Introduction to
anesthesia
Supervised by :
Dr.Mohamed
Almalkawi
Done by :
Mutaz Alfrehat
Marah Alabbasi
Dania Alsinjelawi
Leen Alhashaikeh
•Anesthesia :is a state of controlled,
temporary loss of sensation or awareness
that is induced for medical purposes.
•Anesthesiology is the medical specialty
concerned with the total perioperative care
of patients before, during and after surgery.
•A physician specialized in anesthesiology is
called an anesthesiologist
The three components :-
•1- Analgesia
•2-Hypnosis (amnesia)
•3. Muscle relaxation.
• Muscle relaxation: aided by drugs which affect
skeletal muscle function and decrease the muscle tone
by which immobility and relaxation of the skeletal muscle
produced surgery will be proceeded at ease Purpose
•Analgesic or painkiller :is any member of the group
of drugs used to achieve analgesia, relief from pain
( They are distinct from anesthetics Analgesia is pain
relief without loss of consciousness and without total loss
of feeling or movement; anesthesia is defined as the loss
of physical sensation with or without loss of
consciousness .
•Amnesia: refers to the loss of memories, such as facts,
information and experiences.
•Anxiolytics, or anti-anxiety drugs: are a category of
drugs used to prevent anxiety and treat anxiety related
to several anxiety disorders.
General anesthesia
•☼ Definition:
•An altered physiological state
Characterized by:
- reversible loss of consciousness
- Analgesia of entire body
•- Amnesia
- Some degree of muscle reflex
Types of anesthesia
1 General anesthesia a drug-induced reversible
depression of the CNS resulting in the loss of
response to & perception of all external stimuli.
2 Local anesthesia
A local anesthetic numbs a small part of the body
where you are having the operation. It is used
when nerves can be easily reached by drops,
sprays, ointments or injections. You stay conscious,
but free from pain. Common examples of surgery
using local anesthetic are having teeth removed
and some common operations on the eye.
3-Regional anesthesia
This is when a local anesthetic drug is injected
near to the nerves that supply a larger or
deeper area of the body. The area of the body
affected becomes numb .example:
A-Spinal and epidural anesthesia:
Spinals and epidurals are the most common types of regional
anesthetics. These injections can be used for operations on the
lower body, such as caesarean section, bladder operations or
replacing a hip. You stay conscious, but free from pain.
B-nerve block :injection placed near to a nerve or group of
nerves, for example in the arm or leg , Nerve blocks are also
useful for pain relief after the operation, as the area will stay
numb for a number of hours(brachial plexus block)
•Balanced anesthesia :Modern
anesthetic technique is known
as balanced anesthesia, because it
employs a "cocktail" of different drugs
to achieve the goals of general
anesthesia .
•Balancedanesthesia uses a
combination of agents, to limit the
dose and toxicity of each drug.
•Theobjectives of balanced
anesthesia are to calm the patient,
minimize pain, and reduce the
o Four main stages are
recognized based upon
Patient's body movements
Respiratory rhythm,
Oculomotor reflexes
Muscle tone
stages of anesthesia based
on Guedel’s classification
Stage 1 Amnesia and analgesia stage From
beginning of the anesthetic to the loss of
consciousness During this stage, the patient
progresses from analgesia without amnesia
to analgesia with amnesia Patients can carry
on a conversation at this time
Stage 2 stage of excitement or delirium): from loss
of consciousness to onset of automatic breathing
Eyelash reflex disappear but other reflexes remain
intact During this stage, the
patient's respiration and heart rate may become
irregular In addition, there may be uncontrolled
movements, vomiting, suspension of breathing,
and pupillary dilation
Because the combination of spastic movements,
vomiting, and irregular respiration may compromise
the patient's airway, rapidly acting drugs are used
to minimize time in this stage and reach Stage 3 as
fast as possible.
•Stage 3 Surgical Anesthesia: : from onset of
automatic respiration to respiratory paralysis.
This is the targeted anesthetic level for procedures
requiring general anesthesia.
Airway manipulation is safe at this level.
Ceased eye movement and respiratory depression
are hallmarks of this stage .
Reaction to skin incision disappear
•Plane I - from onset of automatic respiration to
cessation of eyeball movements.
•Eyelid reflex is lost, swallowing reflex disappears,
marked eyeball movement may occur but
conjunctival reflex is lost at the bottom of the plane
•Plane II - from cessation of eyeball movements to
beginning of paralysis of intercostal muscles.
• Laryngeal reflex.،corneal reflex
disappears, secretion of tears increases (a useful
sign of light anesthesia), respiration is automatic
and regular, movement and deep breathing as a
response to skin stimulation disappears.
•Plane III - from beginning to completion of
intercostal muscle paralysis.
Diaphragmatic respiration persists but
there is progressive intercostal paralysis,
pupils dilated and light reflex is abolished.
•PlaneIV - from complete intercostal
paralysis to diaphragmatic paralysis
(apnea).
•Stage 4 - also known as overdose, occurs
when too much anesthetic medication is
given relative to the amount of surgical
stimulation and the patient has
severe brainstem or medullary depression,
resulting in a cessation of respiration and
potential cardiovascular collapse. This
stage is lethal without cardiovascular and
respiratory support.
Phases of Anesthesia
•Induction: putting the patient to sleep(initial entry
to surgical anesthesia )
•Maintenance: keeping the patient asleep without
awareness(Maintain depth of anesthesia, ventilation,
fluid balance, hemodynamic control, homeostasis).
•Emergence(recovery): waking the patient
up(resumption of normal CNS function •
•Extubation , resumption of normal respiration)
Balanced anesthesia
1 Hypnotics drugs : commonly known as sleeping pills,
are a class of psychoactive drugs whose primary
function is to induce sleep
2 Analgesic drugs
paracetamol and acetaminophen
NSAID
Opioid: morphine pethidine fentanyl
Local anesthetic drug (blocks)
3 +/- Muscle relaxant drugs
depolarizing muscle relaxant
Non –depolarizing muscle relaxant
premedication: BNZ
+/- adjuvant drug :
Antiemetic ,
Anti acids ,
Anticholinergic
( atropine ,scopalomine )
Preoperative Evaluation of
patients
TO provide better anesthesia service & prevent anesthesia
complication BY history & physical examination related to
anesthesia & any indicated laboratory tests & imaging
A. History review
1- current problem and operation .
2- other known medical problems & smoking
3- medication history :
*allergies to drug
* drugs intolerance
*present medical therapy (DM & HTN)
* non-therapeutic drugs( alcohol , tobacco)
4- previous anesthetic operation( obstetric history &
pain history & any complication )
5- family history , S.H, M.H
6- Review of organ system:
* general include activity level
* Resp. & CVS
*renal & electrolyte imbalance
*hematology & GI
*neurological ,endocrine , psychiatric
*musculoskeletal & dermatologically
7- last oral intake
Fasting need
• clear fluid 2-4 hr
• breast milk 4 hr
• infant formula 6 hr
• light meal 6 hr
• heavy meal > 8 hr ,
• elective surgery 12-24 hr
Smoking stop
•
☼ > 4-6 hr decrease carboxyHb
☼ > 12-24 hr decrease nicotin
nicotin is sympathomimetic and ꜛꜛ
coronary vasoconstriction
☼ > 6-8 weeks normalize M.C.F
☼ > 2-3 month normalize pulmonary
function
☼ > 6 month -1year return to non-
smoker lung
B. physical
examination :
1- vital sign and general examination
2- airway assessment (LEMON )
L look
E evaluate
M mallampati
O obstruction
N neck mobility
3- heart ( HR , B.P , S1 & S2 , PULSE )
4- lung ( crackles , wheezing , Resp. rate , dyspnea )
5- neurological examination
6- extremities , edema , deformity
C. laboratory evaluation
If patient know to have disease do
investigation according to disease
ex. Thyroid pt do T3 ,T4 ,TSH
D.M Glucose level.
ASA classification
• The ASA physical status classification system is a system for assessing the
fitness of patients before surgery. In 1963 the
American Society of Anesthesiologists (ASA) adopted the five-category
physical status classification system; a sixth category was later added. These
are:
1. Healthy person.
2. Mild systemic disease.
3. Severe systemic disease.
4. Severe systemic disease that is a constant threat to life.
5. A moribund person who is not expected to survive without the operation.
6. A declared brain-dead person whose organs are being removed for donor
purposes.
• If the surgery is an emergency, the physical status classification is followed by
“E” (for emergency) for example “3E
Increase risk of morbidity &
mortality in anesthesia:
• Age > 70
• Smoking
• MI < 6 months OR unstable angina within 3 m
• Pulmonary edema < 1 week
• Hb < 10 g/dl
• Urea > 20 mmol/L & dehydration
• Wt. loss > 10% in 1 month
• Severemedical illness ,also sepsis , emergency ,
major operation
Patients who are at increased
risk of aspiration during
surgery:
o Abdominal pathology, especially obstruction.
o Delayed gastric emptying (e.g. pain ,opioids ).
o Incompetent lower esophageal sphincter
o Alteredconscious level resulting in impaired laryngeal
reflexes
o Pregnancy
RSI:
Rapid Sequence Induction
Rapid sequence induction (RSI) is an established method of
inducing anesthesia in patients who are at risk of aspiration
of gastric contents into the lungs. It involves loss of
consciousness during cricoid pressure followed by intubation
without face mask ventilation. The aim is to intubate the
trachea as quickly and as safely as possible.
Need rapid induction and
intubation :
1. Full stomach
2. Emergency
3. Bleeding
4. Obstetric delay stomach empty.
