AISYAH BINTI MOHD HAMBALI

2062161029
TUTORIAL 1

1. STAGES OF ANESTHESIA
Guedel's classification, designed by Arthur Ernest Guedel in 1937, describes the four stages of
anesthesia. Modern anesthetics and updated delivery methods have improved the speed of
onset, general safety, and recovery, but the four stages remain essentially the same:
Stage 1, or induction: This phase occurs between the administration of the drug and the loss
of consciousness. The patient moves from analgesia without amnesia to analgesia with amnesia
Stage 2, or excitement stage: The period following a loss of consciousness, characterized by
excited and delirious activity. Breathing and heart rate becomes erratic, and nausea, pupil
dilation, and breath-holding might occur.
Because of irregular breathing and a risk of vomiting, there is a danger of choking. Modern,
fast-acting drugs aim to limit the time spent in stage 2 of anesthesia
Stage 3, or surgical anesthesia: Muscles relax, vomiting stops and breathing is depressed.
Eye movements slow and then cease. The patient is ready to be operated on
Stage 4, or overdose: Too much medication has been administered, leading to brain stem or
medullary suppression. This results in respiratory and cardiovascular collapse.
The anesthetist's priority is to take the patient to stage 3 of anesthesia as quickly as possible
and keep them there for the duration of the surgery.

2. NON-REM SLEEP
During sleep, the brain moves through five different stages. One of these stages is rapid eye
movement (REM) sleep. During this phase, the eyes move rapidly in various directions. The
other four phases are referred to as non-REM (NREM) sleep.
Before entering the REM sleep phase, the body goes through each of the stages of non-REM
sleep. Each stage of NREM lasts for 5-15 minutes.
Stage 1 non-REM sleep - a person in this stage is between being awake and asleep or is in a
state of very light sleep.
Stage 2 non-REM sleep - this stage is characterized by a slightly deeper sleep. Body
temperature drops and heart rate slows down.
Stages 3 and 4 non-REM sleep - a state of deep and restorative sleep known as slow-wave
sleep, or delta sleep. The muscles relax, the supply of blood to the muscles increases, and the
body repairs and grows tissue. Hormones are released and energy stores are replenished.
As people age, they tend to get less NREM sleep. Those under 30 usually experience 2 hours of
restorative sleep nightly while older adults may get just 30 minutes.
AISYAH BINTI MOHD HAMBALI
2062161029
TUTORIAL 1

3. REM SLEEP
The sleep cycle begins with non-REM sleep, before moving into the REM sleep stage. The first
phase of REM usually lasts for 10 minutes, with each phase getting progressively longer. The
final phase of REM sleep may last for up to an hour.
During REM sleep, the body and brain go through several changes, including:
 Rapid movement of the eyes.
 Fast and irregular breathing.
 Increased heart rate (to near waking levels).
 Changes in body temperature.
 Increased blood pressure.
 Brain activity similar to that seen while awake.
 Increased oxygen consumption by the brain.
 Sexual arousal in both men and women.
 Twitching of the face and limbs.
In most people, a state of temporary paralysis is experienced as the brain signals the spinal cord
to cease movement of the arms and legs. This lack of muscle activity is known as atonia, and
it may be a protective mechanism to prevent injury that might be caused by acting out our
dreams.
REM sleep is often associated with very vivid dreams due to the increase in brain activity.
Because the muscles are immobilized yet the brain is very active, this stage of sleep is
sometimes called paradoxical sleep.
According to the National Sleep Foundation, REM sleep is believed to benefit learning,
memory, and mood. It is also thought to contribute to brain development in infants. A lack of
REM sleep may have adverse implications for physical and emotional health.
Research suggests that when people are unable to enter REM sleep, they have difficulty
remembering what they were taught before falling asleep.
One study on rats has shown that just 4 days of REM sleep deprivation affects cell proliferation
in the part of the brain that contributes to long-term memory. It is likely that a combination of
both REM and non-REM sleep is important for learning and memory.
AISYAH BINTI MOHD HAMBALI
2062161029
TUTORIAL 1

REFERENCES:
1. Newman, T. and Deborah Weatherspoon, C. (2018). General anesthesia: Side effects,
risks, and stages. [online] Medical News Today. Available at:
https://www.medicalnewstoday.com/articles/265592.php [Accessed 30 Apr. 2019].
2. Medical News Today. (2017). REM sleep: Definition, functions, the effects of alcohol,
and disorders. [online] Available at:
https://www.medicalnewstoday.com/articles/247927.php [Accessed 30 Apr. 2019].