GENERAL PRINCIPLES OF ANAESTHESIA
DR PRECIOUS KADZAMIRA
ANAESTHESIA AND INTENSIVE CARE
PHYSIO 4
ANAESTHESIA
Definition: ‘ temporary state consisting of unconsciousness, loss of
memory, lack of pain and muscle relaxation’
TYPES OF ANAESTHESIA
• General anaesthesia : ‘ suppression of activity in the CNS leading to
unconsciousness and lack of sensation’
• Regional anaesthesia: ‘ blocks transmission of nerve impulses
between area of body and the CNS.’
• Sedation : ‘inhibition of sensation between higher and lower centres
of the brain’ → anxiolysis and long term amnesia
REGIONAL ANAESTHESIA: NERVE
BLOCK
• Nerve block : A nerve or nerves supplying a particular field is blocked
by injection of local anaesthetic
• What is the mechanism of action of Local anaesthesia?
REGIONAL ANAESTHESIA :SPINAL
• Local anaesthetic is deposited into the subarachnoid space
REGIONAL ANAESTHESIA: EPIDURAL
• Local anaesthetic is deposited into the epidural space. Slower onset
compared to spinal.
‘Stages’ of general anaesthesia
• Induction
• Maintenance
• emergence/ reversal/recovery
Conduct of anaesthesia: GA
• Pre-op preparation
• Equipment
• Drugs
• Pain relief
Pre-op1
• Pre-op visit
• History /exam/ investigations
• Informed choice of anaesthesia/anxiolysis
• Preop optimisation
• Risk assessment
• ASA score
• Other comorbidities
Induction
• Putting the patient to sleep initially
• Iv induction
• Thiopentone
• Propofol
• Ketamine
• Inhalational induction
• Halothane
• sevoflurane/isoflurane
Maintenance
• Gases
• Fluids/ blood
• Monitoring
Emergence/ Recovery
• Wake up the patient
• Reverse muscle relaxation
• Temperature
• Pain relief
Equipment : oxygen
Equipment: anaesthetic machine
Anaesthetic machine
Equipment : vaporiser
Equipment:Ambu bag and mask
Equipment
ENDOTRACHEAL TUBES
LARYNGOSCOPE
Equipment : suction machine
Equipment : theatre table
Drugs / Induction agents: propofol
Drugs/Induction agents: ketamine
Drugs/Induction agents: ketamine
Drugs / Muscle relaxants:
vecuronium
Drugs/ muscle relaxants:
suxamethonium
What is the mechanism of action of
hypnotic drugs and muscle relaxants?
Drugs : opiods
Emergency drugs
• Adrenaline
• Atropine
• Ephedrine
• phenylephrine
Monitoring
• Pulse oximeter
• Electrocardiogram (ECG)
• Bp monitoring (NIBP/invasive)
• Central venous pressure
• Capnography
• Temperature
WHAT IS MONITORING???
To watch & check a situation carefully for a period of time
WHY DO WE MONITOR???
• Maintain normal patient physiology and homeostasis throughout
the period of anaesthesia
STANDARDS FOR BASIC
ANAESTHETIC MONITORING
• The American Society of anaesthesiologists’ committee on standards
and practice parameters developed standards for basic anaesthetic
monitoring.
• Originally approved October 1986, last amended October 2020 and
last affirmed December 2020.
Standard 1
Qualified anaesthesia personnel
1. OXYGENATION
Inspired gas • PULSE OXIMETRY
Blood oxygenation
What factors can interfere with
the pulse oximeter reading?
• Shivering – movement may make it difficult for the probe to pick up a signal.
• Pulse volume – the oximeter only detects pulsatile flow. When the blood pressure
is low due to hypovolaemic shock or the cardiac output is low or the patient has
an arrhythmia, the pulse may be very weak and the oximeter may not be able to
detect a signal.
• Vasoconstriction reduces blood flow to the peripheries. The oximeter may fail to
detect a signal if the patient is very cold and peripherally vasoconstricted.
• Carbon monoxide poisoning gives a falsely high saturation reading. Carbon
monoxide binds very well to haemoglobin and displaces oxygen to form a bright
red compound called carboxyhaemoglobin. This is misinterpreted by the oximeter
as oxyhaemoglobin and the oximeter may read 100%, even though the true
oxygen saturation is very low and the patient may be very hypoxic. This is only an
issue in patients following smoke inhalation from a fire
2. VENTILATION • Capnography
Qualitative clinical signs
Quantitative monitoring
3. CIRCULATION • BP(non invasive)
Qualitative clinical signs Correct cuff size
Quantitative methods
• ECG
Rate
Rhythm
Ischaemic changes
4. BODY TEMPERATURE
Quantitative method
References
• https://www.asahq.org/standards-and-guidelines/standards-for-basic-
anesthetic-monitoring
• https://www.uptodate.com/contents/basic-patient-monitoring-
during-anesthesia
Thank You.
