IntroductionCHAPTER 1

General Anaesthesia is a reversible, drug induced state of unconsciousness. This is another definition that explains what General Anaesthesia is:

Anaesthesiology is a science, that is practiced as an art which provides relief of pain during surgery and postoperative period at the same time taking care of the patient's well-being, simultaneously providing good working condition for the surgeon. This gives adequate explanation about Anaesthesiology.

Now anaesthesiology is a major medical discipline whose boundaries extend far beyond the act of an anaesthetic, and the anaesthesiologist is a highly trained medical specialist.

Unfortunately, anaesthesia has not found its place in many undergraduate curricula. Only very few Universities have included a little of the subject in the syllabus of surgery in the recent years. Postgraduate surgeons are often not taught anaesthesia either, with the result many times the house officers and surgeons don't have the basic information about anaesthesia.

It is quite interesting to note that there are certain things described in the “Holy Bible” which have very high relevance to anaesthesia.

After creating this beautiful world, God created our forefather, the first man of this world “Adam” in his own resemblance from earth, blew into his nose and gave life to him. But when he decided to create a companion for Adam, he did not do it the same way. He did it differently. “He (God) made him (Adam) to go into deep sleep, removed one of his ribs, covered it with flesh and blood, gave life to it and thus created the first woman of this world “Eve”, because the father wanted Eve to be the part and parcel of Adam.

Here the statement “He made him to go into deep sleep, removed one of his ribs” is the words of the Holy Bible. That means Adam was in a state that was similar to a state of anaesthesia – (the word anaesthesia was not coined then) when he did not feel any pain of removal of rib. (Rib resection)

Hence we may take that God almighty anaesthetised Adam and did rib resection on him to create Eve. So according to the Holy Bible, the first surgery known to this world is “Rib resection” and that was done for showing God's everlasting love for mankind. Anaesthetists and surgeons may feel proud about this.

Anaesthesia is the basic requirement for any surgery to be conducted as, any surgical procedure, however, small, it is certain to inflict pain on the patient.

All human beings irrespective of their socio-economic status or any other discrimination have their basic fear about two things; one is fear of pain and the other is fear of death. In day today life, the fear of pain persists even with a very trivial injury, and in the event of illness, that too in an illness associated with need for surgery, they develop these two fears together, that is fear of pain and fear of possible death as a consequence of surgery. The patients when they are questioned many times they refer to this and express this as “fear of the unknown”.

Though physiologically pain is a protective reflex to prevent movements and further damage to injured tissues thereby promoting the healing process, uncontrolled pain of severe degree of any cause is detrimental to the physiology itself. Hence, relief of pain in any form is a heavenly blessing. So relief of pain of surgery is essential both during and after surgery, otherwise irreversible damage may be caused to the individual that may be even fatal.

“The relief of pain is purchased always at a price. The price both in morbidity or mortality does not greatly differ, whatever the agent or agents used”

This statement of Ralph Milton Waters, who was one among the pioneers who had contributed enormously for the development of anaesthesia, is absolutely true as, anaesthesia is a highly interventional speciality meaning thereby, the normal physiology is modified for the sake of relief of pain and for the protection of the patient from the ill effects the pain of surgery. Though this modification of physiology is done with an intention of protecting the patient from the likely damage by the pain and reflexes induced by the surgical procedure, there is always a limit for this modification. This limit of modification of physiological status grossly varies from patient to patient depending upon their physical and physiological status, when crossed, certainly leads onto risk that may be even fatal.

Let us think about this;

Both these things can never happen during normal life, but during anaesthesia a patient is made unconscious and is paralysed. When he stops breathing, to prevent him from dying, the anaesthetist takes over the respiration and ventilates him manually by compressing a bag intermittently till he is back to normal to breath on his own.

Three aspects have to be taken into consideration very carefully before anaesthetizing a patient.

This is the basic concept of anaesthesia and the discussions in the following pages are made only with this orientation.