Definition of anaesthesia

- lack conscious awareness - unconsciousness

- lack perception of pain - analgesia
- lack movement - muscle relaxation

Regional anesthesia - regional analgesia - spinal, epidural, plexus block. analgesia is altered sensation of
painful stimuli, but can feel movement and pressure.

midazolam has amnesia effect

sevoflurane - sedation, muscle relaxation
nitrous oxide - sedation, muscle relaxation, analgesia
propofol - sedation, relaxation, amnesia
fentanyl - main analgesia, mild sedation, no relaxation
muscle relaxation - only relaxation

GA
5 phases- preparation, induction, maintanence, emergence ( patient start regain brainstem function first,
breathing, coughing, shivering, then cerebral cortex purposeful movements, respond to command), recovery

indication
- surgical ( need muscle relaxation - abdominal surgery, inability to comfort with LA, RA, duration more
than 3 hours
- patient ( need airway protection, respiratory failure, unstable clinical state)

Type of induction
1. IV induction ( Porpofol, etomidate, ketamine, midazolam) sedative-hypnotic agents
default method starting GA
100% O2 before, during and after
Propofol activates GABA channel. - open Cl channel and causes Cl enter cells, lowers the depolarisation
threshold in cells.

Fentanyl 50-200 mag , Midazolam 150-250mcg/kg

Acts on ascending pathways and GABA. Anterograde amnesia.
Fentanyl - reduced pulmonary compliance, apnea, larnygospams, respi depression, cns depression

2. Rapid sequence induction

indication: Patient at risk for regurgitation and aspiration who require GA eg. pregnancy, abdominal
distension, increased intraabdominal pressure, decreased level of consciousness, recent vomiting.

method- preoxygenation is critical. propofol. cricoid pressure. muscle relaxant. ETT insert.

3. inhalation induction ( Volatile : Isoflurane, desflurane, sevoflurane, Gas: nitrous ocide)

indication: difficult IV access, potential airway obstructiob, thoracic disease
can be administered through mask, LMA, ETTube
C/I : aspiration risk, active bleeding in airway
FOR INDUCTION AND MAINTENANCE OF GA

Inhalaation agent act at the level of CNS by disrupting normal synaptic transmission.
1. interfere release of neurotransmitter from presynaptic nerve terminal
2. alter the re uptake of neurotransmitter
3. changing binding of neurotransmitter to post synaptic sites
Effect on respi - All agents increase threshold of respi centres to CO2. isoflurane and sevoflurane decrease
airway resistance, desflurane does not produce significant change in bronchial tone.

Effect on CVS - Sevoflurane may prolong QT interval. Arryhythmogenic potential of sevoflurane and
desflurane is lower than isoflurane.

MUSCLE RELAXANT
Indication: laryngeal intubation and RSI , abdominal muscle relaxation during laparotomy

Duration: short(mevacurium), intermediate ( atracurium, rocuronium), long (pancuronium)

Depolaring NMB - suxamethonium block postsynaptic receptors on skeletal muscle. side effects: malignant
hyperpyrexia, increased IOP, muscular pain, massive rise in potassium
Non depolarising - rocuronium block postsynaptic receptors on skeletal muscle but does not cause
depolarisation. side effects- bronchospams, allergic

REVERSAL ( ANTI CHOLINEesterase ) - Neostigmine, Sugammadex

LA- membrane stablizing drugs - slow down speed of AP , ultimately stopping AP generation
injectable - low potent short duration - procaine, intermediate potency - lidocaine, high potency and long
duration - tetracaine, bupivacaine