CLINICAL ANESTHESIOLOGY
 is a perioperative specialty that aims to
maintain the patient’s health and wellness
throughout the course of surgery
 requires a clear understanding of how a
person’s preexisting comorbid status and
anticipated surgical procedure can best be
managed to gain the most therapeutic benefits
from interventions with the least incurred risk
ANESTHESIOLOGIST:
 must remain vigilant in order to anticipate the
possibility of derangements to coagulation and
hemostasis that may occur with surgery, trauma
or critical illness
 must also know the best methods for avoiding
hemorrhagic or thrombotic complications of
surgery or treatment modalities to ensure the
ability to treat any problems that arise, while
limiting the risks of transfusion therapy and
hemostatic pharmagologic agents
 experts at controlling the airway and at
emergency resuscitation
 we are real time cardiopulmonologist achieving
hemodynamic and respiratory stability for the
anesthetized patient
 pharmacologist and physiologist, calculating
appropriate doses and desired response
 gurus of postoperative care and patient safety
 internists perfomning perianesthetic medical
interventions
ANESTHESIOLOGY:
 is an amalgam of specialized techniques,
equipment, drugs, and knowledge
 current anesthesia practice is the:
-summation of individual effort and fortuitous
discovery of centuries
 Every component of modern anesthesia was at
some point a new discovery and reflects the
experience, knowledge and inventiveness of
our predecessors.
 Historical examination enables understanding
if how these individual components of
anesthesia evolved.
 knowledge of history of anesthesia enhances
our appreciation of current practice and
intimates where our specialty might be headed
DEFINITION OF TERMS:
1. Anesthesia:
 lack of feeling or sensation
 artificially induced loss of ability to feel pain
done to permit the performance of surgery /
other painful procedures
 may be produced by a number of agents
(anesthetics) capable of bringing about partial
or complete loss of sensation
2. Ambulatory anesthesia:
 Anesthesia performed on OPD basis for
ambulatory surgery
3. Balanced anesthesia:
 Anesthesia that uses a combination of drugs,
each in an amount sufficient to produce its
major desired effect to optimum degree and to
keep undesirable effects to minimum
4. Basal anesthesia:
 a reversible state of central nervous system
depression produced by preliminary
medication so that inhalation of anesthetic
necessary to produce surgical anesthesia is
greatly reduced
5. Block anesthesia:
 regional anesthesia
6. Caudal anesthesia:
 a type of regional anesthesia that was used in
childbirth between the 1940s and the 1960s
 The anesthetizing solution was injected into
the caudal area of spinal canal affecting the
caudal nerve roots redering the cervix, vagina,
perineum insensitive to pain
 caudal block
7. Central anesthesia:
 lack of sensation caused by disease of nerve
centers
8. Closed circuit anesthesia:
 Produced by continuous rebreathing of small
amount of anesthetic gas in a closed system
with an apparatus for removing carbon dioxide
9. Compression anesthesia:
 Loss of sensation resulting from pressure on a
nerve
10. Infiltration anesthesia
 Local anesthesia produced by injection of the
anesthetic solution directly into the area of
terminal nerve endings
11. Inhalation anesthesia:
 anesthesia produced by the respiration of
volatile liquid or gas agent
12. Insufflation anesthesia:
 anesthesia produced by introduction of a
gaseous mixture into the trachea through a
tube
13. Topical anesthesia:
 produced by application of a local anesthetic
directly to the area involved
14. Local anesthesia
 produced in a limited area, as by injection of a
local anesthetic or by freezing with ethyl
chloride
SURGICAL PROCEDURES:
 Drainage procedure for ascites, pleural effusion
or pericardial effusion
 laparotomy/ laparoscopy and bypass or
resection for relief of biliary or bowel
obstruction
 resection of tumor (debulking) for relief of
pain, constitutioanal symptoms, control of odor
 endoscopic interventions for stenting an
obstructed lumen, ablation of tumor,
hemostasis
 gastrotomy (PEG) placement for relief of
obstruction, hunger or feeding
 craniotomy for excision of symptomatic
metastasis or hemorrhage
 fixation of pathologic fracture
GENERAL ANESTHESIA:
 anesthesia is not simply a deafferented state
 amnesia and unconsciousness are important
COMPONENTS OF ANESTHETIC STATE
 unconsciousness
 amnesia
 analgesia
 immobility
 attenuation of autonomic responses to noxious
stimulation
GENERAL ANESTHESIA GUEDEL’S CLASSIFICATION
STAGE 1 (STATE OF ANALGESIA OR DISORIENTATION)
 from the beginning of induction of general
anesthesia to loss of consciousness
STAGE 2(STATE OF EXCITEMENT OR DELIRIUM)
 from loss of consciousness to onset of
automatic breathing. Eyelash reflex disappear
but other reflex remain intact and coughing,
vomiting and struggling may occur; respiration
can be irregular with breath-holding
STAGE 3 (STAGE OF SURGICAL ANESTHESIA)
 from onset of automatic respiration to
respiratory paralysis. it is divided into four
planes
PLANE 1: from onset of automatic respiration to
cessation of eyeball movement. Eyelid reflex is lost,
swallowing reflex disappears, marked eyeball
movement may occur but conjunctival reflex is lost at
bottom of the plane
PLANE 2: from cessation of eye ball movement to
beginning of paralysis of intercostals muscles
-Laryngeal reflex is lost although inflammation of the
URT increase reflex irritability, corneal reflex
disappears; tears increase (a useful sign of light
anesthesia)
- Respiration is automatic and regular movement and
deep breathing as a response to skin stimulation
disappears.
PLANE 3: from beginning to completion of intercostals
muscle paralysis
-Diaphragmatic respiration persist but there is
progressive intercostals paralysis, pupils dilated and
light reflex is abolished
-Laryngeal reflex is lost in plane 2 can still be initiated
but painful stimuli arising from the dilation of anus or
cervix
-The desired plane for surgery when muscle relaxants
were not used
PLANE 4: from complete intercostals paralysis to
diaphragmatic paralysis (apnea)
STAGE 4: From apnea till death
 Anesthetic overdose- caused medullary
paralysis with respiratory arrest and vasomotor
collapse. Pupils are widely dilated and muscles
are relaxed
REGIONAL ANESTHESIA
 Patient refusal: only absolute contraindication
to spinal or epidural anesthesia
 Relative risk
- Hypovolemia or shock increases the risk for
hypotension
- increase ICP: increase the risk of brain
herniation when CSF is lost through the
needle or if a further increase in ICP follows
injection of large volumes of solution into
the epid/ SA spaces

SPINAL OR EPIDURAL ANESTHESIA:

- spinal
- less time to perform
- more rapid onset of better-quality
sensorimotor block
- less pain during surgery

EPIDURAL ANESTHESIA:
- lower risk of PDPH
- less hypotension if epinephrine is not added
to the local anesthetic
- ability to prolong or extend the block via an
indwelling catheter
- option to provide post operative analgesia

COMPLICATIONS OF SUBARACHNOID BLOCK

- Hypotension
- headache
- high spinal
- Nausea/ vomiting
- backache
- major neurologic injury