Anaesthesia
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1
kaf;f kUe;Jfs; Kidtu; f/ kzp gp v!; #p fiy mwptpay; fy;Y}up/ nfhak;g[j;J}h;
,f;fhy kaf;f kUe;Jfs;
<j;ju;; fhyk; ,d;W gadpy; cs;s miu l#d; kaf;f kUe;Jfs; mog;gilapy; 1846 ,y; tpy;ypak; khh;l;ld; (William Morton) vd;gth; gad;gLj;jpa kaf;f kUe;jhfpa <j;jh; vd;w vspjpy; MtpahfptpLk; jputg; bghUisna xj;jpUf;fpd;wd/ ghl;oiyj; jpwe;jJk; fhw;wpy; vspjpy; Mtpahfptplf;Toa epwkw;w jputk; <j;jh; bky;ypa ,dpg;ghd Rit bfhz;lJ/ tpy;;yd; iff;Fl;ilapy; <j;jiu eidj;J fjhehafpapd; Kfj;jpy; itj;J mtis kaf;fkilar; bra;a[k; je;jpuk; giHaJ\ gp!;fl;oy; kUe;ij eidj;Jf; bfhLg;gJ g[jpa je;jpuk;/ Mz;LnjhWk;. E}Wkpy;ypad; ngh;fSf;F kaf;f kUe;J bfhLf;fg;gLfpwJ/ khh;l;lDf;Fg; gpwF kaf;f kUe;J rpfpr;ir Kiwfs; vt;tsnth khwptpl;ld/ kUe;J g[fl;LtJ Kjy;. nehaspiaf; fz;fhzpg;gJ kw;Wk; mtiu vGg;gJ tiuapyhf gy epiyfspy; Vfg;gl;l khw;w';fs; g[Fj;jg;gl;Ltpl;ld/
euk;g[j;jilfs; kaf;f kUe;Jfs; aht[k; euk;g[ kz;lyj;ijj;jhd; Fwpahfitj;Jj; jhf;Ffpd;wd/ euk;g[fs; czh;t[fis Zisf;Ff; flj;jhj tz;zk; gy ,l';fspy; jftiy tHpkwpj;J FWf;fpLfpd;wd/ Rthrk;. ,jaj;Jog;g[ Kjyhd caph;ehor; bray;fs; Zisapd; trk; ,Ug;gjhy; kaf;f kUe;Jfspd; FWf;fPL ,jpYk; ghayhk;/ gytPdkhd ,jaj;Jog;g[. Rthrk; ,Ug;gth;fis kaf;f kUe;J ghjpf;fyhk;/
2 tpgj;jpy; mogl;lth;fSf;F mtru mtrukhf Mg;gnu@d; nkw;bfhs;Sk;nghJ mth;fSf;F ,jak -EiuaPuy; gytPdKs;sjh ,y;iyah vd;bwy;yhk; bjhpe;Jbfhs;s neukpy;yhjjhy; tHf;fj;ijtpl bfh":rk; Fiwthd nlh!: kaf;fkUe;J bfhLg;gJ tHf;fk;/ Kd;igtpl ey;y kUe;Jfs; gad;gLj;JtjhYk;. rpwe;j khdpl;lh;fs; cliy behof;F beho fz;fhzpg;gjhYk; kaf;f kUe;jpdhy; Vw;glf;Toa tpghPj';fs; fzprkhff; Fwie;Jtpl;lJ/ fle;j 15 Mz;Lfspy; 13.000 nfRfspy; xnu xU tpghPjk; jhd; epfH;e;jpUf;fpwJ vd;fpwhh;fs;/ ,jw;FnkYk; ghJfhg;ghd kaf;f kUe;J rpfpr;iria cUthf;fnt KoahJ vd;w epiy Vw;gl;Ltpl;lJ/ ,Ug;gpDk; bghJkaf;f kUe;jpypUe;J tpHpj;jth;fSf;F epidt[rf;jp ,Hg;g[. Zr;Rjpzwy;. g[yzwpt[ Fiwt[ Mfpa gf;f tpist[fis KGtJkhf tp":"hdpfshy; ePf;fKoatpy;iy/
kaf;f kUe;Jfspy; cs;sit kaf;f
kUe;J
fyf;fg;gl;lJjhd;/
vd;gJ
ehd;ife;J
brnl@d;
vdg;gLk;
bghUs;fs; J}f;fk;
Fwpg;gpl;l
(Sedation).
tpfpjj;jpy;
epidt[
,Hg;g[
(Unconsciounes). cly; fl;Lepiy (Immobility) kw;Wk; typ czh;t[ ,Hg;g[ (analgia) Mfpa tpist[fis Vw;gLj;Jk; kUe;Jfs; fye;jJjhd; kaf;f kUe;J/ Mg;gnu@dpd;nghJ ele;jJ vJt[k; gpw;ghL epidt[f;F tuhky; nghtJk;Tl me;j kUe;Jfspd; brayhy;jhd; xt;bthU kUe;Jk; Fwpg;gpl;l euk;g[j; bjhFg;g[ (FLk;g';fs;) fis ,ilkwpf;fpd;wd/ bjspthft[k;. Jy;ypakhft[k; mtw;wpd; bra;Kiw bjhpe;Jtpl;lhy;. mit Vd;. vg;go gf;ftpist[fSf;Ff; fhuzkhfpd;wd vd;gJ g[hpa[k;/ mg;g[wk; mg; gf;ftpist[fs; Vw;gLj;jhj tifapy; kUe;Jfis ek;kp@:lk;nghy totikf;f Koayhk;/
,uz;LtHpfs; kaf;f
kUe;Jfs;
,uz;L
tHpfspy;
g[fl;lg;gLfpd;wd/
Rthrk;
tHpahf
In!h~g[Anud; (Isoflurane) vd;w kUe;jhfg; g[fl;LtJ xU tHp kw;wJ ,uj;jk; tHpahf g;nuhg;ngh~nghy;
(Propofol)
vd;w
kUe;jpd;
Zyk;
tH';FtJ/
,uz;Lk;
~ghh;kf;nfhyh#pf;fy; nfhkh (Pharmacological coma) vd;w jw;fhypf nfhkhepiyiana tH';Ffpd;wd/ nkf;dl;of;
bub!hdd;!;
,nk#p';
(MRI)
kw;Wk;
gh!pl;uhd;
vkp@:@d;
nlhnkhfpuh~gp (PET) vd;fpw glk;gpof;Fk; fUtp Mfpait Zyk; kaf;f epiyapy; Zisapy; ve;bje;j ,l';fs; braypHf;fpd;wd vd;W Muhag;gl;lJ/ kUe;J jz;Ltlj;jpy; bray;gLk;nghJ iffhy; mirt[ Klf;fkilfpwJ/ Raepidt[ ,Hg;g[ vg;go Vw;gLfpd;wJ vd;gJ ,d;dKk; bjspthfj; bjhpatpy;iy/ Raepidt[ vjdhy; Vw;gLfpd;wJ vd;gnj ekf;F Kjypy; bjhpahjjhy; ,ij fz;Lgpog;gJ mj;jid Rygkpy;iy/ Zisapy; cs;s jdpj;jdp m';f';fspd; bray;fs; aht[k; xU';fpizf;Fk; euk;g[g; ghijjhd; Raepidt[f;Ff; fhuzk; vd;gJ xU bfhs;if/ ,e;j xU';fpizg;igj; Jz;oj;Jtpl;lhy; Raepidt[ mWe;JtpLk; vd;gJ ,jpypUe;j ehk; bgWk;
Kot[/
,g;go
mWg;gij
fhf;dpl;ot;
md;igz;o';
(Cognitive
unbinding)
vd;fpwhh;fs;/ bjhiyngrp ,izg;g[fisj; J}z;oj;JtpLtjw;F ,J xg;ghFk;/ ,Jnghf. kaf;f kUe;Jfs; Zisapd; nkhl;lhh; fhh;l;blf;!: gFjpfisa[k; jilbra;tjhy; cly; mirt[ braypHg;gJld;;. bjhL czh;t[fSk; typa[k;
3 kuj;Jg;nghfpwJ/ ,g;gz;g[fs;aht[k; kUe;Jf;F ,Uf;fntz;oaitjhd;/ Mdhy;. ,tw;Wld; epd;Wtplhky; mit ekJ epidt[fs; gjpa[k; ,lkhfpa Zisapd; &pg;nghnfk;g;g!: gFjpiaa[k; jhf;Ftjhy; tpisthf ele;jitaht[k; epidtpy; gjpahky; nghfpwJ / fhkh mikndh g[a{l;lhpf; Mrpl; vd;gJ (Gama amino butyric acid- GABA) euk;g[ bry;fSf;fpilna bray;gLk; euk;g[f;flj;jpg; bghUs;/ euk;g[f;flj;jpfspd; ntiy euk;g[f; fk;gpfspd; tHpna kpd; Jog;g[ flg;gjw;F cWJizahf ,Ug;gJ/ gytpj euk;g[f;flj;jpfs; Zisapy; btt;ntW tif euk;g[g; ghijfspy; kpd;Jog;g[fisf; flj;j cjt[fpd;wd/ epidt[. czh;t[. ngr;R. ghh;it/// Mfpa xt;bthd;Wk; jdpj;jdp euk;g[f;flj;jpfspd; cjtpahy; epfH;fpd;wd/ nkny Twpa `fhgh= -vd;w euk;g[f;flj;jp tpj;jpahrkhdJ/ ,J euk;g[ bry;fspy; gl;lhy;nghJk; me;j euk;g[ bry; kpd;Jog;ig ,He;JtpLk;/ gl;lhRj; jphpapy;
kaf;f kUe;Jfspd; ,af;f';fs; brnl@d; (Sedation) tpHpj;bjH Koahj miuj; J}f;fepiy| tpHpg;g[epiy jLkhWjy;. if fhy; mirt[fs; ke;jkhfpg; nghjy;. tha;FHWjy;. vGe;jpUf;f Koahky; fplj;jy;. Zisapy; fhh;l;blf;!pd; bray;ghLfs; Kl';Fjy;/
epidtpHj;jy; (Unconsciousness) jl;odhy; fps;spdhy; my;yJ Tg;gpl;lhYk; tpHpf;f Koahj epiy/ brnl@idtpl mjpfkhd fhh;l;blf;!; ,af;f';fs; Fiwtjhy;. Zisapd; rfy gFjpfisa[k; xU';fpizf;Fk; ikakhfpa jyhk!py; bray; Fiwjy;
cly; kuf;fl;ilahjy; (Immobility) vd;d bra;jhYk; cliy mirf;f KoahJ fplj;jy;/ NL. Fsph;nghd;w czh;t[fSk; ,y;yhky; kuj;Jg;nghjy;. jz;Ltlk;. brubgy;yk; Mfpa ,uz;oYk; bray;Fiwjy; ,J jw;fhypf guhyp!p!; nghd;wJ/
mk;dPrpah (Amnesia) kwjp kaf;f epiyapy; epfH;e;jtw;iw Kw;wpYk; epidt[gLj;j ,ayhik/ epidt[fis cUthf;Fk; &pg;nghnfk;g;g!;. mkpf;lyh. gphP~gpuhz;ly; fhh;l;blf;!; Mfpait braypHj;jy;/
gpwtpist[fs; jirfs; ,sfpg; nghjy;. typ czuKoahJ cly; kuj;Jg;nghjy; Mfpait jz;Ltlj;jpy; bray; Fiwtjhy; Vw;gLfpwJ/
kaf;f kUe;Jfs; Kidtu; f/ kzp gp v!; #p fiy mwptpay; fy;Y}up/ nfhak;g[j;J}h;
,f;fhy kaf;f kUe;Jfs;
<j;ju;; fhyk; ,d;W gadpy; cs;s miu l#d; kaf;f kUe;Jfs; mog;gilapy; 1846 ,y; tpy;ypak; khh;l;ld; (William Morton) vd;gth; gad;gLj;jpa kaf;f kUe;jhfpa <j;jh; vd;w vspjpy; MtpahfptpLk; jputg; bghUisna xj;jpUf;fpd;wd/ ghl;oiyj; jpwe;jJk; fhw;wpy; vspjpy; Mtpahfptplf;Toa epwkw;w jputk; <j;jh; bky;ypa ,dpg;ghd Rit bfhz;lJ/ tpy;;yd; iff;Fl;ilapy; <j;jiu eidj;J fjhehafpapd; Kfj;jpy; itj;J mtis kaf;fkilar; bra;a[k; je;jpuk; giHaJ\ gp!;fl;oy; kUe;ij eidj;Jf; bfhLg;gJ g[jpa je;jpuk;/ Mz;LnjhWk;. E}Wkpy;ypad; ngh;fSf;F kaf;f kUe;J bfhLf;fg;gLfpwJ/ khh;l;lDf;Fg; gpwF kaf;f kUe;J rpfpr;ir Kiwfs; vt;tsnth khwptpl;ld/ kUe;J g[fl;LtJ Kjy;. nehaspiaf; fz;fhzpg;gJ kw;Wk; mtiu vGg;gJ tiuapyhf gy epiyfspy; Vfg;gl;l khw;w';fs; g[Fj;jg;gl;Ltpl;ld/
euk;g[j;jilfs; kaf;f kUe;Jfs; aht[k; euk;g[ kz;lyj;ijj;jhd; Fwpahfitj;Jj; jhf;Ffpd;wd/ euk;g[fs; czh;t[fis Zisf;Ff; flj;jhj tz;zk; gy ,l';fspy; jftiy tHpkwpj;J FWf;fpLfpd;wd/ Rthrk;. ,jaj;Jog;g[ Kjyhd caph;ehor; bray;fs; Zisapd; trk; ,Ug;gjhy; kaf;f kUe;Jfspd; FWf;fPL ,jpYk; ghayhk;/ gytPdkhd ,jaj;Jog;g[. Rthrk; ,Ug;gth;fis kaf;f kUe;J ghjpf;fyhk;/
2 tpgj;jpy; mogl;lth;fSf;F mtru mtrukhf Mg;gnu@d; nkw;bfhs;Sk;nghJ mth;fSf;F ,jak -EiuaPuy; gytPdKs;sjh ,y;iyah vd;bwy;yhk; bjhpe;Jbfhs;s neukpy;yhjjhy; tHf;fj;ijtpl bfh":rk; Fiwthd nlh!: kaf;fkUe;J bfhLg;gJ tHf;fk;/ Kd;igtpl ey;y kUe;Jfs; gad;gLj;JtjhYk;. rpwe;j khdpl;lh;fs; cliy behof;F beho fz;fhzpg;gjhYk; kaf;f kUe;jpdhy; Vw;glf;Toa tpghPj';fs; fzprkhff; Fwie;Jtpl;lJ/ fle;j 15 Mz;Lfspy; 13.000 nfRfspy; xnu xU tpghPjk; jhd; epfH;e;jpUf;fpwJ vd;fpwhh;fs;/ ,jw;FnkYk; ghJfhg;ghd kaf;f kUe;J rpfpr;iria cUthf;fnt KoahJ vd;w epiy Vw;gl;Ltpl;lJ/ ,Ug;gpDk; bghJkaf;f kUe;jpypUe;J tpHpj;jth;fSf;F epidt[rf;jp ,Hg;g[. Zr;Rjpzwy;. g[yzwpt[ Fiwt[ Mfpa gf;f tpist[fis KGtJkhf tp":"hdpfshy; ePf;fKoatpy;iy/
kaf;f kUe;Jfspy; cs;sit kaf;f
kUe;J
fyf;fg;gl;lJjhd;/
vd;gJ
ehd;ife;J
brnl@d;
vdg;gLk;
bghUs;fs; J}f;fk;
Fwpg;gpl;l
(Sedation).
tpfpjj;jpy;
epidt[
,Hg;g[
(Unconsciounes). cly; fl;Lepiy (Immobility) kw;Wk; typ czh;t[ ,Hg;g[ (analgia) Mfpa tpist[fis Vw;gLj;Jk; kUe;Jfs; fye;jJjhd; kaf;f kUe;J/ Mg;gnu@dpd;nghJ ele;jJ vJt[k; gpw;ghL epidt[f;F tuhky; nghtJk;Tl me;j kUe;Jfspd; brayhy;jhd; xt;bthU kUe;Jk; Fwpg;gpl;l euk;g[j; bjhFg;g[ (FLk;g';fs;) fis ,ilkwpf;fpd;wd/ bjspthft[k;. Jy;ypakhft[k; mtw;wpd; bra;Kiw bjhpe;Jtpl;lhy;. mit Vd;. vg;go gf;ftpist[fSf;Ff; fhuzkhfpd;wd vd;gJ g[hpa[k;/ mg;g[wk; mg; gf;ftpist[fs; Vw;gLj;jhj tifapy; kUe;Jfis ek;kp@:lk;nghy totikf;f Koayhk;/
,uz;LtHpfs; kaf;f
kUe;Jfs;
,uz;L
tHpfspy;
g[fl;lg;gLfpd;wd/
Rthrk;
tHpahf
In!h~g[Anud; (Isoflurane) vd;w kUe;jhfg; g[fl;LtJ xU tHp kw;wJ ,uj;jk; tHpahf g;nuhg;ngh~nghy;
(Propofol)
vd;w
kUe;jpd;
Zyk;
tH';FtJ/
,uz;Lk;
~ghh;kf;nfhyh#pf;fy; nfhkh (Pharmacological coma) vd;w jw;fhypf nfhkhepiyiana tH';Ffpd;wd/ nkf;dl;of;
bub!hdd;!;
,nk#p';
(MRI)
kw;Wk;
gh!pl;uhd;
vkp@:@d;
nlhnkhfpuh~gp (PET) vd;fpw glk;gpof;Fk; fUtp Mfpait Zyk; kaf;f epiyapy; Zisapy; ve;bje;j ,l';fs; braypHf;fpd;wd vd;W Muhag;gl;lJ/ kUe;J jz;Ltlj;jpy; bray;gLk;nghJ iffhy; mirt[ Klf;fkilfpwJ/ Raepidt[ ,Hg;g[ vg;go Vw;gLfpd;wJ vd;gJ ,d;dKk; bjspthfj; bjhpatpy;iy/ Raepidt[ vjdhy; Vw;gLfpd;wJ vd;gnj ekf;F Kjypy; bjhpahjjhy; ,ij fz;Lgpog;gJ mj;jid Rygkpy;iy/ Zisapy; cs;s jdpj;jdp m';f';fspd; bray;fs; aht[k; xU';fpizf;Fk; euk;g[g; ghijjhd; Raepidt[f;Ff; fhuzk; vd;gJ xU bfhs;if/ ,e;j xU';fpizg;igj; Jz;oj;Jtpl;lhy; Raepidt[ mWe;JtpLk; vd;gJ ,jpypUe;j ehk; bgWk;
Kot[/
,g;go
mWg;gij
fhf;dpl;ot;
md;igz;o';
(Cognitive
unbinding)
vd;fpwhh;fs;/ bjhiyngrp ,izg;g[fisj; J}z;oj;JtpLtjw;F ,J xg;ghFk;/ ,Jnghf. kaf;f kUe;Jfs; Zisapd; nkhl;lhh; fhh;l;blf;!: gFjpfisa[k; jilbra;tjhy; cly; mirt[ braypHg;gJld;;. bjhL czh;t[fSk; typa[k;
3 kuj;Jg;nghfpwJ/ ,g;gz;g[fs;aht[k; kUe;Jf;F ,Uf;fntz;oaitjhd;/ Mdhy;. ,tw;Wld; epd;Wtplhky; mit ekJ epidt[fs; gjpa[k; ,lkhfpa Zisapd; &pg;nghnfk;g;g!: gFjpiaa[k; jhf;Ftjhy; tpisthf ele;jitaht[k; epidtpy; gjpahky; nghfpwJ / fhkh mikndh g[a{l;lhpf; Mrpl; vd;gJ (Gama amino butyric acid- GABA) euk;g[ bry;fSf;fpilna bray;gLk; euk;g[f;flj;jpg; bghUs;/ euk;g[f;flj;jpfspd; ntiy euk;g[f; fk;gpfspd; tHpna kpd; Jog;g[ flg;gjw;F cWJizahf ,Ug;gJ/ gytpj euk;g[f;flj;jpfs; Zisapy; btt;ntW tif euk;g[g; ghijfspy; kpd;Jog;g[fisf; flj;j cjt[fpd;wd/ epidt[. czh;t[. ngr;R. ghh;it/// Mfpa xt;bthd;Wk; jdpj;jdp euk;g[f;flj;jpfspd; cjtpahy; epfH;fpd;wd/ nkny Twpa `fhgh= -vd;w euk;g[f;flj;jp tpj;jpahrkhdJ/ ,J euk;g[ bry;fspy; gl;lhy;nghJk; me;j euk;g[ bry; kpd;Jog;ig ,He;JtpLk;/ gl;lhRj; jphpapy;
kaf;f kUe;Jfspd; ,af;f';fs; brnl@d; (Sedation) tpHpj;bjH Koahj miuj; J}f;fepiy| tpHpg;g[epiy jLkhWjy;. if fhy; mirt[fs; ke;jkhfpg; nghjy;. tha;FHWjy;. vGe;jpUf;f Koahky; fplj;jy;. Zisapy; fhh;l;blf;!pd; bray;ghLfs; Kl';Fjy;/
epidtpHj;jy; (Unconsciousness) jl;odhy; fps;spdhy; my;yJ Tg;gpl;lhYk; tpHpf;f Koahj epiy/ brnl@idtpl mjpfkhd fhh;l;blf;!; ,af;f';fs; Fiwtjhy;. Zisapd; rfy gFjpfisa[k; xU';fpizf;Fk; ikakhfpa jyhk!py; bray; Fiwjy;
cly; kuf;fl;ilahjy; (Immobility) vd;d bra;jhYk; cliy mirf;f KoahJ fplj;jy;/ NL. Fsph;nghd;w czh;t[fSk; ,y;yhky; kuj;Jg;nghjy;. jz;Ltlk;. brubgy;yk; Mfpa ,uz;oYk; bray;Fiwjy; ,J jw;fhypf guhyp!p!; nghd;wJ/
mk;dPrpah (Amnesia) kwjp kaf;f epiyapy; epfH;e;jtw;iw Kw;wpYk; epidt[gLj;j ,ayhik/ epidt[fis cUthf;Fk; &pg;nghnfk;g;g!;. mkpf;lyh. gphP~gpuhz;ly; fhh;l;blf;!; Mfpait braypHj;jy;/
gpwtpist[fs; jirfs; ,sfpg; nghjy;. typ czuKoahJ cly; kuj;Jg;nghjy; Mfpait jz;Ltlj;jpy; bray; Fiwtjhy; Vw;gLfpwJ/
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