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Chapter 9 - Anesthesia Techniques: General Anesthesia Techniques in Clinical Practice

Published online by Cambridge University Press:  24 May 2023

Alan David Kaye
Affiliation:
Louisiana State University School of Medicine
Richard D. Urman
Affiliation:
Brigham and Women’s Hospital, Boston
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Summary

Preoperatively, the patient will transition from different depths of anesthesia, including the levels of sedation, to general anesthesia (GA). Sedation is a continuum of symptoms that range from minimal symptoms of anxiolysis to symptoms of moderate and deep sedation. Moderate sedation is defined by the patient remaining asleep, but being easily arousable. Deep sedation is achieved when the patient is only arousable to painful stimulation. GA refers to medically induced loss of consciousness with concurrent loss of protective reflexes and skeletal muscle relaxation. GA is most commonly achieved via induction with intravenous sedatives and analgesics, followed by maintenance of volatile anesthetics [1]. Table 9.1 lists the depths of anesthesia and associated characteristics.

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Publisher: Cambridge University Press
Print publication year: 2023

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References

El-Orbany, M, Woehlck, HJ. Difficult mask ventilation. Anesth Analg. 2009;109(6):1870–80. DOI: 10.1213/ANE.0b013e3181b5881c.CrossRefGoogle ScholarPubMed
Gordon, J, Cooper, RM, Parotto, M. Supraglottic airway devices: indications, contraindications and management. Minerva Anestesiol. 2018;84(3):389–97. DOI: 10.23736/S0375-9393.17.12112-7.CrossRefGoogle ScholarPubMed
Hernandez, MR, Klock, PA, Ovassapian, A. Evolution of the extraglottic airway: a review of its history, applications, and practical tips for success. Anesth Analg. 2012;114(2):349–68. DOI: 10.1213/ANE.0b013e31823b6748.CrossRefGoogle ScholarPubMed
Haas, CF, Eakin, RM, Konkle, MA, Blank, R. Endotracheal tubes: old and new. Respir Care. 2014;59(6):933–55. DOI: 10.4187/respcare.02868.CrossRefGoogle ScholarPubMed
Malhotra, SK. Practice guidelines for management of the difficult airway. In: Malhotra, SK, Kumra, VP, Radhakrishnan, B, Basu, SM, eds. Practice Guidelines in Anesthesia. New Delhi: Jaypee Brothers Medical Publishers; 2016, pp. 127–31. DOI: 10.5005/jp/books/12644_18.Google Scholar
Gray, AW. Endotracheal tubes. Clin Chest Med. 2003;24(3):379–87. DOI: 10.1016/S0272-5231(03)00052-2.CrossRefGoogle ScholarPubMed
Hurford, WE. Techniques for endotracheal intubation. Int Anesthesiol Clin. 2000;38(3):128. DOI: 10.1097/00004311-200007000-00003.CrossRefGoogle ScholarPubMed
Cooper, RM. Strengths and limitations of airway techniques. Anesthesiol Clin. 2015;33(2):241–55. DOI: 10.1016/j.anclin.2015.02.006.CrossRefGoogle ScholarPubMed
Koerner, IP, Brambrink, AM. Fiberoptic techniques. Best Pract Res Clin Anaesthesiol. 2005;19(4):611–21. DOI: 10.1016/j.bpa.2005.07.006.CrossRefGoogle ScholarPubMed
Walton, TEF, Palmer, J. Maintenance of anaesthesia. Anaesth Intensive Care Med. 2020;21(3):121–6. DOI: 10.1016/j.mpaic.2019.12.007.CrossRefGoogle Scholar
Brown, EN, Pavone, KJ, Naranjo, M. Multimodal general anesthesia: theory and practice. Anesth Analg. 2018;127(5):1246–58. DOI: 10.1213/ANE.0000000000003668.CrossRefGoogle ScholarPubMed
McKay, RE. Inhaled anesthetics. In: Pardo, MC Jr, Miller, RD, eds. Basics of Anesthesia, 7th ed. Philadelphia, PA: Elsevier; 2018, pp. 83103. DOI: 10.1016/B978-0-323-40115-9.00007-4.Google Scholar
Perouansky, M, Pearce, RA, Hemmings, HC, Franks, NP. Inhaled anesthetics: Mechanisms of action. In: Gropper, MA, ed. Miller’s Anesthesia, 9th ed. Philadelphia, PA: Elsevier; 2020, pp. 487508. DOI: 10.1016/B978-0-323-59604-6.00019-5.Google Scholar
Naguib, M, Lien, C, Meistelman, C. Pharmacology of neuromuscular blocking drugs. In: Miller, RD, Eriksson, LI, Fleisher, LA, Wiener-Kronish, JP, Cohen, NH, Young, WL, eds. Miller’s Anesthesia, 8th ed. Philadelphia, PA: Elsevier Saunders; 2014, pp. 958–94. DOI: 10.1016/B978-0-323-40115-9.00011-6.Google Scholar
American Society of Anesthesiologists. Standards for basic anesthetic monitoring. 2020. Available from: www.asahq.org/standards-and-guidelines/standards-for-basic-anesthetic-monitoring.Google Scholar
Manohar, M, Gupta, B, Gupta, L. Closed-loop monitoring by anesthesiologists – a comprehensive approach to patient monitoring during anesthesia. Korean J Anesthesiol. 2018;71(5):417–18. DOI: 10.4097/kja.d.18.00033.CrossRefGoogle ScholarPubMed
Checketts, MR, Alladi, R, Ferguson, K, et al. Recommendations for standards of monitoring during anaesthesia and recovery 2015: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2016;71(1):8593. DOI: 10.1111/anae.13316.CrossRefGoogle ScholarPubMed
Association of Anaesthetists. Checking anaesthetic equipment. 2012. Available from: https://anaesthetists.org/Home/Resources-publications/Guidelines/Checking-Anaesthetic-Equipment.Google Scholar
Sessler, DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology. 2008;109(2):318–38. DOI: 10.1097/ALN.0b013e31817f6d76.CrossRefGoogle ScholarPubMed
Difficult Airway Society Extubation Guidelines Group; Popat, M, Mitchell, V, Dravid, R, et al. Guidelines Difficult Airway Society guidelines for the management of tracheal extubation. Anaesthesia. 2012;67(3):318–40. DOI: 10.1111/j.1365-2044.2012.07075.x.Google Scholar
Bala Bhaskar, S. Emergence from anaesthesia: have we got it all smoothened out? Indian J Anaesth. 2013;57(1):13. DOI: 10.4103/0019-5049.108549.CrossRefGoogle Scholar
Miller, KA, Harkin, CP, Bailey, PL. Postoperative tracheal extubation. Anesth Analg. 1995;80(1):149–72. DOI: 10.1097/00000539-199501000-00025.Google ScholarPubMed
Murphy, GS, Szokol, JW, Marymont, JH, Franklin, M, Avram, MJ, Vender, JS. Residual paralysis at the time of tracheal extubation. Anesth Analg. 2005;100(6):1840–5. DOI: 10.1213/01.ANE.0000151159.55655.CB.CrossRefGoogle ScholarPubMed
Krause, M, McWilliams, SK, Bullard, KJ, et al. Neostigmine versus sugammadex for reversal of neuromuscular blockade and effects on reintubation for respiratory failure or newly initiated noninvasive ventilation: an interrupted time series design. Anesth Analg. 2020;131(1):141–51. DOI: 10.1213/ANE.0000000000004505.CrossRefGoogle ScholarPubMed
Naguib, M. Sugammadex: another milestone in clinical neuromuscular pharmacology. Anesth Analg. 2007;104(3):575–81. DOI: 10.1213/01.ane.0000244594.63318.fc.CrossRefGoogle ScholarPubMed
Ali, HH, Savarese, JJ, Lebowitz, PW, Ramsey, FM. Twitch, tetanus and train-of-four as indices of recovery from nondepolarizing neuromuscular blockade. Anesthesiology. 1981;54(4):294–7. DOI: 10.1097/00000542-198104000-00007.CrossRefGoogle ScholarPubMed
Kopman, AF, Yee, PS, Neuman, GG. Relationship of the train-of-four fade ratio to clinical signs and symptoms of residual paralysis in awake volunteers. Anesthesiology. 1997;86(4):765–71. DOI: 10.1097/00000542-199704000-00005.CrossRefGoogle ScholarPubMed

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