Articles: general-anesthesia.
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A state exists after the induction of anaesthesia in which patients may be aware of their surroundings yet unable to communicate. This problem of awareness and recall during general anaesthesia is a recent one in the relatively short history of anaesthesia. Prior to the introduction of muscle relaxants in 1942 by Griffith and Johnson, it was felt that "light anaesthesia" would be signified by violent movements. ⋯ None has yet been found to be totally reliable and numerous reports of awareness can be found in the literature. Light inhalation and total intravenous anaesthesia have been blamed for the majority of these case reports. However, awareness during total intravenous anaesthesia is avoidable with the proper use of a combination of a hypnotic and an analgesic such as midazolam and alfentanil for general anaesthesia.
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Ketamine has been employed as an anesthetic for 25 years. It is the only PCP-like dissociative anesthetic in clinical use. Favourable experience with ketamine in combat situations and at accidents, together with its ability to block the effect of the excitatory neurotransmitter glutamate on NMDA-receptor mediated neurotransmission, has attracted greater attention to this drug in recent years. ⋯ Recent investigations indicate that the analgesic and anesthetic effects as well as the "dissociative" phenomena seen after analgesic doses are due to PCP receptor mediated inhibition of excitatory amino acid transmission at NMDA synapses. The excitatory effect observed at higher doses, however, may be mediated by the haloperidol sensitive sigma-receptor. The enantiomers of ketamine (R- and S-ketamine) differ in pharmacological profile and may enable improvement of ketamine as a drug.
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J Conn State Dent Assoc · Jan 1990
Biography Historical Article"Vignettes" or a portrayal of Horace Wells.