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4. History :
 1st clinical practise was demonstrated by
Carl koller in 1884
 Effective local anesthetic “ Procaine “
Founded in 1905
 Lidocaine was founded By LOFGREN In
1948 and used by T. GORDH in 1949

5. Not irritant
 Low systemic toxicity
 Short onset of action
 Effective
 No allergic effects / reactions

6.  Local anesthesia is defined as a loss
of sensation in a circumscribe area of
the body caused by inhibition of
conduction process in peripheral
nerves
Types :
 Topical
 Infiltration

7.  Local anesthesia is available
in the form of gel or cream
which can be applied on the
surface of the skin
 Drugs like – lidocaine ,
Tetracaine, cocaine,
benzocaine

8. Local infiltration anesthesia is
the technique of producing loss-
of-sensation restricted to a
superficial, localized area in the
body
 Drugs used like – procaine ,
lidocaine, bupivacaine,
ropivacaine

9. Excision ( I&D)
 Dermatology procedure ( removal of moles)
 Dentistry
 Ansthetic adjuvant
 Biopsy
 Catract procedures

10. Ocular complications – due to inj at wrong site
during dental procedures
 Paresthesia – trauma to nerve
 Facial nerve paralysis – occur when over dose of
anesthesia inj into deep lobe of parotid gland
 Soft tissue injury over lips and mouth
 Hematoma
Pain on injection
 Infection – contaminated drugs / needles
 Edema

12.  General anesthesia is defined as reversible loss of
consciousness / sensation in patient using
anesthetic drug.
Types :
 Balanced anesthesia
 Total inhalational anesthesia
 Total intravenous anesthesia

14. Steps involved :
 Premedication
Preoxygenation
 Induction
Intubation
 Maintanance
 Reversal
Extubation

15. 1. Premedication :
administration of drugs before induction. It is given 40 – 30mins prior
to the surgery
Goals
 Analgesic
 To reduce anxiety
 Decreses secretion
 Facilitate induction
 Prevent post op nausea & vomiting
 Facilitate post op analgesia
Drugs used :
 Benzodiazepines
 Barbiturates
 Glyco ; atropine, ranitidine, metaclopramide

16. 2. Pre oxygenation :
after administration of pre
med, monitoring parameters
are connected and 100% of O2
for 3mins are administered to
reduce the stored nitrogen in
the body to increase the o2
reserve capacity. It is also
known as denitrification

17. 3 . Induction : it refers to transition from an
awake to an anesthetized stage
Routes : IV route and inhalational route
Inhalational :
Agents used – Sevoflurane, desflurane, N20,
halothene
Indications :
Young children’s
 URT and LRT obstruction
 No accessible veins

18. Intravenous :
Drugs used : induction agents + opioids + MR
Properties :
Rapid onset
 Rapid recovery
 Minimal cvs & Rs depression
 No toxic reactions
No excitatory actions ( cough, hiccup)
Technique :
 Access for good iv line
 Preoxy is must and connect monitors
 Doses varies with age and weight
 Slow injection is recommended

19. 4. Intubation :
After the effect of muscle
relaxant and induction agents
patient becomes unconscious
and the next step is to secure
the airway.
Airway is secured by using
endotracheal tube Or LMA
 Position is confirmed by
auscultation and capnography

20. 5. Maintanance :
The phase of anesthesia Is maintained with
33% of O2 + 66% of N20 + inhalational agent
6. Reversal and extubation :
At the end Of surgery, the effect of MR is
reversed by Neo + glyco
Once the pt able to breathe by own check for
vitals, remove the tube and suction the oral
cavity

21. Definition : It is a technique of GA which uses a
combination of agents given oly through IV route
without the Use of inhalational agent except O2 and
air
Indications :
 Malignant hyperthermia
 Long QT syndrome
 H/0 severe PONV
 Tubeless ENT / thoracic surgery.
 Difficult intubation

22. Drugs : propofol, ketamine, etomidate, fentanyl
Adv:
 No mask over face
 No risk of hyperthermia
 No incidence of PO delirium
 Less PONV
 Less OR pollution
Disadv :
 Pain
 Difficult finding vein.
 Diff in obese pt
 Risk of bac contamination

23. It refers to the delivery of gases / vapours to
respiratory system to produce anesthesia
Indications :
 For IV cannulation in pediatric
 Control of status epilepticus
 Pt with difficult IV line

24. Advantages :
 Easy to administer
 Rapid induction
 Easy and cheap
 no cvs and rs depression
 No toxic effects
 No post op pain
Disadvantage :
 Adverse drug effects
 Nephrotoxicity, hepatotoxicity
 PONV
 Post op hyperthermia

25. Intra op :
 Chances of aspirations,
 Trauma to lips , teeth and tongue
 Hypoxia and hemodynamics changes due to drug
 Less / over fluid administration
 Anemia
 Air embolism

26. Post op :
 Inadequate reversal
 Laryngospasm
 Bronchospasm
Bradycardia
 Urine retention
Delayed :
 Sore throat
Cough
 Tracheitis
 Hoarseness of voice

28. It is the use of LA to block the sensation of pain
from a Larger region / particular region of the body,
such as arm / leg or abdomen.
Types :
 Neuraxial block
 Peripheral nerve block
 Iv regional

30. It refers to the local
anesthetic placed
around the nerves of
CNS such as spinal,
caudal and epidural
anesthesia

31. SPINAL ANESTHESIA
 Skin
 Subcutaneous tissue
 Supraspinous ligaments
 Interspinous ligaments
 Ligamentum flavum
 Durameter
 Sub dural space
 Arachnoid space
 Subarachnoid space

32. Technique involves 4 P’s
Preparation
Position
Projection
puncture

33.  Spinal tray
 Sterile gloves
 I v lines
 LA with 2 ml syringe
 Spinal drug ( bupi heavy 0.5% )
 5ml syringe
 Spinal needles
betadine solution

34.  Sitting position
 Lateral position

35. Assess for the correct site
 Clean the area
 Feel lumbar
 Inject LA
 After 2 – 3 mins introduce spinal needle
 Remove stylet wait for CSF flow
 Inject bupi and ask pt to lie immediately
 Check for dermatome level

37. It is used to detect the spread of spinal
anesthesia In patient
T10 – umbilicus
T4 – nipples
T6 – xiphoid
T12 – L1 – inguinal
S2- s4 - perineum

38. Types :
Dura cutting - Quincke & pitkin
Dura separating – whitacre
Sizes : 18 – 26 G
18 --- pink 22 – black 26 – brown
19 – ivory 23 – blue
20 – yellow 25 – orange

39. Advantages :
 Cheap
 High patient satisfaction
 Maintain pt airway
 Decresed blood loss
Disadvantage :
 Difficult in elder
 Hypotension
Pt can talk
 Pt increase toxicity

40. Contraindications :
 Hypovolemia
 Patient refusal
 Sepsis
 Increased Intracranial pressure
 Neuro disorder
 Spine deformities
Complications :
 Bleeding
 PDPH
 Total spinal

41. EPIDURAL ANESTHESIA..
An anesthetic drug is injected into the epidural space
surrounding the fluid filled sac around the spine to
numb the larger region eg. Abdomen and legs
Layers piercing :
Skin
Subcutaneous tissue
Supraspinous ligaments
Interspinous ligaments
Ligamentum flavum
Duramater

42.  Inform consent
 Sterile epidural tray & gloves
 NS 100ml
Betadine solution
Plaster
 10,2ml syringe
 Epidural set
 Iv line and set
 Needles, syringes
Drugs – bupivacaine 0.5, lignocaine 2.0, LA with
adrenaline, opioid

43.  Sitting
Lateral

44. Monitor vitals
 Prepare and clean
 Feel lumbar and inject LA
 Needle introduction ( L3 – L4)
Once space confirm introduce 2-
3ml of LA with adrenaline and
insert the cathether
 Fix the cathether and bac filter
carefully

45.  Hanging drop method
 Loss of resistance

46. All operation below diaphragm
 Poor risk patient
 Cardiac and pulmo disease
 GA contraindicated
 Long duration surgery
 Post operative pain relief ( drug infusion)
 Risk in Ceaserean

47. Patient refusal
 Coagulopathy
 Infection at needle site
 Hypovolemia
 Neurological disease
Aortic stenosis
 Increased ICP

48. Anaphylaxis
 Pain
Hypotension
Bradycardia
 Hypothermia
 Nerve damage
 Respiratory failure
Infection
Urinary retention

50. Caudal anaesthesia, is a form
of neuraxial regional
anaesthesia conducted by
accessing the epidural space via
the sacral hiatus. It is typically
used in paediatrics to provide
peri- and post-operative
analgesia for surgeries below
the umbilicus. In adults it is
used for anorectal surgeries

51.  Anesthesia and analgesia below
umblicus
To treat chronic pain in adults
 Ano rectal surgeries in adult
 Pediatric and neonatal
 Inguinal herniorraphy

52.  Infection at needle site
 Coagulopathy
 Pilonidal cyst
 Congenital abnormalities of lower spine
 Meninges

53.  Prone
 Semi prone
Lateral

59.  Intraosseous Injection
 Sepsis
Hematoma
 Urinary retention

61. It is defined as a local
anesthesia induced
blockage of peripheral
nerve impulses from a
targeted body part with
a preserved level of
consciousness

62.  Truncal --- paravertebral
--- Transabdominal plane block
 Plexuses --- brachial
---- lumbar
 Distal
 Topical

63.  No GA complications
 Patient remains awake
 Post op analgesia is maintained with
cathether
 Less PONV – less opioids
 Hemodynamic stability is maintained
 Growing technique

64.  Time delay
 Discomfort during procedure
 Block failure can occur
 Nerve damage
 LA toxicity
 Seizures – in case of any arterial blockage

65.  Pt refusal
 Hemophilia
 Anticoagulant drug
 Infection at site
 LA allergy
 Pediatric patients
 Blood stream infection
 Peripheral neuropathy
 Uncooperative patient

67.  This technique was first
introduced in 1908 by a
surgeon August bier
 Bier block is a technique of
injecting Local anesthesia
solution through intravenous
route

68.  Surgical procedures ( arm below
elbow)
 Surgical procedure ( leg below knee)
 Minor surgical procedures
 Burn patient

69.  Pt refusal
 Compound fracture
 Inability to locate IV line
 Local skin infection
 H/0 local anesthesia
allergy
 Patient with vascular
injury
 Sickle cell disease

70.  Easy
 Low incidence of block failure
 Safe technique
 Rapid onset and recovery
Contraindication
 Chances of compartment syndrome