Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-17T13:54:46.522Z Has data issue: false hasContentIssue false

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

Published online by Cambridge University Press:  24 May 2023

By
Mark R. Jones ,
Edward S. Alpaugh ,
Boris C. Anyama ,
Chikezie N. Okeagu ,
Meredith K. Shaw ,
Madelyn K. Craig  and
Alan David Kaye
Edited by
Alan David Kaye  and
Richard D. Urman
Alan David Kaye
Affiliation:
Louisiana State University School of Medicine
Richard D. Urman
Affiliation:
Brigham and Women’s Hospital, Boston
Get access

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.

Type
Chapter
Information
Cambridge Handbook of Anesthesiology , pp. 131 - 150
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

El-Orbany, M, Woehlck, HJ. Difficult mask ventilation. Anesth Analg. 2009;109(6):1870–80. DOI: 10.1213/ANE.0b013e3181b5881c.Google Scholar
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.Google Scholar
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):1–28. 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. 83–103. 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. 487–508. 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):85–93. 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.Google Scholar
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):1–3. 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 Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×