Genel Anestezikler
Synopsis
This text comprehensively examines the concept of general anesthesia, its stages, and the classification along with the key characteristics of general anesthetic drugs. The term anesthesia, first used in history by Dioscorides, means insensibility, and today general anesthesia refers to temporary neurological changes including loss of consciousness and sensation, amnesia, analgesia, and muscle relaxation. The general anesthesia process consists of three main stages: induction, maintenance, and awakening as vital functions fully return. The features expected from an ideal general anesthetic agent include low toxicity, rapid and smooth induction, reversible action, adequate muscle relaxation, and minimal suppressive effects on the respiratory and circulatory systems. General anesthetic drugs are categorized into two primary groups based on their route of administration: inhalation and intravenous anesthetics. Inhalation anesthetics exist in gas (nitrous oxide, xenon) and volatile liquid (desflurane, isoflurane, sevoflurane, halothane) forms, and their potency is evaluated using the Minimum Alveolar Concentration (MAC) value. Intravenous anesthetics comprise various chemical structures, including barbiturates (thiopental sodium), benzodiazepines (midazolam, diazepam), ketamine providing dissociative anesthesia, the hypnotic agent propofol, and the imidazole derivative etomidate. Each agent possesses a unique profile of actions and adverse effects on the central nervous system, cardiovascular system, liver, and kidneys.
References
Osbaldeston TA, editor. The herbal of Dioscorides the Greek, Ibidis Press. Johannesburg South Africa; 2000. Available from: https://tr.scribd.com/doc/94437559/Dioscorides-De-Materia-Medica.
Morgan GE, Mikhail MS, Murray MJ. History of Anesthetic Practice Clinical Anesthesiology. 3rd ed. Morgan GE, Mikhail MS, Murray MJ (eds). Los Angeles: McGraw-Hill:2001.p:1-10
Drummond JC. Baseline Cerebral Metabolic Rate Is a Critical Determinant of the Cerebral Vasodilating Potency of Volatile Anesthetic Agents. Anesthesiology. 2018;129(1):187.
Kharasch ED. Adverse drug reactions with halogenated anesthetics. Clin Pharmacol Ther 2008; 84: 158–62.
Aranake A, Mashour GA, Avidan MS. Minimum alveolar concentration: ongoing relevance and clinical utility. Anaesthesia 2013; 68:512.
Eger EI 2nd, Eisenkraft JB, Weiskopf RB, editors. The Pharmacology of Inhaled Anesthetics. Edmond I Eger II. 2nd ed.Chicago IL:Healthcare Press, 2002.
Torri G. Inhalation anesthetics: a review. Minerva Anestesiol 2010; 76:215.
Perouansky M, Pearce R, Hemmings H, Jr. Chapter 20—Inhaled anesthetics: mechanisms of action. In: Miller RD, Eriksson LI, Fleisher LA,Wiener-Kronish JP, Young WL, eds. Miller’s Anesthesia, 7th Edn. New York:Churchill Livingstone Elsevier, 2010
Dahmani S, Stany I, Brasher C, Lejeune C, Bruneau B, Wood C, et al. Pharmacological prevention of sevoflurane- and desflurane-related emergence agitation in children: a meta-analysis of published studies. Br J Anaesth 2010;104:216–23.
Riazi S, Larach MG, Hu C, Wijeysundera D, Massey C, Kraeva N. Malignant hyperthermia in Canada: characteristics of index anesthetics in 129 malignant hyperthermia susceptible probands. Anesth Analg. 2014;118(2):381–7.
Jones MV, Brooks PA, Harrison NL "Enhancement of gamma-aminobutyric acid-activated Cl- currents in cultured rat hippocampal neurones by three volatile anaesthetics". The Journal of Physiology. 449: 279–93.
Bradshaw JJ, Ivanetich KM: Isoflurane: A comparison of its metabolism by human and rat hepatic cytochrome P-450. Anesth Analg 1984; 63:805-13
Shankar V, Churchwell KB, Deshpande JK. Isoflurane therapy for severe refractory status asthmaticus in children.Intensive Care Med 2006; 32(6):927-33
Rödig G, Keyl C, Wiesner G, Philipp A, Hobbhahn J. Effects of sevoflurane and isoflurane on systemic vascular resistance: use of cardiopulmonary bypass as a study model. Br J Anesth 1996; 76: 9-12.
Van Allen NR, Krafft PR, Leitzke AS, Applegate RL, Tang J, Zhang JH. The role of Volatile Anesthetics in Cardioprotection: a systematic review. Med Gas Res. 2012 Aug 28;2(1):22.
Hu G, Schwartz DE, Shajahan AN, Visintine DJ, Salem MR, Crystal GJ, et al. Isoflurane, but not sevoflurane, increases transendothelial albumin permeability in the isolated rat lung: role for enhanced phosphorylation ofcaveolin-1. Anesthesiology 2006;104(4):777-85
Lerman, J. (2004) Inhalational anesthetics. Paediatr Anaesth, 14 (5), 380-383.
Khan KS, Hayes I, Buggy DJ. Pharmacology of anaesthetic agents II: inhalation anaesthetic agents. Continuing Education in Anaesthesia Critical Care & Pain, Volume 14, Issue 3, 1 June 2014, Pages 106–111.
Takahoski H, Minaka K. Sevoflurane Does Not Increase ICP In Hyperventilated Dogs. Br J Anesth1993;7:23:237-239
Harper NJ. Inhalational anaesthetics. Anaesthesia and Intensive Care Medicine, 2004, 5:278–282.
Perlata R et al. Halothane hepatotoxicity. (http://emedicine.medscape.com/article/166232-overview, accessed 2 Novem-ber 2011)
Zafirova Z, Sheehan C, Hosseinian L. Update on nitrous oxide and its use in anesthesia practice. Best Pract Res Clin Anaesthesiol. 2018 Jun;32(2):113-123.
Myles PS, Leslie K, Chan MT, Forbes A, Paech MJ, Peyton P, Silbert BS, Pascoe E., ENIGMA Trial Group. Avoidance of nitrous oxide for patients undergoing major surgery: a randomized controlled trial. Anesthesiology. 2007 Aug;107(2):221-31.
. Santhoh J. Nitrous oxide and long-term morbidity and mortality in the ENIGMA trial. Anesth Analg 2011; 112: 387–93(Epub September 22,2010)
Loepke AW, Soriano SG. An assessment of the effects of general anesthetics on developing brain structure and neurocognitive function. Anesth Analg 2008; 106: 1681–707
Srishti, K., Lalita, M., & Ashish, B. 2012.A Study of Pharmacokinetics of Sodium Thiopental in Rats by Histological Examination of Kidney and Heart. Res. J. Pharmaceutic. Sci., 1(2): 1-6.
Liu H, Yao S. Effect of thiopental sodium on the release of glutamate and gamma-aminobutyric acid from rats prefrontal cortical synaptosomes. J Huazhong Univ Sci Technolog Med Sci. 2004;24(6):602-4.
Höhener D, Blumenthal S, Borgeat A. Sedation and regional anaesthesia in the adult patient . BJA 2008; 100(1): 8-16.
Olkkola KT, Ahonen J (2008). "Midazolam and other benzodiazepines". Modern Anesthetics. Handbook of Experimental Pharmacology.182.pp.335–360
Riss J, Cloyd J, Gates J, Collins S (August 2008). "Benzodiazepines in epilepsy: pharmacology and pharmacokinetics". Acta Neurologica Scandinavica. 118 (2): 69–86
Haut SR, Seinfeld S and Pellock J (2016) Benzodiazepine use in seizure emergencies: a systematic review. Epilepsy & Behavior 63:109-117
Browne CA, Lucki I (2013) Antidepressant effects of ketamine: mechanisms underlying fast-acting novel antidepressants. Front Pharmacol, 4:161.
Butkovic D, Kralik S, Matolic M, Jakobovic J, Zganjer M, Radesic L. Comparison of a preincisional and postincisional small doses of ketamine for postoperative analgesia in children. Bratisl Lek Listy 2007;108:184-8.
Craven R (2007) Ketamine. Anaesthesia, 62:48-53
84. Kaisti KK, et al. Anesthesiology. 2003;99(3):603.
Miner JR, Burton JH. Clinical practice advisory: Emergency department procedural sedation with propofol. Ann Emerg Med 2007; 50: 182-187.
Morgan GE, Mikhail MS, Murray MJ. Anesthesia for Ophtalmic Surgery. In: Clinical Anesthesiology. Morgan GE,Mikhail MS, Murray MJ (eds). 4 th edition. New York: Mc Graw-Hill; 2008. 826-36.
Eleveld DJ, Proost JH, Cortínez LI et al. A general purpose pharmacokinetic model for propofol. Anesth Analg 2014; 118:1221–37
Euasobhon P, Dej-Arkom S, Siriussawakul A, Muangman S, Sriraj W, Pattanittum P, et al. Lidocaine for reducing propofol-induced pain on induction of anaesthesia in adults. Cochrane Database Syst Rev. 2016; 2:7874. https://goo.gl/cD15hk
Stuart SA. “Clinical and molecular pharmacology of etomidate”. Anesthesiology 114.3 (2011): 695-707
Morgan G, Maged S.M., Murray M.J., Clinical Anesthesiology 3th edition .The Mc Graw Hill Companies Inc,New York, 2002, p 172.
White PF, Eng MR. Intravenous anesthetics. In: Barash PG, Cullen BF, Stoelting RK, et al., editors. Clinical anesthesia. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2009. pp. 444–65.
Mizrak A, Koruk S, Bilgi M, et al. Pretreatment with dexmedetomidine or thiopental decreases myoclonus after etomidate: a randomized, double-blind controlled trial. J Surg Res. 2010;159(1):e11–16.
Hwang JY, Kim JH, Oh AY, Do SH, Jeon YT, Han SH: A comparison of midazolam with remifentanil for the prevention of myoclonic movements following etomidate injection. J Int Med Res 2008; 36:17–22
