Presentation
Hemodynamic data were recorded at one minute intervals starting from induction till seven minutes after intubation,--the end point of the present study. [ncbi.nlm.nih.gov]
At present commercial TCI systems are only available for propofol. [virtual-anesthesia-textbook.com]
This is due to its unique metabolism by tissue esterases including cholinesterases in erthrocytes. 6 The future Xenon Xenon may be the inhalational anaesthetic of the future. 7 It is an inert gas which is present in the atmosphere in a concentration of [pharmaceutical-journal.com]
Second Gas Effect: If the above condition is present, but a second anesthetic gas is present, the rate of rise of arterial tension of the second gas is enhanced also. [pharmacology2000.com]
Entire Body System
- Falling
There was a significant fall in mean arterial blood pressure in all the cases at two minutes after induction of anaesthesia with no observed concomitant changes in pulse rate. [ncbi.nlm.nih.gov]
There was a significant fall in mean arterial blood pressure in all the cases at two minutes after induction of anaesthesia with no observed concomitant changes in pulse rate [erepository.uonbi.ac.ke]
BARBITURATES 13. • RENAL • Reduce renal blood flow and glomerular filtration rate in proportion to the fall in blood pressure. • HEPATIC • Hepatic blood flow is decreased. • Induction of hepatic enzymes increases the rate of metabolism of some drugs • [slideshare.net]
It is the closest agent to the ideal that we have, but still falls short in certain areas (see Panel 3 for the properties of an ideal intravenous anaesthetic agent). [pharmaceutical-journal.com]
They vividly remember being held down and gradually drowning and falling into some kind of terrible nightmare. It can be used (and often is in developing countries) for the maintenance of anaesthesia after an inhalational induction (6-7%). [anaesthesia.med.usyd.edu.au]
- Surgical Procedure
Each surgical patient at Brandon Park Veterinary Hospital receives a general anaesthetic for all surgical procedures. This ensures the procedure can be carried out safely, in the shortest possible time and with the least discomfort to your pet. [brandonparkvet.com.au]
Current estimates of perioperative mortality in procedures involving general anaesthesia range from one in 53 to one in 5,417. [20] [21] However, a 1997 Canadian retrospective review of 2,830,000 oral surgical procedures in Ontario between 1973 and 1995 [en.wikipedia.org]
Grading of Patients for Surgical Procedures. Anesthesiology. 2 : 281 (1941). CrossRef Google Scholar 24. Clutton-Brock, J. Some Pain Threshold Studies with Particular Reference to Thio-pentone. Anaesthesia. 15 : 71 (1960). [link.springer.com]
[…] anaesthesia ), Diagnostic manoeuvres and procedures not involving intense pain, initially 4 mg/kg, By intravenous injection over at least 60 seconds, short procedures, initially 1�4.5 mg/kg (2 mg/kg usually produces 5�10 minutes of surgical anaesthesia [kck.usm.my]
Its main role is perhaps in long surgical procedures where recovery to consciousness may be more prolonged with other agents or in day case surgery. [pharmaceutical-journal.com]
Gastrointestinal
- Hiccup
The induction period was associated with pain at injection site in 31.2%, some muscle movements in 15.2% and hiccups in 8.8% of all the cases. [ncbi.nlm.nih.gov]
[…] incidence of thrombophlebitis Harmless on extravasation and arterial injection Low incidence of adverse reactions Smooth onset of anaesthesia (within one arm-brain circulation — normally about 30 seconds) Does not cause unwanted movement (eg, coughing, hiccups [pharmaceutical-journal.com]
[…] for short procedures because of its prolonged duration of action. 5 Methohexital is similar to thiopental and has a similar spectrum of respiratory depression to thiopental. 5 Problems associated with the IV administration of methohexital are burning, hiccups [stage.uspharmacist.com]
Cardiovascular
- Hypotension
Hypotension may contraindicate the use of propofol in the hypovolaemic or unfit patient. [ncbi.nlm.nih.gov]
[…] iv induction agents features: lipid-solubility ⇒ rapid crossing of BBB ⇒ rapid plasma:brain equilibrium short duration of action - redistribution to other tissues general principles: in hypotensive patients, consider ketamine 1) (even if head injury) [ozemedicine.com]
Sometimes other agents are used for induction such as etomidate or ketamine, particularly if there is a worry about hemodynamic instability as propofol not uncommonly can cause bradycardia and/or hypotension. [sketchymedicine.com]
Hypotension should be treated accordingly. Second, drugs which have the potential to increase cerebral metabolic rate of oxygen (CMRO2) and ICP should be avoided. [openanesthesia.org]
Patients with hypotension are particularly at risk [ 32 – 34 ] and are more likely to die after tracheal intubation than are normotensive patients [ 34 ]. Hypotension at induction is a common feature in anaesthesia-related deaths [ 35 ]. [ccforum.biomedcentral.com]
- Hypertension
Understanding the pathophysiology of cerebral hypertension and the systemic/cerebral physiological effects of induction agents is far more important than the choice of anesthetic agent. [openanesthesia.org]
The midazolam group was the most effective in preventing intubation stress (tachycardia,hypertension). [ncbi.nlm.nih.gov]
[…] etomidate, or use reduced dose thiopentone with care in those with asthma, consider ketamine as it has bronchodilator properties, or propofol, or etomidate in those with head injury or acute stroke: if hypotensive or normotensive, consider ketamine 2) if hypertensive [ozemedicine.com]
It should be avoided in patients with coronary artery disease, uncontrolled hypertension, congestive heart failure, increased intracranial pressure (ICP) and arterial aneurysms. [omicsonline.org]
[…] containing 1 mg/ mL, longer procedures, induction, total dose of 0.5�2 mg/kg; maintenance, 10�45 micrograms/kg/minute, rate adjusted according to response Indications: For induction and maintenance of anaesthesia Contra-Indications: In patients with hypertension [kck.usm.my]
- Tachycardia
The midazolam group was the most effective in preventing intubation stress (tachycardia,hypertension). [ncbi.nlm.nih.gov]
In a general population, there is association between seizures and tramadol use in males, long-term therapy, suicide attempts, intentional abuse or misuse, and tachycardia 16. [apicareonline.com]
A single intravenous dose averaging 10.7 mg. induces a rapid, calm and light sleep without producing hypotension, tachycardia, apnoea, or vagal stimulation. Narcosis must be complemented with analgesia and curarization. [link.springer.com]
Sevoflurane produces a concentration-dependent decrease in arterial blood pressure, without reflex tachycardia. Thus, it may be a preferable agent in patients prone to myocardial ischaemia. [ijaweb.org]
Isoflurane increases the heart rate slightly, particularly in young patients, resulting in tachycardia (This arrhythmia is seen on an ECG as periods of fast heart rates) in some. All halogenated agents decrease systemic arterial pressure. [ebme.co.uk]
Psychiatrical
- Euphoria
Anxiolysis is not clearly seen, and euphoria and antalgesia may occur. Thiopentone is the most commonly used induction agent in the world. [anaesthesia.med.usyd.edu.au]
Once a state of euphoria is reached (60 to 90 seconds), a volatile inhalation agent is typically added into the inhaled gas mixture. [stage.uspharmacist.com]
Neurologic
- Amnesia
“dissociative anaesthesia” produces catatonia, amnesia & analgesia via block of glutamic acid @ NMDA receptor subtype lipophilic, rapidly distributed to highly vascular organs & subsequently redistributed to less perfused tissues with concurrent hepatic [ozemedicine.com]
Additionally, the volatile anesthetics provide analgesia and amnesia. [stage.uspharmacist.com]
Other medications which are given include: medications that produce short-term memory loss or amnesia medications that minimise nausea and vomiting ( anti-emetics ) medications that counter-act the effect of other medications ( antagonists ) and medications [allaboutanaesthesia.com.au]
Amnesia persists for about 60 to 90 minutes after recovery of consciousness, but ketamine does not produce retrograde amnesia. [slideshare.net]
During this stage, the patient progresses from analgesia without amnesia to analgesia with amnesia. Patients can carry on a conversation at this time. [en.wikipedia.org]
- Excitement
Intravenous induction is preferred because with older inhalational agents it was faster and smoother with less risk of excitement as the patient passes through the phases of anaesthesia, ie, laryngospasm, coughing, bucking. [pharmaceutical-journal.com]
Sevofluorane Directly Excites Locus Coeruleus Neurons of Rats. Anesthesiology 107, 992-1002. [arsmedica.cl]
This excitation movement may be problematic in larger patients, where restraint may be necessary (Zielinska, Holtby and Wolf, 2011). [japractice.co.uk]
Stage 2 Stage 2, also known as the excitement stage, is the period following loss of consciousness and marked by excited and delirious activity. During this stage, the patient's respiration and heart rate may become irregular. [en.wikipedia.org]
As increasing doses are inhaled, patients experience increasing disinhibition, numbness, drowsiness, excitement, disorientation, agitation, unconsciousness, reflex suppression, cardiovascular depression, respiratory depression, and ultimately death. [anaesthesia.med.usyd.edu.au]
- Confusion
Confusion and disorientation are undesirable after anaesthesia. [virtual-anesthesia-textbook.com]
Agitation, tachycardia, confusion and hypertension suggest a possible mild serotonin syndrome. The serotonergic modulating properties of tramadol mean that it has the potential to interact with other serotonergic agents. [apicareonline.com]
While side-effects are noted for both types of induction agent, these are generally rare, although nausea and vomiting may be unpleasant for the child and disorientating confusion following the operation may persist with gaseous agents. [japractice.co.uk]
Undesirable psychological reactions associated with excitement, confusion or fear may occur in 5 – 30% of patients. [developinganaesthesia.org]
This stage may be accompanied by temporary neurologic phenomena, such as agitated emergence (acute mental confusion), aphasia (impaired production or comprehension of speech), or focal impairment in sensory or motor function. [en.wikipedia.org]
- Myoclonus
Up to 175 cases of systemic infection can be traced back to injection of contaminated propofol 5 The fact that it is not licensed for use in children under three years old Occasional excitatory side effects including myoclonus and opisthonus (hyperextension [pharmaceutical-journal.com]
• Ventilation • Depressant effects on ventilation • Pain on Injection • Pain on injection and venous irritation has been virtually eliminated with use of etomidate preparations utilizing a lipid emulsion vehicle rather than propylene glycol • Myoclonus [slideshare.net]
Workup
Serum
- Hypercapnia
Effects on Organ Systems CARDIOVASCULAR • Fall in blood pressure • Elevation in heart rate RESPIRATORY • Ventilatory response to hypercapnia and hypoxia ---Decreases • Tidal volume --- decreased • Respiratory rate --- decreased • Bronchospasm in asthmatic [slideshare.net]
Hypokalaemia, hypermagnesaemia, hypocalcaemia, hypoproteinaemia, dehydration, acidosis, hypercapnia, cachexia increase effects. Not recommended to drive or operate machinery within 24 hr after full recovery. [kck.usm.my]
Treatment
Post ECT HAM-D score done 1-2 days following ECT treatment. Intervention type Procedure/Surgery Phase Drug names Primary outcome measure Hamilton Depression Scale scores and data collection forms. [isrctn.com]
Hoffman-La Roche Ltd. for the insomnia treatment / anaesthesia induction agent flunitrazepam (Eisai product name: Silece, Chugai product name: Rohypnol) as well as the marketing authorization held by Chugai for Rohypnol in Japan has been agreed upon by [acnnewswire.com]
It is generally considered safe with an advantage of more rapid orientation following the treatment. [ijaweb.org]
[…] care in those with asthma, consider ketamine as it has bronchodilator properties, or propofol, or etomidate in those with head injury or acute stroke: if hypotensive or normotensive, consider ketamine 2) if hypertensive, consider etomidate with pre-treatment [ozemedicine.com]
Epidemiology
Access personal reporting Related Content This Book Next chapter The History of Sepsis from Ancient Egypt to the XIX Century By Johan Sebastián Hernández Botero and María Cristina Florián Pérez Related Book First chapter Epidemiology of Severe Sepsis [intechopen.com]
Anesth Analg 2000, 91: 68-75. 10.1097/00000539-200007000-00014 PubMed Google Scholar Annane D, Aegerter P, Jars-Guincestre MC, Guidet B: Current epidemiology of septic shock: the CUB-Réa Network. [ccforum.biomedcentral.com]
Pathophysiology
Understanding the pathophysiology of cerebral hypertension and the systemic/cerebral physiological effects of induction agents is far more important than the choice of anesthetic agent. [openanesthesia.org]
The pathophysiology of propofol infusion syndrome: a simple name for a complex syndrome. Intensive Care Medicine, 29(9), pp.1417-1425. Ved, S. A., Walden, T. L., Montana, J., Lea, D. E., Tefft, M. C., Kataria, B. K. and Milmoe, G.J., 1996. [japractice.co.uk]
Although evidence is lacking to support NMS and MH having a similar pathophysiology, caution is advised when administering general anaesthesia to patients with NMS. [ijaweb.org]
Prevention
[…] oversedation with anesthesia. ( Table 5 lists recommendations from the COD for preventing oversedation in children. 16 ) Consequently, provision for safe sedation in children requires skill and organization of resources to prevent severe negative patient [stage.uspharmacist.com]
If the patient is going to be intubated, a paralytic (muscle relaxant) is also used to relax the vocal cords to prevent unnecessary trauma as the tube is passed through them. [sketchymedicine.com]
"Post-operative shivering, causes, prevention and treatment (letter)". Update in Anaesthesia (15). Archived from the original on 29 May 2011. [en.wikipedia.org]
The incidence of cardiorespiratory depression appears to be higher than that of other induction agents, but, on the other hand, the absence of tachycardiac response prevents the increase in cardiac oxygen demands. [ncbi.nlm.nih.gov]
Therefore, the minimum alveolar concentration (MAC) is the alveolar anesthetic concentration at one atmosphere (760 mm Hg) preventing movement in 50% of patients exposed to noxious stimuli. [pharmacology2000.com]