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| Name = General anaesthesia
| Image = Ana arbeitsplatz.JPG
| Caption = Equipment used for anaesthesia in the operating
| ICD10 =
| ICD9 =
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In the 20th century, the safety and efficacy of general anaesthesia was improved by the routine use of [[tracheal intubation]] and other advanced [[airway management]] techniques. Significant advances in [[Medical monitor|monitoring]] and new [[anesthetic|anaesthetic agents]] with improved [[Pharmacokinetics|pharmacokinetic]] and [[Pharmacodynamics|pharmacodynamic]] characteristics also contributed to this trend. Finally, standardized training programs for anaesthesiologists and [[nurse anesthetist|nurse anaesthetist]]s emerged during this period.
== Purpose and
'''<big><u>Purpose of
General anesthesia serves as a critical tool in surgical practice, facilitating procedures by inducing a state of reversible unconsciousness in patients. Its primary objectives encompass ensuring patient safety, comfort, and pain relief throughout the surgical process.
'''Induction of
An essential aspect of general anesthesia is the induction of complete unconsciousness, rendering patients oblivious to sensory stimuli and surgical events. This profound state of unawareness is achieved through the administration of pharmacological agents targeting the central nervous system, effectively suppressing consciousness and perception.
'''Analgesia and
In addition to inducing unconsciousness, general anesthesia provides effective analgesia to eliminate intraoperative pain. By interrupting the transmission of nociceptive signals within the nervous system, specialized medications mitigate surgical discomfort, enhancing patient comfort and expediting postoperative recovery.
'''Muscle
General anesthesia induces muscle relaxation and abolishes reflex responses, optimizing surgical conditions for precise intervention. This relaxation of skeletal muscles assists surgeons in executing procedures with meticulous precision, ensuring optimal outcomes and minimizing the risk of intraoperative complications.
'''Overall
General anesthesia plays a pivotal role in maintaining physiological stability during surgery, attenuating stress responses and preserving hemodynamic equilibrium. Anesthesiologists vigilantly monitor patients' vital signs and administer medications as necessary to mitigate adverse physiological reactions, promoting procedural safety and minimizing perioperative risks.
'''Psychosocial
Addressing psychosocial concerns and managing anxiety are integral components of perioperative care, particularly in patients facing challenges with stress tolerance or immobility. General anesthesia may be warranted for individuals with movement disorders, while elective use can alleviate anxiety in patients with learning disabilities or severe apprehension. Implementing a patient-centered approach, interdisciplinary collaboration, and comprehensive support are essential strategies for optimizing patient experience and surgical outcomes.<ref name=":12">{{Cite book |title=Miller's anesthesia |date=2020 |publisher=Elsevier |isbn=978-0-323-59604-6 |editor-last=Gropper |editor-first=Michael A. |edition=Ninth |location=Philadelphia, PA}}</ref><ref name=":13">{{Cite book |title=Stoelting's anesthesia and co-existing disease |date=2018 |publisher=Elsevier |isbn=978-0-323-40137-1 |editor-last=Hines |editor-first=Roberta L. |edition=Seventh |location=Philadelphia, PA |editor-last2=Marschall |editor-first2=Katherine E.}}</ref><ref name=":14">{{Cite book |title=Clinical anesthesia |date=2017 |publisher=Wolters Kluwer |isbn=978-1-4963-3700-9 |editor-last=Barash |editor-first=Paul G. |edition=Eighth |location=Philadelphia Baltimore New York London Buenos Aires |editor-last2=Cullen |editor-first2=Bruce F. |editor-last3=Stoelting |editor-first3=Robert K. |editor-last4=Cahalan |editor-first4=Michael K. |editor-last5=Stock |editor-first5=M. Christine |editor-last6=Ortega |editor-first6=Rafael |editor-last7=Sharar |editor-first7=Sam R. |editor-last8=Holt |editor-first8=Natalie F.}}</ref>
'''<u><big>Indications for
General anesthesia is employed in a variety of medical situations to ensure patient comfort, safety, and successful procedural outcomes. Understanding the indications for general anesthesia is essential for healthcare providers to make informed decisions and optimize patient care.
'''Surgical
'''Complex
'''Emergency
'''Pediatric
'''Obstetric
'''Special
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One commonly used premedication is [[clonidine]], an [[Alpha-adrenergic agonist#α2 agonists|alpha-2 adrenergic agonist]].<ref>{{cite journal | vauthors = Bergendahl H, Lönnqvist PA, Eksborg S | title = Clonidine in paediatric anaesthesia: review of the literature and comparison with benzodiazepines for premedication | journal = Acta Anaesthesiologica Scandinavica | volume = 50 | issue = 2 | pages = 135–143 | date = February 2006 | pmid = 16430532 | doi = 10.1111/j.1399-6576.2006.00940.x | s2cid = 25797363 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Dahmani S, Brasher C, Stany I, Golmard J, Skhiri A, Bruneau B, Nivoche Y, Constant I, Murat I | display-authors = 6 | title = Premedication with clonidine is superior to benzodiazepines. A meta analysis of published studies | journal = Acta Anaesthesiologica Scandinavica | volume = 54 | issue = 4 | pages = 397–402 | date = April 2010 | pmid = 20085541 | doi = 10.1111/j.1399-6576.2009.02207.x | s2cid = 205430269 | doi-access = free }}</ref> It reduces postoperative shivering, [[postoperative nausea and vomiting]], and emergence [[delirium]].<ref name=":11" /> However, a randomized controlled trial from 2021 demonstrated that clonidine is less effective at providing anxiolysis and more sedative in children of preschool age. Oral clonidine can take up to 45 minutes to take full effect,<ref>{{Cite journal |last1=Bromfalk |first1=Åsa |last2=Myrberg |first2=Tomi |last3=Walldén |first3=Jakob |last4=Engström |first4=Åsa |last5=Hultin |first5=Magnus |date=November 2021 |editor-last=Cravero |editor-first=Joseph |title=Preoperative anxiety in preschool children: A randomized clinical trial comparing midazolam, clonidine, and dexmedetomidine |journal=Pediatric Anesthesia |language=en |volume=31 |issue=11 |pages=1225–1233 |doi=10.1111/pan.14279 |pmid=34403548 |s2cid=237197251 |issn=1155-5645|doi-access=free }}</ref> The drawbacks of clonidine include [[hypotension]] and [[bradycardia]], but these can be advantageous in patients with hypertension and tachycardia.<ref>{{cite journal | vauthors = Henry RG, Raybould TP, Romond K, Kouzoukas DE, Challman SD | title = Clonidine as a preoperative sedative | journal = Special Care in Dentistry | volume = 38 | issue = 2 | pages = 80–88 | date = March 2018 | pmid = 29364538 | doi = 10.1111/scd.12269 | s2cid = 3875130 }}</ref> Another commonly used alpha-2 adrenergic agonist is dexmedetomidine, which is commonly used to provide a short term sedative effect (<24 hours). [[Dexmedetomidine]] and certain [[atypical antipsychotic]] agents may be also used in uncooperative children.<ref>{{Cite journal |last1=Manning |first1=Alexander N. |last2=Bezzo |first2=Leah K. |last3=Hobson |first3=Jamie K. |last4=Zoeller |first4=Justine E. |last5=Brown |first5=Courtney A. |last6=Henderson |first6=Kristin J. |date=October 2020 |title=Dexmedetomidine Dosing to Prevent Pediatric Emergence Delirium |url=https://pubmed.ncbi.nlm.nih.gov/32990204 |journal=AANA Journal |volume=88 |issue=5 |pages=359–364 |issn=2162-5239 |pmid=32990204}}</ref>
Benzodiazepines are the most commonly used class of drugs for premedication. The most commonly utilized benzodiazepine is [[Midazolam]], which is characterized by a rapid onset and short duration. Midazolam is effective in reducing [[Preoperational anxiety|preoperative anxiety]], including [[Separation anxiety disorder|separation anxiety]] in children.<ref>{{Cite journal |last=El Batawi |first=Hisham Yehia |date=2015 |title=Effect of preoperative oral midazolam sedation on separation anxiety and emergence delirium among children undergoing dental treatment under general anesthesia |journal=Journal of International Society of Preventive & Community Dentistry |volume=5 |issue=2 |pages=88–94 |doi=10.4103/2231-0762.155728 |issn=2231-0762 |pmc=4415335 |pmid=25992332 |doi-access=free }}</ref> It also provides mild sedation, [[sympathicolysis]], and [[anterograde amnesia]].<ref name=":11" />
[[Melatonin]] has been found to be effective as an anaesthetic premedication in both adults and children because of its [[hypnotic]], [[anxiolytic]], [[Sedation|sedative]], [[Nociception|analgesic]], and [[anticonvulsant]] properties. Recovery is more rapid after premedication with melatonin than with midazolam, and there is also a reduced incidence of post-operative [[Psychomotor agitation|agitation]] and delirium.<ref name="Naguib2007">{{cite journal | vauthors = Naguib M, Gottumukkala V, Goldstein PA | title = Melatonin and anesthesia: a clinical perspective | journal = Journal of Pineal Research | volume = 42 | issue = 1 | pages = 12–21 | date = January 2007 | pmid = 17198534 | doi = 10.1111/j.1600-079X.2006.00384.x | doi-access = free }}</ref> Melatonin has been shown to have a similar effect in reducing perioperative anxiety in adult patients compared to benzodiazepine.<ref>{{cite journal | vauthors = Madsen BK, Zetner D, Møller AM, Rosenberg J | title = Melatonin for preoperative and postoperative anxiety in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | pages = CD009861 | date = December 2020 | issue = 12 | pmid = 33319916 | pmc = 8092422 | doi = 10.1002/14651858.CD009861.pub3 }}</ref>
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