Transcript Basics of anaesthesia

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"To care for the body and its breath of life"
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”Reversible lack of awareness,"
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The practice of administering medications or
gases that block the feeling of pain and other
sensations, allowing medical and surgical
procedures to be undertaken without causing
undue discomfort to the patient.
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Thomas Green Morton:
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a public demonstration of ether anaesthesia in
Boston, Massachusetts, on October 16, 1846.
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Procedural sedation
Conscious sedation
Local anaesthesia
Regional anaesthesia
General anaesthesia
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Cocaine
(isolated 1859),
 used by Inca Americans for trephination (spit).
 Eye surgery 1884
 Spinal anaesthesia 1898
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Procaine (1905)
Lignocaine (1943)
Bupivicaine
Ropivicaine
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1275 Raymond Lullus played about with some
chemicals and created “sweet vitriol”
Renamed by Frobenius in 1730 as ether
(“heavenly”).
Priestley discovered nitrous oxide in 1772.
Humphry Davy experimented upon himself in
1799 – “laughing gas”
Chloroform discovered by Simpson in 1831.
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Isoflurane
Sevoflurane
Desflurane
(Halothane)
(Xenon – 80%)
(Nitrogen - >4bar)
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Benzodiazepines
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Barbiturates
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Midazolam
Sodium thiopental
Ketamine
Etomidate
Propofol
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“Milk of human kindness”, “white magic”,
“Michael Jackson juice”
Anaesthetic
Sedative
Antiepileptic
Amnestic
Antiemetic
Antipruritic
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As lamented by Fallopius: “when soporifics are
weak, they are useless, and when strong, they
kill.”
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Adverse effects:
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Apnoea
Hypotension
 Negative inotropy
 Vasodilatation
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Pain on injection
Myoclonus
Priapism
Addiction
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“Special K”, related to PCP
Anaesthetic
Analgesia, antineuropathic
Bronchodilator
Hallucinogen
More cardiovascularly stable
“Preserves airway reflexes”
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Adverse effects:
Hallucination/dysphoria
 Tachycardia/myocardial ischaemia
 Increased salivation
 Increased ICP
 Addiction
 Irritable bladder
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Depolarising:
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Suxamethonium
Non-depolarising:
Vecuronium
 Rocuronium
 Pancuronium
 Atracurium
 Cisatracurium
 Mivacurium
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Opioids
Alfentanil
 Fentanyl
 Remifentanil
 Morphine
 Methadone
 Endone
 Oxycontin
 Buprenorphine
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Anti-neuropathics
TCAs (nortriptyline)
 Antiepileptics (gabapentin)
 Antiarrhythmics (flecainide, lignocaine)
 Ketamine
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Others
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Clonidine
Clonazepam
Simples
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Metaraminol, ephedrine
Noradrenaline, adrenaline
GTN
Dopamine, dobutamine
Milrinone
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Blood, platelets, FFP, cryoprecipitate
Recombinant factor VII