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European Journal of Anaesthesiology Oct 2022Potent inhaled anaesthetics are halogenated hydrocarbons with a large global warming effect. The use of fluorinated hydrocarbons (most are not anaesthetics) are being... (Review)
Review
Potent inhaled anaesthetics are halogenated hydrocarbons with a large global warming effect. The use of fluorinated hydrocarbons (most are not anaesthetics) are being restricted but volatile anaesthetics have been exempted from legislation, until now: the EU has formulated a proposal to ban or at least severely restrict the use of desflurane starting January 2026. This narrative review addresses the implications of a politics-driven decision - without prior consultation with major stakeholders, such as the European Society of Anaesthesiology and Intensive Care (ESAIC) - on daily anaesthesia practice and reviews the potential scientific arguments that would support stopping the routine use of desflurane in anaesthetic practice. Of note, banning or severely restricting the use of one anaesthetic agent should not distract the user from sensible interventions like reducing fresh gas flows and developing technology to capture and recycle or destroy the wasted potent inhaled anaesthetics that we will continue to use. We call to join efforts to minimise our professional environmental footprint.
Topics: Anesthesia; Anesthesiology; Anesthetics, Inhalation; Desflurane; Humans; Isoflurane
PubMed: 36036420
DOI: 10.1097/EJA.0000000000001739 -
Journal of Investigative Surgery : the... Jun 2012Of all milestones and achievements in medicine, conquering pain must be one of the very few that has potentially affected every human being in the world. It was in 1846...
Of all milestones and achievements in medicine, conquering pain must be one of the very few that has potentially affected every human being in the world. It was in 1846 that one of mankind's greatest fears, the pain of surgery, was eliminated. This historical review article describes how the various elements of anesthesiology (gasses, laryngoscopes, endotracheal tubes, intravenous medications, masks, and delivery systems) were discovered and how some brilliant entrepreneurs and physicians of the past two centuries have delivered them to humanity. One name stands out amongst all others when the founder of modern anesthesia is discussed, William T.G. Morton (1819-1868). A young Boston Dentist, Dr. Morton had been in the search for a better agent than what had been used by many dentists: nitrous oxide. With Dr. Morton's tenacity driven by enthusiasm and discovery, he and renowned surgeon at Massachusetts General Hospital, John Collins Warren (1778-1856) made history on October 16, 1846 with the first successful surgical procedure performed with anesthesia. Dr. Morton had single-handedly proven to the world that ether is a gas that when inhaled in the proper dose, provided safe and effective anesthesia. One of the first accounts of an endotracheal tube being used for an airway comes from the pediatrician Joseph O'Dwyer (1841-1898). He used the metal "O'dwyer" tubes in diphtheria cases and passed them into the trachea blindly. Adding a cuff to the tube is credited to Arthur Guedel (1883-1956) and Ralph M. Waters (1883-1979) in 1932. This addition suddenly gave the practitioner the ability to provide positive pressure ventilation. The anesthesiologist Chevalier Jackson (1865-1958) promoted his handheld laryngoscope for the insertion of endotracheal tubes and its popularity quickly caught hold. Sir Robert Reynolds Macintosh's (1897-1989) breakthrough technique of direct laryngoscopy came after being appointed Nuffield professor of anesthetics at the University of Oxford in 1937. He was the first to describe the routinely placing of the tip of his newly re-designed laryngoscope in the epiglottic vallecula which is attached to the base of the tongue, thus when lifted exposed the entire larynx. Macintosh was genuinely astonished at what a great view he could achieve with his new blade and technique. The use of barbiturates as an intravenous anesthetic began in 1932. Sodium thiopental gained popularity after its use was described in detail by a Dr. John Lundy (1894-1973) of the Mayo Clinic. Other I.V. medications were tried over the past seventy years, but the newest induction drug which provided for a substantially shorter recovery period and seemed to actually suppress laryngeal reflexes has brought with it many benefits. Propofol, introduced clinically in 1977, demonstrated many positive effects even as an anti-emetic compound. Before October of 1846, surgery and pain were synonymous but not thereafter. As we entered the information age where the infrastructure of evidence based medicine and newer fields of genetics, transplantation, imaging radiology and even stem cells became quickly integrated into mainstream medicine, we can predict an excellent future on the progress to be made in anesthesia.
Topics: Anesthesia; Anesthesiology; Anesthetics; History, 19th Century; History, 20th Century; Humans; Intubation, Intratracheal; Laryngoscopy; Neuromuscular Blocking Agents
PubMed: 22583009
DOI: 10.3109/08941939.2012.690328 -
Journal of Neurosurgical Anesthesiology Oct 2014General anesthetics mitigate distress and exaggerated hemodynamic responses to pain and stressful stimulation, allowing surgery and diagnostic procedures to be performed... (Review)
Review
General anesthetics mitigate distress and exaggerated hemodynamic responses to pain and stressful stimulation, allowing surgery and diagnostic procedures to be performed worldwide in millions of children every year. Emerging studies, mainly carried out in early postnatal laboratory animals, demonstrate widespread neuronal elimination, alteration in neuronal circuitry, and long-term neurological disabilities following exposure to all commonly used sedatives and anesthetics. These findings have raised concerns among parents, anesthesiologists, neuroscientists, and government regulators about the safety of anesthetic drugs in children, especially infants. Accumulating evidence from epidemiological studies suggests an association between surgery with anesthesia in early childhood and subsequent behavioral and cognitive abnormalities. During the Fourth Pediatric Anesthesia NeuroDevelopmental Assessment (PANDA) symposium, a meeting attended by many stakeholders, the most recent findings in the field were presented and discussed. This review summarizes the current state of clinical research into the effects of anesthetic exposure in human brain development, addresses some of the difficulties in examining the phenomenon, and introduces the most recent clinical findings presented at the PANDA symposium. The unanimous consensus among participants was that additional preclinical and clinical research efforts are urgently required to address this important concern for child health.
Topics: Anesthesia; Anesthesiology; Anesthetics; Biomedical Research; Brain; Child; Humans; Neurotoxicity Syndromes
PubMed: 25144503
DOI: 10.1097/ANA.0000000000000117 -
Canadian Journal of Anaesthesia =... Dec 2017As the use of recreational drugs increases, the likelihood of an anesthesiologist perioperatively encountering patients using or addicted to these drugs will also...
PURPOSE
As the use of recreational drugs increases, the likelihood of an anesthesiologist perioperatively encountering patients using or addicted to these drugs will also increase.
PRINCIPAL FINDINGS
Addicted patients may present for anesthetic care in a variety of circumstances in everyday elective surgeries or in acute or life-saving situations, such as emergency Cesarean delivery or trauma surgery. Therefore, it is important for anesthesiologists to know about the most common illicit drugs being used, their clinical presentation and side effects, and the anesthetic options that are beneficial or detrimental to these patients. The most frequently used illicit substances, apart from alcohol and tobacco, are cannabis, cocaine, heroin, prescription opioids, methamphetamine, and hallucinogens. When planning anesthetic care, it is important for anesthesiologists to understand the effects of these agents, including various drug interactions, to predict tolerance to some anesthetic agents, to recognize drug withdrawal signs and symptoms, and to be prepared to manage all these factors in the perioperative period.
CONCLUSIONS
For optimal patient care through the perioperative period, it is critical to obtain information about patient drug use and other associated treatment in order to construct an appropriate anesthetic plan, including specific considerations during surgery, emergence, and in the postanesthesia care unit.
Topics: Anesthesia; Anesthesia Recovery Period; Anesthesiology; Anesthetics; Humans; Illicit Drugs; Substance Withdrawal Syndrome; Substance-Related Disorders
PubMed: 28956316
DOI: 10.1007/s12630-017-0975-0 -
Ugeskrift For Laeger Dec 1992Anaesthesia with closed anaesthetic systems demands knowledge of the physiology of the patients and of how the various anaesthetic gases behave in the organism as only... (Review)
Review
Anaesthesia with closed anaesthetic systems demands knowledge of the physiology of the patients and of how the various anaesthetic gases behave in the organism as only the gases which the patients produces and absorbs are eliminated and replaced. The system is educational as it provides knowledge of the genuine absorption of oxygen and anaesthetic gases. The method is favourable to the environment as only the gases which are used are supplied and it is thus economical in use although investment in monitoring equipment is necessary. In practice, induction and waking of the patient are complicated with this system and it requires an anaesthetist who constantly adjusts the gases in the circuit.
Topics: Anesthesia, Closed-Circuit; Anesthesiology; Anesthetics; Carbon Dioxide; Gases; Humans; Oxygen Consumption
PubMed: 1471274
DOI: No ID Found -
American Journal of Surgery Nov 1988The practices of anesthesiology are changing to meet the needs of an older and sicker patient population, to adapt to advances in medical technology and operating... (Review)
Review
The practices of anesthesiology are changing to meet the needs of an older and sicker patient population, to adapt to advances in medical technology and operating techniques, and to provide better postoperative conditions for patients and those caring for them. There is a large spectrum of anesthetics and a variety of anesthetic techniques that allow anesthetic onset and recovery to be rapid, vital functions to be maintained within normal limits, and operating conditions to be adapted to the needs of both patients and surgeons. Nevertheless, all anesthetic drugs and techniques have inherent risks as well as benefits, and despite expertise and caution in their use, a satisfactory outcome for the patient cannot be guaranteed.
Topics: Analgesia; Anesthesia, General; Anesthesia, Local; Anesthesiology; Anesthetics; Endorphins; Hypnotics and Sedatives; Neuromuscular Nondepolarizing Agents
PubMed: 2973254
DOI: 10.1016/s0002-9610(88)80199-5 -
Revista Espanola de Anestesiologia Y... 1993
Topics: Allergy and Immunology; Anesthesiology; Anesthetics; Humans; Hypersensitivity, Immediate
PubMed: 8465072
DOI: No ID Found -
Anesthesiology Mar 2012
Topics: Anesthesiology; Anesthetics; Animals; Brain; Cerebrovascular Circulation; Goats; History, 20th Century; Humans; Spinal Cord
PubMed: 22252031
DOI: 10.1097/ALN.0b013e318245c1e0 -
Cleveland Clinic Journal of Medicine 1993Internists are commonly consulted to "clear" patients for anesthesia and surgery. Newer anesthetic agents and techniques now extend limits and possibilities beyond what... (Review)
Review
BACKGROUND
Internists are commonly consulted to "clear" patients for anesthesia and surgery. Newer anesthetic agents and techniques now extend limits and possibilities beyond what many internists were taught.
OBJECTIVE
To update internists on recent changes in anesthetic management and how they affect the preoperative evaluation.
SUMMARY
Recent advances in anesthetic management include new monitoring standards, balanced anesthetic technique, new agents, equipment changes, better understanding of human factors, and expanded pain management techniques.
CONCLUSIONS
Postoperative care will likely assume increasing importance in determining anesthesia-related morbidity and mortality. For this reason, increased interaction and cooperation between surgeons, internists, and anesthesiologists are needed.
Topics: Anesthesiology; Anesthetics; Forecasting; Humans; Internal Medicine; Monitoring, Intraoperative
PubMed: 8513544
DOI: 10.3949/ccjm.60.3.219 -
Anesthesiology Jan 2011
Topics: Anesthesiology; Anesthetics, Inhalation; Animals; Dogs; History, 20th Century; Ischemic Preconditioning, Myocardial; Isoflurane
PubMed: 21169798
DOI: 10.1097/ALN.0b013e3181fe4971