PDF Clinical Anesthesia

CLINICAL ANESTHESIA
By
DR-Muntaser Ammar
Introduction to anesthesia
The word anesthesia
is derived from the Greek: meaning insensible or without feeling.
reversible loss of sensation
Anesthesiology is the branch of medicine that is concerned with
the administration of medication or anesthetic agent to relieve pain
and support physiologic function during a surgical procedure.
Also defined as the practice of medicine dealing with the
management of procedures for a patient insensible to pain during
surgical procedures, and with the support of life functions under
the stress of anesthetic and surgical manipulations.
(American Board of Anesthesiology)
Introduction
The OR team members should be
aware of the effects of.
readily available to assist the anesthesia provider as needed
During several aspects of administration & maintenance of the
anesthetic process.
When the agent given causes unconsciousness, the anesthetic is
termed general (general anesthesia)
when an agent is directed into a specific area to cause analgesia,
the absence of pain, it is called local or regional anesthesia
Common Terms in Anesthesia
Anesthetist – a person who has been trained to
administer an anesthetics.
Anesthesiologist – a physician who specialized in
anesthesia.
Anesthetic agent – a drug that produces local or
general loss of sensitivity.
Anesthesia – loss of feeling or sensation of pain.
Amnesia – loss of memory
Analgesia – lessening of insensibility to pain.
Depolarization – neutralization of polarity as in nerve
or muscle cells in the conduction of impulses.
Fasciculation – it is uncoordinated skeletal muscle
contraction in which groups of muscle fibers
innervated by the same neuron contract together.
Hypnosis – a state of altered consciousness or sleep.
Hypnotic – a drug that induces sleep.
Induction – the period from the beginning of
administration of anesthetics until the pt loses
consciousness.
Biotransformation – metabolism of anesthetic drugs.
It occurs by one of the four mechanisms:
• oxidation, conjugation, hydrolysis, reduction
Assisted respiration – maintenance of adequate alveolar
ventilation by supplementing the pts respiration by
manual or mechanical means.
RR is controlled by pt,
tidal volume by an anesthesiologist.
Ventilation– the constant supply of O2 through the lungs.
PaO2 – partial pressure of arterial O2 tension.
Hypoxia – low blood O2, subnormal O2 content.
Anoxia – Absence of oxygen
Apnea – suspension or cessation of breathing.
Hypocapnia– abnormally low level of CO2 in the blood;
can result from deep or rapid breathing.
Hypercapnia – abnormally high level of CO2 in the
circulating blood.
Hyperkalemia –above normal elevation of
potassium in the blood.
PH – expression of H2 ion concentration in the
blood(alkalinity or acidity).
Normal – value 7.35–7.45
Alkalemia – blood pH value of above 7.45
Acidemia – blood pH value of below 7.35
Respiratory acidosis – the reduction of CO2
excretion through lungs
caused by respiratory depression or obstruction
or pulmonary disease.
Arrythmia -Disturbance of cardiac rhythm.
Bradycardia – slow heart beat <60bpm.
Tachycardia_ fast heart beat>100bpm.
Hemodynamic state – the study of how the physical
properties of the blood and its circulation.
Hypo volemia – Low or decreased blood volume.
Tissue Perfusion – introduction of fluids in to tissues
by their injection in to blood vessels/passage of a
fluid through spaces.
Polarity – the state of having poles or regions
intensity with mutually opposite qualities
TYPES OF ANESTHESIA
General Anesthesia
reversible loss of sensation and consciousness.
purposes of general anesthesia
1. analgesia( loss of response to pain )
2. amnesia ( loss of memory )
3. immobility ( loss of motor reflexes )
4. hypnosis ( unconsciousness)
5. paralysis ( skeletal muscle relaxation )
Characteristics of the ideal general anesthetics:
• Produces analgesia.
• Produces complete loss of consciousness.
• Provides a degree of muscle relaxation.
• Is safe and has minimal side effects.
• Consists of four stages:
• induction, excitement, relaxation and danger.
LOCAL ANESTHESIA :
• Local anesthesia inhibits sensory perception within a
specific location on the body, such as a dental or in hand
surgery.
• Local anesthetics work by temporarily blocking the nerve
conduction of sensory impulses from the peripheral skin
back to the brain
• Nerve signal uses impulses or action potentials by
allowing sodium ions to pass through sodium channels.
• Local anesthetics bind to these sodium channels.
• blocks the flow of sodium ions and prevents the
conduction of nerve impulses
SPINAL ANESTHESIA:
Achieved by injection 1.8 ml of 5% lignocaine

solution into the subarachnoid apace through a
lumber puncture.
• other drugs which can be used are , procaine
and amethocaine.
• It can cause serious hypotension.
Epidural Anesthesia
achieved by injection 1 to 2 % of lignocaine
solution in the epidural space.
It blocks the nerves traverse the epidural space.
It can which cause hypotension, which is less
severe than with spinal analgesia.
For prolonged operations, a catheter may be
passed into the epidural space for intermittent
administration of local anesthesia.
Basic elements of general anesthesia include:
1. unconsciousness
2. amnesia (loss of memory of pain or distress)
3. analgesia
4. muscle relaxation
5. diminished motor response to noxious
stimuli
6. reversibility
Balanced Anesthesia
It is a pharmacologically induced and reversible state of amnesia,
analgesia, loss of responsiveness, loss of skeletal muscle reflexes or
decreased stress response, or all simultaneously.
These effects can be obtained from a single drug which alone with
high dose and increase possibility side effects
provides the correct combination of effects, or occasionally a
combination of drugs (such as hypnotics, sedatives, paralytics and
analgesics) to achieve very specific combinations of results.
This allows patients to undergo surgery and other procedures without
the distress and pain they would otherwise experience
History
• On 14 November 1804, Hanaoka Seishū, a
Japanese surgeon, became the first person on
record to successfully perform cancer breast
surgery using general anesthesia.
Responsibility of anesthiologist
Most anesthetic agents are potentially

lethal substance.
Anesthesia is produced as CNS is affected.
Association path way are blocked in cerebral
cortex to produce more or less complete lack
of sensory perception and motor discharge.
The anesthetist/anesthesiologist must
constantly observe the body reflex responses
to stimuli.
• Respiratory and circulatory depression observed during
operation.
• Vital sings are monitored every 15 minutes.
• Potency of airway and respiratory function.
• Cardiovascular function.
• Clearing secretion from airway.
• Proper positioning of pt.
• IV solution drip rate setting.
• Level of responsiveness.
• Pain management
• Body temperature
Above 37.7c0
Below 36.1c0
• Blood Pressure
SBp < 90 mmHg
DBp < 60 mmHg 67
Continuous watching and appraisal of all clinical
signs must be monitored.
• You are discharging your patient home from
day surgery after a general anesthetic.
• What instruction would you give the patient
prior to the patient leaving the hospital?
Do not sign important papers for the first 12
hours after surgery.

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CLINICAL ANESTHESIA

Achieved by injection 1.8 ml of 5% lignocaine

Most anesthetic agents are potentially

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