Anesthesia, General Health Article

Definition

General anesthesia is the induction of a balanced state of unconsciousness, accompanied by the absence of pain sensation and the paralysis of skeletal muscle over the entire body. It is induced through the administration of anesthetic drugs and is used during major surgery and other invasive surgical procedures.

Purpose

General anesthesia is intended to bring about five distinct states during surgery:

• analgesia, or pain relief
• amnesia, or loss of memory of the procedure
• loss of consciousness
• motionlessness
• weakening of autonomic responses

Precautions

A complete medical history, including a history of allergies in family members, is an important precaution. Patients may have a potentially fatal allergic response to anesthesia known as malignant hyperthermia, even if there is no previous personal history of reaction.

General anesthetics should be administered only by board-certified medical professionals. Anesthesia providers consider many factors, including a patient's age, weight, allergies to medications, medical history, and general health when deciding which anesthetic or combination of anesthetics to use. The American Society of Anesthesiologists has compiled guidelines for classifying patients according to risk levels as follows:

• I: healthy patient
• II: patient with mild systemic disease without functional limitations
• III: patient with severe systemic disease with definite functional limitations
• IV: patient with severe systemic disease that is life-threatening
• V: dying patient not expected to survive for 24 hours without an operation

Equipment for general anesthesia should be thoroughly checked before the operation; all items that might be needed, such as extra tubes or laryngoscope blades, should be available. Staff members should be knowledgeable about the problems that might arise with the specific anesthetic being used, and be able to recognize them and respond appropriately. General anesthetics cause a lowering of the blood pressure (hypotension), a response that requires close monitoring and special drugs to reverse it in emergency situations.

Description

General anesthetics may be gases or volatile liquids that evaporate as they are inhaled through a mask along with oxygen. Other general anesthetics are given intravenously. The amount of anesthesia produced by inhaling a general anesthetic can be adjusted rapidly, if necessary, by adjusting the anesthetic-to-oxygen ratio that is inhaled by the patient. The degree of anesthesia produced by an intravenously injected anesthetic cannot be changed as rapidly and must be reversed by administration of another drug.

The precise mechanism of general anesthesia is not yet fully understood. There are, however, several hypotheses that have been advanced to explain why general anesthesia occurs. The first, the so-called Meyer-Overton theory, suggests that anesthesia occurs when a sufficient number of molecules of an inhalation anesthetic dissolve in the lipid cell membrane. The second theory maintains that protein receptors in the central nervous system are involved, in that inhalation anesthetics inhibit the enzyme activity of proteins. A third hypothesis, proposed by Linus Pauling in 1961, suggests that anesthetic molecules interact with water molecules to form clathrates (hydrated microcrystals), which in turn inhibit receptor function.

Stages of anesthesia

There are four stages of general anesthesia that help providers to better predict the course of events, from anesthesia induction to emergence.

• Stage I begins with the induction of anesthesia and ends with the patient's loss of consciousness. The patient still feels pain in Stage I.
• Stage II, or REM stage, includes uninhibited and sometimes dangerous responses to stimuli, including vomiting and uncontrolled movement. This stage is typically shortened by administering a barbiturate, such as sodium pentothal, before the anesthetic agent.
• Stage III, or surgical anesthesia, is the stage in which the patient's pupillary gaze is central and the pupils are constricted. This is the target depth of surgical anesthesia. During this stage, the skeletal muscles relax, the patient's breathing becomes regular, and eye movements stop.
• Stage IV, or overdose, is marked by hypotension or circulatory failure. Death may result if the patient cannot be revived quickly.