Principles of Surgical Anesthesia

Hemodynamic Effects of General Anesthesia most result in decreased systemic arterial BP

can be due to direct vasodilation, myocardial depression, or both; blunting of baroreceptor control; or decrease in sympathetic
tone
Hypotensive responses are enhanced in volume depleted states (trauma) and pts w/ pre-existing conditions
Respiratory Effects of General Anesthesia airway maintenance is essential since nearly all general anesthetics reduce or
eliminate ventilatory drive and the reflexes that maintain airway patency; the gag reflex and stimulus to cough are also lost
Muscle relaxation with neuromuscular blockers facilitates airway management
Hypothermia general anesthetics lower core temp set point at which vasoconstriction is activated against heat loss, which
offsets cold-induced peripheral vasoconstriction and results in distribution of heat from core to periphery
pts often develop hypothermia due to low ambient temps, exposed body cavities, cold IV fluids, altered thermoregulatory
control, and reduced metabolic rate
Nausea and vomiting caused by action of anesthetics on chemoreceptor trigger zone and brainstem vomiting center which
are modulated by 5-HT, histamine, ACh, and DA
Actions and Mechanisms of General Anesthetics
General anesthesia global but reversible depression of CNS function resulting in loss of response to and perception of all
external stimuli
o Anesthetic state is achieved via a combination of drugs that achieve
Amnesia
Immobility
Attenuation of autonomic responses
Analgesia
Unconsciousness
Cellular Mechanisms of anesthesia
o General anesthetics can hyperpolarize neurons dec likelihood of firing APs
o at anesthetizing concentrations, both inhalational and intravenous anesthetics have substantial effects on synaptic
transmission and much smaller effects on action-potential generation or propagation
Pharmacokinetics
When a person has breathed an inhalational anesthetic for a sufficiently long time that all tissues are equilibrated with the
anesthetic, the partial pressure of the anesthetic in all tissues will be equal to the partial pressure of the anesthetic in inspired
gas. Note, however, that while the partial pressure of the anesthetic may be equal in all tissues, the concentration of anesthetic
in each tissue will be different.
o equilibrium is achieved when the partial pressure of anesthetic gas is equal in two tissues
anesthetic partition coefficients - ratio of anesthetic concentration in two tissues when the partial pressures
of anesthetic are equal in the two tissues
Blood:gas, brain:blood, and fat:blood partition coefficients
o In clinical practice, equilibrium is achieved when the partial pressure in inspired gas is equal to the partial pressure
in end-tidal (alveolar) gas
equilibrium is the point at which there is no net uptake of anesthetic from the alveoli into the blood
anesthetic effects on the brain produce four stages or levels of increasing depth of CNS depression
o Guedels signs
Stage 1 Analgesia; initially w/o amnesia then amnesia is produced
Stage 2 Excitement; appears delirious and may vocalize but is completely amnesic
Respiration is rapid, and HR and BP inc
Stage 3 Surgical Anesthesia; slowing of respiration and HR can extend to apnea
Stage 4 Medullary Depression; severe CNS depression including vasomotor center (BP) in medulla and
respiratory center in brainstem (dependent on circulatory and respiratory support)