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Types of anesthesia

Lecture By: Prof.Nabil H. Mohyeddin
Anesthesiologist & Intensive Board Certified Rostock Universty Germany.

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Types of anesthesia

  1. 1. Types of AnaesthesiaProf. med. Nabil H. Mohyeddin Anesthesiologist & Intensivist Board certified University Rostock, Germany nhm1955@hotmail.com
  2. 2. Objectives Short History Definition/types of anaesthesia General anaesthesia/drugs Phases of GA Regional anaesthesia
  3. 3. Early history Ancient/Medieval period- Opium- Alcohol- Cannabis
  4. 4. History 1845- Horace Wells- N2O 1846- William Morton- Ether 1847- Simpson- Chloroform 1853-John Snow 1878- ETT 1884- Cocaine 1895-98- Spinal analgesia/anaesthesia
  5. 5. History 1921- Epidurals 1934- Thiopentone, cyclopropane 1942- Curare 1946- Lignocaine 1951- Suxamethonium 1952- IPPV 1956-Halothane
  6. 6. Definition ‘Loss of sensation’ General Regional Local
  7. 7. Triad of General anaesthesia HypnosisAnalgesia Muscle relaxation
  8. 8. Hypnosis Death Coma Hypnosis sedation AmnesiaAwake
  9. 9. Hypnotic drugs-intravenous Gold standard- thiopentone Propofol others Etomidate Benzodiazepines Ketamine
  10. 10. Inhalational anaesthetics Nitrous oxide-weak Isoflurane Sevoflurane Desflurane Halothane
  11. 11. Analgesia Good analgesia= good anaesthesia Hypnotic sparing effect Opiates Local anaesthetics NSAIDS Paracetamol
  12. 12. Analgesia-Opiates Gold standard – morphine Derivatives- diamorphine, codeine Synthetic agents- Pethidine- Fentanyl/Alfentanil-short acting- Remifentanil-ultra short acting
  13. 13. Analgesia-NSAIDS Gold standard- aspirin Ibuprofen Diclofenac Cox-2 inhibitors
  14. 14. Muscle relaxation Aids intubation Helps surgeon/surgery Surgery of long duration Reduces maintenance dose of anaesthetics agents
  15. 15. Muscle relaxants Two types Depolarising-short acting eg;suxmethonium Non-depolarising- medium/long acting- Tracurium- Vecuronium- Rocuronium
  16. 16. Prerequisites Oxygen Suction Tilting trolley Resuscitation drugs Monitoring Anaesthetist Skilled assistance Drugs and machine
  17. 17. Phases of general anaesthesia Induction Maintenance Recovery
  18. 18. Induction Intravenous- majority Inhalational- children, needle phobics Monitoring Preoxygenation Hypnotic/analgesic and or relaxant Mask/LMA/ET tube
  19. 19. Stages of anaesthesia Alcohol  General Anaesthesia1.Dizzy, delightful 1.Amnesia, analgesia2.Drunk, disorderly 2.Uninhibited3.Dead drunk response to stimuli4.Dangerously deep 3.Surgical anaesthesia 4.Vital centre depression
  20. 20. Maintenance Intravenous or inhalational Oxygen –40%-100% Nitrous oxide Muscle relaxant Analgesia
  21. 21. Recovery Turn off agent Reverse relaxation Cough reflex Extubate when awake Recovery position Monitor until discharge
  22. 22. Advantages No absolute contraindications Quick to establish Never fails to work
  23. 23. Disadvantages Polypharmacy Effects on various systems Allergic reactions Recovery profile Post operative Nausia &Vomiting Awareness
  24. 24. Regional anaesthesia Spinal/epidural- surgery below umbilicus- Provides analgesia/muscle relaxation Plexus blocks eg brachial plexus Intravenous- Bier’s block
  25. 25. Regional anaesthesiaAnalgesia Muscle relaxation
  26. 26. Local anaesthetics Lignocaine- quick/short acting Bupivacaine/levobupicvacaine- slow and long action Ropivacaine- as above Amethocaine- topical Prilocaine- intravenous
  27. 27. Advantages Effective alternative to GA Avoids polypharmacy Allergic reactions Extended analgesia Patient can remain awake Early drink/feed
  28. 28. Disadvantages Limited scope Higher failure rate Time constraints Anticoagulants/Bleeding diathesis Risk of neural injury