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Types of Anesthesia
Anesthesia involves the use of medicines to block pain sensations (analgesia) during
surgery and other medical procedures. Anesthesia also reduces many of your body's
normal stress reactions to surgery.
• Patient’s medical history, including other surgeries the patient have had and any
conditions she/he may have (such as diabetes). They will also be asked whether
they have had any allergic reactions to any anesthetics or medicines or whether
any family members have had reactions to anesthetics.
• The results of their physical examination. A physical exam will be done to
evaluate the patient’s current health and identify any potential risks or
complications that may affect anesthesia care.
• Tests such as blood tests or an electrocardiogram (EKG, ECG), if needed.
• The type of surgery the patient will be having.
o The patient needs to be able to lie still and remain calm during surgery
done with local or regional anesthesia.
o Young children usually cannot stay still during surgery and need general
anesthesia.
o Adults who are extremely anxious, in pain, or have muscle disorders also
may have difficulty remaining relaxed and cooperative.
o Some surgical procedures require specific positions that may be
uncomfortable for long periods if the patient remains awake.
o Some procedures require the use of medicines that cause muscle relaxation
and affect the patient’s ability to breathe on his/her own. In such cases, the
patient’s breathing can best be supported if general anesthesia is used.
Based on the patient’s medical condition, his/her anesthesiologist may prefer one type of
anesthesia over another for the surgery. When the risks and benefits of different
anesthesia options are equal, the anesthesiologist may let the patient choose the type of
anesthesia.
Anesthesia methods
I. Administration techniques:
1. Narcotics—Natural opiates
and synthetic opioids have been given to produce analgesia and sedation
preoperatively and postoperatively. In addition, they are used intra-
operatively as supplemental agents and/or in combination with oxygen for
complete anesthesia for short procedures and in patients with little
cardiovascular reserve. The most popular narcotics for general anesthesia
are the opioids fentanyl (sublimaze) and meperidine hydrochloride
(Demerol) and the opiate morphine sulfate.
2. Narcotic reversal (Narcotic
Antagonist)—a narcotic antagonist neutralizes or impedes the action of
another drug. An example is Naloxone hydrochloride (Narcan). It reverses
respiratory depression caused by narcotics.
3. Muscle relaxants—skeletal
muscle relaxant drugs, referred to as neuromuscular blockers, facilitate
muscle relaxation for smoother endotracheal intubations and working
conditions during the surgical procedure.
a. Atracrium besylate
(Tracrium)—with duration of action of about 30 minutes,
atracrium metabolizes more quickly than the other blockers, which
may be an advantage in patients with liver or renal disease.
b. Succinylcholine
chloride (Anectine, Quelicin)—an ultra-short acting synthetic drug
with an onset of action in seconds, succinylcholine produces
paralysis for up to 20 minutes. It is used primarily for endotracheal
intubations.
4. Muscle relaxant reversal agents (Cholinergics)—An example is
neostigmine methylsulfate (prostigmin). It inhibits the destruction of
acetylcholine released from parasympathetic nerves. Use with care in
patients with bronchial asthma, bradycardia, seizure disorders, coronary
artery disease, and hyperthyroidism. It is not for use in patients with
peritonitis or bowel or urinary obstruction.
For some minor procedures, a qualified health professional who is not an anesthesia
specialist may give some limited types of anesthesia, such as procedural sedation.
Procedural sedation combines the use of local anesthesia with small doses of sedative or
analgesic agents (painkillers) to relax you.
A wide variety of medicines are used to provide anesthesia. Their effects can be complex,
and they can interact with other medicines to cause different effects than when they are
used alone. Anyone receiving anesthesia-even procedural sedation-must be monitored
continuously to protect and maintain vital body functions. The complex task of managing
the delivery of anesthesia medicines as well as monitoring your vital functions is done by
anesthesia specialists.
Medicines used for anesthesia help you relax, help relieve pain, induce sleepiness or
forgetfulness, or make you unconscious. Anesthesia medicines include:
• Local anesthetics, such as lidocaine (Xylocaine) or bupivacaine (Marcaine), that
are injected directly into the body area involved in the surgery.
• Intravenous (IV) anesthetics, such as sodium thiopental (Pentothal), midazolam
(Versed), propofol (Diprivan), or fentanyl (Sublimaze), that are given through a
vein.
• Inhalation anesthetics, such as isoflurane and nitrous oxide, that you breathe
through a mask.