Introduction to Anesthesia and Pain Relief

Department Of Anesthesiology And Critical Care BPKIHS

Objectives

define anesthesia and pain relief mention components of anesthesia define MAC mention proposed site of anesthetic action mention types of anesthetics in clinical use

Definition

Anesthesia- term first used by Greek philosopher Dioscorides to describe narcotics like effect- 1st century Defect of sensation- Baileys Dictionary 1721 Privation of Sensation- Encyclopedia Britannica- 1771 Sleep like state that makes possible painless surgery- Oliver Wendel Holmes 1846
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Definition contd

General or local insensibility to pain and other sensation, induced by certain drugs GA- Drug induced reversible depression of the CNS resulting in the loss of responses to and perception of all external stimuli Balanced anaesthesia Triad of anesthesia
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Definition contd

SedationAnalgesia- Abolition of pain

History of Anesthesia

Date from ancient time Ether synthesized by V Cordus in 1540, used by Crawford W Long in 1842, publicized by Morton in 1846 N2O synthesized by Priestley in 1772, experimented by Davy in 1800, used in anesthesia by Colton and Wells in 1844. Chloroform used as anesthetic by John Snow in 1853
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History contd

ET tube discovered- 1878 LA with cocaine 1885 Thiopentone first used in 1934 Curare first used in anesthesia in 1942 Age of Anesthesia started Halothane synthesized by Suckling in 1956
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Molecular Mechanism
Unsolved mystery

Components of General Anesthesia

Hypnosis/unconsciousness Analgesia Amnesia Immobility Attenuation of autonomic response to noxious stimuli

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How is Anesthesia Measured?

Minimum alveolar concentration (MAC) is the alveolar partial pressure of a gas at which 50% of humans do not respond to surgical incision Limitations

Quantal concept Not applicable to IVA

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Where In The CNS Do Anesthetic Act?

Spinal cord- inhibition of excitatory synaptic transmission Reticular Activating System (RAS)Locus ceruleus (LC)- Ventrolateral preoptic nucleus (VLPO)Tuberomamillary nucleus (TMN)sedative actions of GABAergic anesthetics
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Where In The CNS Do Anesthetic Act? contd

Cerebral cortex- depression of the excitability of the thalamic neurons, thus blocking thalamo-cortical communication potentially resulting in loss of consciousness.

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Interference With The Electrophysiologic Function

Depress neurons subserving pacemaking (pattern generation) Decrease neuronal excitability Inhibiting excitatory synaptic transmission or enhancing inhibitory synaptic transmission

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Action on the Ion Channels

Voltage dependent channels Ligand gated Glutamate activated GABA activated channels Second messenger activated

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Chemical Nature Of Anesthetic Targets

Meyer- Overton Rule- potencies of gases as anesthetics strongly correlated with their solubility in olive oil Limitations

Only for volatile agents Olive oil is poorly characterized

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Chemical Nature Of Anesthetic Targets

Lipid- membrane perturbation

Membrane expansion Membrane disordering Lipid phase transition

Protein- hydrophobic sites

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What Is Sedation?

It Is Really A Continuum

Level Level Level Level

i minimal sedation ii moderate sedation iii deep sedation iv general anesthesia

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Elements Of Sedation

Responsiveness Airway Spontaneous ventilation Cardiovascular function

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Types Of Anesthetics

General Regional Combination Monitored anesthetic care (MAC)

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General Anesthesia

Spontaneous/controlled ventilation
Endotracheal intubation - ett Laryngeal mask airway lma Mask airway

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Regional Anesthesia

Field block Nerve block Plexus block Epidural Subarachnoid

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Nerve Block

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Plexus Block

Can use a catheter for long term analgesia

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Epidural Block

Can place catheters at different levels for differential blocks Can use infusions with local anesthetics and/or narcotics

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Spinal Anatomy

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More Spinal Anatomy

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Subarachnoid Block

Can use local anesthetics and/or narcotics Morphine lasts 1224 hours

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Combination
General Regional

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Monitored Anesthetic Care (MAC)

Pain management Sedation Airway management

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Acute Postoperative Pain Relief

Oral Intramuscular Intravenous

Epidural

Intermittent bolus Continuous infusion Pca patient controlled analgesia Intermittent/continuous/pcea Narcotics and/or local anesthetic Narcotic

Subarachnoid

Field block Nerve block Plexus block/catheter

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Pain Assessment
Pain scale Physical Emotional Cultural Age

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Pain Relief Practice

Relief of pain adequate for postoperative rehabilitation Around the clock medication Breakthrough pain relief Narcotics Non-steroidal anti-inflammatory Cox 2 receptor inhibitors
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Scope of Anesthesiology Practice

Anesthesia service Critical care Acute and chronic pain management Resuscitation Teaching/training Research Administration
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Objectives

define anesthesia and pain relief mention components of anesthesia define MAC mention proposed site of anesthetic action mention types of anesthetics in clinical use
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Thank you
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