 medical treatment that keeps you from feeling pain

during procedures or surgery

 medications used to block pain are called
anesthetics.
 may be given by injection, inhalation, topical lotion,
spray, eye drops, or skin patch
 There are four main categories of anesthesia
used during surgery and other
procedures: general anesthesia, regional
anesthesia, sedation (sometimes called "monitored
anesthesia care"), and local anesthesia.
 affects the whole body, making patients
unconscious and unable to move

 provide general anesthetics either directly into the

bloodstream (intravenously) or as an inhaled gas

 General anesthesia delivered intravenously will act

quickly and disappear rapidly from the body while
Inhaled anesthetics may take longer to wear off.
 General anesthesia is used for more invasive
surgical procedures, or procedures of the head,
chest, or abdomen.

 Inhalational Gases:
◦ Sevoflurane, Desflurane, Isoflurane

 Intravenous Agents:
◦ Propofol (Diprivan®), Ketamine, Etomidate
INTRAVENOUS ANETHETICS
◦ PROFOPOL - Propofol is a phenol agent with rapid
onset and short duration of action and can be used for
induction and maintenance of anesthesia. Profound
respiratory depression can be caused by an induction
dose. Propofol offers the advantage of effortless
awakening with minimal residual sedation even with
prolonged infusion. Additionally, it has antiemetic
properties making it popular for outpatient procedures.

◦ Propofol (Diprivan®) is the most commonly used IV

general anesthetic. In lower doses, it induces sleep
while allowing a patient to continue breathing on their
own.
 INTRAVENOUS ANETHETICS
◦ Ketamine is a dissociative anesthetic meaning
it distorts perception of sight and sounds as
well as producing feelings of detachment from
environment and self. Unique among IV
anesthetics, ketamine produces intense
analgesia. Important side effects of ketamine
include increased secretions, the risk of
laryngospasm and hallucinations.
 INHALATION ANETHETICS

◦ These liquids are transformed by vaporization

into gas for rapid absorption in and elimination
by the pulmonary circulation. These
medications are absorbed in alveoli, and the
anesthetic concentration in the brain is directly
related to alveolar concentration. Inhalational
agents are commonly used for maintenance of
anesthesia.
 INHALATION ANETHETICS
◦ Halothane was a commonly used agent
◦ Sevoflurane, which offers smoother mask
induction, quicker emergence, and less
myocardial depression and arrhythmogenic
potential than halothane
◦ Isoflurane which contains fluoride is not
completely fluorinated.
◦ Desoflurane It is also used as a maintenance
anesthesia in adults and children after
receiving other anesthetics before and during
surgery.
 blocks pain in a larger part of your body, such as a
limb or everything below your chest
 can be conscious during the procedure
 Two very common types of regional
anesthesia: spinal and epidural anesthesia.
 There are major known contraindications to
neuraxial anesthesia (spinal and epidural). The
absolute contraindications are lack of consent
from the patient, elevated intracranial pressure
(ICP), primarily due to intracranial mass and
infection at the site of the procedure (risk of
meningitis).
 Spinal anesthesia is a type of neuraxial
anesthesia; local anesthetic (LA) is injected into
cerebrospinal fluid (CSF) in the lumbar spine to
anesthetize nerves that exit the spinal cord.

 Spinal anesthesia is most commonly used for

anesthesia and/or analgesia for a variety of
lower extremity, lower abdominal, pelvic, and
perineal procedures.
SUPPLIES NEEDED FOR SPINAL
ANESTHESIA

⚫ Chlorhexidine with alcohol

⚫ Drape, and local infiltrating anesthetic (usually
1% lidocaine)
⚫ Spinal needle (Quincke, Whitacre, Sprotte, or
Greene),
⚫ 3 ml and 5 ml syringes,
⚫ Preservative-free spinal anesthetic solution.
Solutions may range from lidocaine, ropivacaine,
bupivacaine, procaine, or tetracaine.
 Technique for perioperative pain
management with multiple applications in
anesthesiology.
 It is useful as a primary anesthetic, but most
commonly, it is used as a pain management
adjuvant.
 It can be a single shot or a continuous
infusion for long-term pain relief. Aside from
the benefit of potentially providing excellent
analgesia, its use reduces the exposure to
other anesthetics and analgesics, decreasing
side effects.
 Epidural needles: Multiple types have been designed (Tuohy,
Hustead, Crawford, Weiss, etc.), Tuohy being the most used
one. These are usually 17 or 18 G and 3.5 inches long (up to 6
inches for obese patients).

 Loss of resistance syringe: Either made of glass or plastic. It has

very low friction between the plunger and the barrel to permit
detection of the change in resistance at the epidural space. The
syringes may be filled up with air, saline, or both; this apparently
does not affect the success of identifying the epidural space, nor
does it change the complication rate.

 Epidural catheters: used for continuous epidural

anesthesia/analgesia. They may be flexible or stiff. They may
also have a single hole or multiple ones.
DRUGS USED:
 Lidocaine (5%): Onset of action occurs in 3 to 5
minutes with a duration of anesthesia that lasts for
1 to 1.5 hours
 Bupivacaine (0.75%): One of the most widely used
local anesthetics; onset of action is within 5 to 8
minutes, with a duration of anesthesia that lasts
from 90 to 150 minutes
 Tetracaine 0.5%
 Mepivacaine 2%
 Ropivacaine 0.75%
 Levobupivacaine 0.5%
 Chloroprocaine 3%
Nerve blocks are another type of regional
anesthesia that can provide pain relief to a
smaller area, such as an arm or leg. Examples
include femoral nerve block to numb the thigh
and knee, or a brachial plexus block to numb the
shoulder and arm.
 Also known as "monitored anesthesia care“
 Medications are given, usually through an IV,
to make the patient feel drowsy and relaxed.
 Typically is used for minor surgeries or for
shorter, less complex procedures, when an
injection of local anesthetic isn’t sufficient
but deeper general anesthesia isn’t necessary
 An analgesic is a medication used to achieve
analgesia, or pain relief, and is often
combined with sedation.
 Sometimes IV sedation and analgesics will be
combined with other types of pain control —
such as local anesthesia, which involves one or
more injections to numb a small area of the
body, or regional anesthesia, which numbs a
larger part of the body, such as from the waist
down.
The main levels of sedation are:
 Minimal – Minimal sedation will help you relax,
but you will likely be awake. You’ll understand
questions your doctor is asking and be able to
answer as well as follow directions. This level of
sedation is typically used when your doctor
needs you to be involved in the procedure.
 Moderate – You will feel drowsy and may even
fall asleep during the procedure. You may or
may not remember some of the procedure.
 Deep – You won’t actually be unconscious, but
you’ll sleep through the procedure and
probably will have little or no memory of it.
 The main levels of sedation are:
 Minimal – Minimal sedation will help you relax,
but you will likely be awake. You’ll understand
questions your doctor is asking and be able to
answer as well as follow directions. This level of
sedation is typically used when your doctor
needs you to be involved in the procedure.
 Moderate – You will feel drowsy and may even
fall asleep during the procedure. You may or
may not remember some of the procedure.
 Deep – You won’t actually be unconscious, but
you’ll sleep through the procedure and
probably will have little or no memory of it.
 Common Medication Used in
Sedation
 Midazolam (Dormicum)- medication used to
help ease anxiety.
 Diazepam (Valium)
 Analgesic Agents
◦ Morphine- also used preoperatively to reduce anxiety,
cause sedation and reduce the dose of anesthetic.
◦ Fentanyl- opiod, a medicine in the same family as
Morphine. It is used to supplement sedation and
works almost immediately when given intravenously.
 Local anesthesia, also called local anesthetic,
is usually a one-time injection of medicine
that numbs a small area of the body.\
 It is used for procedures such as performing a
skin biopsy or breast biopsy, repairing a
broken bone, or stitching a deep cut.
 The procedure is minor and does not require
general or regional anesthesia.
 The procedure is quite quick, and the person
will not need to stay overnight.
 There is no need to relax the muscles or for
the person to be unconscious.
 There are two main types of local
anesthetics, depending on how they’re
administered.
 Topical anesthetics are applied directly to
your skin or mucus membranes, such as
the inside of your mouth, nose, or throat.
They can also be applied to the surface of
your eye. Topical anesthetics come in the
form of:
◦ liquids
◦ creams
◦ gels
 Examples of procedures that might involve
topical anesthesia include:
 applying or removing stitches
 anything involving a needle poke
 IV insertion
 catheter insertion
 laser treatments
 cataract surgery
 endoscopy
 Local anesthetics can also be given as
an injection. Injectable anesthetics are
typically used for numbing during
procedures, rather than pain
management.
 Procedures that might include an
injection of a local anesthetic include:
◦ dental work, such as a root canal
◦ skin biopsy
◦ removal of a growth under your skin
◦ mole or deep wart removal
 Cocaine was the first anesthetic, but its use is
now rare.
 Lidocaine is the most common local
anesthetic.