IVANO-FRANKIVSK NATIONAL MEDICAL UNIVERSITET
Department Anesthesiology and Intensive
Care
The general
anesthesiologycal
principles of
maintenance of
operative actions
Makoyda Iryna Yaremivna
The main questions of lecture

History of Anesthesia;

Anesthesia. Local anesthesia;
General anesthesia.;

Clinical pictures of narcosis;

Devices for narcosis ;

The general principles of theoretical
and practical anesthesiology
The word is derived from the Greek words
an, which means “without” and aithesia which means “feeling”
The development of anesthesia has made today’s
modern surgical techniques possible
In modern representation the ANESTHESIOLOGY is
an independent section of medicine which develops
questions of the theory and practice of anaesthesia and
protection of an organism from excessive irritates,
which arise during operation.
In other words, it is system of protection of a human body
from an operational trauma.
It expects a number of actions which begin before operation
exist during it and come to an end in the period after operation.
History of Anesthesia
•1772-Joseph Priestly - discovery of N2O
•1846-Dr. William T.G. Morton First anesthesia
specialist Oct. 16,
1846 - Ether Day at
Harvard Medical School
•Oliver Wendell Holmes suggested the name
"Anesthesia"
•Ether synthesized in 1540 by Cordus
•Ether used as anesthetic in 1842 by Dr.
Crawford W. Long
•Ether publicized as anesthetic in 1846 by Dr.
William Morton
1847 - M.I.Pirogov - endotracheal narcosis
and spinal anaesthesia in experiment, rectal
and i/v a narcosis in clinic
1847 y. - Simpson - the first chloroformic
narcosis
1847 y. - John Snow - the first professional
anaesthesiologist
1863 y. - Green - morfin for premedication
1868 y. - Endrys - narcosis N2O in a
combination with О2
•Endotracheal tube discovered in 1878
•Local anesthesia with cocaine in 1885
•1911. Legman - chlorethyleni narcosis
•1922 y.- local infiltration anaesthesia by a method creeping infiltrat
•1932 y. - i/v gexenaly narcosis
•1934 y. - cyklopropanall narcosis
•1936 y. - Landi - i/v thiopentaly narcosis
•1937 y. - Gvedell - classification of stages of a narcosis
•Curare first used in 1942 - opened the “Age of Anesthesia”
Influence of operation on an organism
Local changes:
1.
Occurrence of the painful
irritations
Common changes:
1. Paine
2. Nekrobiotic damage
2. Neurovegetative and
neuroendocrine
disorders
3. Allocation of the local
vasoactive substances,
hormones.
3. Exchanges disorders
4. Development of a local hypostasis
5. Creation of conditions for infection
6. Specific influence on breath bodies
(a thorax wound), blood circulations
(wounds with a bleeding).
4. Breathing disorder
5. Changes of blood
circulation
6. Changes of reological
properties of the
blood.
PAINE This complex sharply negative emotional sensation which
arises owing to action of hurting factors
on special receptors
Stages of formation of painful reaction:
1. Transformation of pathological influence into
electric signal in painful receptors, education of a
painful impulse
2. Transfer of the created painful signal by afferent
nervous ways
3. Formations of sensation of a pain and respective
mental reaction, "decoding", "judgement" of a pain
in the painful centres
4. Formation of reaction-answer and its transfer on
efferent nervous ways
INFLUENCE OF PAINFUL IMPULSES ON THE ORGANISM
PAINE
EXCITATION OF THE VEGETATIVE CENTERS OF THE SUBCORTEX
•
Stimulation of the sympathetic and parasympathetic nervous
systems
2. Hyperproduction of adrenaline, noradrenaline
3. Hyperproduction stressful hormons (ТТH, аldosteroni,
cytokines, glukagoni)
DEVELOPMENT OF SELIE ADAPTABLE SYNDROME
Сardio-vascular
system:
1. Таchicardia
2. Increasing of the BP
3. Spasm of arterioles
4. Microcirculation infringement
5. A blood condensation
6. Deterioration reological
qualities of blood
7. Hypercoagulation
Breathing:
1.Tachypnoe
2. Spasm of bronchioles
3. Decrease of V V of L
4. Increase of breathing
hypoxia
Metabolism:
1. Hyperglykemia
2. Stimulation of neoglukogenesis
3. Braking of the aerobic
glikolisis
4. Disintegration of albumins
5. Increase of acidities and
development of the metabolic
acidosis
Kidneys:
1. Decrease of diuresis
2. Detention of Na+
3. Detention of Н2О
4. Accumulation of the
nitrogenous slags
Secondary infringements of functions of all bodies and systems
With development of poliorganic insufficiency
THE MAIN REQUIREMENTS TO ANESTHESIA METHODS
Common (nonspecific)
Components of anesthesia
1. Аmnesia – disagreement of
consciousness
Than it is provided
Common anesthetics, sedative drugs, hypnosis
2. Аnalgesium (an-disagreement, algos - Common and local anesthetics, narcotic and no
narcotic analgesics
a pain) - deenergizings of painful
sensitivity
Common anesthetic, central and peripheral cholino3. Neurovegetative blockade
and аdrenomimetic, neuroleptic
4. Миоплегия - relaxations of muscles
Common and local anesthetics.
5. Adequate haemodynamics
Drugs for regulation of the rhythm and power of
heart contraction, microcirculation, coagulation and
reological properties of the blood.
6. Adequate gas exchange
Passableness of respiratory ways, blood
oxygenation, auxiliary and V of L
Correction of metabolism, temperature.
Classification of methods of anaesthesia
Local anesthesia
General anesthesia
Types of local anesthsia
1. THE SUPERFICIAL
(Terminal):
a) Greasing
b) Splashes
c) Cooling
2. Infiltration :
a) The opened
b) The closed
3. Explorer
(The regional):
а) topical
b) plexus blocks
(novocaini blocks)
c) caudal
d) epidural
i) spinal
Local narcosis:
•Terminal.
•Infiltration.
•Regional:
juxtaspinal;
intercostal;
sacral;
anaesthesia of jaw area.
•Spinal (subarachnoidal).
•Epidural.
•Intracostal.
•Intravenous regional.
Anaesthesia of cross-sectional.
COMMON (NARCOSIS)
1. The inhalation
a) mask
b) endotracheal
2. NONINHALATION:
а) i\v
б) i\m
в) peroral
г) perrectum
д) intracavital
-
Superficial (terminal) anaesthesia
Switches on
the prevention of occurrence of painful impulses in the
nervous receptors placed in a skin or mucous membranes
It is executed by methods:
-
Greasings (2-5 % a solution of novocaini, lidocaine, paste
“Еmla” with prilocaini that lidocaini)
-
Irrigation (2-5 % solution of novocaini, lidocaine, 10 % an
aerosol lidocaini)
-
Cooling (solution of chlorethyl)
EMLA
INFILTRATIONAL ANESTHESIA
-
Expects the prevention of painful impulses in nervous receptors in all
fabrics on any depth: 0,25-0,5 % solution of novocaini, lidocaine, marcaini or
naropini are spent by such methods:
- Closed - all fabrics which will be hurt during operation, stage by stage spend
infiltration by anesthetic through pierce in a skin, since “a lemon crust”
- Opened – infiltration of fabrics by solution of anesthetic spend gradually,
connecting it with cuts
CONDACTIONAL LOCAL ANESTHESIA
Trunk anesthesia
– Interrupts nervous impulses at level of trunk of
peripheral nerves
1-2% solution of novocaini or lidocaini
enter peri - or endoneural of nervous trunks
which perform nervous support an
operation zone
Anesthesia by OberstLukashevich
Block of n.femoralis
CONDACTIONAL LOCAL ANESTHESIA
Plexus anesthesia (Novocain blocks)
– Interrupts nervous impulses at level of nerves plexus, into
which projection enter 0,25-0,5% solution of novocaini or
lidocaini
Vago-sympathy block
Paranefral block
CONDACTIONAL LOCAL ANESTHESIA
Paravertebral anesthesia
– Interrupts pain impulses at level of spinal nervs (by
arrows it is specified, where enter a solution
1% novocaini, lidocaini, marcaini or naropini)
CONDACTIONAL LOCAL ANESTHESIA
Peri-(epi-) dural anesthesia
– Interrupts pain impulses in peridural space on level of
posterior (sensitive) radicals of spinal cord
CONDACTIONAL LOCAL ANESTHESIA
Sacral (caudal) anesthesia
– variant of epidural, when anesthetic entered in epidural space
throw canalis sacralis
Drugs for epidural
anesthesia
1. 2-2,5% sol. Trimecaini
2. 2. 2% sol. lidocaini
3. 0,5% sol. karbostesini
(bupivacaini)
4. 2% sol. mepivacaini
5. 1% sol. ropivacaini
6.To them it is possible to add:
morphine in doses = 1/10
usual
CONDACTIONAL LOCAL ANESTHESIA
SPINAL ANESTHESIA
Interrupts pain impulses at level of subdural placed posterior
radicals and conductive ways of painful sensitivity of spinal cord
(tractus spino-thalamicus)
Drugs for anesthesia
1. 1,5 – 2 ml 5% sol.
novocaini
2. 4 – 5 ml 2% or 2 ml 5%
sol. lidocaini
3. 0,5 – 1 ml 1% sol. sovcaini
4. 3 ml 0,5% sol. bupivacaini
5. 3-5 ml sol. ropivacaini
GENERAL ANESTHESIA
=
NARCOSIS
Narcosis - is artificial called, potentially
reversible status of an organism to which it is
characteristic loss of consciousness and
oppression of reflex activity;
At a deep narcosis the relaxation of muscles,
neuro-vegetative blockade, oppression of the
vital functions of an organism is observed.
Theory of narcosis
1. Coagulative theory of Claude Bernar (1875).
2. Lipoid theory of Meyer and Overton (1899 1901).
3. Theory of "asphyxiation of nervous cages of
Fervorn" (1912).
4. An adsorption theory (frontier tension) is
offered Traube (1904 - 1913) and Varburg (1914 1918) is supported.
Theory of aquatic microcrystal of Polling (1961).
Narcosis stages
Preparatory stage
Anaesthesia induction (introduction
narcosis)
Stage of maintenance of anaesthesia
Stage of exit from narcosis
Narcosis stages
1. Preparatory stage
The remote preparation:
1. To define an accompanying
pathology
2. To liquidate it or to translate
in a status of proof remission
3. To define degree operational
-anesthesiological risk
4. To spend choice of method
of anesthesias
5. To spend psychological
preventive job with patients
(or his relatives)
The direct reparation:
1. Sanitary processing of the
patient
2. Preparation o GIT
3. Maintenance of the mental
balance and a quiet dream
4. Premedication:
analgesics
Tranquilisator
antiallergic
M-holinolitics
Narcosis stages
2. Introduction narcosis
(inhalator or noninhalator drags)
3. MAINE NARCOSIS
spending in ІІІ1-ІІІ3 stages inhalator or noninhalator drags or their
combination, narcotic or nonnarcotic analgetics,
neuroleptic, hypnotics,
sedatives, stimulators of alfa-2-receptors,
miorelaxants
4. Exit from a narcosis or awakening
5. Early after narcosis period –
Lasts throughout 1 days after operation, demands supervision
over the patient by the anaesthesiologist for the purpose
of correction of vital signs and homeostasis indicators
Narcosis stages
І – analgesic;
ІІ – Excitation;
ІІІ - a surgical stage (ІІІ 1 - ІІІ 4);
IV - awakenings (toxic/agonal)
Stage of analgesia (I).
A patient is in consciousness, but put on the
brakes, dozes, on questions answers
monosyllabically. A superficial algesthesia
absents, but a haptic and thermal sensitiveness
is stored. Implementation of brief interferences
(dissection of phlegmons, abscesses, diagnostic
researches) is possible in this period. Stage brief,
3-4 lasts min
Stage of excitation (II).
There is braking of centers of bark of large brain in this
stage, while under bark centers are in a state of excitation:
consciousness absents, motive and vocal excitation is
expressed. Patients yell, try to get up from an operating
table. The cutaneous covering is bloodshot, pulse frequent,
an arteriotony is enhanceable. Pupil wide, but reacts on
light, a lacrimation is marked. A cough, strengthening of
bronchial secretion, appear often, vomiting is possible.
Surgical manipulations on a background excitation,
conducting is impossible.
In this period it is necessary to continue the satiation of
organism a narcotic mean for deepening of anesthesia.
Duration of the stage depends on the state painof ного,
experience of anaesthetist. Excitation usually lasts 7-15
min
Surgical stage (III).
With the offensive of this stage of
anesthesia of patient calms down,
breathing becomes even, a heart rate
and arteriotony approach an initial level.
Realization of operative interventions is
possible in this period.
Leadingout from anesthesia
Awakening stage, begins from the
moment of stopping of serve of
anesthetic. The concentration of
anesthetic diminishes in blood, a patient
passes upside-down, all stages of
anesthesia and awakening comes.
Monitoring of depth of narcosis
Monitoring of depth of narcosis
Preparation of patient to anesthesia.
A patient is examined before an operation, here not only pay
attention to basic disease which an operation coming
concerning but also in detail find out the presence of
concomitant diseases. If a patient is operated in the plan order.
that if necessary is conducted treatment of concomitant
diseases, sanation of cavity of mouth. A doctor finds out and
estimates the mental condition of patient, allergist anamnesis
finds out, specifies, whether a patient carried in the past
operations and anesthesias.
Pays attention to form of person, thorax, structure of neck,
expressed of fatty hypoderm. All of it is necessary, that it is
correct to choose the method of anaesthetizing and narcotic
preparation.
The important rule of preparation of patient to anesthesia is
clearing of gastrointestinal tract (washing of stomach, cleansing
enemas).
Premedication
 An aim of premedication is a removal of psychical tension,
sedative effect, warning of undesirable neurovegetative
reactions, diminishing of sialosis, to the bronchial
secretion, and also strengthening of anesthetic and
analgetic properties of narcotic matters.
 It is arrived at by application of complex of
pharmacological preparations. In particular, for the
psychical calming tranquilizers, barbiturates, neuroleptic
and other, are effective.
 Strengthening of activity of vaguss, and also diminishing
of secretion of mucous membranes of tracheobronchial tree
and salivary glands can be got by means of atropine,
metacinum or scopolaminum.
Apparatus for anesthesia.
An anesthesia vehicle is the special device, intended for a
serve to the patient of the exactly dosed amounts
(concentrations) of gas and volatile narcotic matters and
creation of optimal terms of interchange of gases in lungs. If
necessary an anesthesia vehicle must provide artificial and
auxiliary ventilation of lungs.
Any anesthesia vehicle consists of 3 knots: reservoir
(source) of gases - oxygen, nitrous oxide, cyclopropanum;
dosimeter of gases and vaporizer for narcotic volatiles (ether,
ftorotanum, trylene and other); respiratory contour.
Bulbs in which gas is under constraint name the source of
gases, that provides a large capacity at a relatively small
volume, reducing gears and dosimeters. Bulbs with oxygen
are painted in blue, with a nitrous oxide - in grey and with
cyclopropanum - in a red color. To decrease pressure on an
exit from bulbs with oxygen and nitrous oxide and to provide
constancy of this (3-4ат) LP, use reducing gears.
Dosimeters.
 Devices, intended for the serve of exact amounts
of oxygen, nitrous and cyclopropanum oxide. On
most vehicles dosimeters are set. At the
simultaneous entering chamber of a few gases, for
example oxygen and nitrous oxide, oxygen and
cyclopropanum, there is their mixing in a
chamber, and from her they act to the patient
simultaneously. The concentration of them will
depend on the size of stream, set on every
rotametr.
Vaporizers.
 The dosed serve of liquid narcotic matters is carried out
through devices in which these matters grow into steam
(evaporate). A patient breathes in them already as steams.
Vaporizers consist of chamber in which pour a narcotic
matter, and batching device. The last allows to skip all or
part of gas stream through a chamber or quite to pass her.
In last case after an exit from a vaporizer gas will not
contain steams of narcotic matter.
 If all stream will get through a chamber, then gas will be
maximally saturated by a narcotic matter. In intermediate
positions a satiation of gas will be less than, than at the
complete "opening" of vaporizer.
Workplace of the anaesthesiologist
 The narcotic machine (device)
 Preparations for a narcosis
 Cardiomonitor multipurpose
 Infusomat
 Pomp with syringe
 Aspirator
 Sterile little table and set of solutions and medicines
"for all occasions"
 Devices for warming of the patient;
 Account materials (cathetrs, masks, tubes)
The basic sites of the narcotic
device
Rotametr (a dosage of gases);
Evaporators (a dosage flying anesthetic);
Adsorber (adsorption СО2);
System of valves of a breath and exhalation;
Respiratory bag, respirator;
Respiratory contour (system of internal tubes and
hoses of the patient);
The monitor of job of the narcotic device;
Additional options (the monitor of the patient, BIS,
the monitor of nervously-muscular conductivity
Types of a respiratory contour
Opened - (a breath from atmosphere - an
exhalation in atmosphere);
Half-opened - (a breath from the device an exhalation in atmosphere);
Half-closed - (partial recirculation of
gases);
Closed - (full recirculation of gases).
GENERAL ANESTHETICS
INHALATORY
GASES
FLUIDES
NONINHALATORY
DERIVATIVES BARBITUR
ACIDS
1. Nitrous 1. Диетиловий ефір
2. Ftorotan
1. Thiopental
oxide
(galotan,
(pentotal)
(N20)
narcotan,
2. Gexenal
fluotan)
(evipan
3. Chloroform
2. Cyclo
natrii)
propan 4. Трихлоретилен
(trylen)
(С3Н6)
5. Metoxyflurane
(pentran)
6. Enflurane
(etran)
7. Іsoflurane
(foran)
8. Sevoflurane
9. Desflurane
Relaxant
NONBARBITURATES
1. Ketamin (kalipsol,
ketallar)
2. Natrii oxybutirat
(ГОМК,Y-он)
3. Viadrili (presureni,
predioni)
4. Аltesin (аlfatesin)
5. Sombrevini
(propanidid, epontol)
6. Etomidat
(hypnomidaqt)
7. Propofoli (diprivan,
recofol)
Basic typical complications of
anesthesia
 Breathing system obstruction
 Anaphylaxis
 Light anesthesia
 Recurarisation
Anaphylaxis
 Allergic reaction of immediate type the
answer to introductions/uses of any
preparation for a narcosis, an antibiotic,
contrast, antiseptics, latex, cement;
 Displays: often "are disguised" by a
narcosis!!!, a hypotension, a
tahy/bradycardia, a bronchospasm, a rash,
hyperemia of faces, breasts;
 Tactics: to stop introduction of probable
allergen, adrenaline i/v, hormones, eufyllini,
Н1-blockers, to reduce depth of anaesthesia.
Laryngospasm
 Instant closing of a vocal crack which is
accompanied by sharp weighting or
impossibility of a breath (inspiratory
stenosis);
 The status threatens a life and can quickly
lead to death through hypoxia!
 The reasons: slime on a vocal crack, irritation
by catheter, an air line, afterintubational
hypostasis (it is frequent at children);
 Tactics: anaesthesia deepening + atropine of
0,5 ml i/v + ditilini 1,5-2 mg/kg i/v + ALV.
BRONCHOSPASM
 Fast deterioration of bronchial conductivity owing
to a spasm of muscles of bronchial tubes;
 Displays: the exhalation, опір on a breath is
sharply weighted or impossible, the exhalation - is
extended, dry whistling rattles on an exhalation;
 The reasons: superficial anaesthesia, mechanical
irritation;
 Tactics: ftorotani 1,5-2,6 % + ventolini 2-4 doses
in line of inspiration + eufylini i/v + dexasoni 12
mg i/v + β2 - adrenomymetix i/v;
REGURGITATION AND
ASPIRATION
 REGURGITATION – Passive hit of gastric
contained in a tracheal-bronchial a tree and lungs;
 ASPIRATION - active hit of gastric contents and
contents of laryngthroat in a tracheal-bronchial
tree and lungs;;
 The reasons: “a full stomach”, infringement of
technics of an induction of anaesthesia, a
nonhermetic trachea;
 Displays: a bronchospasm, decrease сатурации
blood, pressure increase at a breath, pathological
noise in a respiratory contour, gastric contained in
a trachea;
REGURGITATION AND
ASPIRATION
Preventive maintenance:
 -Will lock the food uses 6 hours prior to a
narcosis;
 Stomach-washing before an urgent narcosis;
 - Use of Sellik”s reception;
 -Fast consecutive induction of anaesthesia;
 SELLIK”S Reception: pressing by two hands
on персневидний a cartilage with force of 3 kg
from the moment of the beginning of
"consciousness deenergizing” by the moment of
inflating of cuffs ЕТТ. The trained assistant to the
anaesthesiologist executes.