Learning Objectives

After completing this chapter, the learner will be able to:

1.Differentiate between local and general anesthesia.
2.Mention the routes of administering local
anesthesia.
3.Identify three methods of administering general
anesthesia.
4.Manage the adverse effects of local anesthesia.
5.List two agents used as local anesthesia.
6.Identify the stages of general anesthesia.
7.Mention two agents used for general anesthesia.

Anesthesia, the absence of sensation, may be produced in a

specific body area or systemically. When the agent given
causes unconsciousness, the anesthetic is termed general
(general anesthesia) when an agent is directed into a specific
area to cause analgesia, the absence of pain, it is called
conductive or local or regional.

Types of Anesthesia
Local anesthesia
The agent used during local anesthesia acts on a single
nerve, a group of nerves or on superficial nerve endings.
During all types of local/regional anesthesia including local
infiltration, nerve block, topical, epidural and spinal, the
patient remains conscious.

Local infiltration

The agent is injected intracutaneously and

subcutaneously into tissues at and around the
incisional site to block peripheral sensory nerve
stimuli at their origin.

Nerve block
Anesthesia of a large single nerve or nerves
Injection is done not necessarily at the immediate
surgical site
Commonly used in surgery that is performed on
fingers and toes
The supplying nerve is anesthetized

Topical

Used to numb superficial nerve endings particularly

those of the mucous membranes
The agent may be–swabbed, sprayed or applied in
drops as for eye surgery
Useful in preparing the patient for endoscopic
procedures, such as bronchoscopy and
esophagoscopy

Regional Anesthesia
Epidural
Introduced into the epidural space of the spine
The agent baths the nerve roots of the spinal cord
and the area supplied by these nerves is
anesthetized

Caudal
Type of epidural anesthesia
Directed into the caudal canal at the sacrum
Ideal for obstetrics and procedures on the perineum
Spinal
Introduction of the anesthetic into the subarachnoid
space at the fourth or fifth lumbar interspace.
Here the agent does come into contact with the
spinal fluid

Adverse reactions to local anesthesia

Stimulation: patient may become very talkative or

anxious, signs of tachycardia thready pulse, convulsion.
Depression: patient may appear sleepy and
unresponsive, bradycardia, hypo tension.
Other signs: patient may develop cyanosis, sweating feel
cold, act restless (signs of shock). Fainting, itching,
nausea or sudden headache may also occur.

Treatment of the Reaction

Discontinue the anesthetic immediately
Oxygen administration may be needed
Cardiopulmonary resuscitation is initiated, if necessary
Local and Regional Anesthetic Agents

General Anesthesia
Causes unconsciousness, provides analgesia and
muscle relaxation
Depending upon the type and amount of agent used,
the patient may be slightly or not at all responsive to
stimuli.
A combination of agents is frequently used to achieve
the desired level of muscle relaxation and analgesia
There are four stages of general anesthesia. These are
induction, excitement, relaxation and danger.

Induction
The beginning of administration of the initial agent
Lasts until the patient is unconscious,
During this phase, the patient retains an exaggerated
sense of hearing until the last moment.
For this reason it is mandatory that all personnel in the
room remain as quiet as possible during induction.
Excitement
During this phase, the patient is delirious and
sensitive to external stimuli
Involuntary muscle activity and struggle may be seen
Patient is physiologically unstable
Relaxation
This phase is the level at which surgery may be
performed safely.
o The patient is relaxed, unconscious of pain and is
physiologically stable
o Breathing is steady and automatic
o This phase ends at its deepest level with respiratory
paralysis.

Danger
This stage begins when the amount of agent causes such
severe depression of the central nervous system that the
patient is in immediate danger of cardiopulmonary arrest.

Questions for Study and Review

1.What is the difference between anesthesia and

analgesia?
2. Define local anesthesia.
3. Mention three different kinds of local anesthesia.
4. What effect does epinephrine has on the surgical site?
5. Discuss the various ways a patient might react
adversely to the local anesthesia.
6. What is the maximum safe dosage of xylocaine?
7. What are the various methods in which a general
anesthesia might be administered?
8. Identify the four stages of general anesthesia.