Anaesthesia Definition

General anaesthesia is the induction of a state of unconsciousness with the absence of pain sensation over
the entire body, through the administration of anaesthetic drugs. It is used during certain medical and
surgical procedures.
Purpose
General anaesthesia has many purposes including:
pain relief (analgesia)
blocking memory of the procedure (amnesia)
producing unconsciousness
inhibiting normal body reflexes to make surgery safe and easier to perform
relaxing the muscles of the body
ANESTHETICS: HOW THEY WORK
Description
Anaesthesia performed with general anaesthetics occurs in four stages which may or may not be observable
because they can occur very rapidly:
Stage One: Analgesia. The patient experiences analgesia or a loss of pain sensation but remains conscious
and can carry on a conversation.
Stage Two: Excitement. The patient may experience delirium or become violent. Blood pressure rises and
becomes irregular, and breathing rate increases. This stage is typically bypassed by administering a
barbiturate, such as sodium pentothal, before the anaesthesia.
Stage Three: Surgical Anaesthesia. During this stage, the skeletal muscles relax, and the patient's breathing
becomes regular. Eye movements slow, then stop, and surgery can begin.
Stage Four: Medullary Paralysis. This stage occurs if the respiratory centres in the medulla oblongata of the
brain that control breathing and other vital functions cease to function. Death can result if the patient cannot
be revived quickly. This stage should never be reached. Careful control of the amounts of anaesthetics
administered prevent this occurrence.
Agents used for general Anaesthesia may be either gases or volatile liquids that are vaporized and inhaled
with oxygen, or drugs delivered intravenously. A combination of inhaled anaesthetic gases and intravenous
drugs are usually delivered during general Anaesthesia; this practice is called balanced Anaesthesia and is
used because it takes advantage of the beneficial effects of each anaesthetic agent to reach surgical
Anaesthesia. If necessary, the extent of the anaesthesia produced by inhaling a general anaesthetic can be
rapidly modified by adjusting the concentration of the anaesthetic in the oxygen that is breathed by the
patient. The degree of Anaesthesia produced by an intravenously injected anaesthetic is fixed and cannot be
changed as rapidly. Most commonly, intravenous anaesthetic agents are used for induction of Anaesthesia
and then followed by inhaled anaesthetic agents.
General Anaesthesia works by altering the flow of sodium molecules into nerve cells (neurons) through the
cell membrane. Exactly how the anaesthetic does this is not understood since the drug apparently does not
bind to any receptor on the cell surface and does not seem to affect the release of chemicals that transmit
nerve impulses (neurotransmitters) from the nerve cells. It is known, however, that when the sodium
molecules do not get into the neurons, nerve impulses are not generated and the brain becomes
unconscious, does not store memories, does not register pain impulses from other areas of the body, and
does not control involuntary reflexes. Although Anaesthesia may feel like deep sleep, it is not the same. In
sleep, some parts of the brain speed up while others slow down. Under Anaesthesia, the loss of
consciousness is more widespread.
When general Anaesthesia was first introduced in medical practice, ether and chloroform were inhaled with
the physician manually covering the patient's mouth. Since then, general Anaesthesia has become much
more sophisticated. During most surgical procedures, anaesthetic agents are now delivered and controlled
by computerized equipment that includes anaesthetic gas monitoring as well as patient monitoring
equipment. Anaesthesiologists are the physicians that specialize in the delivery of anaesthetic agents.

Currently used inhaled general anaesthetics include halothane, enflurane, isoflurane, desfluorane,
sevofluorane, and nitrous oxide.
Halothane (Fluothane) is a powerful anaesthetic and can easily be over administered. This drug causes
unconsciousness but little pain relief so it is often used with other agents to control pain. Very rarely, it can be
toxic to the liver in adults, causing death. It also has the potential for causing serious cardiac dysrhythmias.
Halothane has a pleasant odour, and was frequently the anaesthetic of choice for use with children, but since
the introduction of sevofluorane in the 1990s, halothane use has declined.
Enflurane (Ethrane) is less potent and results in a more rapid onset of Anaesthesia and faster awakening
than halothane. In addition, it acts as an enhancer of paralyzing agents. Enflurane has been found to
increase intracranial pressure and the risk of seizures; therefore, its use is contraindicated in patients with
seizure disorders.
Isoflurane (Forane) is not toxic to the liver but can cause some cardiac irregularities. Isofluorane is often
used in combination with intravenous anaesthetics for anaesthesia induction. Awakening from anaesthesia is
faster than it is with halothane and enfluorane.
Desfluorane (Suprane) may increase the heart rate and should not be used in patients with aortic valve
stenosis; however, it does not usually cause heart arrhythmias. Desflurane may cause coughing and
excitation during induction and is therefore used with intravenous anaesthetics for induction. Desflurane is
rapidly eliminated and awakening is therefore faster than with other inhaled agents.
Sevofluorane (Ultane) may also cause increased heart rate and should not be used in patients with narrowed
aortic valve (stenosis); however, it does not usually cause heart arrhythmias. Unlike desfluorane,
sevofluorane does not cause any coughing or other related side effects, and can therefore be used without
intravenous agents for rapid induction. For this reason, sevofluorane is replacing halothane for induction in
paediatric patients. Like desfluorane, this agent is rapidly eliminated and allows rapid awakening.
Nitrous oxide (laughing gas) is a weak anaesthetic and is used with other agents, such as thiopental, to
produce surgical Anaesthesia. It has the fastest induction and recovery and is the safest because it does not
slow breathing or blood flow to the brain. However, it diffuses rapidly into air-containing cavities and can
result in a collapsed lung (pneumothorax) or lower the oxygen contents of tissues (hypoxia).
Commonly administered intravenous anaesthetic agents include ketamine, thiopental, opioids, and propofol.
Ketamine (Ketalar) affects the senses, and produces a dissociative Anaesthesia (catatonia, amnesia,
analgesia) in which the patient may appear awake and reactive, but cannot respond to sensory stimuli.
These properties make it especially useful for use in developing countries and during warfare medical
treatment. Ketamine is frequently used in paediatric patients because Anaesthesia and analgesia can be
achieved with an intramuscular injection. It is also used in high-risk geriatric patients and in shock cases,
because it also provides cardiac stimulation.
Thiopental (Pentothal) is a barbiturate that induces a rapid hypnotic state of short duration. Because
thiopental is slowly metabolized by the liver, toxic accumulation can occur; therefore, it should not be
continuously infused. Side effects include nausea and vomiting upon awakening.
Opioids include fentanyl, sufentanil, and alfentanil, and are frequently used prior to Anaesthesia and surgery
as a sedative and analgesic, as well as a continuous infusion for primary Anaesthesia. Because opioids
rarely affect the cardiovascular system, they are particularly useful for cardiac surgery and other high-risk
cases. Opioids act directly on spinal cord receptors, and are frequently used in epidurals for spinal
Anaesthesia. Side effects may include nausea and vomiting, itching, and respiratory depression.
Propofol (Diprivan) is a non-barbiturate hypnotic agent and the most recently developed intravenous
anaesthetic. Its rapid induction and short duration of action are identical to thiopental, but recovery occurs
more quickly and with much less nausea and vomiting. Also, propofol is rapidly metabolized in the liver and
excreted in the urine, so it can be used for long durations of Anaesthesia, unlike thiopental. Hence, propofol
is rapidly replacing thiopental as an intravenous induction agent. It is used for general surgery, cardiac
surgery, neurosurgery, and paediatric surgery.
General anaesthetics are given only by anaesthesiologists, the medical professionals trained to use them.
These specialists consider many factors, including a patient's age, weight, medication allergies, medical
history, and general health, when deciding which anaesthetic or combination of anaesthetics to use. General

anaesthetics are usually inhaled through a mask or a breathing tube or injected into a vein, but are also
sometimes given rectally.
General Anaesthesia is much safer today than it was in the past. This progress is due to faster-acting
anaesthetics, improved safety standards in the equipment used to deliver the drugs, and better devices to
monitor breathing, heart rate, blood pressure, and brain activity during surgery. Unpleasant side effects are
also less common.
Recommended dosage
The dosage depends on the type of anaesthetic, the patient's age and physical condition, the type of surgery
or medical procedure being done, and other medication the patient takes before, during, or after surgery.
Precautions
Although the risks of serious complications from general Anaesthesia are very low, they can include heart
attack, stroke, brain damage, and death. Anyone scheduled to undergo general Anaesthesia should
thoroughly discuss the benefits and risks with a physician. The risks of complications depend, in part, on a
patient's age, sex, weight, allergies, general health, and history of smoking, drinking alcohol, or drug use.
Some of these risks can be minimized by ensuring that the physician and anaesthesiologist are fully
informed of the detailed health condition of the patient, including any drugs that he or she may be using.
Older people are especially sensitive to the effects of certain anaesthetics and may be more likely to
experience side effects from these drugs.
Patients who have had general Anaesthesia should not drink alcoholic beverages or take medication that
slow down the central nervous system (such as antihistamines, sedatives, tranquilizers, sleep aids, certain
pain relievers, muscle relaxants, and anti-seizure medication) for at least 24 hours, except under a doctor's
care.
Special conditions
People with certain medical conditions are at greater risk of developing problems with anaesthetics. Before
undergoing general Anaesthesia, anyone with the following conditions should absolutely inform their doctor.
ALLERGIES
Anyone who has had allergic or other unusual reactions to barbiturates or general anaesthetics in the past
should notify the doctor before having general Anaesthesia. In particular, people who have had malignant
hyperthermia or whose family members have had malignant hyperthermia during or after being given an
anaesthetic should inform the physician. Signs of malignant hyperthermia include rapid, irregular heartbeat,
breathing problems, very high fever, and muscle tightness or spasms. These symptoms can occur following
the administration of general Anaesthesia using inhaled agents, especially halothane. In addition, the doctor
should also be told about any allergies to foods, dyes, preservatives, or other substances.
PREGNANCY
The effects of anaesthetics on pregnant women and foetuses vary, depending on the type of drug. In
general, giving large amounts of general anaesthetics to the mother during labour and delivery may make
the baby sluggish after delivery. Pregnant women should discuss the use of anaesthetics during labour and
delivery with their doctors. Pregnant women who may be given general Anaesthesia for other medical
procedures should ensure that the treating physician is informed about the pregnancy.
BREASTFEEDING
Some general anaesthetics pass into breast milk, but they have not been reported to cause problems in
nursing babies whose mothers were given the drugs.
OTHER MEDICAL CONDITIONS
Before being given a general anaesthetic, a patient who has any of the following conditions should inform his
or her doctor:
neurological conditions, such as epilepsy or stroke

problems with the stomach or oesophagus, such as ulcers or heartburn

eating disorders
loose teeth, dentures, bridgework
heart disease or family history of heart problems
lung diseases, such as emphysema or asthma
history of smoking
immune system diseases
arthritis or any other conditions that affect movement
diseases of the endocrine system, such as diabetes or thyroid problems
Side effects
Because general anaesthetics affect the central nervous system, patients may feel drowsy, weak, or tired for
as long as a few days after having general Anaesthesia. Fuzzy thinking, blurred vision, and coordination
problems are also possible. For these reasons, anyone who has had general Anaesthesia should not drive,
operate machinery, or perform other activities that could endanger themselves or others for at least 24 hours,
or longer if necessary.
Most side effects usually disappear as the anaesthetic wears off. A nurse or doctor should be notified if these
or other side effects persist or cause problems, such as:
Headache
vision problems, including blurred or double vision
shivering or trembling
muscle pain
dizziness, light-headedness, or faintness
drowsiness
mood or mental changes
nausea or vomiting
sore throat
nightmares or unusual dreams
A doctor should be notified as soon as possible if any of the following side effects occur within two weeks of
having general Anaesthesia:
severe headache
pain in the stomach or abdomen
back or leg pain
severe nausea
black or bloody vomit
unusual tiredness or weakness
weakness in the wrist and fingers
weight loss or loss of appetite
increase or decrease in amount of urine
pale skin
yellow eyes or skin
Interactions
General anaesthetics may interact with other medicines. When this happens, the effects of one or both of the
drugs may be altered or the risk of side effects may be greater. Anyone scheduled to undergo general
Anaesthesia should inform the doctor about all other medication that he or she is taking. This includes
prescription drugs, non-prescription medicines, and street drugs. Serious and possibly life-threatening
reactions may occur when general anaesthetics are given to people who use street drugs, such as cocaine,
marijuana, phencyclidine (PCP or angel dust), amphetamines (uppers), barbiturates (downers), heroin, or
other narcotics. Anyone who uses these drugs should make sure their doctor or dentist knows what they
have taken.
Key Terms
Amnesia
The loss of memory.

Analgesia
A state of insensitivity to pain even though the person remains fully conscious.
Anaesthesiologist
A medical specialist who administers an anaesthetic to a patient before he is treated.
Anaesthetic
A drug that causes unconsciousness or a loss of general sensation.
Arrhythmia
Abnormal heart beat.
Barbiturate
A drug with hypnotic and sedative effects.
Catatonia
Psychomotor disturbance characterized by muscular rigidity, excitement or stupor.
Hypnotic agent
A drug capable of inducing a hypnotic state.
Hypnotic state
A state of heightened awareness that can be used to modulate the perception of pain.
Hypoxia
Reduction of oxygen supply to the tissues.
Malignant hyperthermia
A type of reaction (probably with a genetic origin) that can occur during general Anaesthesia and in which the
patient experiences a high fever, muscle rigidity, and irregular heart rate and blood pressure.
Medulla oblongata
The lowest section of the brainstem, located next to the spinal cord. The medulla is the site of important
cardiac and respiratory regulatory centres.
Opioid
Any morphine-like synthetic narcotic that produces the same effects as drugs derived from the opium poppy
(opiates), such as pain relief, sedation, constipation and respiratory depression.
Pneumothorax
A collapse of the lung.
Stenosis
A narrowing or constriction of the diameter of a passage or orifice, such as a blood vessel.