# Anesthesia General

> All about Anesthesia and Critical Care


## Posts

- [Ketamine Mechanism of Action](https://anesthesiageneral.com/ketamine-mechanism-of-action/): To know about Ketamine mechanism of action we need to know that Ketamine is a non-competitive antagonist to the phencyclidine site of N-methyl-d-aspartate (NMDA) receptor for glutamate, though Ketamine mechanism of action has effects that are mediated by interaction with many others receptors. N-Methyl-D-Aspartate Receptor Antagonism : NMDA receptors are ligand-gated ion channels that are [&hellip;]
- [Hypoxia signs](https://anesthesiageneral.com/hypoxia-signs/): Following are the Hypoxia signs Psychological Hypoxia signs &#8211; Higher centers are first impaired in hypoxia due to deficiency of oxygen to the brain tissue. Psychomotor and emotional judgement is poor in the absence of oxygen. The mechanisms mediating cerebral vasodilation during hypoxia are not fully understood but may include neurogenic effects initiated by peripheral and neuraxial chemoreceptors, [&hellip;]
- [Dural tear](https://anesthesiageneral.com/dural-tear/): Dural tear is a known complication of spinal surgeries, such as laminectomies, spinal fusions, and disc excisions. It most commonly occurs in the lumbar region. In general, the tear is noted at the time of operation when leakage of cerebrospinal fluid (CSF) is noted by the surgeon. A tear in the dura results in decompression [&hellip;]
- [Noncardiac Chest Pain](https://anesthesiageneral.com/noncardiac-chest-pain/): Chest pain in the intensive care unit (ICU) is a common and potentially serious complaint. The differential diagnosis of noncardiac chest pain is broad, and the physician must not be limited to cardiac etiologies, although myocardial infarction and angina must always be considered. The initial approach to Noncardiac Chest Pain requires a rapid evaluation, history, [&hellip;]
- [What causes Hypoxia](https://anesthesiageneral.com/what-causes-hypoxia/): Clinical Causes of Hypoxia During Anesthesia Every doctor should know the answer to the basic question What causes Hypoxia . Factors responsible: 1. Preanaesthesia factors • Poor physiological status • Drug intake • Premedication with narcotics and sedatives depress the respiration • Decreased compensatory mechanism due to any cause 2. Decreased partial pressure and concentration of the inspired oxygen in [&hellip;]
- [Chloroform chemical formula](https://anesthesiageneral.com/chloroform-chemical-formula/): Chloroform anesthesia is prepared from chloroform chemical formula and is a potent, pleasant, non-irritant anaesthetic agent, very popular in the early days of anaesthesia. Physical properties of Chloroform chemical formula are that, it is colourless, sweet odour, non flammable, bp 6 1°C, VP 80mm Hg, blood/gas coefficient 10.3, oil/gas 394, MAC 0.62, metabolism 50% to [&hellip;]
- [Neuraxial regional anesthesia anticoagulation](https://anesthesiageneral.com/neuraxial-regional-anesthesia-anticoagulation/): A special mention must be made here about the novel ways of using neuraxial regional anesthesia anticoagulation . The use started in 1979. Gradually they have become very popular and almost all the clinically available opioids have been tried by this route. Nowadays the flexibility of neuraxial regional anesthesia anticoagulation is available to be given [&hellip;]
- [Treating carbon monoxide poisoning](https://anesthesiageneral.com/treating-carbon-monoxide-poisoning/): Hyperbaric oxygen therapy is currently used in various clinical treatment regimens like for treating carbon monoxide poisoning. These include decompression sickness, carbon monoxide poisoning, cyanide poisoning, gas embolus, gas gangrene, resistant anaerobic infections, and threatened split-thickness skin grafts. The mechanism of action in treating carbon monoxide poisoning purportedly involves increasing tissue oxygenation, which increases collagen [&hellip;]
- [Acute opioid toxicity treatment](https://anesthesiageneral.com/acute-opioid-toxicity-treatment/): Clinical Features for acute opioid toxicity treatment is necessary at times.The clinical occurrence of acute opioid toxicity is due to any of the following three main reasons: • Clinical overdosage: Either iatrogenic or patient-controlled analgesia pumps. • Accidental overdosage by addicts. • Attempts at suicide. Whatever might be the cause, “high degree of suspicion” is [&hellip;]
- [Trichloroethylene health effects](https://anesthesiageneral.com/trichloroethylene-health-effects/): Trichloroethylene Trichloroethylene is also called as Trilene. It is an inhalational anesthetic gas, which was widely used until recently. It is still used in some developing countries because of its cheap cost compared to the other halogenated inhalational anesthetics. Trichloroethylene Physical Properties • It is colorless liquid. • Odor is sweet. • Mildly irritant. • [&hellip;]
- [Midazolam sedation](https://anesthesiageneral.com/midazolam-sedation/): Midazolam sedation is a useful intravenous adjunct to local or regional anesthesia for a variety of therapeutic and diagnostic procedures. Midazolam sedation in doses of 1.0 to 2.5 mg IV (onset within 30-60 sec, time to peak affect 3 to 5 minutes, duration of sedation 15 to 80 minutes) is effective for sedation. Titrated intravenous [&hellip;]
- [Nitroprusside Cyanide Toxicity](https://anesthesiageneral.com/nitroprusside-cyanide-toxicity/): Nitroprusside Cyanide Toxicity is due to the cyanide groups released from metabolism of the nitroprusside molecule. After gaining an electron from the iron moiety of hemoglobin, the sodium nitroprusside produces an unstable radical and methemoglobin. Hypertension is commonly seen in the perioperative setting as well as the intensive care unit (ICU). There are many agents [&hellip;]
- [Propofol mechanism of action](https://anesthesiageneral.com/propofol-mechanism-of-action/): Propofol mechanism of action exerts its sedative hypnotic effects through a GABA receptor interaction. GABA is the principal inhibitory neurotransmitter in the CNS. When GABAA receptors are activated, transmembrane chloride conductance increases, resulting in hyperpolarization of the postsynaptic cell membrane and functional inhibition of the postsynaptic neuron. The interaction of propofol mechanism of action also [&hellip;]
- [Wong baker pain assessment tool](https://anesthesiageneral.com/wong-baker-pain-assessment-tool/): Wong baker pain assessment tool is used in the patients who do not have appropriate cognitive level to use a number scale, like lay persons or children. The patient then points out to face best represents how he/she is feeling at that point of time. The patient must be explained correlation between each face and [&hellip;]
- [Propofol and Egg Allergy](https://anesthesiageneral.com/propofol-and-egg-allergy/): Propofol and egg allergy are quietly related as one of the side effects. Allergic reactions to propofol on first exposure are usually because of the isopropyl groups that may act as epitopes and that are present in various medications andcosmetics. Allergic reactions to propofol upon re-exposure are usually because of the phenol molecule. Propofol and [&hellip;]
- [Acoustic Surgery](https://anesthesiageneral.com/acoustic-surgery/): Acoustic Surgery can be accomplished with suboccipital, translabyrinthine and middle fossa approaches. The sitting, supine, lateral or park-bench position can be used for the suboccipital approach. Small or medium sized tumours are associated with essentially no mortality, whereas large tumors (&gt;4 cm) have mortality rates of 2-4%. Compromise of the anterior inferior cerebellar artery and [&hellip;]
- [Nesiritide drip](https://anesthesiageneral.com/nesiritide-drip/): Of interest to the clinicians is that, while appearing minimally responsive to endogenous BNP, heart failure patients will effectively respond to exogenously administered BNP which is nesiritide drip. In patients with cardiogenic pulmonary edema due to acute decompensated heart failure, plasma brain natriuretic peptide (BNP) measurements can guide the diagnosis, distinguishing this etiology of dyspnea [&hellip;]
- [Differential Block](https://anesthesiageneral.com/differential-block/): Differential Block refers to the gradual and sequential block of the different type of nerve fibres when they are exposed to a local anesthetic. Small diameter axons are more susceptible to block than large diameter fibers, however myelinated fibers are more sensitive than non myelinated. This is because local anesthetics block the fiber at node [&hellip;]
- [Benzodiazepine receptors](https://anesthesiageneral.com/benzodiazepine-receptors/): The sedative effects of benzodiazepine receptors are due to activation of α-1 subunits of GABA receptors. The anxiolytic activity associated with the benzodiazepine is due to α-2 subunit activity. The GABAA receptor is large, providing attachment sites for GABA, benzodiazepines, barbiturates, etomidate, propofol, and alcohol. This property explains the pharmacologic synergy of these substances and [&hellip;]
- [Midazolam in neonates](https://anesthesiageneral.com/midazolam-in-neonates/): Based on the pharmacokinetic parameters and reported clinical experience in preterm and term midazolam in neonates , continuous IV infusion of midazolam should be initiated at a rate of 0.0005 to 0.001 mg/kg/mm (0.5 to 1 mcg/kg/min). IV loading doses should not be used with midazolam in neonates ; rather the infusion may be run [&hellip;]
- [Diazepam metabolism](https://anesthesiageneral.com/diazepam-metabolism/): Diazepam metabolism is carried out by hepatic microsomal enzymes using an oxidative pathway of N-demethylation with the production of desmethyldiazepam, oxazepam, and to a lesser extent temazepam as metabolites. Desmethyl diazepam is metabolized more slowly than oxazepam and is only slightly less potent than diazepam. These metabolites contribute to the sustained effect of diazepam. The [&hellip;]
- [Upper Respiratory Anatomy](https://anesthesiageneral.com/upper-respiratory-anatomy/): The Upper Respiratory Anatomy starts with the nose, which is an essential organ for breathing and conditioning of the air. The main respiratory functions of the nose are to provide passage to the air as well as the warming and moistening of the air. The next part is the pharynx, which is further divided into [&hellip;]
- [Arteriovenous Malformations AVMs](https://anesthesiageneral.com/arteriovenous-malformations-avms/): The reduced cerebrovascular resistance at the site of Arteriovenous Malformations AVMs lead to an increase in blood flow to this area and the formation of a lower resistance shunt along with peri-infarction oedema. They usually represent a high-flow and low-resistance shunts with systemic arterial pressure  more than the vascular intramural pressure ; so, rupture does [&hellip;]
- [Halothane Anesthesia](https://anesthesiageneral.com/halothane-anesthesia/): Halothane Anesthesia is an alkane, halogenated hydrocarbon introduced in 1256. (M Johnston, UK). Physical Properties: Halothane Anesthesia is colorless, sweet smelling, nonirritating, bp 50 degrees C, VP 243 mm Hg, blood/gas 2.5, oil/gas 224, metabolism 20—40%, MAC in 02 ofQ7 /o and 0.29% with N20. It is relat Istable, decopcs on exposure tq.ajr, hence stored [&hellip;]
- [Mechanisms of action of inhalation anesthetics](https://anesthesiageneral.com/mechanisms-of-action-of-inhalation-anesthetics/): The exact site of mechanisms of action of inhalation anesthetics is not certain but possible sites are macroscopic (CNS-brain), microscopic (axons and synapses) and molecular (pre- and postsynaptic membranes). Hence, the possible mechanisms of action of inhalation anesthetics is varied: a) Multiple receptor sites b) Motor inhibition at spinal cord level c) Many neurotransmitters are [&hellip;]
- [Midazolam IM](https://anesthesiageneral.com/midazolam-im/): For sedation prior to anesthesia or procedures, for longer and/or more stimulating procedures, midazolam IM can be used to facilitate insertion of an IV catheter for titration of additional medication. Midazolam IM doses of 0.1 to 0.15 mg/kg are usually effective and do not prolong emergence from general anesthesia. For more anxious patients, doses up [&hellip;]
- [What is Opioid](https://anesthesiageneral.com/what-is-opioid/): There are various ways of describing what is opioid. The common feature of all the drugs belonging to the group of these drugs is a phenanthrene ring with side chain and additional rings that might be added to the central ring itself or to the side chains. 1. Naturally occurring: morphine, codeine, kheline, noscapine, and thebaine. 2. [&hellip;]
- [Propofol on Blood Pressure](https://anesthesiageneral.com/propofol-blood-pressure/): The effect of propofol on blood pressure is that it decreases systemic blood pressure. This decrease in propofol blood pressure is often accompanied by corresponding changes in cardiac output and systemic vascular resistance. Propofol decreases afterload more than thiopental and thus reduces systemic arterial pressure more than thiopental. Propofol preferentially decreases SVR without a significant [&hellip;]
- [Propofol Anesthesia](https://anesthesiageneral.com/propofol-anesthesia/): Propofol anesthesia has become the induction drug of choice for most of the surgical procedures, especially when rapid and complete awakening is desirable. Continuous IV infusion of Propofol anesthesia with or without other anesthetic drugs, is commonly used in TIVA and for sedation. Due to its quick onset and offset characteristics it is also becoming [&hellip;]
- [Convert MmHg to CmH2o](https://anesthesiageneral.com/convert-mmhg-to-cmh2o/): If you want to convert MMhg to CMh2o the following knowledge is important for this. Pressure is defined as the force per unit area. It can be applied either to a solid or a liquid interface at a point perpendicular to the surface and is represented by the height of the column that exerts a [&hellip;]
- [Magnesium on Brain](https://anesthesiageneral.com/magnesium-on-brain/): The neuroprotective effects of Magnesium on Brain have been reported in experimental models of traumatic brain injury, cerebral ischaemia and acute subarachnoid haemorrhage. Magnesium on Brain reduces infarct volume in various animal models of embolic stroke. The mechanisms by which magnesium protects include the reduction of presynaptic release of glutamate, blockade of NMDA receptors, smooth [&hellip;]
- [Sevoflurane](https://anesthesiageneral.com/sevoflurane/): Introduction to Sevoflurane Sevoflurane is a volatile inhalational anesthetic agent that has gained significant acceptance in modern medical practice, especially for its application in both adult and pediatric anesthesia. As a halogenated ether, its chemical structure features a combination of fluoroalkyl and ether groups, which contributes to its unique properties. Its molecular formula is C4H03F7, [&hellip;]
- [GP IIb/IIIa inhibitors](https://anesthesiageneral.com/gp-iibiiia-inhibitors/): Two classes of drugs exist GP IIb/IIIa inhibitors that inhibit these platelet effects at the level of the glycoprotein (GP) IIb/IIIa receptor on the platelet surface membrane. The first group are the thienopyridines (clopidogrel and ticlopidine). Current treatments for acute coronary syndromes including unstable angina and non-ST-elevation myocardial infarction now include agents aimed at inhibiting platelet activation, [&hellip;]
- [Cauda equina syndrome](https://anesthesiageneral.com/cauda-equina-syndrome/): Cauda equina syndrome arises from compression of the lumbosacral nerve roots. Large herniated lumbar intervertebral discs are the most common culprit. Other sources of compression include spinal or sacral fractures or surgery common in ICU trauma patients, lumbosacral neoplasms, spinal stenosis, nonneoplastic masses such as cysts, peripheral neuropathy, and infectious processes. Low back pain is [&hellip;]
- [Diazepam half life](https://anesthesiageneral.com/diazepam-half-life/): Diazepam half life could be observed during rapid absorption from the gastrointestinal tract after oral administration, reaching peak concentrations in about 1 hour in adults and within 15 to 30 minutes in children. There is rapid uptake of diazepam into the brain, followed by redistribution to inactive tissue sites. The Vd of diazepam is large, [&hellip;]
- [Regulation of Respiration](https://anesthesiageneral.com/regulation-of-respiration/): The Regulation of Respiration is mediated by various centers in the brain. They are: • Pneumotaxic centre in upper pons. • Apneustic centre in lower pons. • Ventral group of neurons in medulla (expiratory group). • Dorsal group of neurons in medulla (inspiratory group). Normally pneumotaxic centre has inhibitory effect on apneustic centre which otherwise [&hellip;]
- [Airway Device](https://anesthesiageneral.com/airway-device/): The aim of the airway device is to prevent the tongue fail. The tip of airway gets inserted between tongue and posterior pharyngeal wall and thus prevents the tongue failing back on posterior pharyngeal wall. The various usages of the airway device are: As an alternative to intubation where difficult intubation is anticipated. Securing airway in [&hellip;]
- [Etomidate Mechanism of Action](https://anesthesiageneral.com/etomidate-mechanism-of-action/): Etomidate mechanism of action is shown here. The GABAA receptor plays a central role in the etomidate mechanism of action Etomidate exerts its effects on the receptor by binding directly to a specific site or sites on the protein and allosterically enhancing the apparent affinity of GABA for its receptor. At much higher concentrations etomidate [&hellip;]
- [Synthetic oxygen carriers or Artificial blood](https://anesthesiageneral.com/synthetic-oxygen-carriers-or-artificial-blood/): Synthetic oxygen carriers are also called as artificial blood or substitute blood. The Synthetic oxygen carriers are substances that can be used as alternatives to blood, when blood is required to be transfused to a patient. These Synthetic oxygen carriers or artificial blood is especially useful if due to some reason compatible blood is not [&hellip;]
- [Benzodiazepine equivalence](https://anesthesiageneral.com/benzodiazepine-equivalence/): Among benzodiazepine equivalence , differences in the onset and duration of action are due to their potency, lipid solubility and pharmacokinetics. Benzodiazepine equivalence is used to understand the relative differences in the action and effects of the different types of benzodiazepines. All benzodiazepines are highly lipid soluble and are highly bound to plasma proteins, especially [&hellip;]
- [Vasopressin dose](https://anesthesiageneral.com/vasopressin-dose/): Vasopressin dose should be calculated before giving. Vasopressin is the exogenous, parenteral form of antidiuretic hormone (ADH) that may be used for several conditions in the intensive care unit (ICU), including the treatment of central diabetes insipidus and as a vasopressor agent in shock. Endogenous vasopressin dose is an important stress hormone and plays a [&hellip;]
- [Nitrous Oxide Effects](https://anesthesiageneral.com/pharmacodynamics-of-nitrous-oxide/): Nitrous Oxide Effects the brain and induced analgesia or pain relief and anesthesia. Nitrous Oxide Effects includes the cardiovascular system as well. Nitrous oxide is a myocardial depressant and reduces the cardiac output. This is offset by an increase in sympathetic nerve activity resulting in peripheral vasoconstriction and thereby a minimal change in blood pressure. [&hellip;]
- [Pharmacodynamics of inhaled anesthetics](https://anesthesiageneral.com/pharmacodynamics-of-inhaled-anesthetics/): The pharmacodynamics of inhaled anesthetics is discussed here in detail. The action of inhalation agents are as follows: I. Pulmonary effects 2. Cardiovascular effects 3. Metabolism 4. Toxicity Pulmonary Effects: For pharmacodynamics of inhaled anesthetics , the pulmonary effects of inhalation agents are many and important as this is the portal of entry. There are [&hellip;]
- [Cerebral Aneurysm Clipping](https://anesthesiageneral.com/cerebral-aneurysm-clipping/): Cerebral Aneurysm Clipping is one of the important modalities for the treatment of aneuryms apart from coiling so the anesthetic management of such cases is as follows. Skull is a fixed vault and most intracerebral structures are relatively in compressible, hence even a small haemorrhage can result in a significant anatomic distortion producing significant rise in ICP [&hellip;]
- [Choosing the Right Anesthesia for Hip Surgery: General vs. Regional](https://anesthesiageneral.com/choosing-the-right-anesthesia-for-hip-surgery-general-vs-regional/): When it comes to undergoing hip surgery, one of the critical decisions to make is the choice of anesthesia. Anesthesia plays a crucial role in ensuring a safe and comfortable surgical experience. Two common options for hip surgery are general anesthesia and regional anesthesia. In this article, we will explore the differences between these two [&hellip;]
- [Epidural Ketamine](https://anesthesiageneral.com/epidural-ketamine/): Epidural ketamine and its active enantiomer S(+)ketamine have been used intrathecally and epidurally (caudally) for the management of perioperative pain and in a variety of chronic pain syndromes. Although ketamine has been reported to interact with opioid receptors, binding to local opiate receptors seems to play only a minor role, whereas significant analgesia after even [&hellip;]
- [Ketamine Preemptive Analgesia](https://anesthesiageneral.com/ketamine-preemptive-analgesia/): Ketamine Preemptive Analgesia is an antinociceptive treatment targeted to block CNS hyperexcitability, and thereby leads to a reduced postoperative pain state. Excitatory amino acids aspartate, released by the C fibers, interacts with the NMDA receptors of the dorsal horn neurons, and thus, leads to increase in intracellular calcium ions, which is thought to be the [&hellip;]
- [Barbiturates Metabolism](https://anesthesiageneral.com/barbiturates-metabolism/): All barbiturates metabolism is in the liver. In Barbiturates metabolism , the haemodilution in cardiopulmonary bypass (CPB) causes reduction in total drug concentration and protein binding fraction at the onset of CPB. This decrease in protein binding is counteracted by the dilution of unbound drug, resulting in a stable unbound concentration throughout CPB. The inactive metabolites [&hellip;]
- [Oxygen Toxicity](https://anesthesiageneral.com/oxygen-toxicity/): Oxygen Toxicity occurs when excessive oxygen inhalation is done as in prolonged ventilation with hundred percent (100%) oxygen. When the inspired oxygen saturation or FiO2 of a patient on oxygen therapy is kept for long time Toxicity of oxygen is bound can take place. FiO2 of 100 % should not be kept for more than 12 [&hellip;]
- [Nikethamide Analeptic](https://anesthesiageneral.com/nikethamide/): Nikethamide is a drug used for stimulating the brain. Its chemical name is nicotinic acid diethylamide. Nikethamide is a cerebral stimulant and a good analeptic. It stimulates respiration due to an effect on respiratory center and not through the chemoreceptors of the carotid and aortic bodies. It has a vasoconstrictor effect on the peripheral circulation. It has [&hellip;]
- [Lorazepam uses](https://anesthesiageneral.com/lorazepam-uses/): One of the lorazepam uses , is that the Lorazepam undergoes reliable absorption after oral and I.M. injection. After oral administration, maximal plasma concentrations of lorazepam occur in 2 to 4 hours and persist at therapeutic levels for up to 24 to 48 hours. The recommended oral dose of lorazepam uses preoperative medication which is [&hellip;]
- [Desflurane inhalation agent](https://anesthesiageneral.com/desflurane-inhalation-agent/): Desflurane inhalation agent was synthesized by Dr Terell (1992) among 600 compounds. Desflurane inhalation agent is a halogenated ether. It has the lowest blood/gas solubility coefficient amongst all inhalation agents, including N20, hence quick induction and recovery. Et does not contain chlorine or bromine, so it does not deplete ozone layer in the atmosphere. Physical [&hellip;]
- [Reiki therapy techniques](https://anesthesiageneral.com/reiki-therapy-techniques/): Reiki therapy techniques have been in practice since 2nd—3rd century; it was forgotten and about 130 years back was reinvented by Dr. Mikao Usui. WHO has defined it as “Non physical healing energy comprising universal life force energy (divine in nature) having its own intelligence”. Rei: means in Japanese, universal; Ki : life force energy [&hellip;]
- [Nitric oxide Inhalation](https://anesthesiageneral.com/nitric-oxide-inhalation/): Nitric oxide Inhalation may cause selective reversible dose-dependent pulmonary vasodilatation. It improves ventilation and perfusion of lungs, so beneficial in adult respiratory distress syndrome. It helps to reduce pulmonary vascular resistance in patients with primary pulmonary hypertension. It was known to be atmospheric pollutant produced by internal combustion of engines. It possesses various biological functions—there [&hellip;]
- [Ether effects](https://anesthesiageneral.com/ether-effects/): Ether effects all the systems of the body. A brief account is given below. Ether effects on Cardiovascular system: It does not depress myocardium rather it stimulates sympathetic system causing tachycardia and hypertension. Baroreceptor reflex is preserved with ether so ether can be used safely in patients with shock. Respiratory system: It does not depress respiration rather [&hellip;]
- [General Anesthesia Mask](https://anesthesiageneral.com/general-anesthesia-mask/): General Anesthesia mask is used to ventilate the patient without intubation or before intubation. The mask significantly increases amount of dead space. These are available in sizes from 0 to 4 numbers. Face mask should be made of antistatic rubber. At the bottom of General Anesthesia mask there is air filled cuff which has soft cushioning effect. [&hellip;]
- [Stored Blood](https://anesthesiageneral.com/stored-blood/): Stored blood is one of the commonest transfused volume replacements. Blood is stored in the cold part of refrigerator at 4°C (never in the freezer). Since blood from donors it taken long before it has to be given to a patient, it is stored in the meantime in refrigerator to preserve it from getting spoiled. It can be [&hellip;]
- [Halothane cardiovascular effect](https://anesthesiageneral.com/halothane-cardiovascular-effect/): Halothane cardiovascular effect plays a critical role. The main haemodynamic effect is a reduction in blood pressure secondary to a fall in cardiac output, reduced cardiac contractility and stroke volume, due to alterations in Ca-metabolism and a reduction in intracellular calcium. So, the coronary blood flow is reduced. The heart rate often falls due to [&hellip;]
- [Indications for and Contraindications to Thrombolytics](https://anesthesiageneral.com/indications-for-and-contraindications-to-thrombolytics/): What are the Indications for and Contraindications to Thrombolytics? Mr. XXX is a 66-year-old male who is postoperative day number one after hip replacement surgery and complains of acute onset of chest pain and shortness of breath. An electrocardiogram (ECG) is performed that shows new ST-segment elevation in leads II, III, and aVF. You are alone [&hellip;]
- [Sevoflurane respiratory effects](https://anesthesiageneral.com/sevoflurane-respiratory-effects/): Some of the Sevoflurane respiratory effects include that there is no irritation to the airway, least among inhalation agents, this makes it suitable for inhalational induction, the low blood/gas solubility aids faster induction. Sevoflurane respiratory effects include  respiratory depression, reduces minute ventilation, tidal volume and ventilatory response to CO2. Sevoflurane abolishes hypoxic pulmonary vasoconstriction in [&hellip;]
- [Enflurane metabolism](https://anesthesiageneral.com/enflurane-metabolism/): Enflurane metabolism is briefly discussed. About 80-90% of enflurane is eliminated in expired air, up to 5% is metabolized by hepatic cytochrome P450 (2E1) to difluoromethoxy difluoroacetic acid and free fluoride. Carbon monoxide may be produced in the presence of dry soda lime or baralyme, at higher temperatures and higher anaesthetic concentrations. Also while studying [&hellip;]
- [Midazolam IV](https://anesthesiageneral.com/midazolam-iv/): Midazolam IV is the first benzodiazepine that was produced primarily for use in anaesthesia. Walser and colleagues in 1976 “first described midazolam, the first clinically used water-soluble benzodiazepine. The imidazole ring in its structure accounts for its stability in aqueous solution and rapid metabolism. It is two to three times as potent as diazepam and [&hellip;]
- [Cyclopropane](https://anesthesiageneral.com/cyclopropane/): Cyclopropane is an anesthetic inhalational agent. It is a liquid agent stored in orange colored cylinders at 75 psi and delivered as gas. Among other halogenated inhalational agents used in anesthesia, Cyclopropane is one which is stored in cylinders at room temperature. Some of the important properties and characteristics of it are discussed below. • It is [&hellip;]
- [Etomidate Myoclonus](https://anesthesiageneral.com/etomidate-myoclonus/): Commonly administered IV anesthetics can cause excitatory effects that my manifest as spontaneous movements, such as etomidate myoclonus ,dystonia, and tremor. These spontaneous movements, particularly myoclonus, occur in 50% to 80% of patients receiving etomidate in the absence of premedication. In one report, 87% of patients receiving etomidate developed excitatory effects, of which 69% were [&hellip;]
- [Gallbladder Stones Surgery: A Comprehensive Guide](https://anesthesiageneral.com/gallbladder-stones-surgery-a-comprehensive-guide/): What Are Gallbladder Stones? Gallbladder stones, also known as gallstones, are solid particles that develop in the gallbladder, a small organ located beneath the liver. The primary function of the gallbladder is to store bile, a digestive fluid produced by the liver that aids in the breakdown of fats. Gallstones can vary in size, ranging [&hellip;]
- [Desflurane toxicity](https://anesthesiageneral.com/desflurane-toxicity/): Some of the toxicity issues related to desflurane toxicity is that, renal toxicity is not reported even after prolonged exposures and markers of renal function (albuminuria, glucosuria, urinary p-glutathione transferase, serum creatinine and BUN) were not altered after 7 days of exposure to 8 hours MAC of 1.25% desflurane. Desflurane Toxicity might occur at certain [&hellip;]
- [Spinal cord injury](https://anesthesiageneral.com/spinal-cord-injury/): Acute spinal cord injury (SCI) is common with an estimated 8,000 to 10,000 new cases in the United States each year. The mean age of presentation is 31 years and the majority of patients are male. SCI is associated with significant long-term disability and mortality. Etiology Spinal cord injury has traditionally been classified as traumatic [&hellip;]
- [Pentobarbital coma](https://anesthesiageneral.com/pentobarbital-coma/): The most commonly used barbiturate is pentobarbital. Induced coma with use of barbiturates like thiopentone sodium or pentothal is called barbiturate coma or pentobarbital coma . High-dose barbiturates have been used for more than 60 years in critically ill neurologic patients. The most common application has been to lower elevated intracranial pressure (ICP) in patients [&hellip;]
- [Ketamine Induction Dose](https://anesthesiageneral.com/ketamine-induction-dose/): The Ketamine induction dose of anaesthesia is, 1 to 2 mg/kg IV or 4 to 8 mg/kg IM. Injection of ketamine IV does not produce pain or venous irritation. Consciousness is lost in 30 to 60 seconds after IV administration and in 2 to 4 minutes after IM injection. Unconsciousness is associated with maintenance of [&hellip;]
- [Propofol metabolism](https://anesthesiageneral.com/propofol-metabolism/): The fact that total body clearance of propofol metabolism exceeds hepatic blood flow is consistent with extra hepatic clearance. Indeed hepatic clearance of propofol was approximately 60% of total body clearance.Pulmonary uptake of propofol is significant and influences the initial availability of propofol. Human lungs take part in the elimination of propofol by transforming the [&hellip;]
- [Propofol Bradycardia](https://anesthesiageneral.com/propofol-bradycardia/): Bradycardia and asystole have been observed after induction of anesthesia with propofol. The risk of propofol bradycardia related death during propofol anesthesia has been estimated to be 1.4 in 100,000. Severe, refractory, and fatal bradycardia has been observed with long-term propofol bradycardia infusion. In contrast to thiopentone, propofol apparently lacks central vagolytic activity and may [&hellip;]
- [Butorphanol drug class](https://anesthesiageneral.com/butorphanol-drug-class/): This butorphanol drug class was introduced about 25-30 years back. That was the era of morphine, pethidine, so it did not gain much acceptance. But now re-introduced, has become a major “find”. It is a classical example of “resurrection”. Butorphanol is a morphinan derivative with spectrum of activity almost like pentazocine, only that it is 20 [&hellip;]
- [What is Buprenorphine injection](https://anesthesiageneral.com/what-is-buprenorphine-injection/): What is Buprenorphine injection? Is it an opiod? Buprenorphine is derived from the opium alkaloid thebaine and is closely related to morphine. It has powerful opiod agonist actions as well as partial opiod antagonist actions. It does not seem to cause addiction and physical dependence. Buprenorphine injection Potency It is a potent analgesic, 0.4 mg is equipotent [&hellip;]
- [Phenobarbital Liver](https://anesthesiageneral.com/phenobarbital-liver/): Phenobarbital liver in the absence of other drugs, produces only modest decreases in hepatic blood flow. Induction doses of thiopental do not alter postoperative liver function tests. Barbiturates increase hepatic bile flow. However, there is no correlation between the increase in bile flow and the cytochrome P-450 concentration in the liver. Thiopental decreases intraocular pressure [&hellip;]
- [Safe drugs during pregnancy](https://anesthesiageneral.com/safe-drugs-during-pregnancy/): Many common critical care drugs are among the safe drugs during pregnancy, whereas some should be used with caution and others avoided entirely. When treating pregnant patients, it is the physician&#8217;s responsibility to treat the mother as the primary patient. Fetal considerations are secondary to ensuring maternal well-being because maternal demise will generally result in [&hellip;]
- [Barbiturate Therapy](https://anesthesiageneral.com/barbiturate-therapy/): For the Barbiturate therapy , High-dose barbiturates appear to be useful adjuncts in the control of intracranial hypertension refractory to other methods of therapy. Barbiturates decrease ICP by decreasing cerebral blood volume through drug-induced cerebral vascular vasoconstriction and an associated decrease in cerebral blood flow. This therapy in used either as a anti seizure medication [&hellip;]
- [Nonsteroidal anti inflammatory drugs side effects](https://anesthesiageneral.com/nonsteroidal-anti-inflammatory-drugs-side-effects/): All of these nonsteroidal anti inflammatory drugs side effects collectively lead to breach of the integrity of gastric mucosal lining, and gastric ulceration is the result. Following are the nonsteroidal anti inflammatory drugs side effects : Gastritis : As an overall decrease in production of prostaglandins takes place. Some of the protective PGs like PGE1, PGE2,and [&hellip;]
- [Lorazepam drip](https://anesthesiageneral.com/lorazepam-drip/): Lorazepam drip or Ativan drip is a frequently used sedative in the intensive care unit (ICU). It is a benzodiazepine that can be administered enterally, as intermittent parenteral doses, or as a continuous infusion. The beneficial effects of lorazepam drip include anterograde amnesia and an opioid-sparing effect via a moderation of the anticipatory pain response. [&hellip;]
- [Preoxygenation](https://anesthesiageneral.com/preoxygenation/): The purpose of preoxygenation of a patient before induction of general anesthesia and paralysis is to provide a maximum time that the patient can tolerate apnea. Normal oxygen consumption in a healthy adult is about 250 ml / min desaturations oxygen can occur as quickly as 30-60 seconds in a healthy adult with the FRC [&hellip;]
- [Non-halogenated anesthetics](https://anesthesiageneral.com/non-halogenated-anesthetics/): Diethyl ether (C2H5-O-C2H5) is one of the metabolically safe non-halogenated anesthetics . About 6% is metabolized in the liver to ethanol and acetaldehyde, thereafter to acetic acid and onto carbon dioxide and water. Examples of non-halogenated anesthetics  Divinyl ether Cyclopropane Trichloroethylene Non-halogenated anesthetics are all anesthetic agents mostly inhalation agents that do not contain a hologen in their structure. Divinyl [&hellip;]
- [Autonomic dysreflexia](https://anesthesiageneral.com/autonomic-dysreflexia/): Autonomic dysreflexia is an acute syndrome that frequently occurs in spinal cord injury (SCI) patients with a level usually above T6. It is characterized by excessive unmodulated sympathetic outflow in response to noxious stimuli below the spinal cord level. This can lead to dangerous elevations of blood pressure with disastrous clinical sequelae. Pathophysiology of Autonomic [&hellip;]
- [Benzodiazepines and opiods](https://anesthesiageneral.com/benzodiazepines-and-opiods/): The sedative effect of benzodiazepines and opiods is potentiated by other CNS depressants including alcohol, barbiturates, inhaled and injected anesthetics, and opioids. Anesthetic requirements for inhaled and injected anesthetics are decreased by benzodiazepines and opiods . Benzodiazepines decrease the MAC value of inhaled anesthetics. Benzodiazepines, especially midazolam, potentiate the ventilatory depressant effects of opioids, though [&hellip;]
- [Alveoli gas exchange](https://anesthesiageneral.com/alveoli-gas-exchange/): In alveoli gas exchange , if a second vapour is also administered along with N2O, the percentage of the second gas is also increased due to the shrinking of the alveoli as a result of the speedy uptake of N2O by blood. Diffusion in Alveoli During reversal of anaesthesia, a similar phenomenon is observed in [&hellip;]
- [Propofol Respiratory Depression](https://anesthesiageneral.com/propofol-respiratory-depression/): Propofol at common clinical concentrations-is potent ventilatory depressant and therefore it is sometimes common with the name propofol respiratory depression . The Propofol respiratory depression of ventilation is dose dependent. After induction of anesthesia with propofol apnoea occurs in 25% to 35% of patients which may persist till 3 minutes. It reduces tidal volume (by [&hellip;]
- [Critical illness myopathy](https://anesthesiageneral.com/critical-illness-myopathy/): Acute myopathy has been increasingly recognized as a significant complication of patients cared for in the intensive care unit (ICU). The term critical illness myopathy (CIM) or ICU Myopathy is now used to describe a general syndrome of muscle dysfunction occurring in the critically ill patient, with subtypes of CIM also being defined. The major [&hellip;]
- [Ketamine Cardiovascular Effects](https://anesthesiageneral.com/ketamine-cardiovascular-effects/): Ketamine cardiovascular effects resemble sympathetic nervous system stimulation. Indeed, a direct negative cardiac inotropic effect is usually overshadowed by central sympathetic stimulation. HR and BP rise were similar between S(+)ketamine and racemic mixture. Systemic blood pressure, heart rate, cardiac output, cardiac work, and myocardial oxygen requirements all are increased after IV administration of ketamine cardiovascular [&hellip;]
- [Benzodiazepines in the elderly](https://anesthesiageneral.com/benzodiazepines-in-the-elderly/): Aging and liver disease affect glucuronidation less than oxidative metabolic pathways. And thus, lorazepam, oxazepam, benzodiazepines in the elderly and temazepam are preferentially used in elderly patients over other benzodiazepines as they are metabolized only by glucuronidation and have no active metabolites. Elderly patients may also be intrinsically sensitive to benzodiazepines, suggesting that the enhanced [&hellip;]
- [Tens electrical stimulation](https://anesthesiageneral.com/tens-electrical-stimulation/): The use of tens electrical stimulation to reduce the pain especially of postoperative nature is the main use of this technique. The tens electrical stimulation principle is again based on “gate control theory” of Melzaek and Wall, viz: small fibres stimulation leads to transmission of nociceptive stimuli via substantia gelatinosa (SG) cells which act as [&hellip;]
- [Cardiac pressors](https://anesthesiageneral.com/cardiac-pressors/): Critically ill patients often require cardiac inotrope and/or cardiac pressors support to maintain adequate cardiac output and adequate blood pressure to sustain end-organ perfusion. Because end-organ perfusion has already likely been compromised and may continue to be problematic despite use of these agents, anaerobic metabolism rather than aerobic metabolism is likely to be generating a [&hellip;]
- [Adrenaline Mechanism in Anesthesia](https://anesthesiageneral.com/adrenaline-mechanism-in-anesthesia/): Adrenaline is frequently used in anesthesia, particularly the regional type. The Adrenaline Mechanism in anesthesia to increase the duration of the block can be easily understood. The adrenaline is usually added to increase the duration of the regional anesthesia or the nerve block. It is frequently used in brachial plexus blocks like the Supraclavicular block [&hellip;]
- [Naloxone](https://anesthesiageneral.com/partial-antagonism-placebo-analgesia-naloxane/): Naloxone (N-allyl oxomorphone) and newer drugs like nalmexone, naltrexone, nalmefene, and nalbuphine belong to naloxone group. These drugs have practically no agonist action on any of the receptors or their subtypes. But these drugs completely reverse the action of all the drugs, pure, partial, agonist-antagonists at µ, K, σ, δ and other receptors including analgesia, respiratory [&hellip;]
- [Effect of agonist drug](https://anesthesiageneral.com/effect-of-agonist-drug/): The effect of agonist drug of opoid group have a lot of impact as listed: Cough: The cough center in medulla is suppressed, leading to antitussive action. Pure agonists especially related with codeine have pronounced effect. Nausea and Vomiting: The emesis is usually due to direct stimulation of chemoreceptor trigger zone (CTZ) of area postrema of the [&hellip;]
- [Sulfa allergy](https://anesthesiageneral.com/sulfa-allergy/): Lasix is known to cause Sulfa allergy. The decrease in sodium and chloride reabsorption seems to come from the fact that furosemide competes for the chloride position on the carrier. Furosemide (Lasix) is a member of the general class of loop diuretics that inhibit the Na+/K+/2Cl&#8211;cotransport carrier within the ascending limb of the loop of [&hellip;]
- [Delayed Hemolytic reactions and Acute Hemolytic reactions](https://anesthesiageneral.com/delayed-hemolytic-reactions-and-acute-hemolytic-reactions/): Hemolytic Reactions Hemolytic reactions can be: Acute Hemolytic reactions Delayed Hemolytic reactions: The Delayed Hemolytic reactions are seen after a few days of blood transfusion. &nbsp; Acute hemolytic reactions It is usually due to ABO incompatibility (mismatch reaction). The most common cause of these transfusion reactions is clerical error. There is intravascular hemolysis. Incidence is [&hellip;]
- [Reservoir Bag](https://anesthesiageneral.com/reservoir-bag/): The reservoir bag is also called as the Breathing bag. The bag is attached to anesthesia breathing circuits to ventilate the patient. The bag acts as a reservoir for anesthetic gases as well as for oxygen, which when pressed results in the delivery of the gases or oxygen to the patient. An anesthetized and paralyzed [&hellip;]
- [Propofol pharmacokinetics](https://anesthesiageneral.com/propofol-pharmacokinetics/): Despite the rapid clearance of propofol pharmacokinetics by metabolism, there is no evidence of impaired elimination in patients with cirrhosis of the liver. Chronic alcoholism does not change the propofol pharmacokinetics significantly. Extrahepatic elimination of propofol occurs during the anhepatic phase of orthotopic liver transplantation. Renal dysfunction does not influence the clearance of propofol. Patients [&hellip;]
- [Diazepam IV](https://anesthesiageneral.com/diazepam-iv/): Diazepam IV is a highly lipid-soluble benzodiazepine with a more prolonged duration of action compared with midazolam. Diazepam IV is dissolved in organic solvents (propylene glycol, sodium benzoate) because it is insoluble in water. Dilution with water or saline causes cloudiness but does not alter the potency of the drug. Injection by either the IM [&hellip;]
- [Inhalation anesthetic mechanism of action](https://anesthesiageneral.com/inhalation-anesthetic-mechanism-of-action/): Inhalation anesthetic mechanism of action after being administered and excreted via the lungs. The dose of the agent is defined by the fraction of inhaled concentration that equates with the blood concentration and not the total amount of drug administered. The minimum alveolar concentration (MAC) was introduced in 1963 as a comparison of potency of [&hellip;]
- [Shiatsu techniques relaxation](https://anesthesiageneral.com/shiatsu-techniques-relaxation/): In shiatsu techniques relaxation , treatment is given to the selected points in the palms which are in connection with the different parts of the body. Acupressure means applying pressure to an Acu point representing the area of treatment in question. Sujok is a word derived from Korean word: Su means hand, Jok means feet [&hellip;]
- [Nitrous oxide inhalation anaesthetic](https://anesthesiageneral.com/nitrous-oxide-inhalation-anaesthetic/): Nitrous oxide inhalation anaesthetic is a gaseous inhalation agent first described in 1799 by Hamphrey Davy and introduced by Horace Wells (1846), a dentist, into clinical use in the US and it is still in use. Physical properties: Nitrous oxide inhalation anaesthetic is a colourless, sweet smelling and non-irritant gas, bp-88°C, slightly heaver than air. [&hellip;]
- [Rapid Sequence Induction and Cricoid pressure](https://anesthesiageneral.com/rapid-sequence-induction-and-cricoid-pressure/): An important part of rapid sequence induction is Cricoid pressure was first described by Sellick in 1961, hence it is called as sellicks manoeuvre. The Cricoid pressure is used for the compession of the upper esophagus to close the aspiration of gastric contents during rapid sequence intubation. Pulmonary aspiration of gastric contents occurs usually in [&hellip;]
- [Ketamine Bronchodilation](https://anesthesiageneral.com/ketamine-bronchodilation/): The respiratory effects of Ketamine bronchodilation are noticeable, mainly involving bronchodilation, which is mainly observed in asthmatic patients. Supposedly, Ketamine bronchodilation relaxes the bronchiolar musculature and prevents the bronchoconstriction induced by histamine, which would be an obvious advantage for asthmatic patients. The bronchodilatory activity is as effective as halothane or enflurane in preventing experimentally-induced Ketamine [&hellip;]
- [Propofol General Anesthesia](https://anesthesiageneral.com/propofol-general-anesthesia/): Propofol is a global central nervous system depressant. Propofol general anesthesia decreases cerebral metabolic rate for oxygen (CMRO2), cerebral blood flow (CBF), and intracranial pressure (ICP). Decrease in CBF is more than sevoflurane. Propofol is a cerebral vasoconstrictor and thus lowers ICP. Propofol decreases ICP greater than isoflurane and sevoflurane while cerebral perfusion pressure is [&hellip;]
- [Pentazocine agonist antagonist](https://anesthesiageneral.com/pentazocine-agonist-antagonist/): Pentazocine agonist antagonist is supposedly capable of producing spinal level analgesia. However, it produces significant sedation, drowsiness. The drugs which are equidistant to either pure agonists or pure antagonists in the terms of their activity belong to this group, agonists at one receptor and antagonists at another. Two groups of synthetic compounds belong to this [&hellip;]
- [Ketamine Effects](https://anesthesiageneral.com/ketamine-effects/): Some of the Ketamine effects discussed here. Ketamine does not increase the intraocular pressure (lOP) in routine analgesic doses. Even after the IM injection of 8 mg/kg, ketamine doses not raise lOP. However, in an: other study, in children anaesthetized with halothane, ketamine demonstrated a dose-dependent effect on lOP. A dose of 6 mg/kg IM [&hellip;]
- [Awake Craniotomy Anesthesia](https://anesthesiageneral.com/awake-craniotomy-anesthesia/): The anesthesiologist should know that the essential element of an “anesthetic” for an Awake Craniotomy Anesthesia is the surgeon&#8217;s local anesthetic technique. Craniotomy is required for removal of space occupying lesions, intracranial vascular pathologies and for drainage of extradural or intradural haematoma. Most important postoperative considerations are regulation of patient’s ICP status, maintenance of cerebral [&hellip;]
- [Is Ketamine Addictive](https://anesthesiageneral.com/is-ketamine-addictive/): Ketamine is associated with psychedelic effects and dependence. Well the question here arises is that Is Ketamine addictive ? These effects are dose-related and comprised of multimodal hallucinatory experiences, a sense of slowing, paranoid ideation and enhancement of sexual, musical and sensory enjoyment. The mechanisms of these phenomena are largely due to its complex multi-receptors [&hellip;]
- [Essential Calculation Methods and Tools for Long-Term Venous Access: A Comprehensive Guide for Patients](https://anesthesiageneral.com/essential-calculation-methods-and-tools-for-long-term-venous-access-a-comprehensive-guide-for-patients/): Introduction to Long-Term Venous Access Long-term venous access is a vital component of modern medical treatment, allowing healthcare providers to administer therapies over extended periods. This method is particularly significant in scenarios requiring frequent or continuous access to the bloodstream, such as chemotherapy for cancer patients, dialysis for those with kidney dysfunction, and long-term antibiotic [&hellip;]
- [Non benzodiazepines like Zolpidem](https://anesthesiageneral.com/non-benzodiazepine-like-zolpidem/): Non benzodiazepines like Zolpidem Non benzodiazepines like zopiclone, Zolpidem, zaleplon and efzopiclone (Z agents) are the newer sedative hypnotic agents which have varied chemical structures. They bind selectively to a subset of benzodiazepine receptors and act as benzodiazepine receptor Agonists. Non benzodiazepines characteristic features are: As sedative-hypnotics, they are as effective as benzodiazepines and provide [&hellip;]
- [Effects of Nitrous oxide in neuroanaesthesia](https://anesthesiageneral.com/effects-of-nitrous-oxide-in-neuroanaesthesia/): The Effects of Nitrous oxide in neuroanaesthesia has been questioned many times due to its detrimental effects on the cerebral vasculature and the brain tissue. However, there are no large-scale outcome studies to approve or disapprove its continued use in neuroanaesthesia. Nitrous oxide has been used in neuroanaesthesia for many years. Intraoperative analgesia with haemodynamic [&hellip;]
- [Phenobarbital Status Epilepticus](https://anesthesiageneral.com/phenobarbital-status-epilepticus/): Phenobarbital status epilepticus that does not respond to first-line benzodiazepines (lorazepam or diazepam) or to second-line antiepileptic drugs (phenytoin/fosphenytoin, phenobarbital or valproate) is usually considered refractory and requires more aggressive treatment. Barbiturate anaesthetics, such as pentobarbital and thiopental sodium, are the most frequently used agents and are highly effective for refractory GCSE both in children [&hellip;]
- [Halothane Complications](https://anesthesiageneral.com/halothane-complications/): One of the most dreaded Halothane Complications is hepatic injury. There are two types, the first which is a transient sub clinical type with increases in liver enzymes. Halothane Complications may occur due to decreased hepatic blood flow and reductive biotransformation. Secondly, fatal hepatic necrosis may occur up to one month after exposure. The National Halothane [&hellip;]
- [Phenoperidine new opiod](https://anesthesiageneral.com/phenoperidine-new-opiod/): Phenoperidine a new opoid Phenoperidine is chemically related to pethidine and is similar to fentanyl. It is one of the new opioids available now for use in anesthesia for analgesia and as a pre anesthesia medication. Phenoperidine potency One milligram of this new opioid drug is equianalgesic to 100 mg pethidine. Phenoperidine Onset and Duration of [&hellip;]
- [Midazolam dosage](https://anesthesiageneral.com/midazolam-dosage/): For premedication, the recommended midazolam dosage is 0.07 to 0.08 mg/kg IM (usual dose is about 5 mg IM for an average adult) administered 30 to 60 minutes preoperatively. Lower doses should be used in elderly or debilitated patients. In a study of patients 60 years or older who did not receive concomitant narcotics, 2 [&hellip;]
- [Anesthetic propofol](https://anesthesiageneral.com/anesthetic-propofol/): Anesthetic propofol is a potent intravenous hypnotic agent which is widely used for the induction and maintenance of anesthesia. Propofol is a phenolic (2, 6-diisopropylphenol) derivative that is structurally unrelated to other sedative hypnotic agents. It has been used extensively as an anesthetic propofol agent, particularly in procedures of short duration. More recently it has [&hellip;]
- [Methods of pain relief](https://anesthesiageneral.com/methods-of-pain-relief/): The management of methods of pain relief is and will always remain a challenging task for the clinicians. Many a times in spite of understanding the pathophysiology of pain, it becomes extremely difficult to control that pain. Most of the times the pathophysiology itself, may be shrouded in the mist of uncertain methods of pain [&hellip;]
- [Postoperative management of a kidney transplant recipient](https://anesthesiageneral.com/postoperative-management-of-a-kidney-transplant-recipient/): The postoperative management of a kidney transplant recipient requires meticulous monitoring of urine output and electrolyte levels. Renal allografts will not necessarily make urine as soon as they are reperfused. Depending on the particular center, the incidence of delayed graft function ranges from 5% to 15% in cadaveric and from 0% to 5% in live [&hellip;]
- [Cardiac Output is not Left Ventricular Ejection Fraction](https://anesthesiageneral.com/cardiac-output-is-not-left-ventricular-ejection-fraction/): A common mistake made by many clinicians is that they confuse cardiac output for Left Ventricular Ejection Fraction. Lets see how Cardiac Output is not Left Ventricular Ejection Fraction . Cardiac output equals the volume of blood pumped by the heart per minute, whereas stroke volume (SV) is the amount pumped on a single beat. Cardiac output [&hellip;]
- [Isoflurane volatile anesthetic](https://anesthesiageneral.com/isoflurane-volatile-anesthetic/): Isoflurane volatile anesthetic is a halogenated methyl ethyl ether, which is a racemic mixture. It is very stable at room temperature, soda-lime and UV light. It has an ethereal odour and is irritating to the respiratory tract and not epileptiform. Metabolism 0.2% Physical properties: Isoflurane volatile anesthetic has a bp of 48.5°C similar to halothane, [&hellip;]
- [Intubation Indications](https://anesthesiageneral.com/intubation-indications/): Entotracheal intubation is a life saving technique used frequently in emergencies and in operation theaters. Hence, the Intubation Indications need to be known to all doctors. The Major intubation indications are as follows: For ventilation of the patient: When the patient is unconscious or in a state of apnoea, where he is not breathing, Intubation [&hellip;]
- [Anaesthesia for Laparoscopic Appendicectomy: A Comprehensive Guide](https://anesthesiageneral.com/anaesthesia-for-laparoscopic-appendicectomy-a-comprehensive-guide/): Introduction to Laparoscopic Appendicectomy Laparoscopic appendicectomy, a minimally invasive surgical procedure, has gained prominence as an effective treatment for acute appendicitis. This technique involves the use of small incisions and specialized instruments, allowing surgeons to remove the inflamed appendix with reduced trauma to the surrounding tissues. The primary indications for laparoscopic appendicectomy include acute appendicitis, [&hellip;]
- [Enflurane side effects](https://anesthesiageneral.com/enflurane-side-effects/): Some of the Enflurane side effects are studied below. There is a narrow margin of safety between adequate anaesthesia, unacceptable hypotension and myocardial depression. One of the enflurane side effects includes the seizure activity is rare and without sequelae. Hepatic dysfunction is rare but cross sensitization with other volatile inhalation agents possible. With prolonged anaesthesia [&hellip;]
- [Oxygen Partial Pressure](https://anesthesiageneral.com/oxygen-partial-pressure/): Oxygen partial pressure decreases to 100 mm Hg up to alveoli. Oxygen tension in venous blood is 40 mm Hg. About one-fifth (20.9%) of air contains oxygen. In the inspired air, oxygen has partial pressure at 1/5 of the atmospheric pressure, i.e., 159 mm Hg. The larger the O2 or CO2 tension difference between the [&hellip;]
- [Chronic oxygen deficiency](https://anesthesiageneral.com/chronic-oxygen-deficiency/): Chronic oxygen deficiency is defined as a prolonged lack of oxygen to the body as that occurs in living in high altitudes or by having severe chronic lung disease. Chronic oxygen deficiency have the following effects : There is decreased mental efficiency due the prolonged deficiency of oxygen Sleepiness, headache, lassitude and fatigubility are also common Euphoria is also [&hellip;]
- [Benzodiazepines or BDZ](https://anesthesiageneral.com/benzodiazepines-bdz/): Benzodiazepines or BDZ are compounds have largely replaced the barbiturates as hypnotics and act as sedatives, anticonvulsants, muscle relaxants and anesthetic agents. Mechanism of action of Benzodiazepines or BDZ Benzodiazepines or BDZ bind selectively to the a subunit of the GABA-A receptors surrounding the chloride channels in the CNS, a site distinct from that to which [&hellip;]
- [Midazolam administration](https://anesthesiageneral.com/midazolam-administration/): Reactions such as agitation, involuntary movements, hyperactivity and combativeness are usually reported during midazolam administration . Should such reactions occur, the response to each dose of midazolam and all other drugs, including local anesthetics, should be evaluated before proceeding with the midazolam administration of the drug. For induction of general anaesthesia in healthy patients, the [&hellip;]
- [Blood Type and Crossmatch](https://anesthesiageneral.com/blood-type-and-crossmatch/): Blood Type and Crossmatch is essential for the management of all surgical cases as well as critically ill patients. Although red cell membrane contains more than 300 antigens and 20 blood group antigens are known but still the most important Is ABO grouping because most serious mismatch transfusions reactions are usually caused by ABO incompatible [&hellip;]
- [High Flow oxygen](https://anesthesiageneral.com/high-flow-oxygen/): High Flow oxygen delivery devices are also called as fixed performance devices because their performance is not affected by changes in patient’s tidal volume and respiratory rate and therefore deliver accurate oxygen concentration. High Flow oxygen devices are more effective in treating hypoxemia then low flow systems. Disadvantages of High Flow oxygen devices are: a. Low patient [&hellip;]
- [S-Ketamine](https://anesthesiageneral.com/s-ketamine/): S-Ketamine is a water soluble molecule that structurally resembles phencyclidine. The commercial preparation of S-Ketamine is a racemic mixture of two optical enantiomers R(-) and S(+), and a preservative benzethonium chloride. The presence of asymmetric carbon atom results in the existence of two optical isomers of ketamine. The racemic form of ketamine has been the [&hellip;]
- [Intubation Contraindications](https://anesthesiageneral.com/intubation-contraindications/): Intubation contraindications can be divided into those Both Nasal and Oral lntubation and those for Nasal Intubation. Both Nasal and Oral lntubation Contraindications • Laryngeal edema. • Epiglottitis. • Laryngotracheobronchitis This is one among the important Intubation Contraindications. In these conditions the airway is already compromised giving very little place for the endotracheal Tube to [&hellip;]
- [Pharmacokinetics of inhaled anesthetics](https://anesthesiageneral.com/pharmacokinetics-of-inhaled-anesthetics/): The pharmacokinetics of inhaled anesthetics are explained here with detail • Absorption of agent from alveoli to blood • Distribution in the body • Metabolism (liver) • Elimination (lungs mainly) Uptake and Distribution The pharmacokinetics of inhaled anesthetics depends upon: (1) Respiratory uptake, (2) Alveolar ventilation, (3) The partial pressure of the agent in the [&hellip;]
- [Halothane neuromuscular junction](https://anesthesiageneral.com/halothane-neuromuscular-junction/): Halothane neuromuscular junction effect produces moderate muscle relaxation, it increases the degree and duration of relaxation produced by nondepolarizing muscle relax- ants. The action is at the postjunctional membrane. There is relaxation of the uterine muscle, which is useful in podalic version procedure but may hinder uterine contraction postpartum. Halothane neuromuscular junction effect may produce [&hellip;]
- [Neuroleptanalgesia](https://anesthesiageneral.com/neuroleptanalgesia/): Neuroleptanalgesia Neuroleptanalgesia is method of IV anesthesia which combines at neuroleptic drug with opioid analgesic drug. The most favored combination is neuroleptic droperidol and the analgesic fentanyl. The combination used neuroleptanalgesia induces state which is different from usual general anesthesia. Because the patient is awake during surgery and is cooperative during the operative and surgical [&hellip;]
- [Xenon gas anesthesia](https://anesthesiageneral.com/xenon-gas-anesthesia/): First recognized 50 years ago and used as xenon gas anesthesia in 1957, used for orchidectomy in a 81- year-old. The patient woke up after 2 minutes. Xenon, a by-product of oxygen production during fractional distillation of air. It is said to be a noble gas and is present in air 0.0000087%. Rediscovered in 1990, it [&hellip;]
- [Post operative hypoxia](https://anesthesiageneral.com/post-operative-hypoxia/): Post operative hypoxia is caused by several factors : &nbsp; I. General—patient’s factors Exaggerated preoperative problems such as: • Extreme obesity • Geriatric age • Pre-existing cardiopulmonary disease 2. Diminished inspired oxygen • Lack of oxygen supplementation devices • Excessive suctioning • Diffusion hypoxia after nitrous oxide 3. Impaired ventilatory inefficiency • Obstructed upper airway [&hellip;]
- [Ketamine effect on Blood Pressure](https://anesthesiageneral.com/ketamine-blood-pressure/): The mechanisms for ketamine induced cardiovascular effects are complex and also Ketamine effect on blood pressure characteristics. Direct stimulation of the CNS leading to increased sympathetic nervous system outflow seems to be the most important mechanism for cardiovascular stimulation. One of the characteristic of Ketamine is related to blood pressure and is therefore termed as [&hellip;]
- [Diazepam effects](https://anesthesiageneral.com/diazepam-effects/): Diazepam effects produce minimal depressant effects on ventilation with 0.2 mg/kg IV dose in Respiration system. The slight increase in PaCO2 is due primarily to a decrease in tidal volume. Nevertheless, nearly, small doses of diazepam (&lt;10 mg IV) have produced apnoea. Combination of diazepam with other CNS depressants (opioids, alcohol) or administration of this [&hellip;]
- [Nasal Intubation](https://anesthesiageneral.com/nasal-intubation/): Nasal Intubation can be accomplished by special nasal tubes or by simple oral tubes. Advantages of nasal intubation over oral intubation: 1. Better fixation and therefore less chances of accidental extubation. 2. No possibility of tube occlusion by biting. 3. Better oral hygiene can be maintained. 4. Oral feeding is possible. 5. Better tolerated by [&hellip;]
- [Etomidate Pharmacokinetics](https://anesthesiageneral.com/etomidate-pharmacokinetics/): The etomidate pharmacokinetics is altered in the elderly, with a decrease in initial distribution volume and clearance (a decrease of 2 mL/min/kg every decade). Compared to normal patients, the cirrhotic patients have normal clearance rates, suggesting that cirrhotic patients metabolize etomidate normally, but the distribution volume and elimination half-life were twice as great. A 30% [&hellip;]
- [Blind Nasal Intubation](https://anesthesiageneral.com/blind-nasal-intubation/): Blind nasal intubation is the technique of intubation wherein a nasotracheal tube is passed into the trachea through the nose, without visualization of the glottis with laryngoscope. This is an advanced method that can be carried out only in experienced and skilled hands especially like those of the anesthetists. A blind nasal intubation should always [&hellip;]
- [Respiratory Tract anatomy](https://anesthesiageneral.com/respiratory-tract-anatomy/): The Respiratory Tract anatomy is very essential for understanding the functions of a lung and hence should be known to every doctor. The Respiratory Tract anatomy starts with the oropharynx and the nasopharynx which are spaces in the mouth and the nose that act as conduit for the respiratory gases. At carina trachea divides into [&hellip;]
- [Midazolam half life](https://anesthesiageneral.com/midazolam-half-life/): The midazolam half life elimination of IM administration is comparable to that observed following the IV administration. Midazolam is approximately 97% plasma protein-bound in normal subjects. In patients with chronic renal failure, the free fraction of drug in plasma can be significantly higher than in healthy adults. In animals and humans, Midazolam has shown to [&hellip;]
- [Flumazenil or Anexate](https://anesthesiageneral.com/flumazenil-or-anexate/): Flumazenil or Anexate is an imidazo benzodiazepine that binds competitively to BDZ receptors and antagonizes many of the actions of benzodiazepines. Flumazenil is a benzodiazepine antagonist. It does not block the pharmacologic effects of GABA or all GABA mimetic but it specifically antagonizes the actions of benzodiazepines. Given alone, it has minimal effect on the [&hellip;]
- [Boyle’s law](https://anesthesiageneral.com/boyles-law/): Boyle’s law is an important gas law that states that at a constant temperature, the volume of gas is inversely proportional to the pressure of the gas. This means that when the temperature of a gas is kept constant, the relationship between Volume and pressure of a gas is inverse. Another way to put tis law [&hellip;]
- [Hypnotherapy placebo effect](https://anesthesiageneral.com/hypnotherapy-placebo-effect/): Hypnotherapy placebo effect therapy most probably acts via, placebo effects/auto suggestion mechanisms. Anaesthesiologists have been practicing some form of suggestion therapy even in their day-to-day preoperative visits on the eve of surgery. Even a 5-minute preoperative visit will reduce anxiety of patient significantly. Hypnotherapy placebo effect or what was called mesmerism was described in late [&hellip;]
- [Poynting effect](https://anesthesiageneral.com/poynting-effect/): The Poynting effect refers to the phenomenon where mixing of liquid nitrous oxide at low pressure with oxygen at high pressure (in Entonox) leads to formation of gas of nitrous oxide. So oxygen and nitrous oxide both are present in gaseous state in Entonox cylinder. In anesthesia practice the Poynting effect is seen in the [&hellip;]
- [Oral Transmucosal Etomidate](https://anesthesiageneral.com/oral-transmucosal-etomidate/): Oral transmucosal etomidate produces dose-related increases in sedation and clinically significant serum concentrations.  Animal studies documented etomidate as highly permeable through the buccal mucosa with rapid onset and offset suggesting that oral transmucosal etomidate might be useful when brief mild to moderate sedation with rapid recovery is desirable. Oral transmucosal etomidate exhibited linear pharmacokinetics with [&hellip;]
- [Chest pain guidelines](https://anesthesiageneral.com/chest-pain-guidelines/): According to the chest pain guidelines the faster the diagnosis can be made and the occlusion reversed, the more likely the patient is to salvage myocardial tissue and benefit from improved outcomes. Cardiovascular disease is a dominant cause of morbidity and mortality in the United States and acute myocardial infarction (MI) is one of the [&hellip;]
- [Low alveolar ventilation](https://anesthesiageneral.com/low-alveolar-ventilation/): A lot of anesthetic gases can be dangerous when used in a low alveolar ventilation anesthesia. This is because the anesthetic gases can combine with soda lime or other components of the boyles machine and produce poisonous gases. It is also known as low flow anesthesia where low fresh gas flow is set in a closed circuit or a semi closed [&hellip;]
- [Ketamine Respiratory Depression](https://anesthesiageneral.com/ketamine-respiratory-depression/): Ketamine respiratory depression is considered to be the ideal anesthetic for asthmatic patients because it decreases the risk of bronchospasm during induction of anesthesia and preserves the pulmonary vasoconstriction reflex to hypoxia. It does not produce significant depression of ventilation. The ventilatory response to carbon dioxide is maintained during ketamine respiratory depression anesthesia. The respiratory [&hellip;]
- [Physiologic changes in pregnancy](https://anesthesiageneral.com/physiologic-changes-in-pregnancy/): The physiologic changes in pregnancy occur in response to fetal development and eventual delivery. It is incumbent on the intensive care physician to have an understanding of the normal variants that occur in pregnancy to correctly interpret diagnostic tests and effectively treat clinical conditions. Some changes that occur in pregnancy include the following. Endocrine changes [&hellip;]
- [Therapeutic uses of opioid analgesics](https://anesthesiageneral.com/therapeutic-uses-of-opioid-analgesics/): Following are the therapeutic uses of opioid analgesics : 1. Pain relief: By any and all the possible routes, these drugs have been given to relieve the pain—acute, surgical, non-surgical, visceral, somatic, chronic, and oncogenic, non-oncogenic. 2. Morphine is drug of choice in IHD, myocardial infarction, obstetric analgesia. 3. Dyspnoea: Especially due to left ventricular [&hellip;]
- [Ketamine on Brain](https://anesthesiageneral.com/ketamine-brain/): The effect of Ketamine on brain the Ketamine is traditionally considered to increase cerebral blood flow and CMRO2 however, positron emission tomography shows that subanesthetic doses of racemic ketamine increase cerebral blood flow with a minor increase in regional CBV but do not affect oxygen consumption significantly. The most profound changes in regional CBF with Ketamine on [&hellip;]
- [Understanding Granisetron's Use in Anesthesia for Nausea and Vomiting](https://anesthesiageneral.com/understanding-granisetrons-use-in-anesthesia-for-nausea-and-vomiting/): Understanding Granisetron&#8217;s Use in Anesthesia for Nausea and Vomiting When undergoing anesthesia, one of the common side effects that patients may experience is nausea and vomiting. These unpleasant symptoms can not only cause discomfort but also delay the recovery process. To alleviate this, healthcare professionals may administer medications like granisetron. In this article, we will [&hellip;]
- [Chronic pain syndrome type](https://anesthesiageneral.com/chronic-pain-syndrome-type/): Broadly chronic pain syndrome type can be classified on the basis of aetiopathological origin of the syndrome of chronic pain. The advantage of using this classification is that while deciding the modality of control and management it becomes simpler to choose specific plan of management. 1. Non-oncogenic chronic pain: Chronic pain commonly seen in skeletal [&hellip;]
- [Disadvantages of volatile anesthetics](https://anesthesiageneral.com/disadvantages-of-volatile-anesthetics/): Some disadvantages of volatile anesthetics are listed here. • Poor oxygen availability is one of the disadvantages of volatile anesthetics ; hypoxic insults are poorly tolerated due to dilution of air-oxygen mixture by ethe’ vapour. • Patient breathes dry air because water vapour in the air condenses on the mask due to low temperature because [&hellip;]
- [Bronchopulmonary Segments](https://anesthesiageneral.com/bronchopulmonary-segments/): The Bronchopulmonary Segments are the functional units of the lungs involved in he gaseous exchange. The lungs have the following Bronchopulmonary Segments on the right side: 1 Right main bronchus 2. Right upper lobe bronchus 3. Right middle lobe bronchus 4. Right lower lobe bronchus 5. Apical segment bronchus 6. Posterior segment bronchus 7. Anterior [&hellip;]
- [Acute Lung Injury and ARDS](https://anesthesiageneral.com/acute-lung-injury-and-ards/): The European—American Consensus Conference in 1993 provided working definitions of Acute Lung Injury and ARDS to improve diagnostic consistency and interpretation of the results of clinical and epidemiological studies. Both Acute Lung Injury and ARDS are characterized by the presence of hypoxemia and pulmonary infiltrates without elevated left atrial pressure. The two conditions are distinguished [&hellip;]
- [Nitrous oxide metabolism](https://anesthesiageneral.com/nitrous-oxide-metabolism/): N20 is minimally metabolized. Nitrous oxide metabolism shows us that N20 oxidizes the cobalt in vitamin B12, converting the monovalent form to bivalent form which fails to function as a methyl carrier. Nitrous oxide metabolism is an irreversible oxidation. Vitamin B12 is a cofactor for methionine synthetase and is involved in the production of 5,10 [&hellip;]
- [Blood Brain Barrier Functions](https://anesthesiageneral.com/blood-brain-barrier-functions/): In normal Blood Brain Barrier functions the effective pore size of cerebral capillaries is 7-9 A°. This small pore size does not allow movement of small ions, i.e, Na, K and C1. Therefore, the fluid movement across the Blood Brain Barrier Functions is determined by the ‘total’ osmotic gradient, generated both by large molecules and [&hellip;]
- [Benzodiazepines uses](https://anesthesiageneral.com/benzodiazepines-uses/): Benzodiazepines uses are many. Preoperative medication for anxiolysis and sedation is one where it finds its usage. Midazolam has replaced diazepam as the most commonly administered benzodiazepine in the preoperative period for preoperative medication and intravenous (IV) sedation. Furthermore, the context-sensitive half-times for diazepam and lorazepam are prolonged; and so they are used where prompt [&hellip;]
- [Intrathecal morphine](https://anesthesiageneral.com/intrathecal-morphine/): The intrathecal administration of opioids especially intrathecal morphine has emerged as a popular and effective form of postoperative pain control. Intrathecal opioids are able to provide long-lasting analgesia after a single injection. They work by binding to the µ opioid receptors, which are located in the substantia gelatinosa of the dorsal horn of the spinal [&hellip;]
- [Methodone mechanism of action](https://anesthesiageneral.com/methodone-mechanism-of-action/): The most significant Methodone feature is its exactly identical pharmacodynamics and methodone mechanism of action as that of morphine in equipotent (equianalgesic) doses. Methodone is an agonist with diphenyl structure (2 phenyl rings at the center). The psychological behaviour of methadone addiction is not as markedly abnormal as that of other pure agonists like heroin, [&hellip;]
- [Desflurane respiratory effects](https://anesthesiageneral.com/desflurane-respiratory-effects/): As with other volatile agents desflurane depresses the respiratory system. Desflurane respiratory effects are quite different. There is a dose-dependent decrease in tidal volume, decreased minute volume and CO2 retention, and an increase in respiratory rate. The ventilatory response to CO2 is reduced. One of the desflurane respiratory effects is that, the desflurane is extremely [&hellip;]
- [Midazolam metabolism](https://anesthesiageneral.com/midazolam-metabolism/): Midazolam metabolism is carried out rapidly by hepatic and small intestine cytochrome P450 (CYP3A4) enzymes to active and inactive metabolites. The principal metabolite of midazolam is 1-hydroxymidazolam, which has approximately half the activity of the parent compound. This active midazolam metabolism is rapidly conjugated to 1-hydroxymidazolam glucuronide and is subsequently cleared by the kidneys. This [&hellip;]
- [Sevoflurane complications](https://anesthesiageneral.com/sevoflurane-complications/): The metabolism of Sevoflurane complications yields fluoride ions, which if greater than 50 tmol/Iit is toxic. However, there are no reports of renal toxic effects. Compound A which is a degradation product when exposed to sodalime is also nephrotoxic, however this has not been clinically reported. It is safer to use flows greater than 2 [&hellip;]
- [Midazolam dose](https://anesthesiageneral.com/midazolam-dose/): The midazolam dose must be carefully individualized. In elderly and debilitated patients, lower doses are required. The midazolam dose should further be adjusted according to the type and amount of premedication used. Excess doses or rapid IV administration may result in respiratory depression and/or arrest, particularly in elderly or debilitated patients. For IM use, midazolam [&hellip;]
- [Anesthesia versed](https://anesthesiageneral.com/anesthesia-versed/): Midazolam can be used intravenously for induction of anesthesia versed . As an inducing agent it produces sleep and amnesia but it does not have any analgesic effect. Midazolam is not as rapid acting as thiopental. At approximately equipotent doses (loss of consciousness), thiopental abolishes the eyelash reflex 50—100% faster than midazolam, but it produces [&hellip;]
- [Green Anesthesia: Paving the Way for Environmental Sustainability in Healthcare](https://anesthesiageneral.com/green-anesthesia-paving-the-way-for-environmental-sustainability-in-healthcare/): Introduction to Green Anesthesia Green anesthesia represents a progressive approach in healthcare that seeks to minimize the environmental impact of anesthesia practices. This innovative concept revolves around the principles of sustainability, aiming to reduce waste generation, greenhouse gas emissions, and the overall carbon footprint associated with anesthesia procedures. Traditional anesthesia methods often rely on volatile [&hellip;]
- [Opium classification](https://anesthesiageneral.com/opium-classification/): From time immemorial mankind has been aware of opium classification . The word opium itself is derived from Greek word for juice. Arabian traders popularized it and introduced it to Europe. Paracelsus (1493—1541) reintroduced it and made it popular. It was at one time considered as “God’s own medicine” and used in various remedies from [&hellip;]
- [Local Anesthetics Action](https://anesthesiageneral.com/local-anesthetics-action/): The Local Anesthetics action correlates with lipid solubility. Cm is the minimum concentration of local anesthetic that will block nerve impulse conduction. The Local Anesthetics action depends on number of factors like: i. Dose and concentration: The dose as well as the concentration of the drug is an important determinant of Local Anesthetics Action. ii. pKa: [&hellip;]
- [Chronic pain management anesthesiology](https://anesthesiageneral.com/chronic-pain-management-anesthesiology/): The discussion about chronic pain management anesthesiology is incomplete until and unless the very important aspect of pain is taken into wider consideration which is the chronic pain. Chronic pain is the major symptom of the majority of the patients presenting at outpatient clinics. It is the most commonly overlooked, misunderstood or wrongly labeled and [&hellip;]
- [Midazolam respiratory depression](https://anesthesiageneral.com/midazolam-respiratory-depression/): Midazolam produces dose-dependent decrease in ventilation with 0.15 mg/kg IV producing effect similar to diazepam 0.3 mg/kg IV. Patients with chronic obstructive pulmonary disease experience even greater midazolam respiratory depression . Transient apnoea usually follows after rapid injection of large doses of midazolam (&gt;0.15 mg/kg IV) especially in the presence of premedication with opioids. The [&hellip;]
- [Methoxyflurane](https://anesthesiageneral.com/methoxyflurane/): Methoxyflurane even though being the most potent anesthetic gas to be discovered till now, its use can been restricted due to the different complications that can arise from its usage. Below is a brief discussion on this inhalational agent. Physical Properties of Methoxyflurane • It has sweet odor. • It is non irritant. • It [&hellip;]
- [What is Pulmonary Function Test](https://anesthesiageneral.com/what-is-pulmonary-function-test/): The answer to the question what is Pulmonary Function Test should be known to every doctor. The Pulmonary function tests especially the bedside ones can be used by even a non medico to asses the function of the lung. 1. Simple Bed Side Test Now what is Pulmonary Function Test that can be used at [&hellip;]
- [EMTALA Act](https://anesthesiageneral.com/emtala-act/): The Emergency Medical Treatment and Active Labor Act (EMTALA Act) was passed by the U.S. Congress in 1986 to prevent hospitals from rejecting, refusing, or transferring patients because they are unable to pay or because they have public health insurance. The main purpose of EMTALA Act is to ensure nondiscriminatory patient access to emergency medical [&hellip;]
- [Complications of Transfusion](https://anesthesiageneral.com/complications-of-transfusion/): The major complications of transfusion of blood are the following: 1. Transfusion Reactions : These reactions may be allergic or haemolytic: Haemolytic Reactions These are again divided in to Delayed Hemolytic reactions and Acute Hemolytic reactions. Allergic Reactions These are usually mild, manifesting as urticaria and are mainly due to plasma proteins. Treatment: Antihistamines (Avil) [&hellip;]
- [Analgesia for Total Knee Replacement Surgery](https://anesthesiageneral.com/analgesia-for-total-knee-replacement-surgery/): When it comes to total knee replacement surgery, managing pain and providing effective analgesia is of utmost importance. The procedure itself can be quite invasive and painful, and it is crucial to ensure that patients are comfortable and experience minimal discomfort throughout their recovery process. In this article, we will explore the various options available [&hellip;]
- [Desflurane](https://anesthesiageneral.com/desflurane/): Desflurane is an inhalational agent used in anesthesia that is similar to isoflurane except the chlorine atom of isoflurane is replaced by fluorine atom which produces significant changes in physical properties. Physical Properties of Desflurane : It is colorless liquid. Pungent odor, so induction is not pleasant. Vapor pressure of Desflurane is very high (681 [&hellip;]
- [IV lasix](https://anesthesiageneral.com/iv-lasix/): IV lasix or Furosemide is a loop diuretic that acts by inhibiting the reabsorption of sodium and chloride (via the Na/K/2Cl cotransporter) in the thick ascending limb of the loop of Henle. IV lasix enhances the excretion of sodium, potassium, calcium, chloride, and water. IV lasix is used frequently in the intensive care unit (ICU) setting [&hellip;]
- [Barbiturate Allergy](https://anesthesiageneral.com/barbiturate-allergy/): Incidences of anaphylaxis have been reported after induction with thiopental. The incidence of barbiturate allergy is estimated to be 1 per 30,000 patients. The majority of the patients who suffer from anaphylaxis due to barbiturate allergy also possess history of chronic allergy. Barbiturate Allergic reactions include urticaria, angioneurotic edema, other skin reactions, agranulocytosis and thrombocytopenic [&hellip;]
- [Barbiturates Mechanism of Action](https://anesthesiageneral.com/barbiturates-mechanism-of-action/): Barbiturates mechanism of action is described here. Barbiturates most likely produce their sedative hypnotic effects through an interaction with the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) in the CNS. Barbiturates cause reversible depression of all excitable tissues, the CNS being exquisitely sensitive. They bind to beta subunit of the inhibitory GABA-A receptor, a site distinct from [&hellip;]
- [Anesthesia in Neurological Disease](https://anesthesiageneral.com/anesthesia-in-neurological-disease/): Patients with primary neurodegenerative undergoing Anesthesia in Neurological Disease  (Parkinson’s disease, Huntington’s chorea, Alzheimer’s, amyotrophic lateral sclerosis ) or demyelinating diseases (Guillain-Barre’ syndrome, multiple sclerosis, myeloneuropathies) suffer from progressive and sometimes incurable neurologic impairment, neuromuscular involvement, dysautonomia and pulmonary insufficiency. Elective surgery should be scheduled to coincide with periods of remission along with right application [&hellip;]
- [Acute SLE](https://anesthesiageneral.com/acute-sle/): Acute Systemic lupus erythematosus (Acute SLE) is a multisystem autoimmune disease caused by autoantibodies and the deposition of immune complexes. The disease affects primarily women and has a higher prevalence among African Americans. A series of clinical findings is associated with acute SLE. These include a characteristic malar rash, photosensitivity, arthritis, serositis, and a discoid [&hellip;]
- [Etomidate Adrenal Suppression](https://anesthesiageneral.com/etomidate-adrenal-suppression/): Etomidate causes adrenocortical suppression by producing a dose-dependent inhibition of the conversion of cholesterol to cortisol. This is known as Etomidate adrenal suppression Cortisol and aldosterone are depressed by etomidate, but the clinical relevance is minimal after a single bolus injection. Etomidate adrenal suppression causes a specific and reversible blockade of the 11 beta-hydroxylation of [&hellip;]
- [Anesthesia Inhalation agents](https://anesthesiageneral.com/anesthesia-inhalation-agents/): The discovery of anesthesia Inhalation agents heralded the era of modem anesthesia. In 1842, the first general anesthetic administered was recorded by CF Long and W Clarke using diethyl ether; however, they did not publicize it. The first successful public demonstration of anesthesia Inhalation agents was by W.T.G. Morton on 10th October 1846 at the Massachusetts General Hospital Boston, [&hellip;]
- [Amiodarone therapy](https://anesthesiageneral.com/amiodarone-therapy/): While very effective as an antiarrhythmic, amiodarone therapy is also associated with a wide array of adverse side effects involving the cornea, lungs, liver, skin, and thyroid. Although the majority of amiodarone therapy &#8216;s adverse effects on these organs result from deposition of the drug in the parenchyma, its effect on the thyroid gland is [&hellip;]
- [Hypoxia Mechanism](https://anesthesiageneral.com/hypoxia-mechanism/): Hypoxia mechanism Following phases are included in the Hypoxia mechanism : 1. Anoxic hypoxia—Gas phase. There is inadequate supply of oxygen to the lungs, or the lung is not functioning properly. 2. Anemic hypoxia—Fluid hypoxia (phase). There is a decrease in the oxygen carrying capacity of the blood. 3. Stagnant hypoxia—Fluid phase. There is decreases [&hellip;]
- [Supine hypotension syndrome in pregnancy](https://anesthesiageneral.com/supine-hypotension-syndrome-in-pregnancy/): A woman in the third trimester of pregnancy is predisposed to supine hypotension syndrome in pregnancy while in the supine or sitting position due to the hemodynamic and anatomic changes of pregnancy. The large uterus of late pregnancy can compress the inferior vena cava (IVC) such that venous return is significantly reduced. This decreased preload [&hellip;]
- [Diaphragm Function](https://anesthesiageneral.com/diaphragm-function/): The diaphragm function is the most important determinant of the depth of respiration especially the inspiration. The Diaphragm is the muscle that separates the thorax from the abdomen. It is a thin sheet like muscle that has the right and the left crura. The diaphragm act as a partition between the two major cavities of the [&hellip;]
- [Body Weight Calculation in Pediatric Patients: PALS and WHO Guidelines](https://anesthesiageneral.com/body-weight-calculation-in-pediatric-patients-pals-and-who-guidelines/): Introduction to Pediatric Weight Calculation Calculating the body weight of pediatric patients is a crucial skill for healthcare providers, particularly in emergency situations. Accurate weight estimation not only facilitates proper medication dosing but also ensures appropriate fluid administration. To streamline this process, guidelines from both the Pediatric Advanced Life Support (PALS) program and the World [&hellip;]
- [Benzodiazepines effects](https://anesthesiageneral.com/benzodiazepines-effects/): Benzodiazepines effects appear to produce all their pharmacologic effects by facilitating the actions of gamma-amino butyric acid (GABA). The area where it causes it effect is the principal inhibitory neurotransmitter in the CNS by enhancing their affinity towards GABA receptors leading to increased chloride conductance and hyperpolarization of the postsynaptic cell membrane, and thereby rendering [&hellip;]
- [Missed injuries](https://anesthesiageneral.com/missed-injuries/): Missed injuries, commonly referred to as the trauma surgeon&#8217;s nemesis, are an expected occurrence in the management of multiply injured patients. The definition of a missed injury is institution specific. Generally speaking, however, a missed injury is an injury identified at some defined time after the initial assessment. Missed injuries are not frequently life-threatening. However, [&hellip;]
- [Clonidine](https://anesthesiageneral.com/clonidine/): Clonidine is an alpha-2 receptor agonist that down regulates the sympathetic nervous system. By stimulating alpha-2 adrenergic receptors in the brain stem, clonidine activates inhibitory pathways in the central nervous system (CNS), which results in reduced catecholamine release and reduced sympathetic outflow from the CNS. This effectively causes a decrease in blood pressure, heart rate, [&hellip;]
- [Effects of Ketamine](https://anesthesiageneral.com/effects-of-ketamine/): Several effects of ketamine are discussed here. Ketamine can attenuate important pro-inflammatory key functions of neutrophils in vitro, by inhibiting activated neutrophils, although these inhibitory effects are similar for racemic ketamine and its isomers. Thus ketamine might have role in limiting tissue injury in sepsis or ischemia/reperfusion. In the patients with sepsis caused by gram-negative [&hellip;]
- [Noninfectious Fever](https://anesthesiageneral.com/noninfectious-fever/): The astute clinician will recognize that although a common cause of fever in the ICU is infection, many cases are of noninfectious fever. Fever in the intensive care unit (ICU) patient is a common problem that results in the performance of many diagnostics tests. This increases both the costs of medical care and the exposure [&hellip;]
- [Hyperbaric Oxygen](https://anesthesiageneral.com/hyperbaric-oxygen/): Hyperbaric Oxygen means delivering the oxygen above atmospheric pressure which is 760 mmHg (or 1 atm). Special hyperbaric chambers are made for providing hyperbaric Oxygen, which are very expensive. Hyperbaric Oxygen Uses A. Poisonings: Carbon monoxide poisoning (half life of CO at 1 atm is 214 minutes which can be reduced to 19 minutes at [&hellip;]
- [Autogenic training relaxation technique](https://anesthesiageneral.com/autogenic-training-relaxation-technique/): Autogenic training relaxation technique , systematic alternative tensing and relaxing of muscle groups is taught to patients (autogenic training) leading to deep relaxation and ability. In addition to these, diaphragmatic breathing, focused repetition of words/phrases/prayer (distraction), guided imagery, transcendental meditation, are additional methods used. • Pranic healing, • Psychic healing, • Magnetotherapy, • Aromatherapy, • [&hellip;]
- [Midazolam mechanism of action](https://anesthesiageneral.com/midazolam-mechanism-of-action/): The molecular mechanisms underlying the diverse actions remain unclear, although some of the midazolam mechanism of action and sites of action of benzodiazepines effects are known. Benzodiazepines appear to produce all their pharmacologic effects by facilitating the actions of gamma-aminobutyric acid (GABA), the principal inhibitory neurotransmitter in the CNS. Benzodiazepines do not activate the GABAA [&hellip;]
- [Propofol EEG](https://anesthesiageneral.com/propofol-eeg/): There is an ongoing debate as to whether propofol EEG exhibits pro- or anticoagulant effects, and whether it should be used in patients with epilepsy. In a prospective study, Meyer et al documented propofol EEG as a sedative-hypnotic agent with anticonvulsant properties as shown by depression of spike-wave patterns in children with epilepsy and by [&hellip;]
- [Desflurane muscle relaxation](https://anesthesiageneral.com/desflurane-muscle-relaxation/): Desflurane muscle relaxation chemical depresses the neuromuscular junction, it decreases the force of contraction of muscles and increases fade. Endotracheal intubation is possible. There is a potentiation of nondepolarizing muscle relaxants similar to isoflurane. There have been no reports of malignant hyperthermia in man but has been seen in animals. It is advisable to avoid [&hellip;]
- [Midazolam use](https://anesthesiageneral.com/midazolam-use/): Midazolam use is helpful with hypnotic amnesic during maintenance of general anesthesia. It proved superior to thiopental because fewer adjuvant anesthetics are required to maintain an acceptable depth of anesthesia. Midazolam use , however, cannot be implemented alone to maintain adequate anesthesia. It may be used with inhalational drugs as well. The MAC of halothane [&hellip;]
- [Capnography](https://anesthesiageneral.com/capnography/): Capnography is the continuous measurement of end tidal carbon dioxide (ETCO2) and its waveform. The normal recording from a Capnography is between 32 to 42 mmHg (3 to 4 mmHg less than arterial pCO2 which is 35 to 45 mmHg). Capnography works on the principle that infrared light is absorbed by carbon dioxide. And this [&hellip;]
- [Different Types of Obesity Surgery](https://anesthesiageneral.com/different-types-of-obesity-surgery/): Introduction to Obesity and its Challenges Obesity is a complex, multifactorial health condition characterized by an excessive amount of body fat, significantly impacting an individual&#8217;s overall health and well-being. Defined by a Body Mass Index (BMI) of 30 or higher, obesity has reached alarming prevalence rates worldwide, becoming a major public health concern. The World [&hellip;]
- [Brain Hypothermia](https://anesthesiageneral.com/brain-hypothermia/): The capacity of deliberate Brain Hypothermia to protect the brain and other vital organs during periods of decreased oxygen delivery is used during cardiac surgery. The beneficial effects of Brain Hypothermia were empirically attributed to its ability to decrease cellular metabolism and thus delay the processes leading to irreversible cell death. Based on this, it [&hellip;]
- [Etomidate Brand Name](https://anesthesiageneral.com/etomidate-brand-name/): The Etomidate brand name in common use is Amidate. Amidate is a carboxylated imidazole compound. The imidazole nucleus renders etomidate, like midazolam, water soluble at an acidic pH and lipid soluble at physiologic pH. It is a non-barbiturate hypnotic without analgesic properties that has less cardiovascular and respiratory depressant actions than sodium thiopental. This lipophilic [&hellip;]
- [Extubation](https://anesthesiageneral.com/extubation/): Extubation is the process of removal of an Endotracheal tube from a patient. A person is usually put on endotracheal tube if he is unconscious so as to protect his airways or to ventilate the person if he is not breathing adequately. Intubation is also the best method to secure an airway even in the [&hellip;]
- [Nasotracheal Intubation](https://anesthesiageneral.com/nasotracheal-intubation/): Nasotracheal Intubation can be accomplished by special nasal tubes or by simple oral tubes. It is a specialized technique in which the Endotracheal tube is passed in to the larynx via the nose rather than the mouth. A first the tube size is selected, which should be a size less than that used in the [&hellip;]
- [Surgery for small bowel obstruction](https://anesthesiageneral.com/surgery-for-small-bowel-obstruction/): Surgery for small bowel obstruction is a very common emergency operation done in many hospitals. Intestinal obstruction is a blockage of your small intestine or colon that can prevent food and liquid through it. Intestinal obstruction can occur due to a number of conditions, including attachments in the abdominal tissue (adhesions), hernias and tumours or fibrous [&hellip;]
- [Pure agonist opioid](https://anesthesiageneral.com/pure-agonist-opioid/): Once Pure agent scheme of presentation is executed it becomes very easy to deal with all the actions of the drugs of various classes of opioids, including pure agonist opioid . While understanding the pharmacological, systemic effect of these drugs it is logically possible to fix the action as per the neuroanatomical site of origin [&hellip;]
- [Effects of Barbiturates on the Body](https://anesthesiageneral.com/effects-of-barbiturates-on-the-body/): Effects of Barbiturates on the body are listed here. Thiopentone decreases the tidal volume and the effect on respiratory rate is biphasic ranging from tachypnea during light anesthesia to a progressive slowing of respiration with deepening anesthesia. However, like propofol, functional residual capacity is not reduced by thiopentone. Effects of Barbiturates on the body administered [&hellip;]
- [What is minute ventilation?](https://anesthesiageneral.com/what-is-minute-ventilation/): A common question that arises while studying respiratory physiology is what is minute ventilation and minute volume. The minute ventilation is the amount of air a person breaths in a minute. The minute ventilation is calculated by the multiplication of the tidal volume and the respiratory rate. What is minute ventilation? The normal tidal volume [&hellip;]
- [Chronic Pain Management Strategies Commonly Used](https://anesthesiageneral.com/chronic-pain-management-strategies-commonly-used/): Chronic pain is a persistent condition that affects millions of people worldwide. It can be debilitating and significantly impact a person&#8217;s quality of life. Fortunately, there are various strategies and approaches available to help manage chronic pain effectively. In this article, we will explore some of the commonly used chronic pain management strategies. 1. Medication: [&hellip;]
- [Glucocorticoid therapy](https://anesthesiageneral.com/glucocorticoid-therapy/): Glucocorticoid therapy are most commonly used to mitigate an inflammatory response. They are used in a wide variety of patient populations seen in the intensive care unit (ICU). Unfortunately, these agents have many side effects, which often limit their use. In the ICU setting, the functions most commonly affected are endocrine regulation, immune response, and [&hellip;]
- [Desflurane mechanism of action](https://anesthesiageneral.com/desflurane-mechanism-of-action/): Desflurane mechanism of action is briefly studied. There is a dose-dependent suppression of EEG, at MAC greater than 1.66 the LEG becomes isoelectric. There is no evidence of epileptiform activity. It decreases the amplitude of somatosensory evoked potentials. There is a dose-dependent decrease in cerebral metabolism and cerebral vasodilatation. Cerebral autoregulation is impaired similar to [&hellip;]
- [Cerebral vasospasm treatment](https://anesthesiageneral.com/cerebral-vasospasm-treatment/): The principal options for Cerebral vasospasm treatment and treating delayed cerebral ischaemia are haemodynamic augmentation and endovascular therapy. Alternative therapies include intra-aortic counter pulsation (IABC), therapeutic hypothermia dedicated Cerebral vasospasm treatment and barbiturate coma. The concept of haemodynamic augmentation &#8211; also referred to as hypertension, hypervolemia, hemodilution or triple-H therapy—in patients with aneurysmal subarachnoid haemorrhage [&hellip;]
- [Diethyl ether anesthetic](https://anesthesiageneral.com/diethyl-ether-anesthetic/): Diethyl ether anesthetic is the first volatile anesthetic agent used widely for over one-and-a-half centuries. Volatile anesthetic agents like Ether, ethylene, chloroform, trichloroethylene and methoxyflurane are not in use in developed countries. However, ether, trichloroethylene are still in use in some developing countries. Physical properties of Diethyl ether anesthetic : It has a boiling point [&hellip;]
- [Midazolam pediatric dose](https://anesthesiageneral.com/midazolam-pediatric-dose/): Midazolam pediatric dose loading dose may be followed by a continuous IV infusion to maintain the effect. IV loading doses should not be used in neonates. Continuous IV infusion for sedation in critical care settings is important in pediatric patients. To initiate sedation using midazolam, an IV loading dose of 0.05 to 0.2 mg/kg administered [&hellip;]
- [Propofol Uses](https://anesthesiageneral.com/propofol-uses/): Propofol uses includes that, it does not trigger malignant hyperthermia in susceptible patients or experimental animals. The major Propofol uses are its use as Anesthetic agent or as a sedative. It is the drug most commonly used for induction of anesthesia. It can also be used for maintenance of anesthesia when it is ran as [&hellip;]
- [Etomidate Side Effects](https://anesthesiageneral.com/etomidate-side-effects/): Some Etomidate side effects are explained here. Some Patients receiving etomidate as intravenous injection for induction, frequently complain about pain. The incidence of pain is about 20% and associated with the conventional formulation due to its solvent propylene glycol which causes direct injury to vascular endothelium resulting in pain and venous sequelae. Pain on injection [&hellip;]
- [Hypnotics drugs classification](https://anesthesiageneral.com/hypnotics-drugs-classification/): All hypnotics drugs act on different subunits of GABA receptors. Gamma amino butyric acid (GABA): This is a major inhibitory amino acid Neuro Transmitter in the brain; its synthesis from glutamate is catalyzed by the enzyme glutamic acid decarboxylase. It binds to either GABA-A or GABA-B receptor following its release from the presynaptic vesicles. GABA- [&hellip;]
- [Phenobarbital Schedule](https://anesthesiageneral.com/phenobarbital-schedule/): The Phenobarbital schedule is listed here. The long-term administration of high doses of thiopental is associated with an increased incidence of nosocomial infections and associated mortality. Barbiturate coma may cause reversible leucopenia and an increased infection rate. Long-term administration of thiopental may also promote reversible antibiotic-induced bone marrow suppression. Thiopentone depresses T-lymphocyte function. Loop et [&hellip;]
- [Local Anesthetic Duration](https://anesthesiageneral.com/local-anesthetic-duration/): Local Anesthetic Duration of Action depends on a number of factors. The important factors effecting the duration of action of Local anesthetics are given below: 1. Dose: Increased dose of the local anesthetic increases the duration of action of the nerve block. 2. Pharmacokinetic profile of drug: It includes: i. Plasma protein binding (Alpha1 acid [&hellip;]
- [Doxapram injection doses and uses](https://anesthesiageneral.com/doxapram-injection-doses-and-uses/): Doxapram injection Doxapram is a specific respiratory stimulant. It stimulates the respiratory center preferentially and has relatively less effect on cortical and spinal sites. Following intravenous doxapram injection the drug stimulates ventilation and increases cardiac output and work. Doxapram dose It is given in a dose of 1-1.5 mg/kg by intravenous injection. Intravenous infusion can also [&hellip;]
- [Anesthesia Physics](https://anesthesiageneral.com/anesthesia-physics/): Anesthesia Physics are the very basics that involve the application of the laws of physics in anesthesia. Some knowledge of Physics is very important for anesthetists in their daily practice. The following are the important gas laws in Anesthesia Physics: BOYLE’S LAW At a constant temperature, volume of gas is inversely proportional to the pressure CHARLE’S LAW [&hellip;]
- [Anesthesia for Posterior Fossa Surgery](https://anesthesiageneral.com/anesthesia-for-posterior-fossa-surgery/): Posterior fossa is a tight infratentorial compartment which harbors vital centers like cerebellum, pons and medulla. Anesthesia for Posterior Fossa Surgery  is employed in carious types of space-occupying lesions, i.e., cerebellar tumours, cerebellopontine angle lesions, medulloblastoma, brainstem glioma occur in this area. The patients with posterior fossa tumor presents with features of raised intracranial pressure, brain [&hellip;]
- [Beta blockade](https://anesthesiageneral.com/beta-blockade/): Beta blockade prior to instituting other vasodilator drugs in aortic dessection management is essential. The following case presentation demonstates the importance of beta blockade in Aortic dissection management. A 44-year-old man whose only past medical history consists of hypertension and unilateral cataracts presents to his local emergency department with the acute onset of severe tearing [&hellip;]
- [Barbiturate withdrawal symptoms](https://anesthesiageneral.com/barbiturate-withdrawal-symptoms/): Barbiturate withdrawal is when sudden stopping of barbiturate drugs causes severe illness and withdrawal. This especially happens when infusions are given in the hospital and abruptly stopped. What are the Barbiturate withdrawal symptoms? In the First 12-16 hours: There is an observable improvement. After 16 hours: nausea, vomiting, anxiety, tremors, abdominal cramps, orthostatic hypotension, restlessness. [&hellip;]
- [Autologous blood](https://anesthesiageneral.com/autologous-blood/): Autologous blood Transfusion Techniques: AutoIogous Blood The blood of a person himself is called as autologous blood. Usually, 3 to 4 units of patient’s own blood are taken 4 to 6 weeks before surgery but hematocrit should not be allowed to fall below 35% and hemoglobin less than 11 g%. The patient’s blood is transfused back [&hellip;]
- [History of Anesthesia](https://anesthesiageneral.com/history-of-anesthesia/): The history of anesthesia is very old. Anesthesia was used even in the ancient societies of the oldest civilizations wherein opium extracts, alcohol, coca leaves and other plant products were used. Even regional anesthesia in the form of compression on the nerve trunks, application of cold or use of crude local anesthetics was done in [&hellip;]
- [Delirium tremens](https://anesthesiageneral.com/delirium-tremens/): Withdrawal from alcohol is a serious and common complication associated with hospitalization that can result in the condition known as delirium tremens. Many patients who consume alcohol cease drinking on or prior to admission for both voluntary and involuntary reasons. A patient does not need to be an alcoholic by medical definition to be at [&hellip;]
- [Effects of helium Inhalation](https://anesthesiageneral.com/effects-of-helium-inhalation/): In the atmosphere it is present in the concentration of 0.003%. It is stored as high pressure gas in the cylinders. There are several effects of helium Inhalation . The medical diagnostic utility is secondary to its low density, insolubility and thermal conductivity. • Molecular weight is 4. • Specific gravity is 176. • It [&hellip;]
- [Propofol Contamination](https://anesthesiageneral.com/propofol-contamination/): Propofol contamination in an emulsion formulation, has been associated with infective complications. It becomes contaminated once the ampoules have been opened. Propofol contamination supports the growth of all microorganisms. Diphtheroid bacilli and coagulase-negative staphylococci were the most frequent microorganisms. Others are E. coli, S. aureus, and P. aeruginosa. Adding lidocaine, or storing opened ampoules at [&hellip;]
- [Water soluble propofol prodrug](https://anesthesiageneral.com/water-soluble-propofol-prodrug/): Propofol phosphate, a water soluble propofol prodrug which is enzymatically converted to propofol, formaldehyde and inorganic phosphate, has been shown to produce sedation and anesthesia. A vegetarian formulation of propofol, Cleofol, has been used in a patient from the Jam community of India. Because it contains no lipid vehicles it is devoid of triglyceridaemia and [&hellip;]
- [Midazolam in seizures](https://anesthesiageneral.com/midazolam-seizures/): Use of midazolam in seizures has been used intravenously to treat acute attack of seizure effectively. Recent studies proved its usefulness through oral and intranasal route to control acute seizure attack particularly in children. The efficacy of intranasal and oral midazolam in seizures in hospitalized patients was similar to, and even higher than, that of [&hellip;]
- [What are Barbiturates drugs and examples](https://anesthesiageneral.com/what-barbiturates-drugs/): What are Barbiturates drugs? Barbiturates are the derivatives of barbituric acid which is a condensation product of urea with malonic acid. Barbituric acid itself is devoid of any hypnotic activity. Barbiturates drugs are hardly soluble in water; however, their sodium salts form alkaline solutions in water. Conventionally, they are divided according to their duration of [&hellip;]
- [Midazolam effects](https://anesthesiageneral.com/midazolam-effects/): Midazolam effects cerebral metabolic oxygen requirement (CMRO2) by decreasing it and cerebral blood flow, analogous to barbiturates and propofol. It causes dose-related changes in regional cerebral blood flow in brain regions associated with the normal functioning of arousal, attention, and memory. Patients with decreased intracranial compliance show little or no change in intra-cranial pressure when [&hellip;]
- [Physical properties of carbon dioxide](https://anesthesiageneral.com/physical-properties-of-carbon-dioxide/): Carbon dioxide was discovered by Von Helmont and was isolated by Joseph Black in 1757. Physical properties of carbon dioxide were shown by Yandell Henderson in 1925 and J S Haldane in 1926. It was frequently used to stimulate respiration and there was provision for carbon dioxide cylinders on old Boyle&#8217;s machines. The physical properties of [&hellip;]
- [Hypoxia Effects](https://anesthesiageneral.com/hypoxia-effects/): Physiological response to hypoxia is commonly seen. It depends upon speed and severity of the oxygen lack. The response may be direct or indirect. The direct Hypoxia effects are on cardiorespiratory systems and the secondary effects are due to the failure of organs like brain, liver, kidney and heart. The Hypoxia effects on these organs [&hellip;]
- [Ketamine Hallucinations](https://anesthesiageneral.com/ketamine-hallucinations/): Emergence from ketamine anesthesia in the postoperative period may be associated with audiovisual ketamine hallucinations , confusional state, which may progress to delirium, proprioceptive disturbances (feelings of detachment from the body) and slightly reduced ability to recall objects seen after administration of the drugs. The ability to recall objects seen immediately before drug exposure remains [&hellip;]
- [Perioperative steroids](https://anesthesiageneral.com/perioperative-steroids/): Perioperative steroids are steroids that are used before, during or after a surgery. Human steroids are produced by the adrenal gland and are under the direct or indirect control of the hypothalamus, pituitary, and adrenal glands. The two major classes of steroids that have significant clinical metabolic effects are the glucocorticoids (mainly cortisol), which regulate [&hellip;]
- [Propofol 10 mg](https://anesthesiageneral.com/propofol-10-mg/): Subhypnotic doses of IV like Propofol 10 mg have been used to treat pruritus caused by neuraxial opioids. However, this beneficial effect has not been achieved in other studies. Propofol has been shown to possess antipruritic effect. Subhypnotic doses of propofol may be effective for the short-term symptomatic relief of pruritus associated with liver disease. Such [&hellip;]
- [AMBU ventilation](https://anesthesiageneral.com/ambu-ventilation/): AMBU Ventilation is an important part in resuscitation of an apnoeic person or a person who is not breathing. The AMBU of an AMBU bag is an abbreviation for ‘Artificial Manual Breathing Unit’. The AMBU bag is used to ventilate the patient. An AMBU Ventilation unit consists of one self inflating bag made up of [&hellip;]
- [Normal Cerebral Perfusion Pressure](https://anesthesiageneral.com/normal-cerebral-perfusion-pressure/): Clinical studies using this strategy have claimed that even Normal Cerebral Perfusion Pressure values as low as 50 mm Hg are well tolerated with 8% mortality, and good recovery at 6 months after injury with little or moderate disability in 80% of patients. An increase in MAP may increase brain oedema. Therefore, lower intravascular pressures [&hellip;]
- [Propofol Effects](https://anesthesiageneral.com/propofol-effects/): Propofol decreases intraocular pressure and therefore has lot of propofol effects A single low dose bolus of propofol used for sedation before cataract surgery caused a moderate reduction in intraocular pressure with minimal side effects.  Propofol Effect on Coagulation and Immunity System Some of the propofol effects are discussed here. Propofol does not cause significant coagulation [&hellip;]
- [Oxygen Physical Properties](https://anesthesiageneral.com/oxygen-physical-properties/): There are several oxygen physical properties : 1. Oxygen is colorless, odorless and tasteless gas. 2. Specific gravity is 1.106. 3. Molecular weight is 32. 4. In normal atmospheric pressure it liquefies at 183°C. 5. Solubility in water is 2.4 volume% at 37°C and 4.9 volume% at 0°C. 6. Inflammibility—it cannot be ignited but its [&hellip;]
- [Infected burn](https://anesthesiageneral.com/infected-burn/): Despite the great strides made over the last decades in improving survival after thermal injury, infectious complications remain an important cause of morbidity and mortality. Nearly 50% of all burn deaths are related to infected burn. Several factors contribute to the high incidence and severity of infection in burn patients. First, a profound immune suppression [&hellip;]
- [Hypertonic Saline Infusion](https://anesthesiageneral.com/hypertonic-saline-infusion/): Although mannitol remains the mainstay of hyperosmolar therapy, Hypertonic Saline Infusion is an alternative to mannitol. The main theoretical justification for using Hypertonic Saline Infusion stems from the fact that an intact BBB is less permeable to saline than to mannitol. In clinical reports of intracranial hypertension from various causes, HS has been shown to [&hellip;]
- [Phenobarbital Side Effects](https://anesthesiageneral.com/phenobarbital-side-effects/): Some of the Phenobarbital side effects are discussed. Intra-arterial injection of thiopental usually results in immediate, intense vasoconstriction and severe pain radiates along the distribution of the vessel into which it has been administered. Vasoconstriction may obscure distal arterial pulses, and blanching of the extremity is followed by cyanosis. In awake patients, hypoaesthesia, muscular weakness, [&hellip;]
- [Charle’s law](https://anesthesiageneral.com/charles-law/): Charle’s Law: A Fundamental Gas Law What is Charle’s Law? Charle’s Law is a fundamental principle in thermodynamics that describes how gases behave under varying conditions of temperature and volume. Formulated by Jacques Charles in the late 18th century, this law states that the volume of a gas is directly proportional to its absolute temperature, [&hellip;]
- [Midazolam drip](https://anesthesiageneral.com/midazolam-drip/): For induction of general anesthesia before administration of other anesthetic agents, Individual response to midazolam drip is variable, particularly when a narcotic premedicant is not used. The dosage should be titrated according to the patient’s age and clinical status. Midazolam drip is administered over 20 to 30 seconds, allowing 2 minutes for effect. The recommended [&hellip;]
- [Neuroanesthesia Monitoring](https://anesthesiageneral.com/neuroanesthesia-monitoring/): The growth is reflected in the specialty of Neuroanesthesia Monitoring . These advances result in an abundance of data on which the treating physician can base his clinical decision. Every branch of medicine is advancing at a fast pace with the introduction of newer diagnostic modalities, treatment options and identification of more reliable prognostic indicators. [&hellip;]
- [Famous Anesthesiologists](https://anesthesiageneral.com/famous-anesthesiologists/): A lot of Doctors and famous anesthesiologists have contributed to the evolution of the science of anesthesia. Their hard work and discoveries have made anesthesia a safe and crucial field in pain management and as a medical specialty. The discovery of Nitrous oxide was a major breakthrough, that was later found out to be a [&hellip;]
- [Heliox](https://anesthesiageneral.com/heliox/): Heliox is a mixture of Helium and oxygen being considered for use in asthma patients. Therapeutic strategies for patients with pulmonary medicine often employ bronchodilators or corticosteroids to reduce airway resistance and improve airflow. As an alternative strategy, viscosity and density of the atmosphere manipulated to the same desired effect. Air consists of 21% oxygen, with [&hellip;]
- [Midazolam infusion](https://anesthesiageneral.com/midazolam-infusion/): Midazolam infusion can be used either alone or combined with a narcotic immediately before the procedure, with supplemental doses to maintain the desired level of sedation throughout the procedure. For short endoscopic or short diagnostic procedures and direct current cardioversion, midazolam infusion of 1 mg/mL formulation is recommended for IV sedation to facilitate slow injection. [&hellip;]
- [Fever after burn](https://anesthesiageneral.com/fever-after-burn/): Virtually all burn patients have elevated core body temperatures and even a leukocytosis. Thus, fever after burn patients is not a reliable indicator of infection. One study in children found that fever had no predictive value for the presence of infection and physical examination was a more reliable source of information about wound infection and [&hellip;]
- [Desflurane cardiovascular effects](https://anesthesiageneral.com/desflurane-cardiovascular-effects/): Desflurane cardiovascular effects are mentioned here. There is a decrease in systemic vascular resistance and peripheral vasodilatation. Cardiac depression, a dose-dependent tachycardia and fall in blood pressure are seen. Along with N20 this effect is minimal. Splanchnic and renal blood flow is preserved. Desflurane is a direct coronary vasodilator. A rapid increase in concentration of [&hellip;]
- [Postoperative Nausea and Vomiting (PONV)](https://anesthesiageneral.com/postoperative-nausea-and-vomiting-ponv/): Postoperative Nausea and Vomiting (PONV) is one of the most distressing experiences associated with surgery, and many patients find it more troublesome than postoperative pain itself. It is not only very uncomfortable to the patient in the postoperative period but it also delays the time of starting enteral feeding and normal functions. Especially in day care [&hellip;]
- [Laryngeal Mask Airway - LMA](https://anesthesiageneral.com/laryngeal-mask-airway-lma/): Laryngeal Mask Airway or LMA was discovered by Archies Brain so also called as a Brain Mask. LMA are special type of airways which are useful in difficult intubation. It is placed blindly in the oropharynx and the cuff is inflated with large volume of air tat is about 30 to 40 ml for a [&hellip;]
- [Midazolam syrup](https://anesthesiageneral.com/midazolam-syrup/): As a group, paediatric patients generally require higher doses of midazolam than do adults and younger children may require higher doses than older children. In obese individuals, the midazolam syrup dose should be calculated based on ideal body weight. Oral premedication: Oral midazolam syrup is effective for sedation and anxiolysis at the doses of 0.25—1 [&hellip;]
- [What is Nitrous oxide gas](https://anesthesiageneral.com/nitrous-oxide-gas/): What is Nitrous oxide gas ? Nitrous oxide gas is a Gaseous Anesthetic agent. Nitrous oxide gas is a colorless, inorganic gas with a sweet taste. The oxygen in the nitrous oxide molecule is not available for tissue respiration as nitrous oxide does not undergo significant decomposition in the body. Nitrous oxide gas, if administered [&hellip;]
- [Anatomy of larynx](https://anesthesiageneral.com/anatomy-of-larynx/): The anatomy of larynx is extremely important for an anesthesiologist. A through knowledge of the anatomy of larynx is essential for mastering the skill of intubation with a tracheal tube. Larynx is the organ of voice extending from the root of the tongue to trachea and lies opposite C3 to C6 vertebrae. The distance between [&hellip;]
- [Acupuncture physiotherapy pain](https://anesthesiageneral.com/acupuncture-physiotherapy-pain/): Acupuncture physiotherapy pain reduction technique is an ancient Chinese modality used for various chronic painful conditions, in addition to non pain related problems like acute asthma, chronic sinusitis, etc. The human body has a life force or energy flowing — Chi. This life force is flowing through various channels — Meridians. The life force (Chi) [&hellip;]
- [Opioid receptor mechanism](https://anesthesiageneral.com/opioid-receptor-mechanism/): The binding site is called the ‘receptor’ and the mechanism as opioid receptor mechanism . Any pharmacological activity requires an agent, a target organ and a specific binding site in that organ. The receptor due to its affinity to the drug and opioid receptor mechanism , permits attachment of the drug to itself, which then [&hellip;]
- [Ketamine Uses](https://anesthesiageneral.com/ketamine-uses/): Ketamine Uses are many; here we are describing some of them. NMDA antagonists like ketamine were shown to be effective in suppressing the symptoms of opiate withdrawal. Subanesthetic doses (0.5 mg/kg/hour) of ketamine are effective in the correction of acute precipitated opiate withdrawal. Its use as an sedative is well known. The most common use [&hellip;]
- [Etomidate Injection](https://anesthesiageneral.com/etomidate-injection/): The original formulation of Etomidate injection contains propylene glycol as a solvent contributing to a high incidence of pain during IV injection and occasional venous irritation. The newer lipid emulsion formulation is devoid of pain on injection and venous complications such as reddening, swelling, induration; as well as allergic reactions, whereas the incidence of myoclonus [&hellip;]
- [Etomidate Sedation](https://anesthesiageneral.com/etomidate-sedation/): Etomidate sedation infusion can be used as a suitable alternative for neuroanesthesia when nitrous oxide is contraindicated. Etomidate sedation (100 micrograms/kg/ minute) has been used as a part of total intravenous anesthetic technique with a mean recovery time of about 10 minutes. The infusion is associated with minimal incidences of side effects such as thrombophiebitis [&hellip;]
- [Acute pain management techniques](https://anesthesiageneral.com/acute-pain-management-techniques/): Pain is a personal and subjective experience of each individual. Objectivity in such situation of acute pain management techniques is very difficult. So the best way out of this is: “If patient says it hurts, then it hurts!” After accepting the pain, then try to quantify or assess the severity of the pain using acute [&hellip;]
- [Halothane](https://anesthesiageneral.com/halothane/): Halothane is a widely used inhalational agent. Physical Properties of Halothane : It is colorless liquid, volatile anesthetic. Pleasant to smell so excellent for induction in children. Stored in amber colored bottles and contains thymol 0.01% as preservative (to prevent decomposition by light). Non inflammable, non explosive. Nonirritant, so induction is very smooth. Boiling point [&hellip;]
- [IV Fluid Replacement in neurosurgical patients](https://anesthesiageneral.com/iv-fluid-replacement-in-neurosurgical-patients/): Little substantial human data exists concerning the impact of fluids on the brain, which may guide rational IV Fluid Replacement in neurosurgical patients. Therefore, recommendations arise from known factors that influence water movement into the brain. IV Fluid Replacement in neurosurgical patients can alter three properties of the blood, viz., osmolality, colloid oncotic pressure and [&hellip;]
- [Recovery from inhalant anesthesia](https://anesthesiageneral.com/recovery-from-inhalant-anesthesia/): The kinetics of the anaesthetic agents during recovery from inhalant anesthesia are a reversal of the mechanism seen during induction. On cessation of anaesthetic agent, the fall in alveolar concentration is immediate. The gradient between venous blood and alveoli drives the anaesthetic into the alveoli. In terms of recovery from inhalant anesthesia , the poorly [&hellip;]
- [Mechanism of nsaid action](https://anesthesiageneral.com/mechanism-of-nsaid-action/): Depending upon mechanism of nsaid action involved the drugs can be specifically used to achieve the desired effects. The NSAIDs have been proven to block the synthesis of prostaglandins by inhibition of the enzyme cyclo oxygenase. Cyclo-oxygenase (prostaglandin synthetase) is the enzyme involved in the cell membrane injury related destruction of phospholipids to arachidonic acid, [&hellip;]
- [Blood Brain Barrier crossing Drugs](https://anesthesiageneral.com/blood-brain-barrier-crossing-drugs/): The foregoing discussion is in the situation of a normal blood brain barrier about blood brain barrier crossing drugs. In a brain lesion, where the integrity of BBB varies according to the severity of damage, the control of fluid molecules is further complex. The osmotic/oncotic gradient will not be effective in areas of complete blood [&hellip;]
- [Milrinone in Renal Failure](https://anesthesiageneral.com/milrinone-in-renal-failure/): Mechanism of Action of Milrinone Milrinone is a selective inhibitor of type III cyclic adenosine monophosphate (cAMP) phosphodiesterase isoenzyme in cardiac and vascular smooth muscle. Its inhibitory action on phosphodiesterase results in increased cAMP levels, which in turn increases contractility in cardiac muscle and stimulates vasodilatation in blood vessels. This causes an increase in cardiac [&hellip;]
- [Neuroleptic malignant syndrome](https://anesthesiageneral.com/neuroleptic-malignant-syndrome/): Neuroleptic malignant syndrome (NMS) is a clinical syndrome consisting of four primary features: rigidity, altered mental status, hyperthermia, and autonomic instability. It occurs in the setting of the use of dopamine-blocking agents or the withdrawal of dopamine-enhancing medications. Neuroleptic malignant syndrome Epidemiology Incidence of Neuroleptic malignant syndrome is estimated at 0.1% to 2%. There is [&hellip;]
- [4 Types of Hypoxia](https://anesthesiageneral.com/4-types-of-hypoxia/): There are 4 types of Hypoxia . The 4 types of Hypoxia are as follows: 1. Anoxic hypoxia or Diffusion hypoxia Anoxic hypoxia also called as diffusion hypoxia is essentially due to the deficiency of oxygen being absorbed by the lungs. This is either due to a decrease in the inspired concentration of oxygen in the air [&hellip;]
- [Isoflurane](https://anesthesiageneral.com/isoflurane/): Isoflurane is a fluorinated methyl ethyl ether. It is an isomer of enflurane. Physical Properties of Isoflurane : • It is Colorless. • It has pungent ethereal odor so induction is not smooth. • Non inflammable, non explosive. • Vapor pressure similar to halothane (240 mmHg). Hence it also has agent specific Isoflurane vaporizer. Anesthetic [&hellip;]
- [Ketamine Metabolism](https://anesthesiageneral.com/ketamine-metabolism/): Ketamine is metabolized extensively by hepatic microsornal enzymes. Ketamine metabolism is demethylated to the corresponding N-desmethyl compound to form norketamine (about 60%) the main metabolite. Norketamine rapidly appears (approximately within 5 minutes) in plasma following ketamine administration and had a terminal half-life of 63.6 +1- 23.9 minutes. In animals, norketamine is one-fifth to one-third as [&hellip;]
- [Anesthesia for Interventional Neuroradiology](https://anesthesiageneral.com/anesthesia-for-interventional-neuroradiology/): Anesthesia for Interventional Neuroradiology has progressed from minimally invasive therapy to complex interventional radiology. In the past, anesthesiologists used to be called for resuscitation after some catastrophe had occurred. Interventional neuroradiology (or endovascular neurosurgery) is the radiologically guided endovascular approach to lesions of the central nervous system or its related circulatory structures to deliver therapeutic [&hellip;]
- [Propofol half life](https://anesthesiageneral.com/propofol-half-life/): It is rapidly distributed in the body with a propofol half life of only around 2 mm and has an efficient hepatic and extra hepatic clearance. Because the total body clearance may exceed liver blood flow, an extrahepatic metabolism or extrarenal elimination has been suggested. Hepatic metabolism is rapid and extensive, resulting in inactive, water-soluble [&hellip;]
- [Cyanide Toxicity with sodium nitroprusside](https://anesthesiageneral.com/cyanide-toxicity-with-sodium-nitroprusside/): Cyanide Toxicity can occur with sodium nitroprusside. Hypertension is commonly seen in the perioperative setting as well as the intensive care unit (ICU). There are many agents to lower blood pressure with different mechanisms of action. One of the most potent vasodilators is sodium nitroprusside, which causes arteriolar and venous smooth muscle relaxation via nitric oxide-mediated [&hellip;]
- [Non Rebreather Masks](https://anesthesiageneral.com/non-rebreather-masks/): The Non Rebreather Masks are the masks that do not allow rebreathing of the gases to take place when a patient is ventilated or he takes spontaneous breaths while the mask is being held. These masks of Non Rebreather type need to have a very high flow of oxygen as most of the oxygen is being lost. [&hellip;]
- [Neo-Synephrine](https://anesthesiageneral.com/neo-synephrine/): Neo-Synephrine is the trade name for phenylephrine. It is a pure alpha receptor agonist and has both venous and arterial constrictive effects. Because Alpha1 receptors have been discovered in the myocardium, it is also possible that it has positive inotropic effects. In our current culture of patient safety, it is important to avoid commonly used medical [&hellip;]
- [Halogenated volatile agents](https://anesthesiageneral.com/halogenated-volatile-agents/): Halogenated volatile agents are inhalational anesthesia gases used during surgeries to provide general anesthesia. They are metabolized to varying degrees. There is biotransformation in the liver resulting in cleavage and dehalogenation by the specific enzyme P450, which is a haemocytochrome present in the hepatic cell. Desflurane (CHF2-O-CHFCHF3): It is one of the halogenated volatile agents [&hellip;]
- [Propofol Myoclonus](https://anesthesiageneral.com/propofol-myoclonus/): Excitatory events following propofol administration are well described. The pathophysiology of these propofol myoclonus movements is not known. The drug should be used cautiously in patients with movement disorders. Miller&#8217;s anesthesia says the following about Propofol Myoclonus &#8211; Induction of anesthesia with propofol is associated with several side effects, including pain on injection, propofol myoclonus , apnea, [&hellip;]
- [Acute on chronic pain](https://anesthesiageneral.com/acute-on-chronic-pain/): Acute on chronic pain description is to explain the pain which was chronic and has now become suddenly severe, sharp and unbearable. It could be due to acute exacerbation of the original process. Aetiologically it could be due to sudden increase in the size of the primary or due to deposition of metastases into long bones, [&hellip;]
- [Excess Oxygen and toxicity](https://anesthesiageneral.com/excess-oxygen/): Excess Oxygen can cause pulmonary oxygen toxicity which results in a lot of damage to the body tissues. To summarize briefly, the excess oxygen can cause, pulmonary toxicity, Acute respiratory distress syndrome, rertolental fibroplasia, convulsions and Paul burt effect. Here we will be dicussing the mechanisms of these tissue injuries that occur with use of excess oxygen. The following the changes [&hellip;]
- [Benzodiazepines dependence](https://anesthesiageneral.com/benzodiazepines-dependance/): Benzodiazepines dependence may produce physical and psychological dependence after chronic (&gt;6 months) use of commonly prescribed low-potency benzodiazepines. Withdrawal symptoms (irritability, insomnia, tremulousness) appear within 1 to 2 days for short-acting benzodiazepines dependence and within 2 to 5 days for longer-acting drugs. When administered to patients who have benzodiazepine induced CNS depression of benzodiazepines dependance, flumazenil produces rapid and dependable [&hellip;]
- [Chronic pain syndrome pathophysiology](https://anesthesiageneral.com/chronic-pain-syndrome-pathophysiology/): The chronic pain syndrome pathophysiology is disturbance in the process of acute nociception. The processes of transduction, transmission, modulation and perception have somehow got disturbed. The pain stimuli which were supposed to be sent forward before closing of gate, get more and more intensely forwarded rather than getting modulated. In addition, due to sustained partial [&hellip;]
- [Etomidate Drug Interactions](https://anesthesiageneral.com/etomidate-drug-interactions/): Etomidate shortens the onset time of the neuromuscular block with vecuronium. This etomidate drug interactions enhances the bradycardia induced by vecuronium. Miller&#8217;s anesthesia says the following about etomidate drug interactions &#8211; The specific endocrine effects manifested by etomidate are a dose-dependent reversible inhibition of the enzyme 11β-hydroxylase, which converts 11-deoxycortisol to cortisol, and a relatively minor [&hellip;]
- [Midazolam oral dose](https://anesthesiageneral.com/midazolam-oral-dose/): A syrup is effective for producing sedation and anxiolysis at a Midazolam oral dose of 0.25 mg/kg with minimal effect on ventilation even when administered at doses as large as 1 mg/kg. Midazolam oral is the most commonly used oral preoperative medication for children. Midazolam oral dose which is, 0.5 mg/kg given orally 30 minutes before [&hellip;]
- [Physical Effects of Barbiturates](https://anesthesiageneral.com/physical-effects-of-barbiturates/): Here we study about the physical effects of barbiturates . In normovolemic subjects, thiopental, 4-5 mg/kg IV, produces a transient mild to moderate decrease in blood pressure with a compensatory increase in heart rate. However, bradycardia and junctional rhythm may occur with thiopentone. This dose of thiopental produces minimal to no evidence of myocardial depression. [&hellip;]
- [Physiotherapy management electrotherapy](https://anesthesiageneral.com/physiotherapy-management-electrotherapy/): Physiotherapy management electrotherapy is the application of electrical current to the area of generation of nociception. Physiotherapeutic methods are based on use of mainly two different modalities: 1. Electrotherapy 2. Exercise therapy This can be achieved with following methods of electrical current: • Low frequency • Medium frequency • High frequency Low frequency: i) The [&hellip;]
- [Cause of Hypoxia](https://anesthesiageneral.com/cause-of-hypoxia/): Cause of hypoxia Common cause of hypoxia and Cyanosis are : 1.  Factors present before the operation • Oedema of glottis • Ludwig’s angina • Bilateral quinsy 2. Carcinoma of larynx 3. Tracheal compression and stenosis due to any cause 4. Foreign body in bronchus 5. Carcinoma of bronchus 6. Acute or chronic bronchial asthma [&hellip;]
- [Propofol emulsion](https://anesthesiageneral.com/propofol-emulsion/): Propofol is an insoluble drug that requires a lipid vehicle for emulsification. The standard propofol emulsion formulation contains 10% soya oil as the oil phase and egg lecithin as the emulsifying agent that is composed of long-chain triglycerides. This formulation supports bacterial growth new formulations contain preservatives with bactericidal action, such as propofol with EDTA [&hellip;]
- [Chronic atrial fibrillation](https://anesthesiageneral.com/chronic-atrial-fibrillation/): Chronic atrial fibrillation (A fib) has an incidence of 0.4% in the general population (approximately 10% of those more than 60 years of age) and many of these patients are admitted to intensive or intermediate care units for reasons unrelated to this diagnosis. Chronic atrial fibrillation needs to be clearly differentiated from new-onset atrial fibrillation [&hellip;]
- [The Benefits of Regional Anaesthesia Compared to General Anaesthesia](https://anesthesiageneral.com/the-benefits-of-regional-anaesthesia-compared-to-general-anaesthesia/): When it comes to undergoing a surgical procedure, one of the most important decisions to make is the choice between regional anaesthesia and general anaesthesia. Both options have their advantages and disadvantages, but in this article, we will focus on the benefits of regional anaesthesia over general anaesthesia. What is Regional Anaesthesia? Regional anaesthesia involves [&hellip;]
- [Phenobarbital Metabolism](https://anesthesiageneral.com/phenobarbital-metabolism/): For the phenobarbital metabolism the binding of thiopentone in human serum is about 85% and remarkably constant over the concentration range between 4 and 80 micrograms/mL. The higher percentage of protein binding occurs at lower plasma concentrations of thiopental In phenobarbital metabolism . The percentage binding increases with increasing pH from approximate 75% at pH [&hellip;]
- [Unstable Tachycardias - narrow complex and wide complex tachycardias](https://anesthesiageneral.com/unstable-tachycardias/): Unstable tachycardias can be manifested by chest pain, shortness of breath, decreased urine output, mental status changes, or hypotension. The assessment of a patient with a tachycardia requires a systematic approach. First, the physician must determine whether the patient is experiencing evidence of hemodynamic compromise as a result of the tachycardia, which is generally not [&hellip;]
- [Fentanyl citrate injection](https://anesthesiageneral.com/fentanyl-citrate-injection/): Fentanyl citrate injection is a potent narcotic analgesic and an opioid. It is said to be 100 times more potent than morphine and 1000 times more potent than pethidine. Fentanyl citrate injection effects It causes profound analgesia and sedation in a dose of 0.1 mg intramuscular. Like other narcotic analgesics it causes respiratory depression and is [&hellip;]
- [Cerebral protection](https://anesthesiageneral.com/cerebral-protection/): Cerebral ischaemia or hypoxia may occur as a consequence of shock, vascular stenosis or occlusion, vasospasm, neurotrauma and cardiac arrest. Strategies to protect the brain i.e Cerebral protection from ischemic/hypoxic insults are based on the understanding of pathophysiological processes that follow ischemia/hypoxia to result in neuronal death. Neurologic morbidity is common in those patients experiencing [&hellip;]
- [Desflurane induction](https://anesthesiageneral.com/desflurane-induction/): There is rapid desflurane induction of anesthesia because of low solubility in blood, but a mask induction may produce coughing, breath holding, secretions and desaturation. Also the high initial percentage of desflurane induction may cause tachycardia and hypertension due to sympathetic effects. It is not recommended for inhalation induction. Recovery from desflurane induction is faster [&hellip;]
- [Opiate](https://anesthesiageneral.com/opiate/): Pain control is an important aspect of critical care medicine and the use of opiate medications has typically been an important method of achieving control in the intensive care unit (ICU) setting. The brain has four opiate receptors that include the mu, kappa, delta, and sigma receptors. Currently used opioid analgesics bind to the mu [&hellip;]
- [Isoflurane respiratory effects](https://anesthesiageneral.com/isoflurane-respiratory-effects/): One of the Isoflurane respiratory effects is that, Isoflurane causes bronchodilatation by inhibiting bronchoconstriction. As with other potent vapours, isoflurane impairs both ventilatory drive and hypoxic pulmonary vasoconstriction leading to hypercapnia and V/Q mismatch. In asthmatic patients due to its lack of arrhythmogenic potential, drugs like aminophylline or agonists such as salbutamol may be less [&hellip;]
- [Unfractionated heparin in Acute Coronary syndromes](https://anesthesiageneral.com/unfractionated-heparin-in-acute-coronary-syndromes/): Unfractionated heparin is a mixture of different weights of heparin (5 to 30k) that have varying effects on factors IIa, IXa, and Xa. Low-molecular-weight heparin (LMWH) is a subset of heparin (weight ~5k) that has activity on factor Xa, but not on IIa. LMWH has the advantage of less binding to protein and dose-independent clearance. [&hellip;]
- [What is methylene blue](https://anesthesiageneral.com/what-is-methylene-blue/): One may ask what is methylene blue ? Methylene blue is a water-soluble blue thiazine dye used most commonly as a treatment for methemoglobinemia or as an indicator dye. Its utility as an indicator dye has been applied to several clinical situations including identification of aspiration or placement of nasogastric tubes in critically ill patients; [&hellip;]
- [Heterotopic ossification](https://anesthesiageneral.com/heterotopic-ossification/): Heterotopic ossification may occur following head or spinal cord trauma, burns, or major surgery on the musculoskeletal system. A heterotrophic bone may cause severe physical impairment by surrounding a joint such as the hip or the elbow and fixing the joint in a nonfunctional position (i.e., contracture). Heterotopic ossification is also very common following open [&hellip;]
- [Isoflurane cerebral blood flow](https://anesthesiageneral.com/isoflurane-cerebral-blood-flow/): Functioning of Isoflurane cerebral blood flow is discussed here. Isoflurane reduces cerebral metabolism and so the oxygen consumption is reduced. At 1 MAC there is a 23% reduction in CMRO2. Isoflurane cerebral blood flow is not associated with seizure activity as opposed to Enflurane. The EEG shows progressive development of slow waves after an initial [&hellip;]
- [Isoflurane cardiac function](https://anesthesiageneral.com/isoflurane-cardiac-function/): In Isoflurane cardiac function , the effect is that the cardiac output is maintained due to the slight increase in heart rate reflexly due to hypotension. There is a dose-dependent decrease in arterial pressure due to peripheral vasodilatation and myocardial depression, less than that due to halothane. There is a selective coronary vasodilatation and decrease [&hellip;]
- [Partial agonist buprenorphine](https://anesthesiageneral.com/partial-agonist-buprenorphine/): Partial agonist buprenorphine is an opioid, which strikingly differs chemically from other opioids, in that it is not related to morphine, but to another alkaloid called thebaine. So buprenorphine is a semi synthetic opioid. Pharmacodynamically, partial agonist buprenorphine is highly potent. 0.3 mg is equianalgesic with 10 mg of morphine. It has a 50 times [&hellip;]
- [Colloids Examples](https://anesthesiageneral.com/colloids-examples/): Colloids are the type on intravenous fluids with high osmolarity that are ideal to transfuse in conditions like decreased intravascular volume. A Few Colloids Examples are: Dextrans (Lomodex) Albumins Gelatins (Haemaccel) Hydroxyethyl Starch Perflurocarbon Emulsions Blood Hextend The Colloids Examples are explained in a bit detail below. 1. Dextrans (Lomodex) For more on Dextrans read [&hellip;]
- [Visual analogue scale for pain intensity](https://anesthesiageneral.com/visual-analogue-scale-for-pain-intensity/): Visual analogue scale for pain intensity is a numerical pain rating scale which uses a 10 cm line with the numbers ranging from 0-10. Patients points out the number that corresponds to the level of pain they are feeling. The significance of the numbers must be explained to the patient. Intensity of the pain is [&hellip;]
- [Ketamine Analgesia](https://anesthesiageneral.com/ketamine-analgesia/): Ketamine analgesia produces intense analgesia at sub anesthetic doses and prompt induction of anesthesia when administered IV at higher doses. Ketamine analgesia has an analgesic action at many sites both centrally and peripherally. These actions are mediated via multiple receptor subtypes, including opioid, NMDA, kainate, and GABAA receptors. Ketamine also inhibits serotonin and dopamine reuptake. [&hellip;]
- [Propofol Related Infusion Syndrome](https://anesthesiageneral.com/propofol-related-infusion-syndrome/): Propofol related infusion syndrome is a rare complication firstly reported in paediatric patients and also observed in adults, produced due to prolonged (&gt;48 h) high doses of propofol (&gt;66 mcg/kg/min) intravenous infusion. Even short-term propofol related infusion syndrome for surgical anaesthesia have been associated with development of metabolic acidosis. Propofol related infusion syndrome is characterized [&hellip;]
- [Barbiturate Drugs](https://anesthesiageneral.com/barbiturate-drugs/): Barbiturate drugs are defined as any drug derived from barbitunc acid. Barbituric acid, which lacks central nervous system (CNS) activity, is a cyclic compound obtained by the combination of urea and malonic acid. Barbiturate drugs with sedative hypnotic properties result from substitutions at the number 2 and 5 carbon atoms of barbituric acid. Barbiturates that [&hellip;]
- [Oxygen Delivery Devices](https://anesthesiageneral.com/general-anesthesiaoxygen-delivery-devices/): These are classified as high flow Oxygen Delivery Devices and low flow Oxygen Delivery Devices. Classification of Oxygen Delivery Devices in non intubated patient : 1. High flow (fixed performance) delivery systems. 2. Low flow (variable performance) delivery systems. As the high flow oxygen delivery devices have already been discussed, let us see what the low [&hellip;]
- [Halothane Cerebral effects](https://anesthesiageneral.com/halothane-cerebral-effects/): Halothane Cerebral effects include cerebral vasodilatation and increases cerebral blood flow (CBF). A concentration of I MAC doubles CBF and 1.6 MAC quadruples the CBF. Cerebral autoregulation may be abolished and cerebrospinal fluid (CSF) production reduced by 30%. The cerebral oxygen consumption (CMRO,) may be reduced by 25%. There is no epileptiform activity in the [&hellip;]
- [Managing Pain After Hip Surgery: Understanding Severity and Exploring Analgesia Options](https://anesthesiageneral.com/managing-pain-after-hip-surgery-understanding-severity-and-exploring-analgesia-options/): The Importance of Managing Pain After Hip Surgery Undergoing hip surgery is a significant medical procedure that can greatly improve one&#8217;s quality of life. However, it is not without its challenges, particularly when it comes to managing post-operative pain. Proper pain management is crucial for a successful recovery and ensuring patient comfort during the healing [&hellip;]
- [Open book pelvic fracture and Malgaigne pelvic fracture](https://anesthesiageneral.com/open-book-pelvic-fracture-and-malgaigne-pelvic-fracture/): Unstable pelvic fractures include disruption of the ring anteriorly at the symphysis pubis or through a pubic bone and are broadly categorized into three types: anterior-posterior open book pelvic fracture, lateral compression fracture, and vertical shear malgaigne pelvic fracture. Pelvic fractures from blunt force trauma are broadly categorized as either stable or unstable based on [&hellip;]
- [Solid organ transplantion guidelines](https://anesthesiageneral.com/solid-organ-transplantion-guidelines/): Solid organ transplantation is the therapy of choice for patients with end-organ failure. Despite numerous advances in the field, the number of individuals awaiting solid organ transplantation continues to exceed the supply of organs. One approach to increasing the supply of organs is to maximize donation rates of eligible patients. Family consent rates for donation [&hellip;]
- [Ethyl Chloride Anesthesia](https://anesthesiageneral.com/ethyl-chloride-anesthesia/): Ethyl Chloride Anesthesia is a potent anesthetic. If it has a boiling point of 12.5°C and hence is a gas at room temperature, so it is liquefied and stored under pressure in a bottle with a cap and seal. It is used as a spray. Though ethyl chloride induces anesthesia quickly, the maintenance of a steady [&hellip;]
- [Fentanyl and other opiates](https://anesthesiageneral.com/fentanyl-and-other-opiates/): Drugs like sufentanil, alfentanil, fentanyl and other opiates although belong to phenyl piperidine group like pethidine (meperidine), their spectrum of action is more morphine-mimicking, more like mediated through β endorphin and t receptors. Actually there are some very striking differences between the two: Fentanyl and other opiates unlike, morphine, is very highly lipid soluble, so [&hellip;]
- [Pethidine injection](https://anesthesiageneral.com/pethidine-injection/): Pethidine injection is a synthetic morphine like analgesic. this opioid medication has about one tenth as powerful compared to morphine. This drug has sedative and tranquilizing effects also. It may cause euphoria and sleepiness. Unlike morphine it tends to relax smooth muscles and thus relieves most types of pain associated with plain muscle spasm. But [&hellip;]
- [CEA Anesthesia](https://anesthesiageneral.com/cea-anesthesia/): CEA Anesthesia or Carotid endarterectomy anesthesia can be general or regional or combined. Here is a discussion on the relative advantages and disadvantageous of the different types. Mc CaI Thyet al conducted a prospective, randomized trial investigating patient experience of CEA Anesthesia under local or general anesthesia in 176 patients and found that the recovery [&hellip;]
- [Propofol Injection Pain](https://anesthesiageneral.com/propofol-injection-pain/): Pain with propofol injection occurs in majority of patients. Propofol injection pain can be reduced by the following methods explained here. Propofol causes pain or discomfort on injection in 28% to 90% of awake patients. A number of techniques have been tried for minimizing propofol injection pain with variable results. The propofol injection pain decreases [&hellip;]
- [Propofol Antiemetic](https://anesthesiageneral.com/propofol-antiemetic/): Propofol is known to possess direct antiemetic effects. Propofol antiemetic use for induction and maintenance of anesthesia has been shown to be associated with a lower incidence of postoperative nausea and vomiting (PONV) when compared to any other anesthetic drug or technique. It has been shown that total intravenous anaesthesia (TIVA) with propofol for anesthesia [&hellip;]
- [Uses of carbon dioxide](https://anesthesiageneral.com/uses-of-carbon-dioxide/): There are numerous uses of carbon dioxide in modern anesthesia. It is used : • To increase depth of anesthesia with volatile anesthetic agents by stimulating respiration.- • To increase cerebral blood flow during carotid artery surgery. • To produce hyperventilation during blind nasal intubation. • To stimulate the respiration after artificial hyperventilation. • It [&hellip;]
- [Metabolism of volatile anesthetics](https://anesthesiageneral.com/metabolism-of-volatile-anesthetics/): Metabolism of volatile anesthetics is discussed here. Once thought to be chemically inert, inhalation agents, especially the older ones, undergo significant metabolism, bio-transformation and breakdown to potentially toxic intermediates. This process is affected by age, disease, drug interaction and genetics. Inhalation agents are administered in great excess of the amount metabolized unlike other drugs. For [&hellip;]
- [Trilene anesthesia](https://anesthesiageneral.com/trilene-anesthesia/): Trilene anesthesia is a non-flammable, good analgesic-and cheap agent. Physical properties of trilene anesthesia : It has bp 80°C, VP 60 mm Hg, oil/gas coefficient 600 and blood/gas 12, metabolism 40%, unstable, preservative 1:10,000 thymol as stabilizer and coloured with waxoline blue 1 in 200,000, MAC 0.17%. Trilene anesthesia reacts with sodalime to produce phosgene [&hellip;]
- [Oxygenation Capacity](https://anesthesiageneral.com/oxygenation-capacity/): Oxygenation capacity is the volume of oxygen at standard pressure and temperature carried by 100 mL of blood after saturation with room air. Oxygenation capacity includes the oxygen in combination with haemoglobin (1.39 mL/g) and oxygen in solution in plasma (0.3 mL). It should also be mentioned that most of the oxygen that dissolves in [&hellip;]
- [Ketamine Interactions](https://anesthesiageneral.com/ketamine-interactions/): Ketamine interactions potentiates all non depolarizing muscle relaxants in a dose-dependent manner. Ketamine improves the intubating condition when used with rocuronium. Halothane anesthesia by decreasing uptake, distribution, redistribution and metabolism of ketamine produces significant prolongation of its pharmacologic action on the central nervous system. Ketamine administered in the presence of volatile anesthetics may result in [&hellip;]
- [Versed side effects](https://anesthesiageneral.com/versed-side-effects/): The versed side effects related to Respiratory are respiratory arrest, respiratory failure, apnoea, hypoxia, oxygen desaturation. Danger of respiratory disorders may increase when midazolam is administered with opioids. Therefore, the dosage of both agents should be reduced. Limited information is available from published literature regarding the use of midazolam in paediatric patients. However, based on [&hellip;]
- [Midazolam side effects](https://anesthesiageneral.com/midazolam-side-effects/): The sedative midazolam side effects and fluctuations in vital signs were the most frequent findings following parenteral administration of midazolam injection. These are affected by the lightening or deepening of anesthesia, instrumentation, intubation and use of concomitant drugs. The more frequently encountered fluctuations in vital signs of midazolam side effects included decreased tidal volume and/or [&hellip;]
- [Endotracheal Tube Position](https://anesthesiageneral.com/endotracheal-tube-position/): The endotracheal tube position should always be confirmed because the correct placement of the tube is essential for proper ventilation of a person. If the endotracheal tube position is not correct within no time the patient can become hypoxic due to the unavailability of oxygen to the lungs. The tube may be wrongly placed in [&hellip;]
- [Ketamine Receptors](https://anesthesiageneral.com/ketamine-receptors/): Ketamine receptors have GABAA receptor agonistic properties. Subanaesthetic doses of Ketamine receptors inhibits tonic convulsions induced by the GABAA receptor antagonist bicuculline. The GABAA receptor agonist, muscimol, potentiates ketamin induced anesthesia whereas, bicuculline antagonizes it. Opioid Receptors : Ketamine receptors has been reported to interact with opioid receptors in clinically relevant concentration. Other studies have suggested [&hellip;]
- [What is Chloroform](https://anesthesiageneral.com/chloroform/): What is Chloroform Chloroform is a very toxic compound, which was used in the past as an anesthetic agent. Chloroform use in anesthesia is only of historical value, although it still has some applications outside the medical practice. It was available as a liquid in bottles that would be poured on to a cloth and [&hellip;]
- [Halothane respiratory effects](https://anesthesiageneral.com/halothane-respiratory-effects/): There is very little airway irritation, hence used for inhalation induction especially in children. One of the halothane respiratory effects is that it is a potent respiratory depressant, reduces tidal volume and alveolar minute ventilation. The ventilatory response to raised Paco2 and reduced Pao, may be reduced due to depression of peripheral chemoreceptors in the [&hellip;]
- [Morphine sulphate injection](https://anesthesiageneral.com/morphine-sulphate-injection/): What is Morphine sulphate Morphine sulphate injection is an opium alkaloid and a standard potent opioid analgesic. This opioid acts as an anxiolytic, hypnotic and sedative. It causes both the  stimulation and the depression of the central nervous system. The depression caused by morphine leads to analgesia, respiratory depression, depression of cough reflex and sleep [&hellip;]
- [Enflurane Structure](https://anesthesiageneral.com/enflurane-structure/): Enflurane Structure is a halogenated methyl ethyl ether and is an isomer of isoflurane. Enflurane structure makes it a colourless liquid, noncorrosive to aluminium, iron as well as copper, non-flammable, stable to light and UV light, does not need a chemical stabilizer. Physical properties: The bp is 56.5°C, The SVP 172 mm Hg (22.9 kPa), [&hellip;]
- [Spine instability](https://anesthesiageneral.com/spine-instability/): When a patient returns from the operating room following spinal surgery it is important to establish with the surgical team any spine instability as well as the integrity of the dura. This information is critical should the patient need to be reintubated, vomit, or elevate the head of bed. There would be no greater catastrophe [&hellip;]
- [Cranial Base Surgery](https://anesthesiageneral.com/cranial-base-surgery/): Lesions requiring Cranial Base Surgery represent a heterogeneous group of lesions and vascular malformations associated with cranial base bony structures. These pathologies provide a challenging situation for both neurosurgeon and neuroanaesthesiologist. There is abundance of structures especially vital centers in a relatively smaller infratentorial space. Many patients present with signs and symptoms of brain stem [&hellip;]
- [Halothane Pharmacokinetics](https://anesthesiageneral.com/halothane-pharmacokinetics/): The MAC of halothane pharmacokinetics varies from 1.08 in neonates to 0.64 in the elderly, Addition of N20 in adults reduces MAC to 0.29%. The distribution of halothane is to lungs, VRG organs, muscle, fat around VRG organs and finally peripheral fat. Excretion is primarily through the lungs in a reverse manner. Halothane Pharmacokinetics undergoes [&hellip;]
- [Cranial Perfusion Pressure](https://anesthesiageneral.com/cranial-perfusion-pressure/): Cranial Perfusion Pressure is the blood pressure  in the brain that is required to maintain adequate circulation in the brain and thus maintain the important cerebral functions. Very low Perfusion Pressure in the brain will result in inadequate circulation to the brain and reduced oxygen and glucose supply to the brain with which it functions. The [&hellip;]
- [Succinylcholine hyperkalemia](https://anesthesiageneral.com/succinylcholine-hyperkalemia/): Succinylcholine hyperkalemia is hyperkalemia seen after the usage of succinylcholine. Succinylcholine is a depolarizing muscle relaxant used for urgent endotracheal intubation in the operating room, intensive care unit (ICU), and emergency department. The intravenous (IV) dose is 0.5 to 1.5 mg/kg. Time to effect is 1 minute and duration of action in patients with normal [&hellip;]
- [Ketamine Anesthetic](https://anesthesiageneral.com/ketamine-anesthetic/): The phencyclidine derivatives Ketamine anesthetic is a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist. It produces “dissociative anesthesia”, characterized by evidence on the EEG of dissociation between the thalamo-cortical and limbic systems and a cataleptic state in which the eyes remain open with a slow nystagmic gaze. The patient becomes noncommunicative with an apparent wakefulness state. It [&hellip;]
- [Other Tubes- RAE, Endotrol, Double lumen tube](https://anesthesiageneral.com/other-tubes-rae-endotrol-double-lumen-tube/): Apart from the traditional tubes used for endotracheal intubation, other tubes like R.A.E tube, Endotrol tube and Double lumen tube. R.A.E. tube : The R.A.E. tube is named after the name of 3 scientists — Ring, Adair and Elwyn. R.A.E tube is of two types: • South facing: Used for upper cleft lip and cleft [&hellip;]
- [Anesthesia gases](https://anesthesiageneral.com/anesthesia-gases/): Anesthesia gases are the gases used to anesthetize a patient for surgery. The common gases used in general Anesthesia are: Oxygen Nitrous Oxide Air Halothane Sevoflurane Desflurane Isoflurane and many more&#8230; Nitrous oxide (N2O) is one of the popular anesthesia gases and is not metabolized in human tissue, however it reacts with vitamin 812 and [&hellip;]
- [Desflurane metabolism](https://anesthesiageneral.com/desflurane-metabolism/): Desflurane undergoes very little desflurane metabolism because of low blood/gas and low blood/tissue solubility. However, 0.02% is metabolized during desflurane metabolism with the production of trifluoroacetic acid which may interact with hepatic proteins and induce an immune response in susceptible patients. Previous exposure to halothane may produce antibodies. In desflurane metabolism , the elimination is almost exclusively by [&hellip;]
- [Pentazocine injection](https://anesthesiageneral.com/pentazocine-injection/): Pentazocine injection is a synthetic narcotic analgesic derived from benzomorphan. Pentazocine Potency Its analgesic potency of 30 mg is said to be equal to 10 mg of morphine or 75 to 100 mg of pethidine. Pentazocine Dose The usual dose in adults is 20 to 60 mg i.m. (about 1 mg/kg). The oral dose ranges from [&hellip;]
- [Benzodiazepine overdose treatment](https://anesthesiageneral.com/benzodiacepine-overdose-treatment/): Flumazenil is the first specific benzodiazepine antagonist, used as a specific antidote in known or suspected benzodiazepine overdose treatment . In addition, flumazenil could be employed to reverse sedation produced by benzodiazepines during general anesthesia and prolonged sedation in intensive care units. Flumazenil is a specific and competitive antagonist at the central benzodiazepine receptor, reversing [&hellip;]
- [Treatment modalities in pain management](https://anesthesiageneral.com/treatment-modalities-pain-management/): Treatment modalities in pain management play an important role when dealing with different circumstances which include the following : 1. Treatment of Disease (Cancer) in pain management : After the diagnosis and confirmation, appropriate therapy has to be started, especially for symptom ‘pain’. Symptom like mucositis, dysphagia etc, can be controlled by using local anesthetics, [&hellip;]
- [Sevoflurane metabolic effects](https://anesthesiageneral.com/sevoflurane-metabolic-effects/): Sevoflurane metabolic effects are seen when approximately 5% of the dose is metabolized by the liver, catalyzed by cytochrome P450 (2E1) enzyme. While Sevoflurane metabolic effects are studied we see that, it is broken down to hexafluoro isopropanol (HFIP) and fluoride ions. Hexafluoro isopropanol is conjugated with glucuronic acid to form HFIP glucuronide and excreted [&hellip;]
- [Etomidate Pharmacology](https://anesthesiageneral.com/etomidate-pharmacology/): Etomidate pharmacology is studied using following points. In etomidate pharmacology we find that Etomidate is a potent, direct cerebral vasoconstrictor. It decreases cerebral blood flow and CMRO2 in an independent manner. The cerebral metabolic effects of etomidate are secondary to its effect on neuronal function. As a result, previously increase ICP is lowered by etomidate [&hellip;]
- [Sevoflurane Inhalation anesthetic](https://anesthesiageneral.com/sevoflurane-inhalation-anesthetic/): Sevoflurane Inhalation anesthetic was synthesized by Baxter Laboratories (1960) but introduced into clinical practice in Japan in 1990, now widely used the world over. Unlike isoflurane it does not exist as an optical isomer, it does not have an asymmetric atom. It contains only fluorine atoms, so it does not affect the ozone layer in [&hellip;]
- [Midazolam duration of action](https://anesthesiageneral.com/midazolam-duration-of-action/): In patients with acute renal failure, total body clearance is lower and the elimination half-life, while considering midazolam duration of action becomes longer than in patients with normal kidney function. In patients with impaired kidney function, the excretion of 1-hydroxymethyl midazolam glucuronide, the major metabolite of midazolam, is impaired. In healthy children aged 1 year [&hellip;]
- [Inhalation agent anesthetic](https://anesthesiageneral.com/inhalation-agent-anesthetic/): With respect to inhalation agent anesthetic , an increase in cardiac output and the consequent increased pulmonary blood flow removes more general anesthetic from the alveoli. The alveolar venous anesthetic gradient is determined by the amount of tissue uptake of an inhalation agent anesthetic . This depends on the tissue solubility, tissue blood flow and [&hellip;]
- [Anatomical dead space and its Anesthetic implications](https://anesthesiageneral.com/anatomical-dead-space/): Total dead space (Physiological dead space) = Anatomical dead space + Alveolar dead space. Anatomical Dead Space It is constituted by air which is not participating in diffusion. Therefore it is constituted by air present in nose, trachea and bronchial tree (up to terminal bronchioles). Normally it is 30% of tidal volume or 2 ml/kg or 150 ml. Anatomical dead [&hellip;]
- [Sevoflurane induction](https://anesthesiageneral.com/sevoflurane-induction/): For Sevoflurane induction , the low blood/gas solubility and lack of pungency and irritant effects make it suitable for smooth inhalational induction of general anesthesia especially in children. Loss of consciousness occurs within 1 minute after a single breath induction. Breath holding, laryngospasm and arterial desaturation are uncommon. There is haemodynamic stability in case of [&hellip;]
- [Musculoskeletal chronic pain management](https://anesthesiageneral.com/musculoskeletal-chronic-pain-management/): Interventional techniques of musculoskeletal chronic pain management include use of nerve blocks, root blocks, rhizotomies, cordotomy, etc. Musculoskeletal chronic pain management is required during the following : 1. Low back pain &#8211; Lumbosacral, spinal/vertebral syndromes &#8211; Radiculopathy &#8211; Prolapsed intervertebral disc &#8211; Lumbar canal stenosis 2. Neuropathies: Trigeminal neuralgias (Tic doloroux) 3. Phantom limb pain, [&hellip;]
- [Opoid crisis](https://anesthesiageneral.com/opoid-crisis/): The action of Opoid crisis on hypothalamic nuclei also may be involved in producing slight fall in the body temperature. Modulation of pain through diencephalic areas like periaqueductal grey, thalamic center and hypothalamic areas is produced. The mid-brain (Mesencephalon) basal nuclei, especially due to excitation of parasympathetic region of Edinger Westphal nucleus of the oculomotor nerve [&hellip;]
- [Half Life of Phenobarbital](https://anesthesiageneral.com/half-life-of-phenobarbital/): The detailed description of half life of phenobarbital is discussed here. Thiopentone produces hypnosis within 30 to 40 seconds of intravenous injection. For the half life of phenobarbital , the time required for equilibration of the brain with the thiopental concentration in the blood (effect-site equilibration time) is rapid. Recovery after a small dose is [&hellip;]
- [PCI cardiac](https://anesthesiageneral.com/pci-cardiac/): Percutaneous coronary intervention or pci cardiac with stenting has revolutionized the care for patients with acute myocardial infarctions. Intracoronary stent placement in pci cardiac reduces the long-termrecurrence of stenosis. In addition, the combination of stenting with administration of glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitor agents, which prohibit the binding of fibrinogen and proteins to platelets, has [&hellip;]
- [Tidal Volume: Calculation Methods and Tools](https://anesthesiageneral.com/tidal-volume-calculation-methods-and-tools/): What is Tidal Volume? Tidal volume (VT) is a fundamental parameter in respiratory physiology, representing the amount of air that is inhaled or exhaled during a typical breathing cycle. It is a crucial aspect of pulmonary function that aids in understanding an individual&#8217;s respiratory health. Tidal volume is measured in milliliters (mL) and varies among [&hellip;]
- [Etomidate Dosage](https://anesthesiageneral.com/etomidate-dosage/): Etomidate dosage may be viewed as an alternative to propofol or barbiturates for the IV induction of anaesthesia, especially in the presence of an unstable cardiovascular system. After a standard induction dose of 0.2 to 0.4 mg/kg IV, the onset of unconsciousness occurs within one arm-to-brain circulation time. Involuntary myoclonic movements are common during the [&hellip;]
- [Midazolam drug interactions](https://anesthesiageneral.com/midazolam-drug-interactions/): Midazolam drug interactions should be taken into account before administering this medication. The hypnotic effect of IV Midazolam and the risk of apnoea are accentuated by premedication, particularly narcotics (e.g., morphine, meperidine and fentanyl), secobarbital, and the droperidol-fentanyl combination. Consequently, the midazolam drug interactions should be adjusted according to the type and amount of premedication [&hellip;]
- [Flow Volume Loops](https://anesthesiageneral.com/flow-volume-loops/): Flow Volume Loops are more sensitive and informative in detecting pulmonary diseases than conventional spirometry. Modem microprocessor controlled recording spirometers automatically generate these flow volume loops. The following are the parameters that are assessed in the Flow volume loops. TV= Tidal volume IRV = Inspiratory reserve volume IC = Inspiratory capacity ERV = Expiratory reserve [&hellip;]
- [Anesthetic Ethyl Chloride Spray](https://anesthesiageneral.com/anesthetic-ethyl-chloride-spray/): Anesthetic Ethyl Chloride Spray is first sprayed in the mask, as it is pleasant and potent, it produces unconsciousness in 1-2 minutes. Ether is then introduced till the patient is anesthetized to Guedel ‘s stage III and plane H when respiration is regular, eye movements cease, pupils are in mid position and reflexes absent (eyelid, [&hellip;]
- [Toxicity of inhalational anesthesia](https://anesthesiageneral.com/toxicity-of-inhalational-anaesthesia/): Hepatotoxicily has been seen since the introduction of anesthetics. Chloroform and trichloroethylene have been abandoned for toxicity of inhalational anesthesia . The toxicity may be intrinsic as seen with Chloroform or acetaminophen. Halothane exhibits an allergic or hypersensitivity reaction to a drug metabolite protein. The toxicity of inhalational anesthesia with the incidence of liver injury is Halothane&gt; Isoflurane [&hellip;]
- [The Importance of Mechanical Ventilators in Severe Lung Infections](https://anesthesiageneral.com/the-importance-of-mechanical-ventilators-in-severe-lung-infections/): In severe lung infections, the respiratory system is significantly compromised, making it difficult for patients to get enough oxygen into their bloodstream and remove carbon dioxide. This can lead to respiratory failure, a life-threatening condition where the body&#8217;s vital organs do not receive the oxygen they need to function properly. Mechanical ventilators, also known as [&hellip;]
- [Propofol Anticonvulsant](https://anesthesiageneral.com/propofol-anticonvulsant/): At sub anesthetic doses, propofol anticonvulsant has been effectively used to suppress seizures during refractory status epilepticus, a mechanism, in part, attributed to the inhibition of neuronal sodium channels. It is effective in most patients, and the side effects are infrequent, of minor severity, and fully reversible. However, high doses of propofol may be necessary [&hellip;]
- [Intubation Complications](https://anesthesiageneral.com/intubation-complications/): Endotracheal intubation complications can be intraoperative, postoperative or delayed. The following are the immediate intubation complications that are commonly seen: Esophageal intubation: This is a hazardous complication. Can be done as a mistake. If not detected in time can cause severe hypoxia and even death. This can be easily be detected by measuring carbon dioxide [&hellip;]
- [Lorazepam metabolism](https://anesthesiageneral.com/lorazepam-metabolism/): Lorazepam metabolism is done by glucuronidation in order to form pharmacologically inactive metabolites that are excreted by the kidneys. Lorazepam IV is a long-acting benzodiazepine which is more potent sedative and amnesic than midazolam and diazepam. The effects on ventilation, the cardiovascular system, and skeletal muscles resemble those of other benzodiazepines. The elimination half-time is [&hellip;]
- [Pain assessment methods](https://anesthesiageneral.com/pain-assessment-methods/): Inadequate and incomplete pain assessment methods contribute to inadequate pain management. Thus, to gather all the information about pain is very important. There are multiple methods available depending on: A. Subjective description B. Objective description C. Characteristic of pain D. Description of pain There are many components mentioned for “Ideal pain Assessment” like patient quotes, [&hellip;]
- [Disadvantages of carbon dioxide](https://anesthesiageneral.com/disadvantages-of-carbon-dioxide/): There are several disadvantages of disadvantages of carbon dioxide : • High concentration causes narcosis. • It increases the cerebral blood flow and intracranial pressure. • It stimulates sympathetic nervous system, which may be dangerous in some patients already having systemic hypertension or myocardial ischaemia. • It sensitizes myocardium to externally administered catecholamines. • It [&hellip;]
- [Metabolites – Primary and Secondary](https://anesthesiageneral.com/metabolites/): Many drugs are metabolized to active metabolites. This is usually carried out by the liver in the form of reductions, oxidations, and the addition of methyl, acetyl, and other groups. watchesbest.org While metabolites are usually a fraction as potent as the parent compound, in some situations they may be more potent and may accumulate to [&hellip;]
- [Ketamine Sedation](https://anesthesiageneral.com/ketamine-sedation/): Ketamine produces effective sedation, hence also known as Ketamine sedation . In pediatric patients for short surgical procedures or for putting intravenous catheters before IV induction ketamine has shown effective for producing sedation. It is highly effective with a wide margin of safety, and uniquely preserves protective airway reflexes and also does not require intravenous [&hellip;]
- [Midazolam structure](https://anesthesiageneral.com/midazolam-structure/): Midazolam structure is characterized by pH dependent ring opening phenomenon in which the ring remains open at pH values of less than 4, thus maintaining its water solubility. The pK of midazolam is 6.15, which permits the preparations of salts to be water soluble. The parenteral solution of midazolam used clinically is buffered to an [&hellip;]
- [The Components of Blood](https://anesthesiageneral.com/the-components-of-blood/): The components of blood are frequently used for transfusion, separately in different medical conditions. Many times whole blood may not be indicated and one component is sufficient for treating the patient. Packed Cell Volume (PCV) Among the components of blood, Packed Cell Volume is the most important and commonly transfused component. These are used when [&hellip;]
- [Pharmacological management of pain](https://anesthesiageneral.com/pharmacological-management-of-pain/): The drugs remain the main modality to achieve pharmacological management of pain . Various routes of administration for various drugs have been employed. The quest for an ideal, suitable analgesic continues. Conventionally three classes of drugs are employed to achieve various degrees of analgesia in pharmacological management of pain : 1. Opioids: For a long time [&hellip;]
- [Ketamine Seizures](https://anesthesiageneral.com/ketamine-seizures/): Activation of NMDA receptors has been implicated in cerebral ischaemic damage. Therefore, by its antagonistic effect on NMDA receptors, Ketamine seizures may have a possible neuroprotective role. Systemic administration of ketamine has been reported to have neuroprotective effect, in terms of preoperative treatment, in preventing ischaemic and postischaemic spinal cord injury during thoracic and thoracoabdominal [&hellip;]
- [Barbiturates Effects](https://anesthesiageneral.com/barbiturates-effects/): Some barbiturates effects are explained here. The thiopental sodium causes profound fall in cerebral blood flow (35 to 40%) and thus ICP. Thiopentone also causes profound decrease in CMRO2. Thiopentone increases Cerebral perfusion pressure (CPP). The barbiturates effects increased the amplitudes of subcortical and early cortical components of somatosensory evoked potentials. Even full suppression of [&hellip;]
- [ICU Scoring Systems, APACHE and SAPS](https://anesthesiageneral.com/icu-scoring-systems-apache-and-saps/): Intensive care unit scoring systems or ICU scoring systems like APACHE and SAPS fall into two broad categories. Risk prediction (also called prognostic) models are designed to assess prognosis at the time of admission to the ICU or within the first 24 hours. Severity-of-illness scoring systems are used in the intensive care unit (ICU) setting as tools [&hellip;]
- [Propofol Amnesia](https://anesthesiageneral.com/propofol-amnesia/): Propofol exhibits dose-dependent effects on memory. Infusions of propofol amnesia for conscious sedation produce concentrations below those required for consistent amnesia. In the study by Matsuki et al. Propofol and midazolam did not differ in amnesic effects to non-invasive stimuli. However, for invasive stimuli, midazolam showed a stronger amnesic effect at the moderate sedation level, [&hellip;]
- [Uses of Barbiturates](https://anesthesiageneral.com/uses-of-barbiturates/): There are several uses of barbiturates . Thiopental sodium is used as (1) the sole anesthetic agent for brief (15 minute) procedures, (2) for induction of anesthesia prior to administration of other anesthetic agents, (3) to supplement regional anesthesia, (4) to provide hypnosis during balanced anesthesia with other agents for analgesia or muscle relaxation, (5) [&hellip;]
- [Halothane Hepatitis](https://anesthesiageneral.com/halothane-hepatitis/): The effect of Halothane on the liver is that it causes hepatitis called as halothane hepatitis. Incidence of massive hepatic necrosis as a result of halothane hepatitis is 1 in 35,000. Risk factors for halothane hepatitis are: Multiple exposures is single most important factor. Hypoxia. Middle age. Obesity. Females. Patient with other autoimmune diseases. Pathologic [&hellip;]
- [Anesthesia for Carotid Endarterectomy](https://anesthesiageneral.com/anesthesia-for-carotid-endarterectomy/): Anesthesia for Carotid Endarterectomy is of proven benefit to reduce the risk of stroke in patients with high-grade stenosis of the internal carotid artery. Since the disease is atherosclerotic in origin, these patients often are prone to a variety of cerebrovascular and myocardial complications during the perioperative phase. Anesthesia for Carotid Endarterectomy demands excellent haemodynamic [&hellip;]
- [Halothane Malignant hyperthermia syndrome](https://anesthesiageneral.com/halothane-malignant-hyperthermia-syndrome/): Halothane Malignant hyperthermia syndrome may be triggered by halothane, it is an autosomal dominant inherited condition. There is a massive release of intracellular calcium from the sarcoplasm of the muscle. An increased metabolism results in rise in temperature of 2°C per hour, severe acidzsis, rhabdomyolysis, with associated hyperkalaemia. Mortality is 70%. Treatment is by active [&hellip;]
- [Benzodiazepine half life](https://anesthesiageneral.com/benzodiazepine-half-life/): Benzodiazepine half life is commonly administered through oral, intramuscular and intravenous routes. Intramuscular absorption of diazepam is erratic, whereas midazolam and benzodiazepine half life have good bioavailability through this route. Diazepam and lorazepam are well absorbed from gastrointestinal tract. However, meals and antacids may decrease absorption from the gastrointestinal tract. Midazolam has also been used [&hellip;]
- [Intravenous versed](https://anesthesiageneral.com/intravenous-versed/): Midazolam, 0.2 mg/kg IV, for induction of intravenous versed anesthesia produces a greater decrease in systemic blood pressure and increase in heart rate than does diazepam, 0.5 mg/kg IV. The haemodynamic effects of midazolam are significant in humans. In normal humans, midazolam, 0.15 mg/kg IV over 15 seconds, produces statistically significant reduction in systolic (5%) [&hellip;]
- [Most common causes of acute respiratory distress syndrome ARDS](https://anesthesiageneral.com/most-common-causes-of-acute-respiratory-distress-syndrome-ards/): Most common causes of acute respiratory distress syndrome ARDS cause a clinical condition called as ARDS first described by Ashbaugh in 1967, to describe a group of patients with acute inflammation of the lungs resulting in severe hypoxia that is not amenable for correction by oxygen therapy. The reported incidence of ARDS is about 1.5—13.5% per 100,000 [&hellip;]
- [Health effects of carbon dioxide](https://anesthesiageneral.com/health-effects-of-carbon-dioxide/): Common health effects of carbon dioxide include : • There is fall in peripheral vascular resistance but there is increase in mean arterial pressure. There is increase in blood flow towards skin and so more chances of oozing. • Directly it reduces contractile force of heart but indirectly increases cardiac output. It increases the sympathetic [&hellip;]
- [Pethidine cns excitation](https://anesthesiageneral.com/pethidine-cns-excitation/): Various drugs than but with either less potency, or slight variation in their spectrum of pethidine cns excitation are included. Phenyl piperidines: Meperidine, phenoperidine Diphenyl compounds: Methadone, dextropropoxyphene Miscellaneous: Oxycodeine, hydrocoedine There are specific differences of these drugs as per their clinical importance of pethidine cns excitation. The equianalgesic dosages and potencies of various opioids [&hellip;]
- [Ether](https://anesthesiageneral.com/ether/): Ether is still very rarely used in many Developing countries like India. First public demonstration of ether was given by W.T.G. Morton on I6th October 1846 for the removal of jaw tumor. Physical Properties of Ether : • It is pungent smelling liquid decomposes in presence of light, air and heat so stored in amber [&hellip;]
- [Intrathecal Ketamine](https://anesthesiageneral.com/intrathecal-ketamine/): When administered intrathecal ketamine shows local anesthetic effects in both animals and humans. Intrathecal ketamine when used as a sole agent (0.7-0.95 mg/kg) with or without epinephrine for intrathecal use, although produces motor and sensory block but the analgesia is inadequate and of short duration along with varied psychomimetic disturbances. When added to the intrathecal [&hellip;]
- [What is Sleep](https://anesthesiageneral.com/what-is-sleep/): Below is an answer to the simple question what is sleep? What is Sleep? Physiologically, sleep is regarded as absence of wakefulness, where the responses to environmental stimuli are greatly reduced. But, in fact, it is an active state, related to definite anatomic structures as well to specific biogenic amines. Yet, its exact mechanism is [&hellip;]
- [Common benzodiazepines](https://anesthesiageneral.com/common-benzodiazepines/): Among the common benzodiazepines that are used in anesthesia today are three: namely diazepam, midazolam and lorazepam. Benzodiazepines produce varying degree of anxiolysis, sedation, anticonvulsant actions and anterograde amnesia. Benzodiazepines also produce some degree of skeletal muscle relaxation but that is not sufficient for surgical procedures; and they also do not decrease the dose requirements [&hellip;]
- [Pre Anesthesia drugs and medicines](https://anesthesiageneral.com/pre-anesthesia-drugs-medicines/): Pre anesthesia drugs and medicines is the term applied to the use of drugs prior to the administration of an anesthetic agent, with the objective of making anesthesia safer and more agreeable to the patient. The reasons for using pre anesthesia drugs are: For sedation, to reduce anxiety and apprehension without producing much drowsiness. To obtain an [&hellip;]
- [Isoflurane inhalation induction](https://anesthesiageneral.com/isoflurane-inhalation-induction/): A rapid Isoflurane inhalation induction is possible with isoflurane because of low blood/gas solubility coefficient. It has a pungent odour, patients complain of burning sensation in the airway though there is no increase in airway reflexes or secretions. So a smoother induction is seen with halothane or sevoflurane which are preferred for inhalational induction. Recovery: [&hellip;]
- [Propofol Antioxidant](https://anesthesiageneral.com/propofol-antioxidant/): Propofol has a chemical structure similar to that of phenol-based free radical scavengers such as vitamin E, and reduces free radicals. This Propofol antioxidant may directly intervene at the critical phase of reperfusion injury by reducing free radicals, Ca 2+ influx and neutrophil activity. Oxygen leads to the formation of free oxygen radicals which react [&hellip;]
- [Effect of barbiturates drugs in cerebral ischemia](https://anesthesiageneral.com/effect-of-barbiturates-drugs-in-cerebral-ischaemia/): The primary mechanism of protection of barbiturates drugs in cerebral ischemia has been attributed to its ability to decrease the cerebral metabolic rate of oxygen consumption (CMRO2), thereby increasing the ratio of oxygen supply to oxygen demand. Barbiturates drugs have been the prototype for anesthetic protection against cerebral ischemia. The decrease in CMRO2 is accompanied by a parallel [&hellip;]
- [Midazolam onset of action](https://anesthesiageneral.com/midazolam-onset-of-action/): Midazolam onset of action undergoes rapid absorption from gastrointestinal tract. Only about 50% of the orally administered dose of midazolam reaches the systemic circulation, reflecting extensive first-pass metabolism. It is highly protein bound and this does not depend on the plasma concentration of the drug. The short duration of the drug is due to its [&hellip;]
- [Air embolism and Fat embolism](https://anesthesiageneral.com/air-embolism-and-fat-embolism/): The four most common embolism seen in the critical care patient population are air embolism, fat embolism, cholesterol embolism, and blood embolism (clots). Embolism is an uncommon complication of altered mentation after invasive procedures, but it must be placed on the list of differential diagnoses. Air embolism occurs when air enters the systemic vascular circulation [&hellip;]
- [Indications of Transfusion](https://anesthesiageneral.com/indications-of-transfusion/): In adult with normal hemoglobin and hematocrit blood losses more than 20% of their blood volume (or hematocrit falls below 30%) are to be replaced with blood (while in western countries replacement may be required on loss more than 25 to 30%). A few important indications of transfusion of blood are mentioned below. • Losses [&hellip;]
- [Methoxyflurane Anesthesia](https://anesthesiageneral.com/methoxyflurane-anesthesia/): Methoxyflurane Anesthesia is a halogenated hydrocarbon now obsolete. Physical properties: Colorless, fruity liquid, non-flammable, boiling point of 104°C, blood/gas coefficient 13, oil /gas 825, VP 25 mm Hg, MAC 0.2%, metabolism 50-75%. Methoxyflurane Anesthesia is metabolized to dichloroacetic acid and methoxydifluoro acetic acid and fluoride in high amount which proved nephrotoxic; due to this it [&hellip;]
- [Preparation of carbon dioxide gas](https://anesthesiageneral.com/preparation-of-carbon-dioxide-gas/): The preparation of carbon dioxide gas is needed before it is actually stored in cylinders. The preparation of carbon dioxide gas is done though following steps : 1. From fermentation in the brewing of beer 2. By-product of manufacture of hydrogen in petroleum refining 3. Combustion of other fuels 4. By heating magnesium and calcium [&hellip;]
- [Understanding Minute Ventilation in Anesthesia and Intensive Care: Importance, Measurement, and Interpretation](https://anesthesiageneral.com/understanding-minute-ventilation-in-anesthesia-and-intensive-care-importance-measurement-and-interpretation/): Understanding Minute Ventilation in Anesthesia and Intensive Care In the field of anesthesia and intensive care, minute ventilation plays a crucial role in ensuring the well-being and safety of patients. Minute ventilation refers to the volume of air that is moved in and out of the lungs in one minute. It is a vital parameter [&hellip;]
- [Propofol Sedation](https://anesthesiageneral.com/propofol-sedation/): The depth of propofol sedation increases in a dose dependent manner. The short context-sensitive half-time of propofol, even with prolonged periods of infusion, make this a readily titratable drug for production of IV sedation. The prompt recovery without residual sedation and low incidence of nausea and vomiting make propofol particularly well suited to ambulatory conscious [&hellip;]
- [Alveolar partial pressure of oxygen](https://anesthesiageneral.com/alveolar-partial-pressure-of-oxygen/): For the Alveolar partial pressure of oxygen we see, Increasing the inspired concentration (F1) of an anesthetic agent increases the alveolar concentration (FA). A 75% nitrous oxide (N20) in oxygen mixture increases the FI/FA ratio of N2O. The amount of nitrous oxide absorbed will be greater than the nitrogen given out in the alveoli, hence [&hellip;]
- [Enflurane](https://anesthesiageneral.com/enflurane/): Enflurane is not a very commonly used agent in the developing counties although its usage is on in America. It is a newer inhalational agent like that of halothane. Enflurane is halogenated ether. Enflurane Physical Properties : It is a Colorless gas. It has ethereal odor. It is Non inflammable at clinical concentration but inflammable [&hellip;]
- [Etomidate Half Life](https://anesthesiageneral.com/etomidate-half-life/): Etomidate induces loss of consciousness rapidly (5—15 seconds) and recovery occurs in 5 to 15 minutes. The elimination Etomidate half life is 4.6 +1- 2.6 hours and total apparent volume of distribution, 4.5 +/- 2.2 L/kg. The volume of distribution of etomidate half life is large, suggesting considerable tissue uptake. The plasma clearance is 879 [&hellip;]
- [Acute barbiturate poisoning](https://anesthesiageneral.com/acute-barbiturate-poisoning/): Acute barbiturate poisoning causes depression of the CNS, particularly the respiratory system causing decreased breathing, and the cardiovascular system causing a peripheral circulatory collapse. The frequent and often fatal complications are respiratory (atelectasis, pulmonary edema and bronchopneumonia) or renal (acute renal shutdown). Treatment of acute barbiturate poisoning The severity of barbiturate poisoning is assessed by [&hellip;]
- [History of Oxygen](https://anesthesiageneral.com/history-of-oxygen/): John Mayow of Oxford in 1674 first observed that a component of air is essential for respiration and fire. Stephen Hale prepared oxygen along with other gases in 1927, thus making a memorable mark in the history of oxygen . Discovery, importance and history of oxygen are credited to Priestly (1777), who named it as [&hellip;]
- [Dextran Injection](https://anesthesiageneral.com/dextran-injection/): Dextrans are a type of colloids and are used for intravenous transfusion. The Dextran Injection is aavailable as Dextran 70 (mol. wt. 70,000 Daltons), Dextran 150 (mol. wt. 1,50,000 Daltons) and Dextran 40 (mol. wt. 40,000 Daltons). Dextrans are polysaccharides. These solutions can be stored for 10 years. Half life of dextrans is 2 to [&hellip;]
- [Isoflurane renal effects](https://anesthesiageneral.com/isoflurane-renal-effects/): Isoflurane renal effects are minimal, only 0.2% metabolites are excreted in the urine and fluoride excretion is minimal. In patients for renal transplantation where there is a risk of arrhythmia, due to alteration in plasma electrolyte concentration, release of renin and catecholamines; there is hemodynamic stability. Skeletal muscle tone is reduced to a greater extent [&hellip;]
- [Viable fetus](https://anesthesiageneral.com/viable-fetus/): Fetal distress can be caused by a host of factors; most notably, hypoxemia and hypovolemia are dangerous for the viable fetus. It is not uncommon for a pregnant patient to be affected by critical illness. Examples of nonobstetric maladies that lead to intensive care unit admission among pregnant women are hematologic issues (venous thromboembolism and pulmonary embolus, [&hellip;]
- [Barbiturates List](https://anesthesiageneral.com/barbiturates-list/): Barbiturates list is explained in detail in this article. Thiopentone is prepared commercially from highly alkaline solutions as sodium salt that is readily soluble in water or saline. It is supplied as a yellowish, hygroscopic powder. The pH of a 2.5% solution of thiopental is 10.5. The following is a list of Barbiturates in common [&hellip;]
- [Electrical burn](https://anesthesiageneral.com/electrical-burn/): Electrical burn continue to be clinically and surgically challenging for surgeons and critical care physicians worldwide. Gross underestimation of the initial injury has repeatedly proven to increase morbidity and detrimental to the overall outcome. To briefly review, electricity is the flow of electrons through a conductor via the force of voltage. Voltage is categorized into [&hellip;]
- [Enflurane Mechanism Action](https://anesthesiageneral.com/enflurane-mechanism-action/): Circulatory system and Enflurane Mechanism Action : Enflurane reduces BP due to vasodilatation as a result of decrease in SVR and cardiac depression. There is increase in heart rate and reduction in cardiac output. It does not sensitize the heart to catecholamines or stimulate the sympathetic nervous system. The margin between adequate anaesthesia and unacceptable hypotension [&hellip;]
- [Nitrous oxide induction agent](https://anesthesiageneral.com/nitrous-oxide-induction-agent/): &nbsp; Nitrous oxide induction agent is a weak anaesthetic agent and not suitable as a sole anaesthetic agent. Nitrous oxide induction agent is used to hasten inhalational induction of anaesthesia due to its “concentration and second gas effects”. There is a smooth and pleasant induction. The recovery from anaesthesia is rapid; however, a “diffusion hypoxia” [&hellip;]
- [Phenobarbital Dosage](https://anesthesiageneral.com/phenobarbital-dosage/): Phenobarbital dosage include 3 to 5 mg/kg IV, produces rapid induction producing unconsciousness within 30 seconds. Although propofol is becoming the most popular drug for induction of anesthesia for its quick offset from anesthesia, thiopental is still in use due to its low cost in comparison particularly in developing countries. Phenobarbital dosage still remains the [&hellip;]
- [Hemolytic Reaction](https://anesthesiageneral.com/hemolytic-reaction/): Signs and Symptoms of hemolytic reaction An acute hemolytic reaction occurs when immunologic incompatibility following transfusion, between the donor and the recipient results in lysis of red blood cells. Most hemolytic reactions are due to the transfusion of ABO-incompatible packed red blood cells secondary to clerical or system errors. The severity of the reaction is [&hellip;]
- [Neuromuscular blocker drugs](https://anesthesiageneral.com/neuromuscular-blocker-drugs/): The ideal neuromuscular blocker drugs (NMB) would be rapid in onset, have a predictable offset, be nontoxic, lack deleterious cardiovascular or autonomic effects, undergo a defined means of metabolism and excretion preferably independent of end-organ function, and be inexpensive. Many of these characteristics are found in clinically available drugs like cisatracurium. To briefly review, neuromuscular [&hellip;]
- [Normal Spirometry Values](https://anesthesiageneral.com/normal-spirometry-values/): Spirometer is the instrument used to measure following lung volumes. Normal Spirometry Values are very important and a good doctor especially an anesthetist should always remember the approximate values of them. The Normal Spirometry Values are: • Tidal volume is 400 to 500 ml (10 mI/kg). • Inspiratory reserve volume is is 2,400 to 2,600 [&hellip;]
- [Analeptic Drugs](https://anesthesiageneral.com/analeptic-drugs/): Analeptic Drugs are Cenrtral nervous system stimulants or CNS stimulants that stimulate respiration and also the brain. The different Analeptic Drugs are: Bemegride Nikethamide Doxapram These drugs help to restore the drug-induced depressed function towards normal. Ideally there should be pharmacological antagonism and the analeptic drug should block the depressant drug activity either by inactivation or [&hellip;]
- [Etomidate Metabolism](https://anesthesiageneral.com/etomidate-metabolism/): Etomidate metabolism is rapidly metabolized by hydrolysis of the ethyl ester side chain to its carboxylic acid ester, resulting in a water-soluble, pharmacologically inactive compound. Hepatic microsomal enzymes and plasma esterases are responsible for this hydrolysis. Hydrolysis is nearly complete, as evidenced by recovery of &lt; 3% of an administered dose of etomidate metabolism as [&hellip;]
- [ACDU Scale](https://anesthesiageneral.com/acdu-scale/): McNarry and Goldhill compared ACDU Scale (Alert, Confused, Drowsy, Unresponsive) and AVPU scale (Alert, responds to Voice, responds to Pain, Unresponsive) by the American college of surgeons with GCS scale for neurological assessment of critically ill ward patients. Just like GCS the ACDS Scale is a method to assess the neurological status and level of [&hellip;]
- [Anesthesia for Cerebral Aneurysm](https://anesthesiageneral.com/anesthesia-for-cerebral-aneurysm/): Minimization of the risk of aneurysm rupture during Anesthesia for Cerebral Aneurysm demands smooth induction and maintenance of optimum transmural pressure (TMP) gradient. TMP is the difference between mean arterial pressure (MAP) and ICP. Rise in MAP or fall in ICP affects transmural pressure gradient thereby increasing the risk of rupture of the aneurysmal sac. [&hellip;]
- [Emergence from anesthesia](https://anesthesiageneral.com/emergence-from-anesthesia/): Emergence from anesthesia has cardiorespiratory, metabolic/endocrine and neurologic consequences. Awakening and extubation after anesthesia are associated with haemodynamic arousal lasting 10-25 minutes. This activation is partially mediated by elevations in catecholamine levels and partially by nociceptive stimuli. The aim of emergence after a neurosurgical procedure is to maintain intracerebral and extra-cerebral homeostasis. This implies maintenance [&hellip;]
- [Malignant hyperthermia](https://anesthesiageneral.com/malignant-hyperthermia/): Malignant hyperthermia (MH) is a hypermetabolic disorder of skeletal muscle that is triggered in susceptible individuals by several inhalation anesthetic agents (sevoflurane, desflurane, isoflurane, halothane, enflurane, and methoxyflurane) and succinylcholine. These anesthetic triggers cause intracellular hypercalcemia in skeletal muscle by decreasing the uptake of calcium by the sarcoplasmic reticulum. The intracellular hypercalcemia activates metabolic pathways [&hellip;]
- [IV Anesthesia](https://anesthesiageneral.com/2492-2/): IV Anesthesia or intravenous anesthesia is when anesthesia is given through a vein through injections. Anesthesia is usually started or induced with intravenous or IV anesthesia drugs. The different IV Anesthesia drugs are: Thiopental sodium Midazolam Methohexitone Ketamine Etomidate Propofol Some Steroids Ultra short acting barbiturates The ultra-short acting barbiturates administered as IV Anesthesia to [&hellip;]
- [Use of nitrogen](https://anesthesiageneral.com/use-of-nitrogen/): Nitrogen is present in the atmosphere and it constitutes 78.08% of total air. Moreover, the use of nitrogen is growing very rapidly these days. Use of nitrogen in medicine is helpful as it can be used as diluent of oxygen in order to avoid oxygen toxicity. It is stored in either compressed air or in [&hellip;]
- [Cardiovascular effects of inhalation anesthetics](https://anesthesiageneral.com/cardiovascular-effects-of-inhalation-anesthetics/): Cardiovascular effects of inhalation anesthetics occur on all aspects of cardiovascular function, namely, inotropic, chronotropic, dromotropic and lusitropic state of the heart. Their effects are as follows: a) Myocardial b) Coronary circulation c) Conduction d) Circulation Cardiovascular effects of inhalation anesthetics produce dose-related myodial depression of LV, RV and LA contractility as well LV diastolic [&hellip;]
- [Ketamine Half Life](https://anesthesiageneral.com/ketamine-half-life/): The pharmacokinetics of ketamine is characterized by rapid onset of action, relatively short duration of action, and high lipid solubility. Ketamine half life has a pK of 7.5 at physiologic pH. Ketamine half life can be given by multiple routes: IV, TM, SC, oral, sublingual, rectal, nasal, transdermal, epidural, or intrathecal. Peak plasma concentrations of [&hellip;]
- [Diazepam uses](https://anesthesiageneral.com/diazepam-uses/): Diazepam remains a popular oral drug for preoperative medication of adults and is the benzodiazepine most likely to be selected for management of delirium tremens and treatment of local anesthetic induced seizures. This is considered to be one of the diazepam uses that are very common. Production of skeletal muscle relaxation by diazepam is often [&hellip;]
- [Advancements in Anesthesia for Total Hip Replacement: Exploring Patient Choices](https://anesthesiageneral.com/advancements-in-anesthesia-for-total-hip-replacement-surgery/): Introduction to Total Hip Replacement Surgery Total hip replacement (THR) surgery is a common orthopedic procedure aimed at alleviating pain and restoring mobility in individuals suffering from hip joint diseases, such as osteoarthritis, rheumatoid arthritis, or hip fractures. Patients typically seek this surgery after conservative treatments, such as medications and physical therapy, have failed to [&hellip;]
- [Sevoflurane cardiovascular effects](https://anesthesiageneral.com/sevoflurane-cardiovascular-effects/): One of the Sevoflurane cardiovascular effects is that the Sevoflurane has minimal effect on heart rate. There is a fall in systemic vascular resistance and blood pressure, but less than isoflurane. Also Sevoflurane cardiovascular effects are complex such as the pulmonary arterial pressure is also reduced. There is a lesser depression of left ventricular systolic [&hellip;]
- [Midazolam overdose](https://anesthesiageneral.com/midazolam-overdose/): The manifestations of midazolam overdose are sedation, somnolence, confusion, impaired coordination, diminished reflexes, and untoward effects on vital signs, coma and possible cardio respiratory arrest. Treatment of midazolam overdose is the same as that followed for overdosage with other benzodiazepines. Continuous monitoring of vital signs including ECG should be immediately instituted and general supportive measures [&hellip;]

## Pages

- [What is General Anesthesia and general anesthetic?](https://anesthesiageneral.com/): General anesthesia is a procedure by which a person is put into sleep like state for the performance of surgery or other painful medical procedures. Although anesthesia was used throughout history, in primitive forms, to help in performing surgeries, the world was introduced to what is general anesthesia for the first time in 1844. It [&hellip;]
- [Contact Us](https://anesthesiageneral.com/contact-us/): &nbsp; If you have any questions, suggestions or just want to reach out contact us with the form below or email us at admin@anesthesiageneral.com
- [About](https://anesthesiageneral.com/about/): &nbsp; Anesthesia General .com is a website offering detailed but simplified information regarding Anesthesia for the patient’s knowledge as well as for the learning of medical students and practitioners. All articles written on  this website are by Qualified and Well Trained anesthesiologists. The information on Anesthesia General, are well established facts from Medical textbooks, that is being presented in a [&hellip;]

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