Canis ISSN: 2398-2942

General anesthesia: overview

Synonym(s): Anesthesia, balanced anesthesia, narcosis, intravenous / inhalational anesthesia.

Contributor(s): John Dodam, Marieke de Vries

Introduction

  • Anesthesia means 'without feeling'; includes without pain.
  • Is used to describe the loss of sensation to the entire or any part of the body.
  • Reversible, controlled process of intoxication of the central nervous system (CNS).
  • Aims of anesthesia are to prevent awareness of, and response to pain; to provide restraint, immobility and muscle relaxation without creating a risk to the patient's safety.
Always discuss the dangers of anesthesia with the owner in advance - this gives the owner time to ask questions. Give information in a written form to avoid misunderstandings.
  • Emphasize some special risks, eg brachycephalic breeds Anesthesia: breed considerations, individual hypersensitivity; intercurrent or pre-existing conditions.
  • Conditions which relate to prognosis, eg diabetes, cardiac dysfunction, renal or hepatic insufficiency merit special mention.

Indications

  • Restraint, eg for diagnostic procedures.
  • To allow surgery that would otherwise cause pain.
  • Legal requirement, eg experimental animals.
  • Capture, handling of wild animals.

Mechanisms

  • Volatile agents: largely unknown.
  • Some anesthetics act at receptors, enhancing inhibitory pathways (ie propofol Propofol and alfaxalone Alfaxalone).
  • Ketamine Ketamine:  multiple binding sites, including NMDA-receptors (antagonist).
  • Some probably disrupt membranes, affecting ion channels/receptors (volatile agents).

Measurement of anesthesia

  • Depth of anesthesia (developed by John Snow) describes the signs and stages of ether anesthesia, based on observations of the patient (viz ocular reflexes, nature of breathing). Correlation of changing physical signs with anesthetic depth progression.

Stages of ether anesthesia (now historic), based on original observations by Guedel

  • I: induction or voluntary excitement stage.
  • II: involuntary excitement.
  • III: surgical anesthesia: divided into planes 1-3 (or 4) of light to deep surgical anesthesia.
  • IV: overdose → excessive central nervous system and cardiovascular function.
  • Assumes linear effect of anesthesia, all anesthetics have same action.
  • Different agents have different effects, eg greater respiratory depression with halothane than ether.
  • Anesthesia is a dynamic state, depends on all inputs/overall result on brain.
  • Modern techniques include various drugs affecting autonomic nervous system (balanced anesthesia), making Guedel's classification less reliable.

Modern methods of measurement

  • Absence of spontaneous movements. jaw tone.
  • Ocular: reflexes and position - presence of palpebral and corneal reflexes, nystagmus. (Do not check corneal reflexes as this could result in trauma to the cornea.)
  • Cardiovascular: heart rate and rhythm, blood pressure, cardiac output, etc. Most inhalation agents produce dose dependent depression of cardiovascular function Anesthetic monitoring: overview.
  • Respiratory: rate and tidal volume - minute ventilation, arterial carbon dioxide and oxygen tensions, and hemoglobin saturation. Most inhalation agents produce dose dependent depression of respiratory function.
  • End-tidal inhalation agent concentration indicates relative depth for inhalation agent of known MAC (minimum alveolar concentration).
  • Plasma: concentrations of intravenous agents of known pharmacokinetics.
  • Electroencephalogram: brain electrical activity with surface electrodes. Depth of anesthesia/anesthetic agents used produce characteristic patterns of electrical activity.
Print off the owner factsheet All about anaesthesia All about anaesthesia to give to your client.

Balanced anesthesia

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Adverse effects of anesthesia

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Methods for general anesthesia

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Anesthetic records and patient safety checklist

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Further Reading

Publications

Refereed papers
  • Recent references from VetMed Resource and PubMed.
  • Brodbelt D C, Blissitt K J, Hammond R A et al (2008) The risk of death: the confidential enquiry into perioperative small animal fatalities. Vet Anaesth Analg 35, 365-373 PubMed.
  • Hall L W & Weaver B M Q (1954)Some notes on balanced anesthesia for the dog and cat. Vet Rec66, 289-293.

Other sources of information

  • Duke-Novakovski T, de Vries M, Seymour C (2016) BSAVA Manual of Canine and Feline Anaesthesia and Analgesia 3rd edn. BSAVA Quedgeley, UK.
  • Grimm K A, Lamont L A, Tranquilli W J, Greene S A & Robertson S A (2015) Lumb and Jones' Veterinary Anesthesia and Analgesia 5th edn. Wiley Blackwell, Ames, IA, USA.
  • Clarke K W, Trim C W, Hall L W (2014) Veterinary Anaesthesia. 11th edn. Saunders Elsevier, London, UK.


ADDED