Anesthesia, or anaesthesia (see spelling differences; from Greek αν- an- “without” + αἲσθησις aisthesis “sensation”), has traditionally meant the condition of having sensation (including the feeling of pain) blocked. American and British English spelling differences are one aspect of American and British English differences. Greek (el ελληνική γλώσσα or simply el ελληνικά — "Hellenic" is an Indo-European language, spoken today by 15-22 million people mainly In Psychology, sensation is the first stage in the biochemical and neurologic events that begins with the impinging of a stimulus upon the receptor cells of a Pain, in the sense of physical pain, is a typical sensory experience that may be described as the unpleasant awareness of a noxious stimulus or bodily harm This allows patients to undergo surgery and other procedures without the distress and pain they would otherwise experience. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental The word was coined by Oliver Wendell Holmes, Sr. in 1846. Oliver Wendell Holmes Sr, (August 29 1809 &ndash October 7 1894 was a Physician by profession but achieved fame as a Writer; he was one of the best Another definition is a "reversible lack of awareness", whether this is a total lack of awareness (e. g. a general anaesthestic) or a lack of awareness of a part of a the body such as a spinal anaesthetic or another nerve block would cause. Anesthesia differs from analgesia in blocking all sensation, not only pain.

Today, the term general anesthesia in its most general form can include:

• Analgesia: blocking the conscious sensation of pain;
• Hypnosis: produces unconsciousness without analgesia;
• Amnesia: preventing memory formation;
• Relaxation: preventing unwanted movement or muscle tone;
• Obtundation of reflexes, preventing exaggerated autonomic reflexes. Consciousness has been defined loosely as a constellation of attributes of Mind such as Subjectivity, Self-awareness, Sentience, and the See also Unconscious mind. Unconsciousness, more appropriately referred to as loss of Consciousness or lack of consciousness is Amnesia (from Greek) is a condition in which Memory is disturbed In Psychology, memory is an organism's ability to store retain and subsequently retrieve information Obtunded refers to a Patient that has less than full Mental capacity, typically as a result of a Medical condition or trauma.

Patients undergoing surgery usually undergo preoperative evaluation. It includes gathering history of previous anesthetics, and any other medical problems, physical examination, ordering required blood work and consultations prior to surgery.

There are several forms of anesthesia. The following forms refer to states achieved by anesthetics working on the brain:

• General anesthesia: "Drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. " Patients undergoing general anesthesia can often neither maintain their own airway nor breathe on their own. While usually administered with inhalational agents, general anesthesia can be achieved with intravenous agents, such as propofol. Intravenous therapy or IV therapy is the giving of Liquid substances directly into a Vein. Propofol is a short-acting Intravenous sedative agent used for the induction of general Anesthesia for adults and children maintenance of general anesthesia and ^[1]
• Deep sedation/analgesia: "Drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. Sedation is a Medical procedure involving the administration of Sedative drugs generally to facilitate a medical procedure with Local anaesthesia. " Patients may sometimes be unable to maintain their airway and breathe on their own. ^[1]
• Moderate sedation/analgesia or conscious sedation: "Drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. " In this state, patients can breathe on their own and need no help maintaining an airway. ^[1]
• Minimal sedation or anxiolysis: "Drug-induced state during which patients respond normally to verbal commands. " Though concentration, memory, and coordination may be impaired, patients need no help breathing or maintaining an airway. ^[1]

The level of anesthesia achieved ranges on a continuum of depth of consciousness from minimal sedation to general anesthesia. The depth of consciousness of a patient may change from one minute to the next.

The following refer to states achieved by anesthetics working outside of the brain:

• Regional anesthesia: Loss of pain sensation, with varying degrees of muscle relaxation, in certain regions of the body. Administered with local anesthesia to peripheral nerve bundles, such as the brachial plexus in the neck. Examples include the interscalene block for shoulder surgery, axillary block for wrist surgery, and femoral nerve block for leg surgery. The femoral nerve, the largest branch of the Lumbar plexus, arises from the dorsal divisions of the second third and fourth Lumbar nerves. While traditionally administered as a single injection, newer techniques involve placement of indwelling catheters for continuous or intermittent administration of local anesthetics. In Medicine a catheter is a tube that can be inserted into a body cavity duct or vessel
  • Spinal anesthesia: also known as subarachnoid block. Spinal analgesia, (or commonly called spinal anesthesia or sub-arachnoid block (S Refers to a Regional block resulting from a small volume of local anesthetics being injected into the spinal canal. The spinal canal (or vertebral canal or spinal cavity) is the space in Vertebrae through which the Spinal cord passes The spinal canal is covered by the dura mater, through which the spinal needle enters. The dura mater (from the Latin "hard mother" or pachymeninx, is the tough and inflexible outermost of the three layers of the Meninges surrounding the The spinal canal contains cerebrospinal fluid and the spinal cord. Cerebrospinal fluid ( CSF) Liquor cerebrospinalis, is a clear Bodily fluid that occupies the Subarachnoid space and the Ventricular system The spinal cord is a long thin tubular bundle of Nerves that is an extension of the Central nervous system from the brain and is enclosed in and protected The sub arachnoid block is usually injected between the 4th and 5th lumbar vertebrae, because the spinal cord usually stops at the 1st lumbar vertebra, while the canal continues to the sacral vertebrae. In Anatomy, lumbar is an Adjective that means of or pertaining to the Abdominal segment of the Torso, between the diaphragm and A vertebra (plural vertebrae) is an individual Irregular bone in the spinal or Vertebral column ( aka ischis a flexuous and flexible column The sacrum is a large triangular bone at the base of the spine and at the upper and back part of the Pelvic cavity, where it is inserted like a wedge between It results in a loss of pain sensation and muscle strength, usually up to the level of the chest (nipple line or 4th thoracic dermatome). A Dermatome is an area of Skin associated with a pair of Dorsal roots from the spine
  • Epidural anesthesia: Regional block resulting from an injection of a large volume of local anesthetic into the epidural space. The term epidural is often short for epidural anesthesia, a form of Regional anesthesia involving injection of drugs through a Catheter placed into the For a discussion about the anesthetic procedure see Epidural. The epidural space is a potential space that lies underneath the ligamenta flava, and outside the dura mater (outside layer of the spinal canal). In Anatomy, potential space refers to a space or cavity that can exist because two adjacent features that are not tightly adjoined but does not appear during normal functioning The ligamenta flava connect the Lamina of adjacent Vertebra, from the axis to the first segment of the Sacrum. This is basically an injection around the spinal canal.
• Local anesthesia is similar to regional anesthesia, but exerts its effect on a smaller area of the body. Local anesthesia is any technique to render part of the body insensitive to pain without affecting consciousness

Contents 1 History 1.1 Herbal derivatives 1.2 Non-pharmacological methods 1.3 Early gases and vapours 1.4 Early local anesthetics 2 Anesthesia providers 2.1 Physician anesthesiologists/anaesthetists/anaesthesiologists 2.2 Nurse Anesthetists 2.3 Anesthesiology assistants 2.4 Anesthesia technicians 2.5 Veterinary Anesthetists/anesthesiologists 3 Anesthetic agents 3.1 Local anesthetics 3.1.1 Adverse effects of local anaesthesia 3.2 Current inhaled general anesthetic agents 3.3 Current intravenous anesthetic agents (non-opioid) 3.4 Current intravenous opioid analgesic agents 3.5 Current muscle relaxants 3.5.1 Adverse effects of muscle relaxants 3.6 Current intravenous reversal agents 4 Anesthetic equipment 5 Anesthetic monitoring 6 Anesthesia record 7 Anesthesia Information Management System (AIMS) 8 Anesthesia in popular culture 9 See also 10 References 11 External links

History

Herbal derivatives

The first anesthesia (a herbal remedy) was administered in prehistory. Herbalism is a traditional Medicinal or Folk medicine practice based on the use of Plants and Plant extracts Herbalism is also known as Stone Age Paleolithic See also Paleolithic, Recent African Origin, Early Homo sapiens, Early human migrations "Paleolithic" Opium poppy capsules were collected in 4200 BC, and opium poppies were farmed in Sumeria and succeeding empires. Opium is a Narcotic formed from the Latex (ie sap released by lacerating (or "scoring" the immature seed pods of opium poppies ( The use of opium-like preparations in anaesthesia is recorded in the Ebers Papyrus of 1500 BC. The Ebers Papyrus of about 1550 BC is among the most important Medical papyri of Ancient Egypt. By 1100 BC poppies were scored for opium collection in Cyprus by methods similar to those used in the present day, and simple apparatus for smoking of opium were found in a Minoan temple. Cyprus (Κύπρος transliterated: Kýpros,; Kıbrıs officially the Republic of Cyprus (Κυπριακή Δημοκρατία Kypriakī́ Dīmokratía Opium was not introduced to India and China until 330 BC and 600–1200 AD, but these nations pioneered the use of cannabis incense and aconitum. Cannabis ( Cán-na-bis) is a Genus of Flowering plants that includes three putative species Cannabis sativa subsp Aconitum ( A-co-ní-tum) known as aconite, monkshood, wolfsbane, leopard's bane, women's bane In the second century, according to the Book of Later Han, the physician Hua Tuo performed abdominal surgery using an anesthetic substance called mafeisan (麻沸散 "cannabis boil powder") dissolved in wine. The Book of the Later Han ( is one of the official Chinese Historical works which was compiled by Fan Ye in the 5th century, using Hua Tuo (d 208 was a renowned physician during the Eastern Han Dynasty and Three Kingdoms era of China. Throughout Europe, Asia, and the Americas a variety of Solanum species containing potent tropane alkaloids were used, such as mandrake, henbane, Datura metel, and Datura inoxia. Tropane alkaloids, also known as Belladonna alkaloids are a class of Alkaloids and Secondary metabolites that contain a Tropane ring Henbane ( Hyoscyamus niger) also known as stinking nightshade, is a plant of the family Solanaceae These psychoactive properties include visual Datura metel, commonly known as Angel's Trumpet, Devil's trumpet, metel, downy thorn-apple and along with Datura Datura innoxia ( thorn-apple, downy thorn-apple, Indian-apple, Moonflower, sacred datura, toloatzin Classic Greek and Roman medical texts by Hippocrates, Theophrastus, Aulus Cornelius Celsus, Pedanius Dioscorides, and Pliny the Elder discussed the use of opium and Solanum species. Hippocrates of Cos II or Hippokrates of Kos ( ca. 460 BC – ca Theophrastus ( Greek:; 371 – c 287 BC a Greek native of Eressos in Lesbos, was the successor of Aristotle in the Peripatetic Aulus Cornelius Celsus (ca 25 BC—ca 50 was a Roman encyclopedist and Physician. Pedanius Dioscorides (Πεδάνιος Διοσκορίδης ca Gaius or Caius Plinius Secundus, ( AD 23 – August 25, AD 79 better known as Pliny the Elder, was an ancient Author In 13th century Italy Theodoric Borgognoni used similar mixtures along with opiates to induce unconsciousness, and treatment with the combined alkaloids proved a mainstay of anaesthesia until the nineteenth century. Theodoric Borgognoni, (1205-1296 also known as Teodorico de'Borgognoni, and Theodoric of Lucca, was an Italian who became one of the most significant surgeons of In the Americas coca was also an important anaesthetic used in trephining operations. Not to be confused with Cocoa. Coca is a Plant in the family Erythroxylaceae, native to north-western South America Trepanation (also known as trepanning, trephination, trephining or burr hole) is surgery in which a hole is Drilled or scraped into Incan shamans chewed coca leaves and performed operations on the skull while spitting into the wounds they had inflicted to anaesthetize the site. Alcohol was also used, its vasodilatory properties being unknown. Ancient herbal anaesthetics have variously been called soporifics, anodynes, and narcotics, depending on whether the emphasis is on producing unconsciousness or relieving pain. Sleep is a Natural state of bodily rest observed throughout the animal kingdom An anodyne ( Greek αν loss and οδυνη pain a cause which relieves pain is a medicine that relieves or soothes pain by lessening the sensitivity of the brain or The term narcotic (ναρκωτικός is believed to have been coined by the Greek physician Galen to refer to agents that benumb or deaden causing loss

In Central Asia, in the 20th century work of Shahnameh, the author, Ferdowsi, describes a caesarean section performed on Rudaba when giving birth, in which a special wine agent was prepared as an anesthetic^[2] by a Zoroastrian priest, and used to produce unconsciousness for the operation. Central Asia is a region of Asia from the Caspian Sea in the west to central China in the east and from southern Russia in the north to northern Pakistan in the south Shāhnāmé, or Shāhnāma ((alternative spellings are Shahnama Shahnameh Shahname Shah-Nama, etc Hakīm Abū l-Qāsim Firdawsī Tūsī ( more commonly transliterated as Ferdowsi, (935&ndash1020 was a highly revered Persian Poet. A Caesarean section (or Cesarean section in American English) also known as C-section, is a form of Childbirth in which a surgical Rūdāba or Roodabeh (in Persian رودابه is a Persian mythological female figure in Ferdowsi 's epic Shahnameh. Wine is an Alcoholic beverage made from the fermentation of Grape juice Zoroastrianism (ˌzɔroʊˈæstriəˌnɪzəm is the religion and philosophy based on the teachings Although largely mythical in content, the passage does at least illustrate knowledge of anesthesia in ancient Persia. The Persian Empire was a series of Iranian empires that ruled over the Iranian plateau, the original Persian homeland and beyond in Western Asia

The use of herbal anaesthesia had a crucial drawback compared to modern practice — as lamented by Fallopus, "When soporifics are weak they are useless, and when strong, they kill. " To overcome this, production was typically standardized as much as feasible, with production occurring from specific famous locations (such as opium from the fields of Thebes in ancient Egypt). Thebes ( Thēbai) was a city in Ancient Egypt located about 800 km south of the Mediterranean on the east bank of the river Nile ( Anaesthetics were sometimes administered in the spongia somnifera, a sponge into which a large quantity of drug was allowed to dry, from which a saturated solution could be trickled into the nose of the patient. At least in more recent centuries, trade was often highly standardized, with the drying and packing of opium in standard chests, for example. Opium is a Narcotic formed from the Latex (ie sap released by lacerating (or "scoring" the immature seed pods of opium poppies ( In the 19th century, varying aconitum alkaloids from a variety of species were standardized by testing with guinea pigs. The Guinea pig (also commonly called the cavy after its scientific name Cavia porcellus) is a species of Rodent belonging to the family Caviidae Despite these refinements, the discovery of morphine, a purified alkaloid that soon afterward could be injected by hypodermic for a consistent dosage, was enthusiastically received and led to the foundation of the modern pharmaceutical industry. Medical uses Morphine can be used as an analgesic in hospital settings to relieve pain in Myocardial infarction pain in A hypodermic needle is a hollow needle commonly used with a Syringe to inject substances into the body

Another factor affecting ancient anaesthesia is that drugs used systemically in modern times were often administered locally, reducing the risk to the patient. Opium used directly in a wound acts on peripheral opioid receptors to serve as an analgesic, and a medicine containing willow leaves (salicylate, the predecessor of aspirin) would then be applied directly to the source of inflammation. Opioid receptors are a group of G-protein coupled receptors with Opioids as Ligands The Endogenous Opioids are Dynorphins Willows, sallows and osiers form the Genus Salix, around 400 species of Deciduous Trees and Shrubs found primarily Salicylic acid (from the Latin word for the willow tree Salix, from whose bark it can be obtained is a Beta hydroxy acid (BHA with the formula Aspirin, or acetylsalicylic acid (ASA (əˌsɛtɨlsælɨˌsɪlɨk ˈæsɨd is a Salicylate drug, often used as an Analgesic to relieve

In 1804, the Japanese surgeon Seishū Hanaoka performed general anaesthesia for the operation of a breast cancer (mastectomy), by combining Chinese herbal medicine know-how and Western surgery techniques learned through "Rangaku", or "Dutch studies". Seishū Hanaoka (華岡青洲 Hanaoka Seishū November 30, 1760 &ndash November 21, 1835) was a Japanese Physician, who Anesthesia, or anaesthesia (see spelling differences; from Greek grc αν- an-, "without" and grc αἲσθησις In Medicine, mastectomy is the medical term for the surgical removal of one or both Breasts partially or completely Rangaku ( Kyūjitai: ja {{linktext 蘭 學}}/ Shinjitai: ja {{linktext 蘭学}} literally “Dutch Learning” and by extension “Western learning” is a body of His patient was a 60-year-old woman called Kan Aiya. ^[3] He used a compound he called Tsusensan, based on the plants Datura metel, Aconitum and others. Datura is a Genus of 12-15 species of vespertine Flowering plants belonging to the family Solanaceae. Aconitum ( A-co-ní-tum) known as aconite, monkshood, wolfsbane, leopard's bane, women's bane

Non-pharmacological methods

Hypnotism and acupuncture have a long history of use as anesthetic techniques. Hypnosurgery is the term given to an operation where the Patient is sedated using Hypnotherapy rather than traditional anaesthetics History Antiquity In China, the practice of acupuncture can perhaps be traced as far back as In China, Taoist medical practitioners developed anesthesia by means of acupuncture. China ( Wade-Giles ( Mandarin) Chung¹kuo² is a cultural region, an ancient Civilization, and depending on perspective a National Taoism (pronounced /ˈdaʊɪzəm/ or /ˈtaʊɪzəm/ also spelled '''Daoism''') refers to a variety of related Philosophical and Religious traditions Chilling tissue (e. g. with ice) can temporarily cause nerve fibers (axons) to stop conducting sensation, while hyperventilation can cause brief alteration in conscious perception of stimuli including pain (see Lamaze). Ice is a Solid phase, usually crystalline, of a Non-metalic substance that is liquid or gas at Room temperature, such as Ammonia An axon or nerve fiber is a long slender projectionof a nerve cell or Neuron, that conducts electrical impulses away from the neuron's Cell In Medicine, hyperventilation (or overbreathing) is the state of Breathing faster and/or deeper than necessary bringing about lightheadedness and other Lamaze International is a nonprofit organization whose mission is to promote support and protect normal birth through education and advocacy

In modern anesthetic practice, these techniques are seldom employed.

Early gases and vapours

The works of Greek authors such as Dioscorides were well-known among the Persians in the Islamic Empire, and Persian/Iranian physicians such as al-Razi, Avicenna, and Abu al-Qasim wrote medical textbooks of great importance in the development of medicine in Europe and the Middle East. Pedanius Dioscorides (Πεδάνιος Διοσκορίδης ca TemplateInfobox Muslim scholars --> ( Persian /ابو علی الحسین ابن عبدالله ابن سینا (born TemplateInfobox Muslim scholars --> Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi (936 - 1013 (أبو القاسم بن خلف Iranian anesthesiologists were the first to utilize oral as well as inhalant anesthetics. An anaesthetist ( English) or anesthesiologist ( US English) also "anaesthesiologist" is a medical doctor trained to administer Inhalational anaesthetics are gases or Vapours possessing Anaesthetic qualities In Islamic Spain, Abu al-Qasim (Abulcasis) and Ibn Zuhr (Avenzoar), among other Muslim surgeons, performed hundreds of surgeries under inhalant anesthesia with the use of narcotic-soaked sponges. Al-Andalus (الأندلس was the Arabic name given to those parts of the Iberian Peninsula governed by Muslims or Abū Merwān ’Abdal-Malik ibn Zuhr ( أبو مروان عبد الملك بن زهر) (also known as Ibn Zuhr, Avenzoar, Abumeron or Ibn-Zohr Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental The sponges or poriferans (from Latin porus "pore" and ferre "to bear" are Animals Abulcasis and Ibn Sina (Avicenna) wrote about anesthesia in their influential medical encyclopaedias, the al-Tasrif and The Canon of Medicine. TemplateInfobox Muslim scholars --> ( Persian /ابو علی الحسین ابن عبدالله ابن سینا (born The Kitab al-Tasrif ( Arabic, كتاب التفسير) ( The Method of Medicine) was an influential Arabic medical encyclopedia The Canon of Medicine ( Arabic: القانون في الطب Al-Qanun fi al-Tibb " The Law of Medicine " Persian ^[4][5] These were precursors to the true narcotic derivatives which were not made until Dr. Janssen developed narcotics, except morphine, in the past 50 years.

In the West, the development of effective anesthetics in the 19th century was, with Listerian techniques, one of the keys to successful surgery. Joseph Lister 1st Baron Lister, OM, FRS ( 5 April 1827 &ndash 10 February 1912) was an English surgeon Henry Hill Hickman experimented with carbon dioxide in the 1820s. Henry Hill Hickman ( January 27, 1800 - April 2, 1830) was born to tenant Farmers at Lady Halton (near Bromfield,just outside Carbon dioxide ( Chemical formula:) is a Chemical compound composed of two Oxygen Atoms covalently bonded to a single The anesthetic qualities of nitrous oxide (isolated in 1773 by Joseph Priestley) were discovered by the British chemist Humphry Davy about 1799 when he was an assistant to Thomas Beddoes, and reported in a paper in 1800. Nitrous oxide, commonly known as " laughing gas," is a Chemical compound with the Chemical formula N 2 O. Joseph Priestley (13 March 1733 ( Old Sir Humphry Davy 1st Baronet FRS MRIA (17 December 1778 &ndash 29 May 1829 was a British Chemist and inventor Thomas Beddoes ( April 13, 1760 - December 24, 1808) English Physician and scientific writer was born at Shiffnall But initially the medical uses of this so-called "laughing gas" were limited — its main role was in entertainment. It was used on 30 September 1846 for painless tooth extraction upon patient Eben Frost by American dentist William Thomas Green Morton. Events 1399 - Henry IV is proclaimed King of England. 1744 - France and Spain defeat the Dentistry' is the "evaluation diagnosis prevention and/or treatment (nonsurgical surgical or related procedures of diseases disorders and/or conditions of the oral cavity Horace Wells of Connecticut, a traveling dentist, had demonstrated it the previous year 1845 at Massachusetts General Hospital. Horace Wells ( January 21, 1815 – January 24, 1848) was an American Dentist who pioneered the use of Anaesthesia Connecticut ( is a state located in the New England region of the northeastern United States of America. Massachusetts General Hospital ( Mass General or MGH) is a Teaching hospital of Harvard Medical School and a Biomedical research Wells made a mistake in choosing a particularly sturdy male volunteer, and the patient suffered considerable pain. This lost the colorful Wells any support. Later the patient told Wells he screamed in shock and not in pain. A subsequently drunk Wells died in jail, by cutting his femoral artery, after allegedly assaulting a prostitute with sulfuric acid.

Another dentist, William E. Clarke, performed an extraction in January 1842 using a different chemical, diethyl ether (discovered by Valerius Cordus in 1540). Diethyl ether, also known as ether and ethoxyethane, is a clear colorless and highly Flammable liquid with a low Boiling point and a Valerius Cordus ( 18 February 1515 &ndash 25 September 1544) was a German Physician and botanist who authored In March 1842 in Danielsville, Georgia, Dr. Danielsville is a city in Madison County, Georgia, United States. Crawford Long was the first to use anaesthesia during an operation, giving it to a boy (John Venables) before excising a cyst from his neck; however, he did not publicize this information until later. Crawford Williamson Long ( November 1, 1815 &ndash June 16, 1878) was an American Physician and Pharmacist best known for

On October 16, 1846, another dentist, William Thomas Green Morton, invited to the Massachusetts General Hospital, performed the first public demonstration of diethyl ether (then called sulfuric ether) as an anesthetic agent, for a patient (Edward Gilbert Abbott) undergoing an excision of a vascular tumor from his neck. Events 456 - Magister militum Ricimer defeats the Emperor Avitus at Piacenza and becomes master of the western In a letter to Morton shortly thereafter, Oliver Wendell Holmes, Sr. proposed naming the procedure anæsthesia.

Despite Morton's efforts to keep "his" compound a secret, which he named "Letheon" and for which he received a US patent, the news of the discovery and the nature of the compound spread very quickly to Europe in late 1846. Here, respected surgeons—including Liston, Dieffenbach, Pirogoff, and Syme—undertook numerous operations with ether. Ether is a class of Organic compounds which contain an ether group — an Oxygen Atom connected to two (substituted Alkyl An American-born physician, Boott—who had traveled to London—encouraged a leading dentist, Mr James Robinson, to perform a dental procedure on a Miss Lonsdale. This was the first case of an operator-anesthetist. On the same day, 19 December 1846 in Dumfries Royal Infirmary, Scotland, a Dr. Events 324 - Licinius abdicates his position as Roman Emperor. Scott used ether for a surgical procedure. The first use of anesthesia in the Southern Hemisphere took place in Launceston, Tasmania, that same year. Ether has a number of drawbacks, such as its tendency to induce vomiting and its flammability. Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the Flammability is the ease with which a substance will ignite causing Fire or Combustion. In England it was quickly replaced with chloroform. Chloroform, also known as trichloromethane and methyl trichloride, is a Chemical compound with formula C[[Hydrogen H]] Cl

Discovered in 1831, the use of chloroform in anesthesia is usually linked to James Young Simpson, who, in a wide-ranging study of organic compounds, found chloroform's efficacy on 4 November 1847. Sir James Young Simpson ( June 7, 1811 &ndash May 6, 1870) was a Scottish doctor and an important figure in the History Events 1333 - Flood of the Arno River, causing massive damage in Florence as recorded by the Florentine chronicler Giovanni Villani Year 1847 ( MDCCCXLVII) was a Common year starting on Friday (link will display the full calendar of the Gregorian Calendar (or a Common Its use spread quickly and gained royal approval in 1853 when John Snow gave it to Queen Victoria during the birth of Prince Leopold. John Snow ( 15 March 1813 &ndash 16 June 1858) was a British physician and a leader in the adoption of Anaesthesia and medical Victoria (Alexandrina Victoria 24 May 1819 – 22 January 1901 was from 20 June 1837 the Queen of the United Kingdom of Great Britain and Ireland The Prince Leopold Duke of Albany (Leopold George Duncan Albert 7 April 1853 &ndash 28 March 1884) was a member of the British Royal Unfortunately, chloroform is not as safe an agent as ether, especially when administered by an untrained practitioner (medical students, nurses, and occasionally members of the public were often pressed into giving anesthetics at this time). Medical education A medical school or faculty of medicine is a Tertiary educational institution—or part of such an institution—that teaches Medicine A nurse is responsible—along with other Health care Professionals —for the treatment safety and recovery of acutely or chronically This led to many deaths from the use of chloroform that (with hindsight) might have been preventable. The first fatality directly attributed to chloroform anesthesia (Hannah Greener) was recorded on 28 January 1848. Events 1077 - Walk to Canossa: The Excommunication of Henry IV Holy Roman Emperor is lifted Year 1848 ( MDCCCXLVIII) was a Leap year starting on Saturday (link will display the full calendar of the Gregorian Calendar (or a Leap

John Snow of London published articles from May 1848 onwards 'On Narcotism by the Inhalation of Vapours' in the London Medical Gazette. Snow also involved himself in the production of equipment needed for inhalational anesthesia.

The surgical amphitheatre at Massachusetts General Hospital, or "ether dome" still exists today, although it is used for lectures and not surgery. The public can visit the amphitheater on weekdays when it is not in use.

Early local anesthetics

The first effective local anesthetic was cocaine. Cocaine ( benzoylmethyl ecgonine) is a Crystalline Tropane Alkaloid that is obtained from the leaves of the Coca plant Isolated in 1859, it was first used by Carl Koller, at the suggestion of Sigmund Freud, in ophthalmic surgery in 1884. Karl Koller (born December 3 1857 in Schüttenhofen, Bohemia (now Susice, Czech Republic) died March 21 1944 in New York New York Sigmund Freud (ˈziːkmʊnt ˈfʁɔʏt born Sigismund Shlomo Freud (May 6 1856 &ndash September 23 1939 was an Austrian Psychiatrist who founded Before that doctors had used a salt and ice mix for the numbing effects of cold, which could only have limited application. Similar numbing was also induced by a spray of ether or ethyl chloride. A number of cocaine derivatives and safer replacements were soon produced, including procaine (1905), Eucaine (1900), Stovaine (1904), and lidocaine (1943). Procaine is a Local anesthetic drug of the Amino Ester group It is used primarily to reduce the pain of Intramuscular injection of Lidocaine ( INN) (ˈlaɪdoʊkeɪn or lignocaine (former BAN) (/ˈlɪgnoʊkeɪn/ is a common Local anesthetic and antiarrhythmic drug

Opioids were first used by Racoviceanu-Piteşti, who reported his work in 1901. An opioid is a chemical Substance that has a Morphine -like action in the body

Anesthesia providers

Physicians specialising in peri-operative care, development of an anesthetic plan, and the administration of anesthetics are known in the United States as anesthesiologists and in the UK and Canada as anaesthetists or anaesthesiologists. All anaesthetics in the UK, Australia, New Zealand and Japan are administered by physicians. Nurse anesthetists also administer anesthesia in 109 nations. ^[6] In the US, 35% of anesthetics are provided by physicians in solo practice, about 55% are provided by ACTs with anesthesiologists medically directing Anesthesiologist Assistants, CRNAs, and about 10% are provided by CRNAs in solo practice. ^{[7] [8] [9]} - ^[10] - ^[11]

Physician anesthesiologists/anaesthetists/anaesthesiologists

In the US, medical doctors who specialize in anesthesiology are called anesthesiologists, and dentists who specialize in anesthesiology are called dental anesthesiologists. Such physicians in the UK, Canada and Australia are called anaesthetists or anaesthesiologists.

In the U. S. , a physician specializing in anesthesiology completes 4 years of college, 4 years of medical school, 1 year of internship, and 3 years of residency. According to the American Society of Anesthesiologists, anesthesiologists provide or participate in more than 90 percent of the 40 million anesthetics delivered annually. ^[12]

In the UK this training lasts a minimum of seven years after the awarding of a medical degree and two years of basic residency, and takes place under the supervision of the Royal College of Anaesthetists. The Royal College of Anaesthetists (RCoA is "the professional body responsible for the specialty of Anaesthesia throughout the United Kingdom " In Australia and New Zealand, it lasts five years after the awarding of a medical degree and two years of basic residency, under the supervision of the Australian and New Zealand College of Anaesthetists. Other countries have similar systems, including Ireland (the Faculty of Anaesthetists of the Royal College of Surgeons in Ireland), Canada and South Africa (the College of Anaesthetists of South Africa).

In the UK, Fellowship of the Royal College of Anaesthetists (FRCA), is conferred upon medical doctors following completion of the written and oral parts of the Royal College's examination. In the US, completion of the written and oral Board examinations by a physician anesthesiologist allows one to be called "Board Certified" or a "Diplomate" of the American Board of Anesthesiology (or of the American Osteopathic Board of Anesthesiology, for osteopathic physicians). A physician, medical practitioner or medical doctor who practices Medicine, and is concerned with maintaining or restoring human Health

Other specialties within medicine are closely affiliated to anaesthetics. These include intensive care medicine and pain medicine. Intensive Care Medicine or critical care medicine is a branch of medicine concerned with the provision of Life support or organ support systems in patients Pain management (also called pain medicine is the medical discipline concerned with the relief of Pain. Specialists in these disciplines have usually done some training in anaesthetics. The role of the anaesthetist is changing. It is no longer limited to the operation itself. Many anaesthetists perform well as peri-operative physicians, and will involve themselves in optimizing the patient's health before surgery (colloquially called "work-up"), performing the anaesthetic,including specialized intraoperative monitoring (like [1] transesophageal echocardiography), following up the patient in the post anesthesia care unit and post-operative wards, and ensuring optimal analgesia throughout. "PACU" redirects here For the fish see Pacu (fish. A post anesthesia care unit, often abbreviated PACU, is a vital

It is important to note that the term anesthetist in the United States usually refers to registered nurses who have completed specialized education and training in nurse anesthesia to become certified registered nurse anesthetists (CRNAs). As noted above, the term anaesthetist in the UK and Canada refers to medical doctors who specialize in anesthesiology.

Nurse Anesthetists

In the United States, advance practice nurses specializing in the provision of anesthesia care are known as Certified Registered Nurse Anesthetists (CRNAs). A nurse anesthetist ( AE) is a Registered nurse and advanced practice nurse who has acquired additional education and training to administer Anesthesia. According to the American Association of Nurse Anesthetists, the 36,000 CRNAs in the US administer approximately 27 million anesthetics each year, roughly two thirds of the US total[2]. Thirty-four percent of nurse anesthetists practice in communities of less than 50,000. CRNAs start school with a bachelors degree and at least 1 year of acute care nursing experience[3], and gain a masters degree in nurse anesthesia before passing the mandatory Certification Exam. The average CRNA student has 5-7 years of nursing experience before entering a 27-36 month masters level anesthesia program. ^[13]

CRNAs may work with podiatrists, dentists, anesthesiologists, surgeons, obstetricians and other professionals requiring their services. CRNAs administer anesthesia in all types of surgical cases, and are able to apply all the accepted anesthetic techniques -- general, regional, local, or sedation. CRNAs do not require Anesthesiologist supervision in any state and only require surgeon/dentist/podiatrists to sign the chart for medicare billing in all but 16 states.

Anesthesiology assistants

In the US, anesthesiologist assistants (AAs) are graduate-level trained specialists who have undertaken specialized education and training to provide anesthesia care under the direction of an Anesthesiologist. AAs typically hold a masters degree and practice under Anesthesiologist supervision in sixteen states through licensing, certification or physician delegation. ^[14]

In the UK, a similar group of assistants are currently being evaluated. In Scotland they are named Physician's Assistant - Anaesthesia and in the rest of the UK, they are called anaesthesia practitioners. Their background can be nursing, operating department professional or another profession allied to medicine or a science graduate. Training takes 27 months and to date, the first five have graduated in England.

Anesthesiology Assistants should be distinguished from Anesthesia Technicians.

Anesthesia technicians

Anesthesia technicians are specially trained biomedical technicians who assist anesthesiologists, nurse anesthetists, and anesthesiology assistants with monitoring equipment, supplies, and patient care procedures in the operating room.

In New Zealand, anaesthetic technicians complete a course of study recognized by the New Zealand Association of Anaesthetic Technicians and Nurses.

In the United Kingdom, personnel known as ODPs (operating department practitioners) or anaesthetic nurses provide support to the physician anaesthetist (anaesthesiologist). Operating Department Practitioners ( ODP s are Healthcare professionals working in the United Kingdom.

Veterinary Anesthetists/anesthesiologists

Main article: Veterinary anesthesia

Veterinary anesthetists utilize much the same equipment and drugs as those who provide anesthesia to human patients. Veterinary anesthesia is Anesthesia performed on animals (excluding humans performed by a Veterinarian. In the case of animals, the anesthesia must be tailored to fit the species ranging from large land animals like horses or elephants to birds to aquatic animals like fish. For each species there are ideal, or at least less problematic, methods of safely inducing anesthesia. For wild animals, anesthetic drugs must often be delivered from a distance by means of remote projector systems ("dart guns") before the animal can even be approached. Large domestic animals, like cattle, can often be anesthetized for standing surgery using only local anesthetics and sedative drugs. While most clinical veterinarians and veterinary technicians routinely function as anesthetists in the course of their professional duties, veterinary anesthesiologists in the U. S. are veterinarians who have completed a two-year residency in anesthesia and have qualified for certification by the American College of Veterinary Anesthesiologists.

Anesthetic agents

Local anesthetics

Main article: Local anesthetic

• procaine
• amethocaine
• cocaine
• lidocaine
• prilocaine
• bupivacaine
• levobupivacaine
• ropivacaine
• dibucaine

Local anesthetics are agents which prevent transmission of nerve impulses without causing unconsciousness. A local anesthetic is a drug that causes reversible Local anesthesia and a loss of Nociception. Tetracaine ( INN, also known as amethocaine; trade name Pontocaine) is a potent Local anesthetic of the Ester group Prilocaine (ˈpraɪloʊkeɪn is a Local anesthetic of the Amino Amide type Bupivacaine ( rINN) (bjuːˈpɪvəkeɪn is a Local anaesthetic drug belonging to the Amino Amide group Levobupivacaine ( rINN) (liːvoʊbjuːˈpɪvəkeɪn is a Local anaesthetic drug belonging to the Amino Amide group Ropivacaine ( rINN) (roʊˈpɪvəkeɪn is a Local anaesthetic drug belonging to the Amino Amide group Cinchocaine (or Dibucaine) is an Amide Local anesthetic. It is the active ingredient in some topical hemorrhoid creams They act by binding to fast sodium channels from within (in an open state). Sodium channels are Integral membrane proteins that form Ion channels, conducting sodium ions ( Na+) through a cell's Plasma membrane Local anesthetics can be either ester or amide based. Esters are a class of Chemical compounds and Functional groups Esters consist of an inorganic or organic Acid in which at least In Chemistry, an amide is one of three kinds of Compounds (sometimes called acid amide the organic Functional group characterized

Ester local anesthetics (e. g. , procaine, amethocaine, cocaine) are generally unstable in solution and fast-acting, and allergic reactions are common.

Amide local anesthetics (e. g. , lidocaine, prilocaine, bupivicaine, levobupivacaine, ropivacaine and dibucaine) are generally heat-stable, with a long shelf life (around 2 years). They have a slower onset and longer half-life than ester anaesthetics, and are usually racemic mixtures, with the exception of levobupivacaine (which is S(-) -bupivacaine) and ropivacaine (S(-)-ropivacaine). In Chemistry, a racemic mixture, or racemate, is one that has equal amounts of left- and right-handed enantiomers of a chiral These agents are generally used within regional and epidural or spinal techniques, due to their longer duration of action, which provides adequate analgesia for surgery, labor, and symptomatic relief.

Only preservative-free local anesthetic agents may be injected intrathecally. A preservative is a natural or synthetic chemical that is added to products such as foods pharmaceuticals paints biological samples wood etc Intrathecal is an adjetive that refers to something that happens inside of the spinal canal

Adverse effects of local anaesthesia

Adverse effects of local anesthesia are generally referred to as Local Anesthetic Toxicity. While generally safe Local anesthetic agents can be toxic if used in excessive doses or administered improperly

Effects may be localized or systemic.

Examples of systemic effects of local anesthesia:

Local anesthetic drugs are toxic to the heart (where they cause arrhythmia) and brain (where they may cause unconsciousness and seizures). Dysrhythmia redirects here For the American band see Dysrhythmia (band. An epileptic seizure is caused by excessive and/or hypersynchronous electrical Neuronal activity and is usually self-limiting Arrhythmias may be resistant to defibrillation and other standard treatments, and may lead to loss of heart function and death. Defibrillation is the definitive treatment for the life-threatening Cardiac arrhythmias Ventricular fibrillation and Ventricular tachycardia.

The first evidence of local anesthetic toxicity involves the nervous system, including agitation, confusion, dizziness, blurred vision, tinnitus, a metallic taste in the mouth, and nausea that can quickly progress to seizures and cardiovascular collapse.

Toxicity can occur with any local anesthetic as an individual reaction by that patient. Possible toxicity can be tested with pre-operative procedures to avoid toxic reactions during surgery.

An example of localized effect of local anesthesia:

Direct infiltration of local anesthetic into skeletal muscle will cause temporary paralysis of the muscle. Skeletal muscle is a type of Striated muscle, which usually attaches to tendons

Current inhaled general anesthetic agents

Main article: General anaesthesia

• Nitrous oxide
• Halothane
• Enflurane
• Isoflurane
• Sevoflurane
• Desflurane
• Xenon (rarely used)

Volatile agents are specially formulated organic liquids that evaporate readily into vapors, and are given by inhalation for induction and/or maintenance of general anesthesia. In modern medical practice general anaesthesia ( AmE: anesthesia) is a state of total unconsciousness resulting from General anaesthetic drugs Nitrous oxide, commonly known as " laughing gas," is a Chemical compound with the Chemical formula N 2 O. Halothane vapour (or Fluothane) is an inhalational General anaesthetic. Enflurane (2-chloro-112-trifluoroethyl-difluoromethyl ether is a Halogenated ether that was commonly used for inhalational Anesthesia during the 1970s and 1980s Isoflurane (2-chloro-2-(difluoromethoxy-111-trifluoro-ethane is a Halogenated ether used for inhalational Anesthesia. Sevoflurane (222-trifluoro-1-ethyl fluoromethyl ether also called fluoromethyl hexafluoroisopropyl ether, is a sweet-smelling non-flammable highly fluorinated methyl isopropyl Desflurane (222-trifluoro-1-fluoroethyl-difluoromethyl ether is a highly fluorinated methyl ethyl ether used for maintenance of General anaesthesia. Xenon (ˈzɛnɒn or) is a Chemical element represented by the symbol Xe. Nitrous oxide and xenon are gases at room temperature rather than liquids, so they are not considered volatile agents. The ideal anesthetic vapor or gas should be non-flammable, non-explosive, lipid-soluble, and should possess low blood gas solubility, have no end organ (heart, liver, kidney) toxicity or side-effects, should not be metabolized, and should be non-irritant when inhaled by patients.

No anesthetic agent currently in use meets all these requirements. The agents in widespread current use are isoflurane, desflurane, sevoflurane, and nitrous oxide. Isoflurane (2-chloro-2-(difluoromethoxy-111-trifluoro-ethane is a Halogenated ether used for inhalational Anesthesia. Desflurane (222-trifluoro-1-fluoroethyl-difluoromethyl ether is a highly fluorinated methyl ethyl ether used for maintenance of General anaesthesia. Sevoflurane (222-trifluoro-1-ethyl fluoromethyl ether also called fluoromethyl hexafluoroisopropyl ether, is a sweet-smelling non-flammable highly fluorinated methyl isopropyl Nitrous oxide is a common adjuvant gas, making it one of the most long-lived drugs still in current use. Because of its low potency, it cannot produce anesthesia on its own but is frequently combined with other agents. Halothane, an agent introduced in the 1950s, has been almost completely replaced in modern anesthesia practice by newer agents because of its shortcomings. ^[15] Partly because of its side effects, enflurane never gained widespread popularity. ^[15]

In theory, any inhaled anesthetic agent can be used for induction of general anesthesia. However, most of the halogenated anesthetics are irritating to the airway, perhaps leading to coughing, laryngospasm and overall difficult inductions. For this reason, the most frequently used agent for inhalational induction is sevoflurane. All of the volatile agents can be used alone or in combination with other medications to maintain anesthesia (nitrous oxide is not potent enough to be used as a sole agent).

Volatile agents are frequently compared in terms of potency, which is inversely proportional to the minimum alveolar concentration. Minimum alveolar concentration or MAC is a concept used to compare the strengths of anaesthetic vapours; in simple terms it is defined as the concentration of Potency is directly related to lipid solubility. This is known as the Meyer-Overton hypothesis. Minimum alveolar concentration or MAC is a concept used to compare the strengths of anaesthetic vapours; in simple terms it is defined as the concentration of However, certain pharmacokinetic properties of volatile agents have become another point of comparison. Most important of those properties is known as the blood:gas partition coefficient. This concept refers to the relative solubility of a given agent in blood. Those agents with a lower blood solubility (i. e. , a lower blood–gas partition coefficient; e. g. , desflurane) give the anesthesia provider greater rapidity in titrating the depth of anesthesia, and permit a more rapid emergence from the anesthetic state upon discontinuing their administration. In fact, newer volatile agents (e. g. , sevoflurane, desflurane) have been popular not due to their potency (minimum alveolar concentration), but due to their versatility for a faster emergence from anesthesia, thanks to their lower blood–gas partition coefficient.

Current intravenous anesthetic agents (non-opioid)

While there are many drugs that can be used intravenously to produce anesthesia or sedation, the most common are:

• Barbiturates
  • Thiopental
  • Methohexital
• Benzodiazepines
  • Midazolam
  • Lorazepam
  • Diazepam
• Propofol
• Etomidate
• Ketamine

The two barbiturates mentioned above, thiopental and methohexital, are ultra-short-acting, and are used to induce and maintain anesthesia. Barbiturates are drugs that act as central nervous system Depressants and by virtue of this they produce a wide spectrum of effects from mild Sedation The fictional truth drug Hyoscine-pentothal does not describe real pentothal accurately Methohexital (marketed under the brand name Brevital) is a drug which is a Barbiturate derivative The benzodiazepines (pronounced, often abbreviated to "benzos") are a class of Psychoactive drugs with varying Hypnotic Midazolam (marketed under brand names Dormicum, Flormidal, Versed, Hypnovel and Dormonid, pronounced mɪˈdæzəlæm Lorazepam (also known by its brand name Ativan or Temesta) is a Benzodiazepine drug with short to medium duration of action Diazepam (daɪˈæzɨpæm first marketed as Valium by Hoffmann-La Roche, is a Benzodiazepine derivative Drug. Propofol is a short-acting Intravenous sedative agent used for the induction of general Anesthesia for adults and children maintenance of general anesthesia and Etomidate is a short acting Intravenous anaesthetic agent used for the induction of General anaesthesia and for Sedation for short procedures Ketamine is a drug for use in human and veterinary medicine developed by Parke-Davis (today a part of Pfizer) in 1962 ^[16] However, though they produce unconsciousness, they provide no analgesia (pain relief) and must be used with other agents. ^[16] Benzodiazepines can be used for sedation before or after surgery and can be used to induce and maintain general anesthesia. ^[16] When benzodiazepines are used to induce general anesthesia, midazolam is preferred. ^[16] Benzodiazepines are also used for sedation during procedures that do not require general anesthesia. ^[16] Like barbiturates, benzodiazepines have no pain-relieving properties. ^[16] Propofol is one of the most commonly used intravenous drugs employed to induce and maintain general anesthesia. ^[16] It can also be used for sedation during procedures or in the ICU. ^[16] Like the other agents mentioned above, it renders patients unconscious without producing pain relief. ^[16] Because of its favorable physiological effects, "etomidate has been primarily used in sick patients". ^[16] Ketamine is infrequently used in anesthesia practice because of the unpleasant experiences which sometimes occur upon emergence from anesthesia, which include "vivid dreaming, extracorporeal experiences, and illusions. "^[17] However, like etomidate it is frequently used in emergency settings and with sick patients because it produces fewer adverse physiological effects. ^[16] Unlike the intravenous anesthetic drugs previously mentioned, ketamine produces profound pain relief, even in doses lower than those which induce general anesthesia. ^[16] Also unlike the other anesthetic agents in this section, patients who receive ketamine alone appear to be in a cataleptic state, unlike other states of anesthesia that resemble normal sleep. Ketamine-anesthetized patients have profound analgesia but keep their eyes open and maintain many reflexes. ^[16]

Current intravenous opioid analgesic agents

While opioids can produce unconsciousness, they do so unreliably and with significant side effects. ^[18][19] So, while they are rarely used to induce anesthesia, they are frequently used along with other agents such as intravenous non-opioid anesthetics or inhalational anesthetics. ^[16] Furthermore, they are used to relieve pain of patients before, during, or after surgery. The following opioids have short onset and duration of action and are frequently used during general anesthesia:

• Fentanyl
• Alfentanil
• Sufentanil
• Remifentanil

The following agents have longer onset and duration of action and are frequently used for post-operative pain relief:

• Buprenorphine
• Butorphanol
• Diamorphine, (diacetyl morphine, also known as heroin, not available in U. Fentanyl is one of the most powerful Opioid Analgesics with a potency approximately 81 times that of Morphine. Alfentanil (trade name Alfenta) is a potent but short-acting synthetic Opioid Analgesic drug, used for Anaesthesia in Surgery Sufentanil is a synthetic Opioid Analgesic drug approximately 5 to 10 times more potent than Fentanyl. Remifentanil (marketed by GlaxoSmithKline and Abbott as Ultiva) is a potent ultra short-acting synthetic Opioid Analgesic drug. Buprenorphine (or colloquially "Bupe" is a semi-synthetic Opiate with partial agonist and antagonist actions Butorphanol ( INN) is a Morphinan -type synthetic Opioid Analgesic. Heroin ( INN: diacetylmorphine, BAN: diamorphine) is a semi-synthetic opioid synthesized from Morphine, a derivative Heroin ( INN: diacetylmorphine, BAN: diamorphine) is a semi-synthetic opioid synthesized from Morphine, a derivative S. )
• Hydromorphone
• Levorphanol
• Meperidine, also called pethidine in the UK, New Zealand, Australia and other countries
• Methadone
• Morphine
• Nalbuphine
• Oxycodone, (not available intravenously in U. Hydromorphone, a more common synonym for dihydromorphinone hydrochloride (trade names Palladone IR, Palladone SR, Dilaudid and numerous others Levorphanol (Levo-Dromoran is an Opioid medication used to treat severe pain Pethidine ( INN) or meperidine ( USAN) (commonly referred to as Demerol but also referred to as isonipecaine lidol pethanol piridosal Algil Alodan Methadone ( Dolophine Amidone Methadose Physeptone Heptadon and many others is a synthetic Opioid, used medically as an Analgesic, Antitussive Medical uses Morphine can be used as an analgesic in hospital settings to relieve pain in Myocardial infarction pain in Nalbuphine (nalbuphine hydrochloride is a synthetic Opioid used commercially as an Analgesic under a variety of trade names including Nubain. Oxycodone is an Opioid Analgesic Medication synthesized from Thebaine. S. )
• Oxymorphone
• Pentazocine

Current muscle relaxants

Muscle relaxants do not render patients unconscious or relieve pain. Oxymorphone ( Opana, Numorphan, Numorphone) or 14-Hydroxydihydro Morphinone is a powerful semi-synthetic Opioid Analgesic Pentazocine is a synthetically-prepared prototypical mixed agonist-antagonist Narcotic ( Opioid Analgesic) drug used to treat mild to moderately severe pain Instead, they are sometimes used after a patient is rendered unconscious (induction of anesthesia) to facilitate intubation or surgery by paralyzing skeletal muscle. In Medicine, intubation refers to the placement of a tube into an external or internal orifice of the body

• Depolarizing muscle relaxants
  • Succinylcholine (also known as suxamethonium in the UK, New Zealand, Australia and other countries, "Celokurin" or "celo" for short in Europe)
• Non-depolarizing muscle relaxants
  • Short acting
    • Mivacurium
    • Rapacuronium
  • Intermediate acting
    • Atracurium
    • Cisatracurium
    • Vecuronium
    • Rocuronium
  • Long acting
    • Pancuronium
    • Metocurine
    • d-Tubocurarine
    • Gallamine
    • Alcuronium
    • Doxacurium
    • Pipecuronium

Adverse effects of muscle relaxants

Succinylcholine may cause hyperkalemia if given to burn patients, or paralyzed (quadraplegic, paraplegic) patients. Suxamethonium chloride (also known as succinylcholine, scoline, or colloquially as sux) is a medication widely used in Emergency medicine and Mivacurium is a Bisbenzylisoquinolinium based Neuromuscular blocker or Muscle relaxant. Rapacuronium bromide (trade name Raplon, Organon) is a rapidly acting non-depolarizing neuromuscular blocker used in modern Anaesthesia, to Atracurium is a neuromuscular-blocking drug or skeletal muscle relaxant in the category of non-depolarizing Neuromuscular-blocking drugs, used adjunctively Cisatracurium (usually as cisatracurium besilate, trade name Nimbex) is a Neuromuscular-blocking drug. Vecuronium bromide (trade name Norcuron) is a Muscle relaxant in the category of non depolarising Neuromuscular blocking agents. Rocuronium is an Aminosteroid non-depolarizing (that is it does not cause initial stimulation of muscles before weakening them neuromuscular blocker or Pancuronium is a Chemical compound, used in medicine as the Bromide salt pancuronium bromide. Gallamine (as gallamine triethiodide) is a Non-depolarising muscle relaxant. Doxacurium chloride is a Muscle relaxant in the Quaternary ammonium compound family Pipecuronium bromide (trade name Arduan) is a Muscle relaxant. Hyperkalemia ( AE) or Hyperkalaemia ( BE) is an elevated blood level of the Electrolyte Potassium. The mechanism is reported to be through upregulation of acetylcholine receptors in those patient populations. An acetylcholine receptor (abbreviated AChR) is an Integral membrane protein that responds to the binding of the Neurotransmitter Acetylcholine Succinylcholine may also trigger malignant hyperthermia in susceptible patients. Malignant hyperthermia ( MH or MHS for "malignant hyperthermia syndrome" or "malignant Hyperpyrexia due to anaesthesia" is a rare life-threatening

Another potentially disturbing complication can be 'anesthesia awareness'. Anesthesia awareness, or "unintended intra-operative awareness" occurs during general anesthesia, when a patient has not had enough general anesthetic or Analgesic In this situation, patients paralyzed with muscle relaxants may awaken during their anesthesia, due to decrease in the levels of drugs providing sedation and/or pain relief. If this fact is missed by the anaesthesia provider, the patient may be aware of his surroundings, but be incapable of moving or communicating that fact. Neurological monitors are becoming increasingly available which may help decrease the incidence of awareness. Most of these monitors use proprietary algorithms monitoring brain activity via evoked potentials. Despite the widespread marketing of these devices many case reports exist in which awareness under anesthesia has occurred despite apparently adequate anesthesia as measured by the neurologic monitor.

Current intravenous reversal agents

• Naloxone, reverses the effects of opioids
• Flumazenil, reverses the effects of benzodiazepines
• Neostigmine, reverses the effects of non-depolarizing muscle relaxants

Anesthetic equipment

Main article: Anaesthetic equipment

In modern anesthesia, a wide variety of medical equipment is desirable depending on the necessity for portable field use, surgical operations or intensive care support. Naloxone is a drug used to counter the effects of Opioid overdose, for example Heroin or Morphine overdose Flumazenil (also known as flumazepil, code name Ro 15-1788, trade names Anexate, Lanexat, Mazicon, Romazicon Neostigmine is a Parasympathomimetic, specifically a reversible Cholinesterase inhibitor. This article discusses various equipment used in Anaesthesia, particularly General anaesthesia but also Local anaesthesia. Anesthesia practitioners must possess a comprehensive and intricate knowledge of the production and use of various medical gases, anaesthetic agents and vapours, medical breathing circuits and the variety of anaesthetic machines (including vaporizers, ventilators and pressure gauges) and their corresponding safety features, hazards and limitations of each piece of equipment, for the safe, clinical competence and practical application for day to day practice. The anaesthetic machine (or anesthesia machine in America is used by Anaesthesiologists to support the administration of Anaesthesia.

Anesthetic monitoring

Patients being treated under general anesthetics must be monitored continuously to ensure the patient's safety. For minor surgery, this generally includes monitoring of heart rate (via ECG or pulse oximetry), oxygen saturation (via pulse oximetry), non-invasive blood pressure, inspired and expired gases (for oxygen, carbon dioxide, nitrous oxide, and volatile agents). Measuring heart rate The Pulse rate (which in most people is identical to the heart rate can be measured at any point on the body where an Artery 's pulsation Pulse oximetry is a non-invasive method allowing the monitoring of the Oxygenation of a patient's Hemoglobin. Oxygen saturation is a relative measure of the amount of Oxygen that is Dissolved or carried in a given medium Blood pressure is also the title of a short story by Damon Runyan in Guys and Dolls and Other Stories Oxygen (from the Greek roots ὀξύς (oxys (acid literally "sharp" from the taste of acids and -γενής (-genēs (producer literally begetteris the For moderate to major surgery, monitoring may also include temperature, urine output, invasive blood measurements (arterial blood pressure, central venous pressure), pulmonary artery pressure and pulmonary artery occlusion pressure, cerebral activity (via EEG analysis), neuromuscular function (via peripheral nerve stimulation monitoring), and cardiac output. Core temperature, also called core body temperature, is the operating Temperature of an Organism, specifically in deep structures of the body such as the Blood pressure is also the title of a short story by Damon Runyan in Guys and Dolls and Other Stories Central venous pressure (CVP describes the pressure of blood in the thoracic Vena cava, near the Right atrium of the heart Cardiac output (Q is the volume of blood being pumped by the Heart, in particular by a ventricle in a minute In addition, the operating room's environment must be monitored for temperature and humidity and for buildup of exhaled inhalational anesthetics which might impair the health of operating room personnel. Inhalational anaesthetics are gases or Vapours possessing Anaesthetic qualities

Anesthesia record

The anesthesia record is the medical and legal documentation of events during an anesthetic. ^[20] It reflects a detailed and continuous account of drugs, fluids, and blood products administered and procedures undertaken, and also includes the observation of cardiovascular responses, estimated blood loss, urinary body fluids and data from physiologic monitors (Anesthetic monitoring, see above) during the course of an anesthetic. The anesthesia record may be written manually on paper; however, the paper record is increasingly replaced by an electronic record as part of an Anesthesia Information Management System (AIMS).

Anesthesia Information Management System (AIMS)

An AIMS refers to any information system that is used as an automated electronic anesthesia record keeper (i. The term information system (IS sometimes refers to a System of persons Data records and activities that process the data and Information in an organization e. , connection to patient physiologic monitors and/or the Anaesthetic machine) and which also may allow the collection and analysis of anesthesia-related perioperative patient data. The anaesthetic machine (or anesthesia machine in America is used by Anaesthesiologists to support the administration of Anaesthesia. Analysis (from Greek ἀνάλυσις, "a breaking up" is the process of breaking a complex topic or substance into smaller parts to gain a Debt AIDS Trade in Africa (or DATA) is a Multinational non-government organization founded in January 2002 in London by U2 's

Anesthesia in popular culture

The 1958 film Corridors of Blood starring Boris Karloff depicts an 1840's surgeon who experiments with anesthetic gases in an effort to make surgery pain free. Corridors of Blood is a 1958 Horror film directed by Robert Day. Boris Karloff ( 23 November, &ndash 2 February,) was an English actor who emigrated to Canada in the 1910s

A bestseller by Robin Cook "Harmful Intent" has an anesthesiologist as the main character, who uncovers a legal conspiracy aimed at his specialty. Dr Robin Cook (born May 4, 1940 in New York City, New York) is an American doctor / novelist who writes about Medicine

The 1978 film Coma depicts a series of events at the Boston Memorial Hospital in which patients are intentionally put into a Comatose state via anesthesia and their organs later sold. Coma is a 1978 Suspense film based on the novel Coma by Robin Cook. In Medicine, a coma (from the Greek koma, meaning deep sleep is a profound state of Unconsciousness.

Metallica has a song from their album Kill 'Em All called (Anesthesia) Pulling Teeth. Metallica is an American heavy metal band that formed in 1981 in. Kill 'Em All is the debut album by Metallica. It was recorded in only two weeks on a small budget

Awake, a 2007 suspense thriller, is about anaesthesia awareness^{[see below]}. Awake is a 2007 suspense thriller written and directed by Joby Harold. Anesthesia awareness, or "unintended intra-operative awareness" occurs during general anesthesia, when a patient has not had enough general anesthetic or Analgesic

See also

• ASA score
• EEG measures during anesthesia
• Patient safety
• Perioperative mortality
• Anaesthetic Technician
• Anaesthesia awareness
• Allergic reactions during anaesthesia

References

External links

• World Anaesthesia Online International resource of anaesthetic articles
• International Anesthesia Research Society
• International Federation of Nurse Anesthetists
• Anesthesia Wiki Site

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