Masui. The Japanese journal of anesthesiology
-
Ketamine was first used in humans over 40 years ago. Since then, ketamine has not been always used in anesthetic practice because of its unique pharmacological properties such as sympathomimetic or psychomimetic effect. ⋯ These pharmacological actions are based on property of ketamine as an NMDA receptor antagonist. We describe basic NMDA receptor function and possible action of ketamine via the receptor.
-
Anticholinesterase, such as neostigmine, was used to be a standard drug at the end of surgery for reversal of nondepolarizing neuromuscular block. Neostigmine decreases the metabolism of acetylcholine (ACh) at the neuromuscular junction and allows its concentration to increase and overcome the effect of the muscle relaxant. But this approach is ineffective against profound block. ⋯ In addition to donepezil, two other cholinesterase inhibitors have recently been approved for the treatment of AD patients. The drugs have slightly different pharmacological properties, but they all work by inhibiting the breakdown of acetylcholine, an important neurotransmitter associated with memory, by blocking the enzyme acetylcholinesterase. Donepezil can also reverse opioid-induced respiratory depression.
-
Anesthesia is a state made by multiple pharmacological agents that affect the functions of central, peripheral and autonomic nervous systems. Antagonists are often used to reverse the effects of anesthetic agents, muscle relaxants, and so forth. Antagonists often have side effects other than their specific antagonistic effect. ⋯ These agents may antagonize the effects of non-depolarizing muscle relaxants. Flumazenil may have adverse effects in patients on chronic benzodiazepines and tricyclic or tetracyclic antidepressants. Because sugammadex has little adverse effects, it has become a popular agent to reverse muscle relaxation by rocuronium in Japan.
-
Local anesthetics block impulses in peripheral nerves through the inhibition of voltage-gated sodium channels. However, the effects of local anesthetics may be more complex. It has been reported that local anesthetics not only block the impulses in nerve roots, but could also interact with many membrane phospholipids and proteins, including various receptors, and thereby affect a variety of cellular activities. ⋯ Recently, the interaction between local anesthetics and TRPV1 agonist has attracted the attention because they raise the possibilities of producing analgesic effect without affecting motor or other sensory functions. The effects of local anesthetics may have some aspects which have not been clarified. Further investigations will be required to fully understand the actions of local anesthetics.