General anesthetics

A general anaesthetic (or anesthetic, see spelling differences) drug is an anaesthetic drug that brings about a reversible loss of consciousness. These drugs are generally administered by an anesthesia provider in order to induce or maintain general anaesthesia to facilitate surgery.

Drugs given to induce or maintain general anaesthesia are either given as:


 * Gases or vapors (inhalational anaesthetics)
 * Injections (intravenous anaesthetics)

Most commonly these two forms are combined, with an injection given to induce anaesthesia and a gas used to maintain it, although it is possible to deliver anaesthesia solely by inhalation or injection.

Inhalational anaesthetic substances are either volatile liquids or gases and are usually delivered using an anaesthesia machine. An anaesthesia machine allows composing a mixture of oxygen, anaesthetics and ambient air, delivering it to the patient and monitoring patient and machine parameters. Liquid anaesthetics are vaporized in the machine.

Many compounds have been used for inhalation anaesthesia, but only a few are still in widespread use. Desflurane, isoflurane and sevoflurane are the most widely used volatile anaesthetics today. They are often combined with nitrous oxide. Older, less popular, volatile anesthetics, include halothane, enflurane, and methoxyflurane. Researchers are also actively exploring the use of xenon as an anaesthetic.

Injection anaesthetics are used for induction and maintenance of a state of unconsciousness. Anaesthetists prefer to use intravenous injections as they are faster, generally less painful and more reliable than intramuscular or subcutaneous injections. Among the most widely used drugs are:


 * Propofol
 * Etomidate
 * Barbiturates such as methohexital and thiopentone/thiopental
 * Benzodiazepines such as midazolam and diazepam (commonly known as Valium)
 * Ketamine is used in the UK as "field anaesthesia", for instance at a road traffic incident, and is more frequently used in the operative setting in the US.

The volatile anaesthetics are a class of general anaesthetic drugs. They share the property of being liquid at room temperature, but evaporating easily for administration by inhalation (some experts make a distinction between volatile and gas anesthetics on this basis, but both are treated in this article, since they probably do not differ in mechanism of action). All of these agents share the property of being quite hydrophobic (i.e., as liquids, they are not freely miscible with in water, and as gases they dissolve in oils better than in water

Books

 * Aitkenhead, A. R. (1993). Conscious awareness. Englewood Cliffs, NJ: Prentice-Hall, Inc.
 * Bejenke, C. J. (1996). Can patients be protected from the detrimental consequences of intraoperative awareness in the absence of effective technology? Assen, Netherlands: Van Gorcum & Co.
 * Bennett, H. L. (1993). F.A.C.E.: A sensitive and specific monitor for the adequacy ('depth') of anesthesia. Englewood Cliffs, NJ: Prentice-Hall, Inc.
 * Bennett, H. L. (1993). Memory for events during anesthesia does occur: A psychologist's viewpoint. Englewood Cliffs, NJ: Prentice-Hall, Inc.
 * Block, R. I., Ghoneim, M. M., Pathak, D., Kumar, V., & Hinrichs, J. V. (1990). Studying effects of a subanaesthetic concentration of nitrous oxide to select assessments sensitive to learning during general anaesthesia. Lisse, Netherlands: Swets & Zeitlinger Publishers.
 * Bonebakker, A. E., Bonke, B., Klein, J., Wolters, G., & et al. (1996). Information-processing during general anaesthesia: Evidence for unconscious memory. Assen, Netherlands: Van Gorcum & Co.

Papers

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 * Adam, N., Castro, A. D., & Clark, D. L. (1974). Production, estimation, and reproduction of time intervals during inhalation of a general anesthetic in man: Journal of Experimental Psychology Vol 102(4) Apr 1974, 609-614.
 * Adam, N., Castro, A. D., & Clark, D. L. (1974). State-dependent learning with a general anesthetic (isoflurane) in man: T -I -T Journal of Life Sciences Vol 4(4) 1974, 125-133.
 * Albert, D. J., Walsh, M. L., Zalys, C., & Dyson, E. M. (1987). Maternal aggression and intermale social aggression: A behavioral comparison: Behavioural Processes Vol 14(3) Jun 1987, 267-276.
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 * Alkire, M. T., Haier, R. J., & Fallon, J. H. (2000). Toward a unified theory of narcosis: Brain imaging evidence for a thalamocortical switch as the neurophysiologic basis of anesthetic-induced unconsciousness: Consciousness and Cognition: An International Journal Vol 9(3) Sep 2000, 370-386.
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 * Arhem, P., Klement, G., & Nilsson, J. (2003). Mechanism of anesthesia: Towards integrating network, cellular, and molecular level modeling: Neuropsychopharmacology Vol 28(Suppl1) Jul 2003, S40-S47.
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 * Bernthal, P. J., & Koss, M. C. (1978). Some physiologic characteristics of the electrodermal reflex in the cat: Brain Research Bulletin Vol 3(5) Sep-Oct 1978, 437-441.
 * Betancor Rodriguez, V., Rodriguez Perez, A., Rodriguez Perez, A., & Sanchez Garcia, J. (2001). Information processing under general anesthesia: Effects on the disabiguation of social information: Psicothema Vol 13(2) May 2001, 318-323.
 * Bethune, D. W., Ghosh, S., Gray, B., Kerr, L., Walker, I. A., Doolan, L. A., et al. (1993). Learning during general anesthesia: Implicit recall following methohexital or propofol infusion. Englewood Cliffs, NJ: Prentice-Hall, Inc.
 * Bethune, D. W., Ghosh, S., Walker, I. A., Carter, A., Kerr, L., & Sharples, L. (1993). Intraoperative positive therapeutic suggestions improve immediate postoperative recovery following cardiac surgery. Englewood Cliffs, NJ: Prentice-Hall, Inc.
 * Blacher, R. S. (1993). Psychological reactions to awareness in anesthesia. Englewood Cliffs, NJ: Prentice-Hall, Inc.
 * Block, R. I., Ghoneim, M. M., Pathak, D., Kumar, V., & et al. (1988). Effects of a subanesthetic concentration of nitrous oxide on overt and covert assessments of memory and associative processes: Psychopharmacology Vol 96(3) Nov 1988, 324-331.
 * Bonebakker, A. E., Bonke, B., Klein, J., Wolters, G., & et al. (1996). Information processing during general anesthesia: Evidence for unconscious memory: Memory & Cognition Vol 24(6) Nov 1996, 766-776.
 * Bonebakker, A. E., Jelicic, M., Passchier, J., & Bonke, B. (1996). Memory during general anesthesia: Practical and methodological aspects: Consciousness and Cognition: An International Journal Vol 5(4) Dec 1996, 542-561.
 * Bonke, B., Bovill, J. G., & Moerman, N. (1996). Memory and awareness in anaesthesia 3. Assen, Netherlands: Van Gorcum & Co.
 * Bonke, B., Fitch, W., & Millar, K. (1990). Memory and awareness in anaesthesia. Lisse, Netherlands: Swets & Zeitlinger Publishers.
 * Bonke, B., Rupreht, J., & Van Eijndhoven, J. H. (1986). Stimulus processing during apparent unconsciousness in anesthetized volunteers: Perceptual and Motor Skills Vol 62(2) Apr 1986, 587-591.
 * Bonke, B., Van Dam, M. E., Van Kleef, J. W., & Slijper, F. M. E. (1993). Implicit memory tested in children with inhalation anesthesia. Englewood Cliffs, NJ: Prentice-Hall, Inc.
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 * Couture, L. J., & Bennett, H. L. (1990). Multi-modal content analysis of post-anaesthetic hypnotic regressions. Lisse, Netherlands: Swets & Zeitlinger Publishers.
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 * Donker, A. G., Phaf, R. H., Porcelijn, T., & Bonke, B. (1996). Processing familiar and unfamiliar material during general anaesthesia. Assen, Netherlands: Van Gorcum & Co.
 * Edmonds, H. L., Jr., Andrews, P. J. D., Ackerman, W. E., Tabatabai, A., Juneja, M., Cases-Cristobal, V., et al. (1993). Facial EMG quantifies anxiety and anesthetic adequacy during labor. Englewood Cliffs, NJ: Prentice-Hall, Inc.
 * Elkins, G., Rajab, M. H., Marcus, J., & Staniunas, R. (2004). Prevelence of Anxiety Among Patients Undergoing Colorectal Surgery: Psychological Reports Vol 95(2) Oct 2004, 657-658.
 * Erskine, R., Murphy, P., & Langton, J. A. (1994). The effect of ethyl alcohol on the sensitivity of upper airway reflexes: Alcohol and Alcoholism Vol 29(4) Jul 1994, 425-431.
 * Evans, C., & Richardson, P. H. (1990). A double-blind randomized placebo-controlled study of therapeutic suggestions during general anaesthesia. Lisse, Netherlands: Swets & Zeitlinger Publishers.
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 * Fraser, L. S. M., Vincent, C., Oakley, D. A., Pearce, S., & et al. (1996). Pain perception during surgery performed under adequate general anaesthesia. Assen, Netherlands: Van Gorcum & Co.
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 * Gasparini, M., Vanacore, N., Schiaffini, C., Brusa, L., Panella, M., Talarico, G., et al. (2002). A case-control study on Alzheimer's disease and exposure to anesthesia: Neurological Sciences Vol 23(1) 2002, 11-14.
 * Gazdag, G., & Ivanyi, Z. (2007). Hemodynamic effects of etomidate and propofol: Journal of ECT Vol 23(3) Sep 2007, 206.
 * Ghoneim, M. M., & Block, R. I. (1993). Memory for events during anesthesia does occur: An anesthesiologist's viewpoint. Englewood Cliffs, NJ: Prentice-Hall, Inc.
 * Ghoneim, M. M., & Block, R. I. (1996). Recent advances in the study of memory and awareness during general anaesthesia. Assen, Netherlands: Van Gorcum & Co.
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 * Giannini, J. A. (1987). Postoperative response to behavioral suggestions administered to surgical patients while under surgical levels of general anesthesia: Dissertation Abstracts International.
 * Gidron, Y., Barak, T., Henik, A., Gurman, G., & Stiener, O. (2002). Implicit learning of emotional information under anesthesia: Neuroreport: For Rapid Communication of Neuroscience Research Vol 13(1) Jan 2002, 139-142.
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 * Local anesthesia
 * Mechanical ventilation
 * Intraoperative awareness

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