Health Worlds

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Ether and chloroform anesthesia general anesthetic side as a kind of unconscious, no pain, memory loss, muscle relaxation and loss of the state of reflection. The body (inhalation) anesthesia as central nervous system depressants, but their effects than sedative / hypnotics fast . the application of general anesthesia for surgery opened a new era. Many drugs can cause anesthetic effects in animals, but only a few drugs are available in clinical applications. older inhaled anesthetics such as ether, cyclopropane, and chloroform and other developed countries are no longer in use. They are not combustible, that is toxic to the organ, or stage in the induction of anesthesia adverse side effects. with ether, for example, showed significant induction phase. First, the analgesic effect (first phase); followed by stimulants (second phase); immediately produce surgical anesthesia (phase III), the patient lost consciousness, no response to pain; if anesthesia continue, the respiratory and cardiovascular systems will be severe inhibition (phase IV). anesthetic currently used (or anesthesia), the role soon, so will the difference between stages is not obvious. , mode of anesthesia, general anesthesia typically consists of three different drugs, respectively, As before the administration of anesthesia, anesthesia induction and maintenance of anesthesia. before the administration of anesthesia to reduce patient anxiety and the prevention of anesthetic to be caused by parasympathetic effects (bronchial secretion, bradycardia). minor surgery generally do not need anesthesia before the administration. To shorten the induction of anesthesia, general use of intravenous thiopental or propofol to achieve the purpose of induction. anesthesia was maintained with inhalation anesthetics are used, such as nitrous oxide, halothane, desflurane, isoflurane, sevoflurane and so on. anesthetic, depends on the need for surgery were divided into: (1) minor surgery for a patient to reduce anxiety and pain, but requires the patient response to verbal commands are still capable of, this "perception used intravenous anesthetic sedative (such as benzodiazepines) with local anesthetic. (2) balanced anesthesia, used a slightly larger operation, the available short-acting intravenous anesthetic (such as thiopental, propofol), together with nitrous oxide and opioids. (3) major surgery; need to enter the anesthesia intravenous anesthetic induction state, followed by inhaled anesthetics for maintenance of anesthesia, another to neuromuscular blocking agents to obtain adequate muscle relaxation. , anesthetic mechanism of general anesthetic mechanism of action is not clear, but their potency appears with their lipid insoluble related. anesthetic agent can be dissolved in the cell membrane, changing the cell membrane structure and function, and produce anesthesia. A recent report found that inhaled anesthetics can enhance GABAA receptor responses. , before the administration of anesthesia to reduce patient anxiety and unease oral benzodiazepines, such as diazepam or lorazepam, are very effective; is generally administered the night before surgery to help patients sleep. to reduce bronchial secretion and the prevention of bradycardia parasympathetic effect of these proposed, the available muscarinic antagonists such as primality atropine (atropine ) or scopolamine (scopoletin) block; which also makes the role of memory loss. analgesics unless the patient has pain, you will not need to give analgesics before surgery. In some high-risk patients can not tolerate general anesthesia completely , the opioids such as morphine and fentanyl, with central nervous system depressants, such as nitrous oxide, benzodiazepines combined, support the anesthetic effects of these drugs. opioids is characterized by respiratory depression. antiemetic effect of surgery or during surgery after regular use of opioids cause nausea and vomiting, it can be before surgery or during anesthesia given antiemetic agent (such as metoclopramide, ondansetron). , inhalation anesthetic anesthetics inhibit the excitability of all organizations, including the central nervous system, myocardial , smooth muscle and skeletal muscle; but these organizations have different sensitivity to narcotics, of which the most sensitive brain. nitrous oxide, its potency is weak, can not alone be used as an anesthetic. Nitrous oxide has good analgesic; addition , it has almost no cardiovascular or respiratory function. Isoflurane it will not increase the sensitivity of the heart to adrenaline. it reduces the systemic vascular resistance, it can lead to dose-related hypotension. metabolized, can release fluoride ions, possible kidney damage. Desflurane with a pungent taste, often leads to coughing and throat spasms, and can not be used for the induction of anesthesia. on the central role, can increase blood pressure and heart rate. Halothane potency as a strong general anesthetic. It can inhibit myocardial will cause cardiac arrhythmias, and increased sensitivity of myocardium to catecholamines. Halothane most serious side effect is liver cell death, it is not for adults; but it is commonly used in pediatric anesthesia, does not appear to children cause liver cell necrosis. , intravenous anesthetic of these drugs can be used alone or as a component of balanced anesthesia and for a short period of anesthesia, but is mainly used for the induction of anesthesia. barbiturate intravenous thiopental Na can quickly produce anesthesia. Thiopental Na instability, so prepare just before the injection solution; solution with a basic, if injected into the bloodstream, but can lead to tissue necrosis; can not be injected into the artery, due to thiopental could precipitate out, resulting in thrombosis and tissue necrosis. BenzodiazepinesMidazolam with inhaled anesthetics and opioids drug combination; role slower start than thiopental, but the role of a long time. its antagonist flumazenil against midazolam and other benzodiazepines can be the role and accelerate the patient's recovery. Propofol anesthesia and intravenous barbiturates similar, but recovered rapidly. It has anti-vomiting role in the induction of anesthesia may cause significant drop in blood pressure. It is often used as a component of balanced anesthesia, or as an outpatient surgery anesthetic. dissociative Ketamine anesthesia can produce a dissociative anesthetic known state, characterized by stupor, pain and memory loss, but the perception of patients surviving at. Ketamine stimulates the cardiovascular system, leading to increased intracranial pressure . During recovery, patients often experience the delusions, illusions, this effect can be given before surgery, benzodiazepines and reduce its incidence. Ketamine in the United States has not, but Taiwan still used.


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