Lecture 3 GENERAL ANESTHESIA Excessive depth

UST Medicine & Surgery (1st half)

sensory motor mental
inability to reestablish
I. GENERAL ANESTHESIA normal ventilatory fxn at
The anesthetic agent is introduced through no the termination of
response anesthesia obtundation
the ff: a. oral
b. rectal
c. intramuscular reflexes
d. intravenous circulatory respiratory GI
e. inhalation dec BP/PR apnes atony
II. Regional Anesthesia arrythmia ileus
--- blocks the transmission of nerve action potential intolerance to
along all types of nerve fibers changes in
Ex. Topical position
Infiltration
Field block PHARMACOKINETICS
Peripheral nerve block --- factors that determine how an administered
Epidural anesthesia dose will achieve a resulting blood concentration of
Subarachnoid or spinal anesthesia the drug

GENERAL ANESTHESIA It involves:

--- reversible state of unconsciousness produced absorption
by anesthetic agents with loss of sensation of pain distribution
over the whole body elimination

MECHANISM OF ACTION PHARMACOKINETICS

General anesthesia is the result of --- is influenced by the movt of drugs across cell
reversible changes in neurologic function membranes
caused by drugs that inhibit synaptic
communication. Movement of the drug across cell membrane is
In Inhalation anesthesia, the inhibition of controlled by
the synapses most probably occurs in the molecular size of the drug
region of the neurobasal thalamus. solubility of the drug at the site of
administration
Components of General anesthesia its lipid solubility
1. analgesia Sensory block ease in w/c it crosses the cell membrane
2. muscle relaxation Motor block fraction of the drug in the ionized and non-
3. hypnosis Loss of consciousness ionized form
4. block of reflexes Blunting of reflexes at equilibrium, concentration of polar
compounds is equal on both sides of the
Clinical signs of general anesthesia membrane
insufficient depth differences in ph across the membrane
sufficient depth influence ionization of the molecule on
excessive depth each side, producing an electrochemical
gradient that affects the final equilibrium
Insufficeint depth
ABSORPTION
sensory motor mental
---intake of an agent by the body and uptake of the
breath holding mov't delirium agent by the tissues assuming equilibrium exists
deep breating insufficient uninhibited between the anesthetic and cells of the entire body
muscle speeches
Distribution is determined by:
relaxation
1. lipid solubility
2. regional blood flow
reflexes 3. protein binding
circulatory respiratory GI
inc. BP/PR inc. mucus nausea
Dec. BP/PR spasm retching
arrythmias salivation
Swallowing

Sufficient Depth
sensory motor mental
minimal adequate muscular amnesia
response relaxation sleep
stable CV

reflexes When an agent has a high blood gas solubility, the

circulatory respiratory GI blood acts as a reservoir, slowing the rate at which
absence of troublesome the agent can reach an effective concentration or
reflexes partial; pressure in the brain, therefore slowing
induction.

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 Methods of maintaining a patent airway

Head Tilt-Chin Lift Manuever

1. Place 1 of your hand on the patients forehead
and apply gentle, firm, backward pressure using
the palm of your hand
2. Place the fingers of the other hand under the
bony part of the chin
3. Lift the chin forward and support the jaw, helping
to tilt the head back
4. This maneuver will lift the tongue away from the
back of the throat and provide an adequate airway

Elimination
--- termination of drug action depends on
elimination

2 Steps Process
1. metabolism
2. excretion

Modern inhalation anesthetics depend almost

exclusively on excretion via the lungs.

PHARMACODYNAMICS Jaw-Lift
--- how the concentration of the drug will affect the Jaw is lifted upward, moving the tongue
patient with it by putting the fingers behind the
--- Usually a specific interaction of the drug with the vertical ramus of the mandible. Extension
target cell, the receptor which is a protein of the cervical spine and movement of the
macromolecule head to the side may help.

Different techniques of General Anesthesia

A. IV General Anesthesia
B. General Inhalation Anesthesia

Types of General Inhalation Anesthesia

1. General Mask Inhalation Anesthesia
Anesthetic vapors are delivered
from the machine to the patient
with a face mask applied to the
patients face

2. General Endotracheal Anesthesia

Introduction of anesthetic gases into
the trachea by way of a tube inserted
a. through the mouth orotracheal
b. thru the nose nasotracheal
c. thru the tracheal stroma- tracheostomy
Oral and Nasopharyngeal Airway
The purpose is to displace the tongue
anteriorly

General Inhalation

Advantage
Process of intubation is avoided as
long as the patency of the airway is
maintained

Disadvantage
May encounter difficulty in maintaining
a patent airway resulting in respiratory
obstruction
Threat of aspiration is always present
For operation lasting more than an
hour, anesthetic gases and oxygen
are introduced into the stomach
causing gastric distention

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Endotracheal Intubation Complications of General anesthesia and its
--- Done if jaw-lift, oral or nasopharyngeal airway prevention
does not correct the obstruction
Intraoperative complications

I. Respiratory hypoventilation due to

respiratory depression
Mx oxygen inhalation, assist
respiration with artificial ventilation

A. Upper airway obstruction due to falling back

of
the tongue
Rx Nasopharyngeal airway, jaw-lift
maneuver, endotracheal
intubation
General Endotracheal Anesthesia
1. Foreign Body above the glottis
Mx direct laryngoscopy
Advantages
2. Endotrcheal ntubation
Patency of airway is assured especially for
Mx reposition the endotracheal tube
long procedures
to ventilate right and left bronchus
Protection from aspiration and
regurgitation certain
Gastric dilatation is prevented. Anesthetic 3. Laryngospasm and Hiccups
gases are delivered directly to the trachea. Mx control the spasm and hiccup with
oxygen ventilation, give muscle
Disadvantage relaxant
Difficulty of performing the technique
especially if the anesthesiologist is not Intraoperative Complications
adept to the technique
B.Lower airway obstruction
Complications of General Endotracheal 1. Aspration
Anesthesia and Management Mx Suction airway
1. Trauma during intubation Bronchial lavage
2. Endobroncheal Intubation Ventilate with oxygen
Mx Make sure right and left Give antibiotics & steroids
bronchus are ventilated 2. Bronchospasm
3. Esophageal intubation Mx Break spasm by applying positive
Mx Check equal ventilation pressure with 100% oxygen
Give muscle relaxant
4.Endotracheal Tube Obstruction Endotracheal intubation
Mx Check For: Bronchial dilators
a) Kinking of the tube II. Cardiovascular complications
b) Presence of foreign body in a) Hypertension
the tube Rx if due to light anesthesia, increase depth
c) Put a little block to prevent the Give hypertensives
patient from biting the tube b.) Arrythmia
5.Laryngospasm Rx decrease concentration of anesthetic, give
a) Deliver 100% oxygen while antiarrythmic drugs, oxygen inhalation
applying positive pressure
breathing to break the spasm
b) Keep patient under sufficient III. Ocular Complications
depth anesthesia
Corneal Abrasions
Indications for General Anesthesia Due to ill-fitting masks pressing on the eye
1. infants and children Leak of anesthetic vapor in the cornea
2. Adults who prefr general anesthesia
3. extensive surgical procedures Rx apply eye ointment
4. patients with mental disease Keep lids closed
5. prolonged surgery ( long duration of Use poper size mask on patient
surgery) Ophthalmologic consult
6. surgery for which local anesthesia is
impractical or unsatisfactory
7. patients with a history of toxic or allergic
reactions to local anesthetic drugs
8. patients on anticoagulant therapy

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IV. Malignant Hypethermia
Inherited abnormality
Anesthetic may precipitate a rapid
increase In body temp of 2 degrees/hour
Increase creatine phosphokinase and
myoglobinuria

Rx
Control temp with surface cooling ice
packs
Antipyretics
Refrigerate IVF for temperature control
Ice water lavage of the stomach
Pulmonary ventilation
NaHCO3 for metabolic acidosis
Procainamide for cardiac arrythma
Insulin and glucose infusion for
hyperkalemia
Crystalloids to maintain circulatory
adequacy
Dantrolene- give immediately IV