GENERAL ANASTHESIA
General anaesthetics (Gas) are drugs which produce reversible loss of
all sensation and consciousness.
The cardinal features of general anaesthesia are:
• Loss of all sensation, especially pain
• Sleep (unconsciousness) and amnesia
• Immobility and muscle relaxation
• Abolition of somatic and autonomic reflexes.
It is a complex procedure involving:
- Pre-anaesthetic assessment
- Administration of general anaesthetic drugs
- Cardio-respiratory monitoring
- Analgesia
- Airway management
- Fluid management
- Postoperative pain relief
Routes of Administration
ENTERAL
- Oral
- Rectal.
• PARENTERAL
- Sublingual.
- Intra nasal.
- Intra muscular.
- Intra venous.
Stages and signs
GA cause an irregularly descending depression of the CNS, i.e.
The higher functions are lost first and progressively lower areas
of the brain are involved, but in the spinal cord lower segments
are affected earlier than the higher segments. The vital centres
located in the medulla are paralysed last as the depth of
anaesthesia increases.
Traditional Description of signs and stages of GA also called Guedel’s sign
Typically seen in case of Ether
Stage I: Stage of Analgesia
• Starts from beginning of anaesthetic inhalation and lasts upto loss of consciousness
• Pain is progressively abolished during this stage
Patient remains conscious, can hear and see, and feels a dream like state
• Reflexes and respiration remain normal
• It is difficult to maintain – use is limited to short procedures only
Stage II: Stage of Delirium
• From loss of consciousness to beginning of automatic breathing
Eyelash reflex diasaapear
Apparent Excitement is seen – patient may shout, struggle and hold his breath
• Muscle tone increases, jaws are tightly closed.
• Breathing is jerky; vomiting, involuntary micturition or defecation may occur. No stimulus or operative procedure
carried out during this stage.
• Potentially dangerous responses can occur during this stage including vomiting, laryngospasm and uncontrolled
movement.
•This stage is not found with modern anaesthesia – preanaesthetic medication, rapid induction etc
Stage III: Stage of Surgical anaesthesia
• Extends from onset of spontaneus respiration to respiratory paralysis.
• This has been divided into 4 planes:
- Plane 1: Roving eye balls. This plane ends when eyes become fixed.
- Plane 2: Loss of corneal and laryngeal reflexes.
- Plane 3: Pupil starts dilating and light reflex is lost
-Plane 4: Intercostal paralysis, shallow abdominal respiration, dilated pupil.
Stage IV: Medullary / respiratory paralysis
• Cessation of breathing – failure of circulation – death
Pupils: widely dilated
• Muscles are totally flabby
• Pulse is imperceptible
• BP is very low.
Diethyl Ether
• Colourless, highly volatile liquid with a pungent odour. Boiling point –
35ºC
• Produces irritating vapours and are inflammable and explosive
• Pharmacokinetics:
85 to 90 percent is eliminated through lung and remainder through
skin, urine, milk and sweat – Can cross the placental barrier
DISADVANTAGES
ADVANTAGES
- Can be used without complicated
apparatus - Inflammable and explosive
-Potent Anaesthetic and good analgesic
- Slow induction and unpleasant
- Muscle relaxation –Wide safety of margin atropine
- Respiratory stimulation and
bronchodilatation - Slow recovery – nausea &
vomiting – Cardiac arrest
- Does not sensitize the heart to adrenaline
- No cardiac arrythmias - Convulsion in children
- Can be used in delivery - Cross tolerance – ethyl alcohol
- Less likely hepato or nephrotoxicity
NITROUS OXIDE
Colourless, odourless inorganic gas with sweet taste Noninflammable
and nonirritating, but of low potency
Very potent analgesic
Carrier and adjuvant to other anaesthetics
• As a single agent used wit Oz in dental extraction and in obstetrics
ADVANTAGES DISADVANTAGES
- Non-inflammable and
nonirritant
- Rapid induction and - Not potent alone
recovery (supplementation)
- Very potent analgesic - Hypoxia
(low concentration)
-Inhibits methionine
- No nausea and synthetaze (precursor to
vomiting
DNAsynthesis) – Inhibits
- Nontoxic to liver, vitamin B-12 metabolism
kidney and brain
HALOTHANE
Fluorinated volatile liquid with sweet odour, non-irritant non-
inflammable and supplied in amber coloured bottle
Potent anaesthetic, 2-4% for induction and 0.5-1% for maintenance
• Pharmacokinetics: 60 to 80% eliminated unchanged. 20% retained in
body for 24 hours and metabolized
ADVANTAGES DISADVANTAGES
Non-inflammable and non- Special apparatus
irritant
Poor analgesic and muscle relaxation
Pharyngeal and laryngeal Hypotension and-direct action (Ca++) and
reflexes bronchodilatation failure of sympathetic activity Arrythmia
- Potent and speedy induction Direct vagal stimulation, direct depression of
& recovery SA node and lack of baroreceptor action
Respiratory depression
- Controlled hypotension
Decreased urine formation – due to
- Inhibits intestinal and decreased gfr
uterine contractions Hepatitis: 1 in 10,000 Malignant
hyperthermia: Ryanodine receptor
• Prolong labour
ENFLURANE
Non-inflammable, with mild sweet odour and boils at 57°C • Similar to
halothane in action, except better muscular relaxation
• Depresses myocardial force of contraction and sensitize heart to
adrenaline
* Induces Seizure in deep anasthesia and hence not used now
• Metabolism releases fluoride ion– renal toxicity
ISOFLURANE
• Isomer of enflurane and have similar properties but slightly more
potent
• Induction dose is 1.5 – 3% and maintenance dose is 1-2%
ADVANTAGES DISADVANTAGES
Rapid induction and recovery Good muscle Pungent and respiratory irritant
relaxation
• Good coronary vasodilatation Less Special apparatus required
Myocardial depression than no
myocardial sensitization to adrenaline.
Respiratory depression
• No renal or hepatotoxicity
• Low nausea and vomiting No dilatation of
pupil and no loss of light reflex in deep Maintenance only, no induction 8 adrenergic
anaesthesia . receptor stimulation
• No seizure and preferred in neurosurgery
Uterine muscle relaxation Costly
Thiopentone sodium
⚫ Barbiturate: Ultra short acting
- Dose-dependent suppression of CNS activity – Dose: 3-5mg/kg iv
(2.5%) solution – 15 to 20 seconds
CNS depression persists for long (>12 hr)
