General Anesthesia

General Anesthesia

A controlled state of unconsciousness

Partial or complete loss of protective reflexes

Inability to maintain an airway and respond

purposefully to verbal commands
 Four Stages of Anesthesia

Stage I - Analgesia
Stage II - Delirium
Stage III - Surgical Anesthesia
Stage IV - Medullary Paralysis
 Stage I

Begins with administration of

CNS depressant drug

Ends when patient loses consciousness

eg., sedation
 Stage II

Begins with loss of consciousness

Ends with entry into surgical anesthesia

eg., IV General Anesthesia
 Stage II

Reflexes are hyperactive

Respiratory pattern is irregular

Risk of laryngospasm
 Stage III

Surgical anesthesia, Planes 1, 2, 3, 4

Respirations regular, patient most likely

intubated

Plane 2 - most surgical procedures performed

 Stage IV

Respiratory and circulatory arrest

Reversible clinical death

 General Anesthesia

A progressive depression of the CNS

Controlled passage through Stage I and II to

arrive in Stage III
 Advantages

Patient cooperation not absolutely essential

Unconsciousness
Amnesia
Rapid onset of action
Titration possible
 Disadvantages

Loss of protective reflexes

Depression of vital signs
Advanced training required
Additional personnel required
Special equipment / setting
 Disadvantages

Need for recovery room

Greater risk of intra-op complications
Post anesthetic complications
More extensive pre-op evaluation, including
lab work
 Indications

Extreme anxiety and fear

Mentally and/or physically disabled adults or
children
Poor patient cooperation
Age - infants and children
Traumatic procedures - short or prolonged
 Contraindications

Lack of adequate:
Training by doctor
Trained personnel
Equipment
Facilities
Medically compromised patient
(require inpatient GA)
 Training Required
for General Anesthesia
Ability to secure and manage the airway is
essential

O.M.S. or anesthesia residency

 Types of General Anesthesia

IV general anesthesia

Conventional O.R. type general anesthesia

Hospital same day surgery, or Surgicenter

Inpatient general anesthesia

 IV General Anesthesia

Used primarily in O.M.S.

Short procedures (30 min. or less)
ASA I, selected ASA II patients
Excellent safety record (1:400,000 mortality)
NPO & escort essential
 IV General Anesthesia Agents

Barbiturates
Ultra short acting
-Methohexital

Nonbarbiturates
-Propofol
 Monitors

ECG
Blood Pressure
Pulse Oximeter
Pretracheal stethoscope
Capnograph
Technique-IVGeneral Anesthesia

N2O/O2 administered
IV access
Titration of sedative agents (Fentanyl/Versed)
Administration of Methohexital
- titration throughout procedure
 Technique- IVGA (cont.)

Throat pack and suctioning essential

Administer local anesthetic
Surgical procedure
100% O2
Transfer to recovery area when awake
 OR Type General Anesthesia

Involves tracheal intubation to secure airway

Administration of inhalational agents

May be as Outpatient or Inpatient GA

 Outpatient GA

Hospital same-day surgery or Surgicenter

ASA I or II (occasional III)
For procedures of 30 mins. to 4 hrs. duration
Avoids overnight hospitalization
 Inpatient GA

Hospital stay (24 hrs or more)

May be any ASA classification
Indicated for procedures that require lengthy
recovery
Less cost-effective
 Armamentarium

General anesthesia machine

IV equipment
Ancillary anesthesia equipment
Monitors (incl. capnograph)
Crash cart & emergency medications
 General Anesthesia Machine

Delivers O2, N2O and other anesthetic gases

Closed system, partial rebreathing

Multiple components
 Components of GA Machine

Ventilator
Vaporizers
Monitors
Alarms
Ancillary Anesthesia Equipment

Suction

Face masks

Oropharyngeal & nasopharyngeal airways

Ancillary Anesthesia Equipment

Laryngoscope & blades

Magill forceps

Endotracheal tubes
 Drugs for General Anesthesia

IV induction agents
Narcotics
Neuroleptic / dissociative agents
Muscle relaxants
Inhalation anesthetics
 IV Induction Agents

Used to achieve Stage III rapidly

IV agents preferred to inhalation agents

Methohexital, Thiopental, Propofol

 Narcotics

Used for maintenance of general anesthesia

"Balanced Technique"

Morphine, Fentanyl, Alfentanil, Sufentanil

 Dissociative Agents

Ketamine
Dissociates patient from environment
Minimal depression of protective reflexes
Hallucinations are common on emergence
 Muscle Relaxants

Neuromuscular blockade
Administer after Stage III obtained
Defasciculating dose /paralyzing dose
Succinylcholine, Atracrurium, Pancuronium
 Inhalation Anesthetics

Produce general anesthesia

Easily titrated since pulmonary ventilation
affects uptake and elimination
Can be used for induction or maintenance
Halothane, Enflurane, Isoflurane
 Technique - General Anesthesia

Pre-Op evaluation and lab work

NPO
Holding area (IV Access)
Pre-oxygenation
IV induction (Thiopental, Propofol)
 Technique- GA (cont.)

Bag-mask to insure patent airway

Narcotic, muscle relaxant
Intubation
Verify placement and secure ET tube
 Technique- GA (cont.)

Inhalation agent
Maintenance of Stage III
Administer local anesthetics
Surgical procedure
 Technique- GA (cont.)

D/C inhalation agents, give reversal agents

Spontaneous respirations, adequate tidal
volume
Extubation
Transfer to recovery or hospital room