General

Anesthesia
2020-MPHIL-1351
FARHAN NASEER
Anesthesia :
Total loss of sensation in a body part or whole body , induced by a drug or
drugs that depress the central nervous tissue either regionally, locally or
Centrally (Generalized).

Anesthesia is the reversible loss of sensation in the patient to

perform different surgical procedures smoothly and is produced by
different drugs in different ways.
Purpose of Anesthesia :
 Analgesia( loss of pain)
 Amnesia (loss of memory)
 Immobility (loss of motor reflexes)
 Hypnosis (unconsciousness)
 Paralysis (relaxation of skeletal muscles)
Types of anesthesia

General Anesthesia :
Loss of consciousness, loss of sensation, Analgesia along with muscle relaxation can
be produced by single or combination of drugs.

Local Anesthesia :
Loss of sensation limited to the specific area where the drug is administered.
General Anesthesia
IT IS A STATE OF UNCONSCIOUSNESS COMBINED WITH LOSS OF
SENSITIVITY AND REDUCED MOTOR RESPONSE TO STIMULI
PRODUCED IN A CONTROL MANNER BY A PROCESS OF REVERSIBLE
INTOXICATION OF CNS.

GENERAL ANESTHESIA TECHNIQUES

IT INVOLVES AN INDUCTION PHASE WHICH IS GENERAL
ACHIEVED WITH INJECTABLE DRUGS AND A MAINTENANCE
PHASE WHICH MAY BE ACHIEVED WITH EITHER INJECTABLE
DRUGS OR INHALATIONAL ANESTHETICS OR COMBINATION OF
THE TWO.
Stages of Anesthesia : Stage 1
Induction Stage
 The period between the administration of anesthetic agent to the loss of consciousness.
 It progresses from analgesia without amnesia to analgesia with amnesia.
 From beginning of induction of general anesthesia to loss of consciousness.
 The patient experience sedation, analgesia(but still feel pain), and eventually
amnesia.
 From loss of consciousness to onset of automatic breathing.
Stage 2
 Excitement Stage
 The period following the loss of consciousness and excited activity.
 Respiration and heart rate becomes irregular, dilation of pupils.
 Eyelash reflex disappear but other reflexes remain intact
and coughing, vomiting and struggling may occur.
 respiration can be irregular with breath-holding.
Stage 3 :
 Surgical anesthesia
 In this stage patient is unconscious and ready for surgery.
 Skeletal muscles relaxed, Respiratory depression occurs.
 From onset of automatic respiration to respiratory paralysis.
 It is divided into four planes:
A. Plane I
B. Plane II
C. Plane III
D. Plane IV
Four Planes 3rd stage
 I - From onset of automatic respiration to cessation of eyeball movements.
Eyelid reflex is lost, swallowing reflex disappears, marked eyeball movement
may occur but conjunctival reflex is lost at the bottom of the plane.
 Plane II - from cessation of eyeball movements to beginning of paralysis of
intercostal muscles. Corneal reflex disappears, secretion of tears increases (a
useful sign of light anesthesia), respiration is automatic and regular.
 Plane III - from beginning to completion of intercostal muscle paralysis.
Diaphragmatic respiration persists but there is progressive intercostal
paralysis.
 This was the desired plane for surgery when muscle relaxants were not used.
 Plane IV - From complete intercostal paralysis to diaphragmatic paralysis
(apnea).
Stage 4 :

 Medullary paralysis
 Occurs due to overdose of anesthetic agent.
 Results in cessation of respiration and cardiovascular collapse.
 From stoppage of respirtion till death. Anesthetic overdose-caused
medullary paralysis with respiratory arrest and vasomotor collapse.
 Coma and death.
Methods of Anesthesia :
 Inhalation
 Intravascular
 Intra peritoneal
 Intramuscular
 Oral or Rectal
 Local or Regional
General considerations in the choice of
anesthetic agents :
 History
The patients with epilepsy , renal and heart failure must be monitored carefully
during anesthesia
 Recent Feeding :
Fasting of animal is recommended for 14-48 hours in large animals and 6-12 hours in
small animals, to avoid the risk of vomiting after induction of anesthesia.
 Physical examination of surgical patient
Obesity , emaciation , dehydration, GIT Infections , hyperthermia , hypothermia etc.
Age :
The more the age , the more risk of anesthesia.
Breed :
 Brachycephalic breeds e.g pugs are extremely prone to airway obstruction, due to
long soft palate and shortened muzzle.
 They require rapid induction and rapid recovery from anesthesia.
Pregnancy :
Anesthesia should be avoided in pregnancy to avoid teratogenic and abortifacient
effects.
Pre anesthetics
THESE ARE THE DRUGS USED PRIOR TO THE ADMINISTRATION OF
AN ANESTHETIC AGENT, TO MAKE THE ANESTHESIA MORE SAFE
AND MORE AGREEABLE TO THE PATIENT.
PURPOSE
o SEDATION, TO REDUCE ANXIETY AND APPREHENSION
o TO OBTAIN AN ADDITIVE OR SYNERGISTIC EFFECT SO THAT
INDUCTION COULD BE SMOOTH AND RAPID.
o TO COUNTERACT CERTAIN ADVERSE EFFECTS OF THE
ANESTHETIC DRUG.
o TO RELIEVE FROM PAIN.
Pre anesthetics
o A GOOD PRE ANESTHETIC SEDATION FACILITATES
SMOOTH INDUCTION AND HAS ANESTHETIC SPARING
EFFECT DURING MAINTENANCE.

o THERE ARE MANY CHOICES AVAILABLE. SEDATIVE/

OPIOID COMBINATION IS MOST POPULAR E.G.
ACEPROMAZINE AND MORPHINE WHICH PROVIDES
BETTER RESTRAINT AND ANALGESIA.
 Pre anesthetic medications

Preanesthetic Drug Sedative and other actions Cardiovascular Analgesia

drug class effects
Phenothiazines Acepromazine Mild to moderate sedation Vasodilation None
No muscle relaxation
Benzodiazepines Diazepam,midazolam Minimal to mild sedation Minimal effects None
zolazepam Muscle relation
Alpha-2- Xylazine, medetomidine Mild to profound sedation Vasoconstriction Somatic and
Adrenoceptor Dexmeditomidine, Romifidine Muscle relaxation Bradycardia visceral
agonists
Dissociatives Ketamine Moderate sedation, increased Increased heart rate Somatic and
muscle tone,Increased salivation and blood pressure visceral
and airway secrection

Opioids Morphine, hydromorphone, Mild sedation and no effect on Decrease in heart Somatic and
pethidine,butorphanol,Fentanyl muscle tone. rate visceral
Methadone,mepridine etc.

Anticholinergics Atropine, Glycopyrolate None Increased in heart None

rate and decrease in
salivation.
Induction Anesthesia
INDUCTION ANESTHESIA IS GIVEN IN
GENERAL ANESTHESIA WITH DRUGS THAT PUT THE PATIENT TO
SLEEP AND ONCE THESE DRUGS BEGIN TO WEAR OFF,
MAINTENANCE ANESTHESIA IS ADMINISTERED.
KETAMINE
o KETAMINE IS ASSOCIATED WITH INCREASED MUSCLE TONE
AND EXCESSIVE SALIVATION
o KETAMINE MAY CAUSE INCREASED HEART RATE, CARDIAC
OUTPUT, AND BLOOD PRESSURE
o A WIDE RANGE OF SEDATIVES ARE COMBINED WITH KETAMINE
TO INDUCE DEEP SEDATION OR LIGHT ANESTHESIA.
Induction Anesthesia
KETAMINE- MEDETOMIDINE / XYLAZINE
o MEDETOMIDINE AT 5 – 40 MCG/KG ADDED TO KETAMINE AT 6-10
MG/KG GIVEN EITHER IM OR IV PRODUCES DEEP SEDATION
OFTEN RECUMBENCY.
o BUTORPHANOL 0.1-0.4 MG/KG IV, IM CAN BE INCLUDED IN THIS
COMBINATION FOR BETTER SEDATION, ANALGESIA AND MUSCLE
RELAXATION.
o MEDETOMIDINE CAN BE SUBSTITUTED BY XYALZINE 0.5-1 MG/
KG, RESULTING IN SHORTER DURATION OF EFFECT.
o ATROPINE AT THE DOSE RATE OF 0.02-0.04MG/KG CAN BE ADDED
TO KETAMINE AND XYLAZINE COMBINATION.
o KAX RATIO IS = 0.7+0.1+0.2
Induction Anesthesia
KETAMINE-DIAZEPAM/MIDAZOLAM
o THIS COMBINATION WILL PRODUCE LESS CARDIOVASCULAR
DEPRESSION THAN XYLAZINE-KETAMINE
o DIAZEPAM 0.1-0.4 MG/KG AND KETAMINE 5 MG/KG GIVEN IV.
o THE KETAMINE AND DIAZEPAM RATIO IS 1+0.5ML
o MIDAZOLAM IS ADMINISTERED AT 0.1 – 0.3 MG/KG IV, IM,
SUBSTITUTING DIAZEPAM
o BUTORPHANOL 0.1-0.4 MG/KG IV, IM CAN BE INCLUDED IN THIS
COMBINATION FOR BETTER SEDATION, ANALGESIA AND
MUSCLE RELAXATION
Induction Anesthesia
THIOPENTAL SODIUM
o THE INDUCTION DOSE IN NONPREMEDICATED DOG AND CAT IS
15-20MG/KG IV.
o THE INDUCTION IS USUALLY RAPID, SMOOTH AND EXCITEMENT
FREE.
o PREMEDICATION WITH ACEPROMAZINE, XYLAZINE,
MEDITOMIDINE,DEXMEDITOMIDINE, DIAZEPAM OR OPIOIDES
CAN REDUCE THE INDUCTION DOSE TO 6-10MG/KG.
Induction Anesthesia
PROPOFOL
o IT PROVIDES RAPID INDUCTION AND IS VERY RAPIDLY
ELIMINATED FROM THE PLASMA.
o 6 MG/KG IV IS CALCULATED DOSE FOR THE ANESTHETIC
INDUCTION. RESPIRATORY ARREST IS NOT UNCOMMON
PARTICULARLY WITH RAPID IV BOLUS.
o IT IS NON-ACCUMULATIVE AND MAINTENANCE OF ANESTHESIA
FOR PROLONGED DURATION CAN BE ACHIEVED USING A
CONSTANT RATE OF INFUSION.
 ketamine:
 A short acting anesthetic induces a dissociated state in which patient is
unconscious and does not feel pain.
 It provides amnesia , sedation and immobility.
 Is a potent bronchodilator.

Diazepam :
 Induces mild sedation
 Minimal cardiorespiratory side effects.
 Short duration of action with no analgesia
Intravenous Anesthetics :
 Propofol
 Chloral hydrate
 Diazepam
 Thiopental sodium
 Ketamine
 Xylazine
 Dexmedetomidine
 Medetomidine
 Propofol :
 Onset is smooth and rapid.
 Decrease blood pressure without depressing the myocardium. Also
reduces intracranial pressure.
 Poor analgesia.
 It has replaced thiopental as first choice for anesthesia induction and
sedation, does not cause nausea and vomiting.
Dexmedetomidine :
 It has sedative , analgesic , anxiolysis and moderate muscle relaxation.
 Fast onset of action
 It enhances the analgesic and anesthetic effects of other drugs.
Combinations :
 Ketamine + Xylazine + atropine
 Ketamine + atropine+ acepromazine
 ketamine + diazepam
 Tiletamine + zolazepam
 Ketamine + dexmedetomidine
 Ketamine + midazolam
 Ketamine + medetomidine
 Ketamine + medetomidine +buprenorphine + midazolam
Inhalation Anesthetic Agents
o INHALANT ANESTHETICS USE IN VETERINARY ANESTHESIA
INCLUDE NITROUS OXIDE, HALOTHANE, ISOFLURANE,
SEVOFLURANE, AND DESFLURANE.
o THESE AGENTS REQUIRES AN ANESTHESIA MACHINE THAT
PROVIDES OXYGEN, A BREATHING CIRCUIT, AND A FACEMASK OR
ENDOTRACHEAL TUBE, AS WELL AS A WAY TO REMOVE
ACCUMULATIONS OF CARBON DIOXIDE.
o THE TWO MORE COMMON INHALATION AGENTS USED IN
VETERINARY MEDICINE TODAY ARE HALOTHANE AND
ISOFLURANE. ISOFLURANE IS GENERALLY USED AT
CONCENTRATIONS OF 2–4% FOR INDUCTION AND 0.5–2.0% FOR
MAINTENANCE OF GENERAL ANESTHESIA.
o THE CONCENTRATION OF HALOTHANE IN SMALL ANIMALS IS
2-3% FOR INDUCTION ANESTHESIA, AND 1-1.5% FOR
MAINTENANCE ANESTHESIA.
Inhalation :
Inhalant anesthetic equipment includes an anesthetic machine and a breathing circuit.
Components of anesthetic machine :
 Flow meter
 Regulator
 Vaporizer
 Gas supply
 Scavenger system
 Flow meters :
 Is used to control the delivery of specific amount of medical gas through vaporizer
to the patient.

Regulators :
 The pressure regulator is used to reduce the high pressure from the medical gas
which is supplied from a storage tank that does not damage the machine or
patients airway.

Vaporizers :
 Is used to add a specific amount of inhalant anesthetic gas to the oxygen / nitrous
oxide mixture to anesthetize the patient.
Gas supply :
 Refers to medical gas supply to the anesthetic machine.
 Oxygen is the most common carrier gas. Sometimes nitrous oxide is also used.

Scavenger system :
 It minimizes the pollution , in such a way that waste gas exits to an active charcoal
canister. The active charcoal absorbs the waste gas.
Inhalants :
 desflurane
 Isoflurane
 Halothane
 Sevoflurane
 Nitrous oxide
Isoflurane is most commonly used,
 Potent anesthetic
 Fast and smooth induction and recovery
 Easy to control
 Less cardiac depression
 Less expensive
Monitoring of Anesthetized patient:
 Respiratory Rate
 Heart rate and rhythm
 Mucous membrane color and capillary refill time
 Body temperature
 Pupillary reflexes
Minimum Alveolar Concentration :
 Refers to the amount of anesthetic gas at equilibrium at one atmospheric pressure
that produces 50 % of immobility in the subject with respect to the stimuli.
 Is the measure of inhalant gas potency.
Factors that decrease MAC :
 Hypothermia
 Metabolic acidosis
 Hypoxia
 Age
 Pregnancy
 Nitrous oxide
Factors that increase MAC :
 Hyperthermia
 Hypernatremia
Monitoring of Circulation :
 Palpation of pulse
 Auscultation of heart sounds
 Capillary refill time
 ECG
 Blood pressure monitoring
 Doppler ultrasound for blood flow and pressure
Monitoring of oxygenation :
 Mucous membrane colour
 Pulse oximeter
 Monitoring signs of pain
 Monitoring respiration
 Blood glucose levels
 Blood lactate levels
 Body temperature
 Depth of anesthesia.
Complications :
 Human error
 Incorrect drug dosage or administration.
 Equipment failure
 Failure to obtain adequate physical exam of the patient.
 Failure to recognize early patient difficulty.
 Patient related factors (systemic diseases , brachycephalic breeds etc)
Risk and Complications of
Anesthesia
o ANESTHESIA IS NEVER WITHOUT RISK. THE PREANESTHETIC
EXAMINATION AND DIAGNOSIS HELP TO REDUCE THE RISK OF
ANESTHESIA BY UNCOVERING POTENTIAL PROBLEMS.
o COMPLICATIONS THAT OCCUR UNDER GENERAL ANESTHESIA ARE
APNEA (NOT BREATHING), BRADYCARDIA (SLOW HEART RATE),
HYPOTENSION (LOW BLOOD PRESSURE), BLOOD LOSS AND
SOMETIMES CARDIAC ARREST.
o TO PREVENT THESE COMPLICATIONS FROM OCCURRING, THE
PATIENT IS MONITORED CONTINUOUSLY.
o THERE ARE FEW COMPLICATIONS ASSOCIATED WITH LOCAL
ANESTHETIC.
o THE MOST COMMON COMPLICATION IS ALLERGIC REACTION.