catheter that allows intermittent boluses or continuous infusion.
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Caudal anesthesia :

drug is injected into caudal canal lying below the cord and affects the nerve trunks that supply the perineal area. widely used in paediatric patients. Effective in postoperative analgesia.

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NERVE BLOCK :

drug is injected into or around the nerve a short distance from the site of operation. used for patients needing dental procedures or plastic surgery. Pudendal block- Drug injected to anesthetise internal pudendal nerve. It is combined with perineal infiltration of local anesthetic to provide perineal anesthesia during second stage of labour.
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General anesthesia :
temporarily

makes you unconscious so that your brain does not perceive any pain signals from the nervous system. During that time, no messages are processed, and you cannot experience pain or other conscious sensations. It is as if the switchboard operator is on a coffee break and is not there to connect the phone calls!
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General anesthesia:
you

are unconscious and have no awareness or other sensations. number of general anesthetic drugs. Some are gases or vapors inhaled through a breathing mask or tube and others are medications introduced through a vein. During anesthesia, you are carefully monitored, controlled and treated by your anesthesiologist, who uses sophisticated equipment to track all your major bodily functions.
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General anesthesia: contd.

A

breathing tube may be inserted through your mouth and into the windpipe to maintain proper breathing during this period. length and level of anesthesia is calculated and constantly adjusted with great precision. At the conclusion of surgery, your anesthesiologist will reverse the process and you will regain awareness in the recovery room. generally used for most surgeries above the umbilicus e.g.- thyroidectomy, mastectomy. Surgeries in children and infants are usually done under GA.
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 information

Proper preparatory evaluation

regarding your medical condition blood and laboratory tests, or other preliminary examinations, such as ECG or x-rays. Blood grouping and cross matching, and other investigations according to anaesthetists orders. opportunity to discuss your medical history, various anesthetic options and their risks, and pertinent questions of concern with the anesthesiologist. bring list of all medications that you take on regular basis or have taken recently (include dose 26/06/2013 16 information )

This information, combined with the laboratory data from your tests, is the basis upon which many anesthetic decisions are made.
Cigarettes and alcohol affect your body

let your anesthesiologist know about your consumption of these substances. 26/06/2013

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Informed consentAn

informed consent must be got from the patient and nearest relative. Before getting consent explain the procedure to be carried out and all possible consequences of the procedure.
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Physical preparation
Thorough

cleaning of the skin surrounding the operative area is carried out preoperatively to decrease wound infection postoperatively. Enema should be given preoperatively especially for abdominal surgeries- on the day before surgery and the day of surgery. essential for the patient to rest the night before surgery. Medications most commonly used include barbiturates, narcotics and anticholinergic drugs such as atropine. Drugs are usually administered 30-60 minutes before the procedure.
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Preoperative fasting Adults-

If under GA patient must not take anything after midnight including fluids. Parenteral fluids may be given preoperatively if the person is dehydrated. Children- Children over the age of two years can have clear fluids four hours prior to anesthesia. Depending on age solid foods are stopped 4-8 hours before surgery. Follow what the anaesthetist has ordered!!!
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Transportation to operative room Shift

the patient to Operation theatre in a stretcher with all relevant records after completing the preoperative nurses record.

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Postoperative care Postoperatively

the patient must be monitored frequently- BP, Pulse rate, Respiratory rate, temperature . Observe patients level of consciousness and ability to follow commands.

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Doctor behind the mask

Most people think of their anesthesiologist only as the doctor behind the mask who helps them sleep through surgery without pain and who wakes them up when surgery is over!

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Masked medical man has many responsibilities:

The

anesthesiologist must possess a wide range of knowledge about medications, internal medicine, how the human body works, and its responses to the stress of surgery. Prior to surgery, evaluate the patient's medical condition and formulate an anesthetic plan for each individual patient taking into consideration that patient's physical status.
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Masked medical man has many responsibilities:

Beyond

ensuring the patient's comfort during surgery, makes judgments to protect / regulate patient's critical life functions including breathing, heart rhythm, blood pressure, brain and kidney functions during surgery. Manage/ treat any medical problem that may develop during or immediately after surgery during recovery period. interpret sophisticated monitors used during surgeries in order to appropriately diagnose, regulate and treat body's organ systems while a personalized, very delicate balance of anesthetic medication is administered. 26/06/2013 25

Masked medical man has many responsibilities:

At

the conclusion of surgery, anesthesiologists reverse the effects of the anesthetic medications, and return the patient to consciousness once again. They maintain the patient in a comfortable state during recovery, and are involved in the provision of critical care medicine in the intensive care unit. Finally, they also take part in the treatment of pain of long standing durations.
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THANK YOU !

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