Information AboutAnesthesia |
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Anesthesia ( American English ), also '''anaesthesia''' ( British English ), is the process of blocking the perception of Pain and other Sensation s. This allows patients to undergo Surgery and other procedures without the distress and pain they would otherwise experience. It comes from the Greek roots ''an-'', "not, without" and ''aesthētos'', "perceptible, able to feel". The word was coined by Oliver Wendell Holmes, Sr. in 1846 . TYPES There are several forms of anesthesia:
HISTORY Anesthesia was used as early back as the classical age. Dioscorides for example reports of section seems to be missing here--can someone please repair it? in anesthesia from an accredited program and are supervised directly by an anesthesiologist. In the United Kingdom, specially trained anaesthetic personnel known as ODPs (operating department practitioner, specialised practitioners within the operating department area) or '''Anaesthetic nurses''' (nurses with prior nursing training choosing to specialize in anaesthetics) provide crucial support and aid in the administration, safety and running of the anaesthetic list. All anaesthetics administered in the UK at present are administered by physicians. Non-pharmacological methods Hypnotism and Acupuncture have a long history of use as anaesthetic techniques. In China , Taoist medical practitioners developed anaesthesia by means of Acupuncture . Chilling tissue (e.g. with Ice ) can temporarily cause nerve fibres ( Axon s) to stop conducting sensation, while Hyperventilation can cause brief alteration in conscious perception of stimuli including pain (see Lamaze ). In modern anaesthetic practice, these techniques are seldom employed. Herbal derivatives The first Herbal anaesthesia was administered in Prehistory . Opium and Hemp were two of the most important herbs used. They were ingested or burned and the smoke inhaled. Alcohol was also used, its Vasodilatory properties being unknown. In early America preparations from datura, effectively Scopolamine , were used as was Coca . In Medieval Europe various preparations of Mandrake were tried as was Henbane ( Hyoscyamine ). Early gases and vapours , 1846 , ether operation; daguerrotype by Southworth & Hawes .]] The development of effective anaesthetics in the 19th Century was, with Listerian techniques, one of the keys to successful surgery. Henry Hill Hickman experimented with Carbon Dioxide in the 1820s . The anaesthetic qualities of Nitrous Oxide (isolated by Joseph Priestley ) were discovered by the British chemist Humphry Davy about 1795 when he was an assistant to Thomas Beddoes , and reported in a paper in 1800 . But initially the medical uses of this so-called "laughing gas" were limited - its main role was in entertainment. It was used in December 1844 for painless tooth extraction by American Dentist Horace Wells . Demonstrating it the following year, at Massachusetts General Hospital , he made a mistake and the patient suffered considerable pain. This lost Wells any support. Another dentist, William E. Clarke , performed an extraction in January 1842 using a different chemical, Diethyl Ether (discovered in 1540 ). In March 1842 in Danielsville, Georgia , Dr. Crawford Williamson Long was the first to use anaesthesia during an operation, giving it to a boy before excising a cyst from his neck; however, he did not publicize this information until later. 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 undergoing an excision of a tumour from his neck. 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 has a number of drawbacks, like its tendency to induce Vomiting and its Flammability . In England it was quickly replaced with Chloroform . Discovered in 1831 , its use in anaesthesia is usually linked to James Young Simpson , who, in a wide-ranging study of organic compounds, found chloroform's efficacy in 1847 . Its use spread quickly and gained royal approval in 1853 when John Snow gave it to Queen Victoria during the birth of Prince Leopold . 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 anaesthetics at this time). This led to many deaths from the use of chloroform which (with hindsight) might have been preventable. The surgical amphitheater 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. ANAESTHETIC EQUIPMENT AND PHYSICS 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. Anaesthesiologists and '''CRNAs''' 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 Machine s (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. ANAESTHETIC AGENTS Local anaesthetics The first effective local anaesthetic was Cocaine . Isolated in 1859 it was first used by Karl Koller , at the suggestion of Sigmund Freud , in ophthalmic surgery in 1884 . Prior to 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. Cocaine soon produced a number of derivatives and safer replacements, including Procaine ( 1905 ), Eucaine ( 1900 ), Stovaine ( 1904 ), and Lidocaine ( 1943 ). Local anaesthetics are agents which prevent transmission of nerve impulses without causing unconsciousness. They act by binding to fast '''Sodium channels''' from within (in an open state). Classification: Local anaesthetics can be either ester or '''amide based'''. - Ester local anaesthetics (eg. procaine, amethocaine, cocaine) are generally fast acting, unstable in solution, and allergic reactions are common - Amide local anaesthetics (eg. lidocaine, prilocaine, bupivicaine, levobupivicaine, ropivicaine, dibucaine) are generally heat stable with a long shelf life of 2 years, with a slower onset (longer half life) and present in a ''' Racemic ''' mixture. It is this type of local anaesthetic agent that is generally used within regional and epidural/spinal techniques namely due to their longer duration of action providing adequate analgesia suitable for surgery, labour and symptomatic relief. NB: Only local anaesthetic agents that are preservative free may be injected intrathecally (i.e within the subarachnoid space). Early opioids and hypnotics Opioid s were first used by Racoviceanu-Pitesti, who reported his work in 1901 . Current pharmacological agents
Adverse Effects Of Local Anaesthesia Convulsion, tremor, dizziness, blurred vision, nervousness, tinnitus, a metal like taste, nausea and respiratory arrest. Cardiovascular collapse and cardiac arrest have also occurred in some cases due to a high systemic dose of bupivacaine. It is very important to be alert following local anesthesia because symptoms may occur quickly without warning. Paralysis of the injected area. VOLATILE AGENTS These are specially formulated gerationeous vapors for the use of induction or maintenance of general anaesthesia. The ideal anesthetic vapor or gas should be non-flammable; non-explosive; lipid soluble; low blood gas solubility; have no end organ (heart, liver, kidney) side effects; not be metabolized and be easy and comfortable to deliver to the patient. No anesthetic gas currently in use meets all of these requirements. The vapors in current use are Halothane , Isoflurane , Desflurane and Sevoflurane . Nitrous Oxide is still in widespread use, making it one of the most long lived and successful drugs in use. Ether is still used in poorer countries as it is safe, particularly when administered by untrained personnel, it also very cheap. In theory, any anesthetic vapor can be used for induction of general anesthesia, however most of the vapors are very irritating to the airway, resulting in coughing, laryngospasm and overall difficult inductions. Commonly used agents for inhalational induction include sevoflurane and halothane. All of the modern vapors can be used alone or in combination with other medications to maintain anesthesia. Currently research into the use of Xenon as an anesthetic gas is being pursued but it is very expensive and may require special equipment for delivery and recovery to be used. Volatile agents are mostly compared in terms of potency, which is inversely proportional to the Minimum Alveolar Concentration . 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 solubilty of a given agent in blood. Namely, those agents with a lower blood solubilty (i.e. a lower blood:gas partition coefficient) gives the anesthesia provider a greater degree of versatiliy in terms of titrating the depth of anesthesia. In the same regard, those agents with a lower blood:gas partition coefficient (e.g. desflurane) permits 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 alveolar concentration , but their versatility for a faster emergence from anesthesia, thanks to their lower blood:gas partition coefficient. CHOICE OF ANESTHETIC TECHNIQUE The choice of anesthetic technique is a complex one, requiring consideration of both patient and surgical facto. In certain patient populations, however, Regional Anesthesia may be safer than General Anesthesia . Neuraxial Blockade may reduce the risk of Deep Vein Thrombosis , Pulmonary Embolism , Transfusion , Pneumonia , Respiratory Depression , Myocardial Infarction and Renal Failure {Link without Title} {Link without Title} . SEE ALSO
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