INTRODUCTION TO

ANAESTHESIA
 History of Anesthesia

 Ancient/Medieval period
- Opium
- Alcohol
- Cannabis
• Ether synthesized in 1540 by Cordus
• Ether used as anesthetic in 1842 by Dr. Crawford W.
Long
• Ether publicized as anesthetic in 1846 by Dr. William
Morton
• Chloroform used as anesthetic in 1853 by Dr. John
Snow for Queen Victoria’s Anesthetic for the birth
of Prince Leopold;
 Revolutions in History of Anesthesia

• Endotracheal tube discovered in 1878

• Local anesthesia with cocaine in 1885
• Thiopental first used in 1934
• Curare first used in 1942 - opened the
“Age of Anesthesia”
 Basic Principles of Anesthesia
• Anesthesia defined as the abolition of
sensation
• Analgesia defined as the abolition of pain
• TYPES
• General
• Regional
• Local
• “Triad of General Anesthesia”
– need for unconsciousness
– need for analgesia
– need for muscle relaxation
Inhalational Hypnotic drugs-
anaesthetics intravenous
• Nitrous oxide-weak • Gold standard-
• Isoflurane Thiopentone
• Sevoflurane • Propofol
• Desflurane • Etomidate
• Halothane • Benzodiazepines
• Ketamine
 Analgesia
 Good analgesia= good anaesthesia
 Hypnotic sparing effect
 TYPES
Opiates
Local anaesthetics
NSAIDS
Paracetamol
 Analgesia
• Opiates  NSAIDS
• Gold standard –  Gold standard-
morphine aspirin
• Derivatives-
diamorphine, codeine
 Ibuprofen
• Synthetic agents  Diclofenac
- Pethidine  Cox-2 inhibitors-
- Fentanyl/Alfentanil- Ketorolac
short acting
- Remifentanil-ultra short
acting
 Muscle relaxation
• Aids intubation
• Helps surgeon/surgery
• Surgery of long duration
• Reduces maintenance dose of anaesthetics agents
Two types
• Depolarising-short acting
- Suxmethonium

• Non-depolarising- medium/long acting

- Atracurium
- Vecuronium
- Rocuronium
 Prerequisites
 Oxygen
 Suction
 Tilting trolley
 Resuscitation drugs
 Monitoring
 Anaesthetist
 Skilled assistance
 Drugs and machine
Phases of General anaesthesia

• Induction
• Maintenance
• Recovery
 Induction
• Intravenous- majority
• Inhalational- children, needle phobics
• Monitoring
• Preoxygenation
• Hypnotic/analgesic and or relaxant
• Airway-Mask/LMA/ET tube
 Maintenance
• Intravenous or inhalational
• Oxygen –40%-100%
• Nitrous oxide
• Muscle relaxant
• Analgesia
 Recovery
• Turn off agent
• Reverse relaxation
• Cough reflex
• Extubate when awake
• Recovery position
• Monitor until discharge
• Advantages • Disadvantages
• No absolute • Polypharmacy
contraindications • Effects on various
• Quick to establish systems
• Never fails to work • Allergic reactions
• Recovery profile
variable
• PONV
• Awareness
 Regional anaesthesia
• CENTRAL NEUROAXIAL BLOCKS
• Spinal/epidural
- Surgery below umbilicus
- Provides analgesia/muscle relaxation

• Plexus blocks e:g brachial plexus

• Intravenous- Bier’s block
 Local anaesthetics
• Lignocaine- quick/short acting
• Bupivacaine/levobupicvacaine- slow and
long action
• Ropivacaine- as above
• Amethocaine- topical
• Prilocaine- intravenous
• Advantages • Disadvantages
• Effective • Limited scope
alternative to GA • Higher failure rate
• Avoids polypharmacy • Time constraints
• Allergic reactions • Anticoagulants/Blee
• Extended analgesia ding diathesis
• Patient can remain • Risk of neural injury
awake
• Early drink/feed
INTENSIVE CARE PAIN MANAGEMENT
UNIT SERVICES
• Postoperative • Acute Pain
Patient • Chronic Pain
• Poisoning
• Medical diseases
• Accidents & Trauma
• End of Life
• Ventilatory Services