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ANAESTHESIA

INTRODUCTION

The word anaesthesia is derived from the Greek: meaning insensible or without feeling.

Insensible does not necessary imply loss of consciousness.

Why do we need anesthesia ?

Horace Wells
Williams Mortons Dr. John Snow

Nitrous oxide Used as anaesthetic in 1844 by Horace Wells

HISTORY

ETHER Used as anaesthetic in 1846 by Dr. William Morton.


CHLOROFORM Used as anesthetic in 1853 by Dr. John Snow

GENERAL ANAESTHESIA

General anaesthetics (GAs) are drugs which produce reversible loss of all sensations and consciousness. It usually involves a loss of memory and awareness with insensitivity to painful stimuli, during a surgical procedure
General anesthesia

need for unconsciousness

need for analgesia

need for muscle relaxation

Characteristic of ideal anaesthesia


Rapid and pleasant induction of surgical anesthesia Rapid and pleasant withdrawal from anesthesia Nontoxic Non-flammable/ non-explosive Inexpensive

STAGES OF ANAESTHESIA
Starts from beginning of anaesthetic inhalation and lasts upto the loss of

Stage of Analges ia

consciousness Pain is progressively abolished Reflexes and respiration remain normal Use is limited to short procedures From loss of consciousness to beginning of regular respiration Patient may shout, struggle and hold his breath; muscle tone increases, jaws are tightly closed, breathing is jerky; vomiting, involuntary micturition or defecation may occur Heart rate and BP may rise and pupils dilate due to sympathetic stimulation No operative procedure carried out Can be cut short by rapid induction, premedication

Stage of Delirium

Surgical anaesthesia

Extends from onset of regular respiration to cessation of spontaneous breathing. This has been divided into 4 planes which may be distinguished as: Plane 1 roving eye balls. This plane ends when eyes become fixed. Plane 2 loss of corneal and laryngeal reflexes. Plane 3 pupil starts dilating and light reflex is lost. Plane 4 Intercostal paralysis, shallow abdominal respiration, dilated pupil.

Medullary paralysis

Cessation of breathing to failure of circulation and death. Pupil is widely dilated, muscles are totally flabby, pulse is thready or imperceptible and BP is very low

GABA, endogenous compound, causes GABA to open Receptor capable of binding 2 GABA molecules, between an alpha and beta subunit Binding of GABA causes a conformational change in receptor Opens central pore, chloride ions pass down electrochemical gradient ,net inhibitory effect, reducing activity of the neuron

Anesthetics bind to specific sites on the receptor protein.

They do not compete with GABA for its binding on the receptor. They inhibit the response to painful stimuli by interacting with beta3 subunit of GABAA receptor.

I. INHALATION ANESTHETICS
Ether (diethyl ether)
H3C O CH3

Spontaneously explosive Irritant to respiratory tract High incidence of nausea and vomiting during induction and post-surgical emergence

I. INHALATION ANESTHETICS
O Nitrous Oxide Rapid onset N N Good analgesia Used for short procedures and in combination with other anesthetics Supplied in blue cylinders

I. INHALATION ANESTHETICS
Halothane (Fluothane) F Volatile liquid F C Narrow margin of safety Less analgesia and muscle relaxation F Hepatotoxic Reduced cardiac output leads to decrease in mean arterial pressure Increased sensitization of myocardium to catecholamines
Br CH Cl

I. INHALATION ANESTHETICS
Pharmacokinetics The concentration of a gas in a mixture of gases is proportional to the partial pressure Inverse relationship between blood and gas solubility and rate of induction
Alveoli Nitrous oxide (low solubility) Blood Brain

Halothane (high solubility)

NEW TRENDS IN ANAESTHESIA


1. Balanced anaesthesia:
Use of different potent drugs for every

component of anaesthesia :

Unconsciousness by low inhalational Analgesia by narcotics or nitrous oxide Muscle relaxation by muscle relaxant.
So we can get best results with less side effects

and can be reversed.

2. Multimodal anaesthesia: Use of combination Regional with light general Local analgesia with sedation IV induction and inhalational maintenance

References

The Pharmacological basis of therapeutics- Goodman & Gilman Clinical Pharmacology- Bennett & Brown Essentials of medical pharmacologyTripathi KD Basic & Clinical Pharmacology- Katzung