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Anesthetic Agents and Surgery during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
The most commonly used inhalation anesthetic agent in obstetrics, nitrous oxide, is usually part of a balanced general anesthetic regimen that includes a fast-acting anesthetic (e.g., use of propofol instead of thiopental), a muscle relaxant (e.g., succinylcholine), and a halogenated agent (e.g., isoflurane). The frequency of congenital anomalies was not increased among more than 650 infants exposed to nitrous oxide during the first trimester (Heinonen et al., 1977; Crawford and Lewis, 1986; Teschke et al., 2011). As with many other agents, nitrous oxide was reported to be associated with increased fetal loss, growth retardation, and congenital anomalies in animal studies (Friedman, 1988; Mazze et al., 1984).
Anesthesia and the Patient with Epilepsy
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
Samantha L. Mullis, A. Donald Finek
Inhalational anesthetics have gained worldwide acceptance and utilization by anesthesiologists because of their ease of administration and low incidence of patient intolerance. In order to appropriately describe the effects of the various inhalational anesthetic agents upon the electroencephalogram (EEG), it is of utmost importance to be familiar with the normal signs and stages of anesthesia. In 1920, Arthur Guedel described the stages through which a patient anesthetized with ethyl ether will progress, ranging from conscious analgesia to medullary paralysis with increasing anesthetic depth (1). Advances in electrophysiologic monitoring have allowed anesthesiologists to further explore this classification by correlating EEG background frequency with anesthetic depth, and have shown that the early stages of some anesthetics are characterized by an increase in disorganized electrical activity (2). Hence, the initial planes of anesthesia and epilepsy possess similar electrophysiologic features and explain how anesthetic agents may appear to possess both pro- and anticonvulsant properties (3,4). For our purposes, the discussion of inhalational anesthetics will be limited to those agents in clinical usage today.
General Anesthetics
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Aman Upaganlawar, Abdulla Sherikar, Chandrashekhar Upasani
Elimination of anesthesia by inhalational anesthetics is a reverse process. For agents with little blood and tissue solubility, recovery from anesthesia should be parallel to anesthetic induction irrespective of duration of its administration whereas for agents with high blood and tissue solubility, recovery from anesthesia depend on the duration of anesthetic administration because the accumulated amounts of anesthetic in the fat reservoir will prevent blood (and therefore alveolar) partial pressures from falling rapidly. Patients will be arousal when alveolar partial pressure reaches MACawake, a partial pressure somewhat lower than MAC (Brunton et al., 2011; Rang et al., 2011).
Effects of sevoflurane on reproductive function of male rats and its main mechanism of action
Published in Inhalation Toxicology, 2019
Yanhong Cui, Jingying Liu, Yulin Zhu, Kun Xie, Jingui Yu, Lingzhi Yu, Yanhao Wang
Forty adult male Sprague–Dawley rats, weighing 180–200 g and at age of 9 weeks old, were purchased from Jinan Pengyue Experimental Animal Breeding Co., Ltd., (license number SCXK (Lu) 20140007). These rats were raised at 22–25 °C in a room with relative humidity 50–60% and 12 h light/12 h dark cycle and free to water and standard diet. After accommodated to the environment for 3 days, rats were randomly divided into 4 groups: control group (0 ppm, no administration), low concentration sevoflurane group (50 ppm), medium concentration sevoflurane group (300 ppm), and high concentration sevoflurane group (1800 ppm) (Xu et al. 2012) with 10 in each group. Rats in each group inhaled anesthetic sevoflurane for 2 h per day for consecutive 15 days (Xu et al. 2012). Each four rats were placed in a 240 L static exposure chamber. Vapor generation commenced when a predetermined amount of isoflurane liquid was injected through the injection port onto filter papers upended below the sealed lid. The fan, which is mounted inside the cover, is then opened, which helps to quickly evaporate the solvent and dis, was then opened, which helps to quickly evaporate the solvent and dispense the medicament into the chamber. A defined amount of inhalational anesthetics was introduced into the closed system and mixed with trapped air. Test rats were exposed to isoflurane for 2 h/d, 15 consecutive days. Animals from the control group were kept in the inhalation chamber for the same time. Chamber air was manually sampled twice with a glass airtight syringe for each exposure. The concentration of evaporable isoflurane vapor was determined by gas chromatographic analysis (GS).
Effects of occupational exposure to trace levels of halogenated anesthetics on the liver, kidney, and oxidative stress parameters in operating room personnel
Published in Toxin Reviews, 2020
Abbas Jafari, Fatemeh Jafari, Iraj Mohebbi
Several inhalational anesthetic agents are being used to induce and maintain anesthesia. Even in modern operating rooms (ORs), the trace levels of volatile anesthetics may leak from the breathing circuit and pollute the ambient air. Contamination of the OR environment occurs due to several reasons, including induction of anesthesia, pediatric anesthesia, exhalation of the patient, anesthesia machine leakage, inadequate scavenging system, and so on (Hoerauf et al.1996; Irwin et al.2009, Jafari et al.2018). Thus, OR personnel are unavoidably exposed to inhalational anesthetics that may lead to adverse health effects (Byhahn et al.2001, Irwin et al.2009). According to previous experimental studies, long-term exposure to anesthetic gases, especially halogenated agents (e.g. isoflurane, sevoflurane, enflurane, and methoxyflurane), can result in genotoxicity, neurotoxicity, spontaneous abortion, congenital malformations, as well as liver and kidney damage (McGregor 2000, Grasshoff and Antkowiak 2006, Rocha et al.2015, Zhu et al.2017). Although the exact mechanisms underlying these effects have not been elucidated, some researchers believe that anesthetic agents exert their adverse effect via inducing of oxidative stress (Malekirad et al.2005, Türkan et al.2005). Oxidative stress is defined as a marked imbalance between the production of reactive oxygen species (ROS) and antioxidant defense. Based on previous investigations, chronic exposure to anesthetic gases induces the ROS formation and oxidative damage to macromolecules (i.e. DNA, proteins, and lipids; Ranjbar et al.2007, Irwin et al.2009).
Sedative drugs used for mechanically ventilated patients in intensive care units: a systematic review and network meta-analysis
Published in Current Medical Research and Opinion, 2019
Hongliang Wang, Changsong Wang, Yue Wang, Hongshuang Tong, Yue Feng, Ming Li, Liu Jia, Kaijiang Yu
In the rankings of the competing sedation methods based on the duration of ICU stay, the inhalation anesthetic sedation method was 31.7%, which indicates the highest potential to shorten the ICU duration. Volatile anesthetics are potent hypnotics that facilitate fast introduction and awakening and easy titration, and they may be administered as a single-use sedative64. In contrast to other sedative substances, such as benzodiazepines or α2 agonists, volatile anesthetics have a low risk of accumulation and delayed recovery64. Furthermore, the pharmacokinetics of inhalation anesthetics result in a short wake-up time, which may affect the ICU length of stay38.