PRESENTED BY:

HAFSA JAMIL

Facilitator :
Dr.Muhammad Asadullah
shahzad
Anesthesia
ANESTHESIA:
• Is a temporary state consisting of
unconsciousness, loss of memory, lack of pain,
and muscle relaxation.
• A patient under the effects of anesthesia is said
to be anesthetized.
• Types of Anesthesia
• Local anesthesia
• General anesthesia
Pre-Anesthetic Medication :
• Drugs administered before an anesthetic to decrease
anxiety and to obtain:
 Smoother induction.
 Maintenance.
 Emergence from anesthesia.
These drugs are
• Sedative hypnotic ::
• To subside worry and tension e.g Diazepam .
• Analgesics:
• For smooth induction and decrease post operative pain
e.g Morphine.
• Anticolinergic::
• To reduce bronchial secretion e.g Atropine .
• Antiemetics:
• To prevent nausea and vomiting e.g Promathiazine .
General Anesthesia:
• A drug that brings about a
reversible loss of sensation along
with the loss of consciousness .
 8

General Anaesthesia (GA)

• A variety of drugs are given

to the patient that have
unconsciousness
different effects with the
overall aim of ensuring
unconsciousness, amnesia
and analgesia.

analgesia. amnesia
 Stages Of General Anesthesia

Stage I: Analgesia
decreased awareness of pain . Consciousness may be
impaired but not lost..

Stage II: Disinhibition

Excitatory stage, uncontrolled movement, irregular
breathing.
Goal is to move through this stage as rapidly as possible.

Stage III: Surgical anesthesia

return of regular respiration.
Loss of blink reflex, regular respiration . Surgical
procedures can be performed at this stage.

Stage IV: Medullary Depression

This is the stage between respiratory arrest and death due
to circulatory collapse..
•CLASSIFICATION
General Anesthetics divide into 2 classes

Inhalation Intravenous
Anesthetics Anesthetics
• Gasses or • Barbiturates
Vapors • Dissociative
• Halogenated • Opioids
• Benzodiazepines
Inhalation Anesthetics
• Nitrous oxide
• Cycloprapane
Gas

• Halothane
Halogenated • Isoflurane
agents: • Sevoflurane
• Enflurane
Intravenous Anesthesia:
• Thiopental
• Thiamylal
Barbiturates • Methohexital

• Ketamine
Dissociative
agents
 • Morphine
Opioids • Fentanyl
citrate

• Midazolam
Benzodiazipines • Lorazepam
• Diazepam
Mechanism of Action
• Interaction with protein receptors.

• Volatile A – increase GABA and Glycine.

( inhibitory neurotransmitters).
MECHANISM OF
ACTION :
MAC(minimum alveolar concentration)

• A measure of potency of
inhaled anesthetics.
.
Pharmacokinetics of Inhaled
Anesthetics
1. Amount that reaches the brain
Indicated by oil:gas ratio (lipid solubility)

2. Solubility of gas into blood

The lower the blood:gas ratio, the more anesthetics will arrive at
the brain
Rate of Entry into the Brain: Influence of Blood
and Lipid Solubility
General Actions of Inhaled Anesthetics
• Respiration
• Depressed respiration and response to CO2.
• Kidney
• Depression of renal blood flow and urine output.
• Muscle
• High enough concentrations will relax skeletal muscle.
Cont’
• Cardiovascular System
• Generalized reduction in arterial pressure and peripheral vascular
resistance.
• Isoflurane maintains CO and coronary function better than other
agents.
• Central Nervous System
• Increased cerebral blood flow and decreased cerebral metabolism.
Nitrous oxide
• Merits • Demerits
• Rapid induction and • Diffusion hypoxia
recovery • Post operative nausea
• No adverse effects on and vomiting
circulation and • Ineffective anesthetic
respiration alone.
• Good analgesia • Inadequate muscle
relaxation
Nitrous Oxide
Halothane
• MERITS • DEMERITS
• Non irritating • Weak analgesia and
• Safe for children
inadequate muscle
relaxation.
• Can be given in
• Hepatotoxicity
asthmatics.
• CVS and respiratory
disturbances .
• Expensive
 Malignant Hyperthermia

• Malignant hyperthermia (MH) is a

pharmacogenetic hypermetabolic
state of skeletal muscle induced in
susceptible individuals by
inhalational anesthetics and/or
succinylcholine (and maybe by
stress or exercise).
Malignant Hyperthermia

• Signs: tachycardia, hyperthermia,

muscle rigidity, sweating, arrhythmia.

• May be fatal.

• Treated with Dantrolene.

ENFLURANE
• Merits • DEMERITS
• Rapid inhalation and • CNS excitation
recovery . • May cause seizures
ISOFLURANE
• Merits • Demerits
• Rapid and smooth • Uterine relaxation
anesthesia • Progressive regulatory
• No hepatic/renal depression
toxicity
 Intravenous Anesthetics

• Most exert their actions by potentiating

GABAA receptor.

• GABAergic actions may be similar to

those of volatile anesthetics, but act at
different sites on receptor.
 Organ Effects
• Most decrease cerebral metabolism and intracranial
pressure.

• Most cause respiratory depression.

• May cause apnea after induction of anesthesia.

 Cardiovascular Effects

• They cause cardiovascular

depression.
Ketamine
• Merits • Demerits
• Short acting • Post operative
• Dissociative hallucination
anesthesia • Increase cerebral
• Can be used in blood flow
children
• Very good analgesic
Propofol
• Merits • Demerits
• Rapid and smooth • Poor analgesic
onset and recovery • Excreted through
• Reduce intracranial kidney
pressure
Local Anaesthesia
• DEFINITION: Local anaesthesia is drug-induced
reversible local blockade of nerve conduction in a specific
part of the body that does not alter consciousness.
Prosperities of ideal LA
• Reversible action.
• Non-irritant.
• No allergic reaction.
• No systemic toxicity.
• Rapid onset of action.
• Sufficient duration of action.
• Potent.
• Stable in solutions.
• Not interfere with healing of tissue.
• Have a vasoconstrictor action or compatible with VC.
• Not expensive
 Six Placement Sites

Surface/topical Local Peripheral

anesthesia infiltration nerve block

Bier block (IV Epidural Spinal

regional anesthesia anesthesia
anesthesia)
 Esters vs Amides
• The ester linkage is more easily broken so the ester drugs
are less stable in solution and cannot be stored for as
long as amides.
• Amide anaesthetics are also heat-stable.
• The metabolism of most esters results in the production of
para-aminobenzoate (PABA) which is associated with
allergic reaction.
• Amides, in contrast, very rarely cause allergic
phenomena. For these reasons amides are now more
commonly used than esters.
 The mechanism of action of local
anaesthetics
• Disruption of ion
channel function via
specific binding to
sodium channels,
holding them in an
inactive state.
• Disruption of ion
channel function by the
incorporation of local
anaesthetic molecules
into the cell membrane
.
• Small nerve fibres are more sensitive than large nerve
fibres

• Myelinated fibres are blocked before non-myelinated

fibres of the same diameter.

• Thus the loss of nerve function proceeds as loss of pain,

temperature, touch, proprioception, and then skeletal
muscle tone. This is why people may still feel touch but
not pain when using local anaesthesia.
 Absorption and distribution
• Some of the drug will be absorbed into the systemic
circulation: how much will depend on the vascularity of the
area to which the drug has been applied.

• The distribution of the drug is influenced by the degree of

tissue and plasma protein binding of the drug. the more
protein bound the agent, the longer the duration of action
as free drug is more slowly made available for
metabolism.
 Metabolism and excretion
• Esters (except cocaine) are broken down rapidly by
plasma esterases to inactive compounds and
consequently have a short half life. Cocaine is hydrolysed
in the liver. Ester metabolite excretion is renal.

• Amides are metabolised hepatically by amidases. This is

a slower process, hence their half-life is longer and they
can accumulate if given in repeated doses or by infusion.
Uses:

• Local anesthesia.

• Ventricular arrhythmia.

• Decrease haemodynamic response to tracheal intubation

also decrease cough.

• Treatment of epileptic fits.

Advantages of local anaesthesia

• Non inflammable.

• Excellent muscle relaxant effect.

• During local anesthesia the patient remains conscious.

• It requires less skilled nursing care as compared to other

anesthesia like general anesthesia.

• Maintains his own airway.

• Less pulmonary complication.s

• Aspiration of gastric contents unlikely.

• Less nausea and vomiting.

• Contracted bowel so helpful in abdominal and pelvic

surgery.

• Postoperative analgesia.

• There is reduction surgical stress.

• Earlier discharge for outpatients.

Advantage of using adrenaline:
•Epinephrine vasoconstricts arteries reducing bleeding and also
delays the resorption of lidocaine, almost doubling the duration of
anaesthesia.

•Bupivacaine has caused several deaths when the epidural

anaesthetic has been administered intravenously accidentally.
 Adverse Effects
• CNS: excitation followed by
dépression (drowsiness to
unconsciousness and death due to
respiratory depression.

• Cardiovascular System: bradycardia,

heart block, vasodilation
(hypotension)

• Allergic reactions: allergic dermatitis

to anaphylaxis (rare, but occur most
often by ester-type drugs).
 Causes :
• Accidental rapid
intravenous injection.

• Rapid absorption, such

as from a very vascular
site ie mucous
membranes.

• Overdose .
Factors reducing toxicity:

• Decide on the concentration of the local anaesthetic that

is required for the block to be performed. Calculate the
total volume of drug that is allowed according to the table
below.
Hope you all get it…