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GeneralAnesthesia

GeneralAnesthesia
Acontrolledstateofunconsciousness

Partialorcompletelossofprotectivereflexes
Inabilitytomaintainanairwayandrespond
purposefullytoverbalcommands

FourStagesofAnesthesia
StageIAnalgesia
StageIIDelirium
StageIIISurgicalAnesthesia
StageIVMedullaryParalysis

StageI
Beginswithadministrationof
CNSdepressantdrug

Endswhenpatientlosesconsciousness
eg.,sedation

StageII
Beginswithlossofconsciousness
Endswithentryintosurgicalanesthesia
eg.,IVGeneralAnesthesia

StageII
Reflexesarehyperactive

Respiratorypatternisirregular
Riskoflaryngospasm

StageIII
Surgicalanesthesia,Planes1,2,3,4
Respirationsregular,patientmostlikely
intubated
Plane2mostsurgicalproceduresperformed

StageIV
Respiratoryandcirculatoryarrest
Reversibleclinicaldeath

GeneralAnesthesia
AprogressivedepressionoftheCNS
ControlledpassagethroughStageIandIIto
arriveinStageIII

Advantages
Patientcooperationnotabsolutelyessential
Unconsciousness
Amnesia
Rapidonsetofaction
Titrationpossible

Disadvantages
Lossofprotectivereflexes
Depressionofvitalsigns
Advancedtrainingrequired
Additionalpersonnelrequired
Specialequipment/setting

Disadvantages
Needforrecoveryroom
Greaterriskofintraopcomplications
Postanestheticcomplications
Moreextensivepreopevaluation,including
labwork

Indications
Extremeanxietyandfear
Mentallyand/orphysicallydisabledadultsor
children
Poorpatientcooperation
Ageinfantsandchildren
Traumaticproceduresshortorprolonged

Contraindications
Lackofadequate:
Trainingbydoctor
Trainedpersonnel
Equipment
Facilities
Medicallycompromisedpatient
(requireinpatientGA)

TrainingRequired
forGeneralAnesthesia
Abilitytosecureandmanagetheairwayis
essential
O.M.S.oranesthesiaresidency

TypesofGeneralAnesthesia
IVgeneralanesthesia

ConventionalO.R.typegeneralanesthesia
Hospitalsamedaysurgery,orSurgicenter

Inpatientgeneralanesthesia

IVGeneralAnesthesia
UsedprimarilyinO.M.S.
Shortprocedures(30min.orless)
ASAI,selectedASAIIpatients
Excellentsafetyrecord(1:400,000mortality)
NPO&escortessential

IVGeneralAnesthesiaAgents
Barbiturates
Ultrashortacting
Methohexital
Nonbarbiturates
Propofol

Monitors
ECG
BloodPressure
PulseOximeter
Pretrachealstethoscope
Capnograph

TechniqueIVGeneralAnesthesia
N2O/O2administered
IVaccess
Titrationofsedativeagents(Fentanyl/Versed)
AdministrationofMethohexital
titrationthroughoutprocedure

TechniqueIVGA(cont.)
Throatpackandsuctioningessential
Administerlocalanesthetic
Surgicalprocedure
100%O2
Transfertorecoveryareawhenawake

ORTypeGeneralAnesthesia
Involvestrachealintubationtosecureairway
Administrationofinhalationalagents
MaybeasOutpatientorInpatientGA

OutpatientGA
HospitalsamedaysurgeryorSurgicenter
ASAIorII(occasionalIII)
Forproceduresof30mins.to4hrs.duration
Avoidsovernighthospitalization

InpatientGA
Hospitalstay(24hrsormore)
MaybeanyASAclassification
Indicatedforproceduresthatrequirelengthy
recovery
Lesscosteffective

Armamentarium
Generalanesthesiamachine
IVequipment
Ancillaryanesthesiaequipment
Monitors(incl.capnograph)
Crashcart&emergencymedications

GeneralAnesthesiaMachine
DeliversO2,N2Oandotheranestheticgases
Closedsystem,partialrebreathing
Multiplecomponents

ComponentsofGAMachine
Ventilator
Vaporizers
Monitors
Alarms

AncillaryAnesthesiaEquipment
Suction
Facemasks
Oropharyngeal&nasopharyngealairways

AncillaryAnesthesiaEquipment
Laryngoscope&blades
Magillforceps
Endotrachealtubes

DrugsforGeneralAnesthesia
IVinductionagents
Narcotics
Neuroleptic/dissociativeagents
Musclerelaxants
Inhalationanesthetics

IVInductionAgents
UsedtoachieveStageIIIrapidly

IVagentspreferredtoinhalationagents
Methohexital,Thiopental,Propofol

Narcotics
Usedformaintenanceofgeneralanesthesia
"BalancedTechnique"
Morphine,Fentanyl,Alfentanil,Sufentanil

DissociativeAgents
Ketamine
Dissociatespatientfromenvironment
Minimaldepressionofprotectivereflexes
Hallucinationsarecommononemergence

MuscleRelaxants
Neuromuscularblockade
AdministerafterStageIIIobtained
Defasciculatingdose/paralyzingdose
Succinylcholine,Atracrurium,Pancuronium

InhalationAnesthetics
Producegeneralanesthesia
Easilytitratedsincepulmonaryventilation
affectsuptakeandelimination
Canbeusedforinductionormaintenance
Halothane,Enflurane,Isoflurane

TechniqueGeneralAnesthesia
PreOpevaluationandlabwork
NPO
Holdingarea(IVAccess)
Preoxygenation
IVinduction(Thiopental,Propofol)

TechniqueGA(cont.)
Bagmasktoinsurepatentairway
Narcotic,musclerelaxant
Intubation
VerifyplacementandsecureETtube

TechniqueGA(cont.)
Inhalationagent
MaintenanceofStageIII
Administerlocalanesthetics
Surgicalprocedure

TechniqueGA(cont.)
D/Cinhalationagents,givereversalagents
Spontaneousrespirations,adequatetidal
volume
Extubation
Transfertorecoveryorhospitalroom