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2.1
Anaesthetic Induction Agent
Induction of Anaesthesia

Presentation

At present commercial TCI systems are only available for propofol. [virtual-anesthesia-textbook.com]

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]

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]

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]

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]

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]

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]

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