General
Anesthetics By Abril Santos
Universidad Popular Autónoma del Estado de Puebla
International Intership Program
introduction
General anesthetics (GAs) are drugs
which:
• Reversible loss of all sensations and
consciousness.
• Loss of memory and awareness
with insensitivity to painful stimuli,
during a surgical procedure.
General Anesthesia
Need for Need for analgesia
unconsciousness Need for muscle
‘Loss of sensory and relaxation
‘Amnesia-hypnosis’ autonomic reflexes’
• 1846 – Oliver Wendell Sr. “Anesthesia”
meaning:
Insensibility during surgery produced by
inhalation of ether.
• William T. G. Morton (dentist) was the first
to publicly demonstrate the use of ether
during surgery.
• 1860 – Albert Niemann Cocaineas.
Types of Anesthesia
• General anesthesia
• Local and regional anesthesia
• Local Infiltration
• Topical block
• Surface anesthesia
• Nerve Block
• Spinal or subarachnoid anesthesia
• Peridural anesthesia
Balanced Anesthesia
Describes the multidrug approach to managing the patient needs.
Beneficial effects Adverse Qualities
Intraoperative, an ideal anaesthetic drug:
1. Would induce anesthesia smoothly, rapidly
2. Permit rapid recovery as soon as administration ceased.
*So a ‘balanced anesthesia’ is achieved by a combination of I.V and inhaled anesthesia and Pre-anaesthetic medications
General Anesthesia
Inhalational Intravenous
Gas Volatile liquids Slower acting Inducing agents
Nitrous oxide Dissociative Opiod analgesia Benzodiazepines
Zenon anesthesia
Thiopentone sod.
Ether
Methohexitone sod.
Halothane Diazepam
Ketamine Fentanyl Propofol
Enflurane Lorazepam Etomidate
Isoflurane Midazolam Droperidol
Desflurane
Sevoflurane
Methoxyflurane
Stages of
anesthesia
Guedel (1920) described four stages with
ether anesthesia, dividing the III stage into 4
planes.
The order of depression in the CNS is:
1. Cortical centers
2. Basal ganglia
3. Spinal cord
4. Medulla
Surgical Period and GA protocol
Use pre-anesthetic medication
↓
Induce by I.V thiopental or suitable alternative
↓
Use muscle relaxant
↓
Intubate
↓
Use, usually a mixture of N2O and a halogenated hydrocarbon→maintain and
monitor.
↓
Withdraw the drugs → recover
Pre-operative Period
• Meet the patient personally.
• Choose the right technique by
the preferences, case and
patient.
Use the ASA and GOLDMAN scale
for anaesthetic risk.
ASA
score
Use to measure risk for anaesthetic
procedures.
Pre-
anaesthetic
Medications
Pre-anaesthetic Medications
Serve to
• Calm the patient, relieve pain
• Protect against undesirable effects of the subsequently administered anesthetics or the
surgical procedure.
• Facilitate smooth induction of anesthesia
• Lowered the dose of anaesthetic required
Preanesthetic Medicine:
• Benzodiazepines; midazolam or diazepam: Anxiolysis & Amnesia.
• Barbiturates; pentobarbital: sedation
• Diphenhydramine: prevention of allergic reactions: antihistamines
• H2 receptor blocker- ranitidine: reduce gastric acidity.
Intraoperative Period
• Induction: Onset of anesthetic to the surgical anesthesia (I.V thiopental
or inhalated halothane or sevoflurane)
• Maintenance: Volatile anesthetics = good minute-to-minute control
over the depth. (halothane, isoflurane or fentanyl, morphine,
pethidine + N.M blocking agents)
• Recovery: From discontinuation of anesthesia until
• Consciousness
• Protective physiologic reflexes
Regained.
Post-operative Period
• N.M blocking agents and Opioids worn off or reversed by
antagonists.
• Regained consciousness and protective reflex restored
• Relief of pain: NSAIDs
• Postoperative vomiting: metoclopramide, prochlorperazine
Properties of Intravenous Anesthetics.
Drug Induction and recovery Main unwanted effects Notes
Thiopental Fast onset (accumulation Cardiovascular and respiratory Used as induction agent declining. ↓
occurs, giving slow recovery) depression CBF and O2 consumption
hangover Injection pain
Etomidate Fast onset, fairly fast Excitatory effects during Less cvs and resp depression than with
recovery induction adrenocortical thiopental, injection site pain
suppression
Propofol Fast onset, very fast Cvs and resp depression Most common induction agent. Rapidly
recovery Pain at injection site. metabolized; possible to use as
continuous infusion. Injection pain.
Antiemetic
Ketamine Slow onset, after-effects Psychotomimetic effects Produces good analgesia and amnesia.
common during recovery following recovery, postop No injection site pain
nausea, vomiting， salivation
Midazolam Slower onset than other Minimal CV and resp effects. Little resp or cvs depression. No pain.
agents Good amnesia.
Non-barbiturate induction drugs effects
on BP and HR
Drug Systemic BP Heart rate
Propofol ↓ ↓
Etomidate No change or slight ↓ No change
Ketamine ↑ ↑
Local Anesthetics
Order of sensory
function block
1. Pain
2. Cold
3. Warmth
4. Touch
5. Deep pressure
6. Motor
*Recovery in reverse order.
Vasoconstrictors decrease the rate of vascular absorption which allows
more anesthetic to reach the nerve membrane and improves the depth
of anesthesia.
Vasoconstrictor
In Conclusion:
• Type of surgical procedure
• Duration of surgical procedure
• Type of anesthesia
• PATIENT
• Risk vs Benefit
• ALWAYS monitor
References
• American Society of Anesthesiologists (2011). Guidelines for patient care in
anesthesiology. Available online: http://www.asahq.org/For-
Members/Standards-Guidelines-and-Statements.aspx.
• Dorian RS (2010). Anesthesia of the surgical patient. In FC Brunicardi et al., eds.,
Schwartz’s Principles of Surgery, 9th ed., pp. 1731–1752. New York: McGraw-Hill.
• Brown DL (2010). Spinal, epidural and caudal anesthesia. In RD Miller et al., eds.,
Miller's Anesthesia, 7th ed., pp. 1611–1638. Philadelphia: Churchill Livingstone.
• Handbook of Local Anesthesia 6th ed. Stanley F. Malamed, DDS iii Handbook of
Local Anesthesia, 6th Edition
Thank You!
