General Anaesthesia

Prashant Koirala
Anish Tamrakar
 Introduction
General anaesthetics are the drugs which causes reversible loss of all sensation
and consciousness

The cardinal features of general ananesthetics are:

• Loss of sensation (esp. pain)
• Unconsciousness (sleep) and amnesia
• Immobility and muscle relaxation
• Abolition of somatic and autonomic reflexes
 Routes of administration
1. Enteral
• Oral
• Rectal

2. Parenteral
• Sub lingual
• Intra nasal
• Intra muscular
• Intra venous
 Classification
General anaesthetics can be classified into two categories:
A. Inhalation
B. Intravenous

Inhalation general anaesthetics

1. Gases 2. Volatile liquids
• Nitrous oxide • Ether
• Halothane
• Enflurane
• Isoflurane
• Desflurane
• Sevoflurane
 Intravenous general anaesthetics
1. Inducing agents 2. Benzodiazepines
• Thiopentone • Diazepam
• Methohexitone sodium • Lorazepam
• Midazolam
• Propofol
• Etomidate

3. Dissociative anaesthetics *Neurolept analgesia

• Fentanyl
• Ketamine
Pathway of general anaesthesia
(Inhalation)

Source: https://clinicalgate.com/general-anesthetics/
 Halothane
Halothane is a general inhalation anesthetic used for induction and
maintenance of general anesthesia. Chemically it is named as 1-bromo-1-
chloro-2,2,2-trifluoroethane.

Properties: Halothane
It is a fluorinated volatile liquid with sweet odour.
It is non-irritant, non-inflammable and potent anaesthetic.

Storage:
It should be kept in a well-closed amber coloured bottle.
Uses:
It is used:
1. For bronchodilation
2. For potent and speedy induction of as well as recovery from anaesthesia
3. For controlled hypotension
4. It inhibits intestinal and uterine contractions.

Dose: Induction dose: 2-4%

Maintenance dose: 0.5-1%

Dosage forms:
1. Halothane inhalant

Brand names:
1. Fluothane
Synthesis:
The commercial synthesis of halothane starts from trichloroethylene, which is
reacted with hydrogen fluoride in the presence of antimony trichloride at
130 °C to form 2-chloro-1,1,1-trifluoroethane. This is then reacted
with bromine at 450 °C to produce halothane.
 Nitrous Oxide
Nitrous oxide, commonly known as "laughing gas", is a chemical compound
with the chemical formula N2O. Chemically it is named as diazooxidane.
N- = N + = O
Nitrous Oxide

Properties:
It is a colourless, odourless inorganic gas with a sweet taste. It is non-irritant
and non-inflammable but less potent anaesthetic. However, it is a very
potent analgesic. It is non toxic to liver, kidney and brain. It does not
induce nausea or vomiting.

Storage:
It should be kept in an air tight container and protected from light.
Uses:
It is used:
1. For rapid induction of as well as recovery from anaesthesia.
2. As a very potent analgesic(low concentration).
3. As a single agent used with oxygen in dental extraction and in obstetrics.
4. As carrier and adjuvant to other anaesthetics – 70% + 25-30% + 0.2-2%

Dose:

Dosage forms:
1. Nitrous oxide inhalant

Brand names:
1. Nitrous oxide
 Thiopentone sodium
Thiopentone sodium is an ultra short acting barbiturate, admninistered
intravenously for the induction of general anaesthesia . Chemically it is
named as (RS)-[5-Ethyl-4,6-dioxo-5-(pentan-2-yl)-1,4,5,6-
tetrahydropyrimidin-2-yl]sulfanide sodium.

Thiopental sodium

Properties:
It is yellowish powder with faint garlic smell and bitter taste. It is alkaline and
water soluble. It has a dose dependent suppression of CNS activity. It is
non-explosive, non-inflammable, non-irritant and does not cause nausea or
vomiting. Under hepatic metabolism it has an elimination half life of 7-12
hrs.
Storage:
It should be kept in a well-closed container and protected from light. It should be kept in
refrigerated conbdition for longer shelf life.

Uses:
It is used:
1. As sole anaesthetic agent for brief (15mins) procedures.
2. For rapid induction of anaesthesia prior to the administration of other anaesthetic
agents.
3. To supplement regional anaesthesia and control the convulsive states during or
following inhalation or local anaesthesia.
4. To provide hypnosis during balanced anaesthesia with other agents for analgesia or
muscle relaxation.
5. In neurosurgical patients with increased intercranial pressure.
6. For narcoanalysis and narcosynthesis in psychiatric disorders.

Dose: 3-5 mg/kg IV (2.5%) solution for 15 to 20 seconds

Dosage forms:
1. Thiopental sodium injection
2. Thiopental sodium powder
3. Thiopental sodium solution

Brand names:
1. Pentothal
2. Thiosol
 Thiamylal sodium
Thiamylalsodium is an ultra short acting barbiturate, act as nonselective depressant
s of the central nervous system. Chemically it is named as 5-allyl-5-(1-methylb
utyl)-2-thioxodihydropyrimidine-4,6(1H,5H)-dione.

Properties:

Thiamylal
Thiomylal is a highly hydrophobic sodium
thiobarbiturate having its structural feature
very much related to thiopental. Its biological activities are almost identical to
thiopental. Used as
intravenous anaesthetic.
Storage:
It should be kept in a well-closed container and protected from light.

Uses:
It is used:
1. For production of complete anaesthesia for a short duration.
2. For the induction of general anasthesia.
3. For inducing a hypnotic state.

Dose:

Dosage forms:
1. Thiamylal sodium injection

Brand names:
1. Surital
2. Thioseconal
 Ketamine
Ketamine is an NMDA receptor antagonist with a potent anesthetic effect . It is
a phencyclidine derivative. Chemically it is named as 2-(2-Chloro-phenyl)-
2-methylamino-cyclohexanone.

Ketamine

Properties:
Dissociative anaesthesia- a state characterized by immobility, amnesia and
analgesia with light sleep and feeling of dissociation from one’s own body
and mind and the surroundings.
Officially it exists as ketamine hydrochloride, a water-soluble, white crystalline
powder that has a pka of 7.5. Its free base, ketamine, has lipid solubility 10
times that of thiopentntone. The commercially available pharmaceutical form is
n aqueous solution for injection of the racemic mixture of the hydrochloride
salt. Ketamine acts on the NMDA receptors on the cortex and sub-cortical
areas. The S- enantiomer of ketamine is more pharmacologically active than R-
enantiomer.

Storage:
It should be kept in a well-closed container and protected from light.

Uses:
It is used:
1. For characteristics of sympathetic nervous system stimulation- increased
heart rate, blood pressure and cardiac output, during hypovolaemic shock
2. In head and neck injury
3. In asthmatics
4. For short surgical procedures- burn dressings, dentistry, forceps delivery
5. In combination with diazepam for angiography, cardiac catheterization
6. During OPD surgical procedures
Dose: 5-10 mg/kg IM or 1-2 mg IV

Dosage forms:
1. Ketamine injection
2. Ketamine solution

Brand names:
1. Aneket
2. Ketajet
3. Ketamax
4. Kmine
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