Lecture By: Prof.Nabil H. Mohyeddin Anesthesiologist & Intensive Board Certified Rostock Universty Germany.

1. Types of Anaesthesia
Prof. med. Nabil H. Mohyeddin
Anesthesiologist & Intensivist
Board certified
University Rostock, Germany
nhm1955@hotmail.com

2. Objectives
 Short History
 Definition/types of anaesthesia
 General anaesthesia/drugs
 Phases of GA
 Regional anaesthesia

3. Early history
 Ancient/Medieval period
- Opium
- Alcohol
- Cannabis

4. History
 1845- Horace Wells- N2O
 1846- William Morton- Ether
 1847- Simpson- Chloroform
 1853-John Snow
 1878- ETT
 1884- Cocaine
 1895-98- Spinal analgesia/anaesthesia

5. History
 1921- Epidurals
 1934- Thiopentone, cyclopropane
 1942- Curare
 1946- Lignocaine
 1951- Suxamethonium
 1952- IPPV
 1956-Halothane

6. Definition
‘Loss of sensation’
 General
 Regional
 Local

7. Triad of General
anaesthesia
Hypnosis
Analgesia Muscle relaxation

8. Hypnosis
Death
Coma
Hypnosis
sedation
Amnesia
Awake

9. Hypnotic drugs-intravenous
 Gold standard- thiopentone
 Propofol
others
 Etomidate
 Benzodiazepines
 Ketamine

10. Inhalational anaesthetics
 Nitrous oxide-weak
 Isoflurane
 Sevoflurane
 Desflurane
 Halothane

11. Analgesia
 Good analgesia= good anaesthesia
 Hypnotic sparing effect
 Opiates
 Local anaesthetics
 NSAIDS
 Paracetamol

12. Analgesia-Opiates
 Gold standard – morphine
 Derivatives- diamorphine, codeine
 Synthetic agents
- Pethidine
- Fentanyl/Alfentanil-short acting
- Remifentanil-ultra short acting

13. Analgesia-NSAIDS
 Gold standard- aspirin
 Ibuprofen
 Diclofenac
 Cox-2 inhibitors

14. Muscle relaxation
 Aids intubation
 Helps surgeon/surgery
 Surgery of long duration
 Reduces maintenance dose of
anaesthetics agents

15. Muscle relaxants
 Two types
 Depolarising-short acting
eg;suxmethonium
 Non-depolarising- medium/long acting
- Tracurium
- Vecuronium
- Rocuronium

16. Prerequisites
 Oxygen
 Suction
 Tilting trolley
 Resuscitation drugs
 Monitoring
 Anaesthetist
 Skilled assistance
 Drugs and machine

17. Phases of
general anaesthesia
 Induction
 Maintenance
 Recovery

18. Induction
 Intravenous- majority
 Inhalational- children, needle phobics
 Monitoring
 Preoxygenation
 Hypnotic/analgesic and or relaxant
 Mask/LMA/ET tube

19. Stages of anaesthesia
 Alcohol  General Anaesthesia
1.Dizzy, delightful 1.Amnesia, analgesia
2.Drunk, disorderly 2.Uninhibited
3.Dead drunk response to stimuli
4.Dangerously deep 3.Surgical anaesthesia
4.Vital centre
depression

20. Maintenance
 Intravenous or inhalational
 Oxygen –40%-100%
 Nitrous oxide
 Muscle relaxant
 Analgesia

21. Recovery
 Turn off agent
 Reverse relaxation
 Cough reflex
 Extubate when awake
 Recovery position
 Monitor until discharge

22. Advantages
 No absolute contraindications
 Quick to establish
 Never fails to work

23. Disadvantages
 Polypharmacy
 Effects on various systems
 Allergic reactions
 Recovery profile
 Post operative Nausia &Vomiting
 Awareness

24. Regional anaesthesia
 Spinal/epidural
- surgery below umbilicus
- Provides analgesia/muscle relaxation
 Plexus blocks eg brachial plexus
 Intravenous- Bier’s block

26. Regional anaesthesia
Analgesia Muscle relaxation

27. Local anaesthetics
 Lignocaine- quick/short acting
 Bupivacaine/levobupicvacaine- slow
and long action
 Ropivacaine- as above
 Amethocaine- topical
 Prilocaine- intravenous

28. Advantages
 Effective alternative to GA
 Avoids polypharmacy
 Allergic reactions
 Extended analgesia
 Patient can remain awake
 Early drink/feed

29. Disadvantages
 Limited scope
 Higher failure rate
 Time constraints
 Anticoagulants/Bleeding diathesis
 Risk of neural injury