General anaesthesia

1774:, and failure of vital organs. Over the last several decades, the overall anesthesia related mortality rate improved significantly for anesthetics administered. Advancements in monitoring equipment, anesthetic agents, and increased focus on perioperative safety are some reasons for the decrease in perioperative mortality. In the United States, the current estimated anesthesia-related mortality is about 1.1 per million population per year. The highest death rates were found in the geriatric population, especially those 85 and older. A review from 2018 examined perioperative anesthesia interventions and their impact on anesthesia-related mortality. Interventions found to reduce mortality include pharmacotherapy, ventilation, transfusion, nutrition, glucose control, dialysis and medical device. Interestingly, a randomized controlled trial from 2022 demonstrated that there is no significant difference in mortality between patient receiving handover from one clinician to another compared to the control group. 783:. Minimizing sensory stimulation or distraction by video games may help to reduce anxiety prior to or during induction of general anaesthesia. Larger high-quality studies are needed to confirm the most effective non-pharmacological approaches for reducing this type of anxiety. Parental presence during premedication and induction of anaesthesia has not been shown to reduce anxiety in children. It is suggested that parents who wish to attend should not be actively discouraged, and parents who prefer not to be present should not be actively encouraged to attend. 1267:(i.e. halothane or sevoflurane) which is called a gas or inhalational induction. Spontaneous ventilation can also be maintained using intravenous anaesthesia (e.g. propofol). Intravenous anaesthesia to maintain spontaneous respiration has certain advantages over inhalational agents (i.e. suppressed laryngeal reflexes) however it requires careful titration. Spontaneous Respiration using Intravenous anaesthesia and High-flow nasal oxygen (STRIVE Hi) is a technique that has been used in difficult and obstructed airways. 1634: 1314: 792:

injury if anesthesia is used on a concussed person. Concussions create ionic shifts in the brain that adjust the neuronal transmembrane potential. In order to restore this potential more glucose has to be made to equal the potential that is lost. This can be very dangerous and lead to cell death. This makes the brain very vulnerable in surgery. There are also changes to cerebral blood flow. The injury complicates the oxygen blood flow and supply to the brain.

6091: 1685:(e.g., one milligram of morphine). The PCA device then "locks out" for a preset period to allow the drug to take effect, and also prevent the patient from overdosing. If the patient becomes too sleepy or sedated, they make no more requests. This confers a fail-safe aspect that is lacking in continuous-infusion techniques. If these medications cannot effectively manage the pain, local anesthetic may be directly injected to the nerve in a procedure called a 6101: 1510:(TCI), it involves using a computer-controlled syringe driver (pump) to infuse propofol throughout the duration of surgery, removing the need for a volatile anaesthetic and allowing pharmacologic principles to more precisely guide the amount of the drug used by setting the desired drug concentration. Advantages include faster recovery from anaesthesia, reduced incidence of postoperative nausea and vomiting, and absence of a trigger for 25: 131: 1495:(usually propofol or midazolam). Propofol can be used for total intravenous anaesthetia (TIVA), therefore supplementation by inhalation agents is not required. General anesthesia is usually considered safe; however, there are reported cases of patients with distortion of taste and/or smell due to local anesthetics, stroke, nerve damage, or as a side effect of general anesthesia. 379:, many patients chose certain death rather than undergo surgery. Although there has been a great deal of debate as to who deserves the most credit for the discovery of general anaesthesia, several scientific discoveries in the late 18th and early 19th centuries were critical to the eventual introduction and development of modern anaesthetic techniques. 617:

limited accuracy, and other evaluations are routinely performed addition to the Mallampati test including mouth opening, thyromental distance, neck range of motion, and mandibular protrusion. In a patient with suspected distorted airway anatomy, endoscopy or ultrasound is sometimes used to evaluate the airway before planning for the airway management.

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Enhanced Recovery After Surgery (ERAS) is a society that provides up-to-date guidelines and consensus to ensure continuity of care and improve recovery and peri-operative care. Adherence to the pathway and guidelines has been shown to associate with improved post-operative outcomes and lower costs to

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General anaesthesia can also be induced with the patient spontaneously breathing and therefore maintaining their own oxygenation which can be beneficial in certain scenarios (e.g. difficult airway or tubeless surgery). Spontaneous ventilation has been traditionally maintained with inhalational agents

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Paralysis is most easily monitored by means of a peripheral nerve stimulator. This device intermittently sends short electrical pulses through the skin over a peripheral nerve while the contraction of a muscle supplied by that nerve is observed. The effects of muscle relaxants are commonly reversed

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Anesthesia has little to no effect on brain function, unless there is an existing brain disruption. Barbiturates, or the drugs used to administer anesthesia, do not affect auditory brain stem response. An example of a brain disruption would be a concussion. It can be risky and lead to further brain

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may also be used; it works by directly binding muscle relaxants and removing it from the neuromuscular junction. Sugammadex was approved for use in the United States in 2015, and rapidly gained popularity. A study from 2022 has shown that Sugammadex and neostigmine are likely similarly safe in the

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and requires ventilation until the drugs wear off and spontaneous breathing starts. In other words, ventilation may be required for both induction and maintenance of general anaesthesia or just during the induction. However, mechanical ventilation can provide ventilatory support during spontaneous

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The duration of action of intravenous induction agents is generally 5 to 10 minutes, after which spontaneous recovery of consciousness will occur. In order to prolong unconsciousness for the duration of surgery, anaesthesia must be maintained. This is achieved by allowing the patient to breathe a

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around the patient's arm, forearm, or leg. A machine takes blood pressure readings at regular, preset intervals throughout the surgery. The second method is invasive blood pressure (IBP) monitoring, which allows beat to beat monitoring of blood pressure. This method is reserved for patients with

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Prior to a planned procedure, the anesthesiologist reviews medical records, interviews the patient, and conducts a physical examination to obtain information regarding their medical history and current physical state, and to determine an appropriate anesthetic plan, including what combination of

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Prior to administration of a general anaesthetic, the anaesthetist may administer one or more drugs that complement or improve the quality or safety of the anaesthetic or simply provide anxiolysis. Premedication also often has mild sedative effects and may reduce the amount of anaesthetic agent

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technologies allow for a controlled induction of, maintenance of, and emergence from general anaesthesia. Standard for basic anesthetic monitoring is a guideline published by the ASA, which describes that the patient's oxygenation, ventilation, circulation and temperature should be continually

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are checked, and neck flexibility and head extension are observed. The most commonly performed airway assessment is the Mallampati classification, which evaluates the airway base on the ability to view airway structures with the mouth open and the tongue protruding. Mallampati tests alone have

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Orbach-Zinger S, Bizman I, Firman S, Lev S, Gat R, Ashwal E, et al. (October 2019). "Perioperative noninvasive cardiac output monitoring in parturients undergoing cesarean delivery with spinal anesthesia and prophylactic phenylephrine drip: a prospective observational cohort study".

819:, is the period between the administration of induction agents and loss of consciousness. During this stage, the patient progresses from analgesia without amnesia to analgesia with amnesia. Patients can carry on a conversation at this time, and may complain about visual disturbance. 1498:

At the end of surgery, administration of anaesthetic agents is discontinued. Recovery of consciousness occurs when the concentration of anaesthetic in the brain drops below a certain level (this occurs usually within 1 to 30 minutes, mostly depending on the duration of surgery).

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drugs and dosages will likely be needed for the patient's comfort and safety during the procedure. A variety of non-invasive and invasive monitoring devices may be necessary to ensure a safe and effective procedure. Key factors in this evaluation are the patient's age, gender,

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Meersch, Melanie; Weiss, Raphael; Küllmar, Mira; Bergmann, Lars; Thompson, Astrid; Griep, Leonore; Kusmierz, Desiree; Buchholz, Annika; Wolf, Alexander; Nowak, Hartmuth; Rahmel, Tim; Adamzik, Michael; Haaker, Jan Gerrit; Goettker, Carina; Gruendel, Matthias (28 June 2022).

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Boet, Sylvain; Etherington, Cole; Nicola, David; Beck, Andrew; Bragg, Susan; Carrigan, Ian D.; Larrigan, Sarah; Mendonca, Cassandra T.; Miao, Isaac; Postonogova, Tatyana; Walker, Benjamin; De Wit, José; Mohamed, Karim; Balaa, Nadia; Lalu, Manoj Mathew (30 November 2018).

645:. However, a randomized controlled trial from 2021 demonstrated that clonidine is less effective at providing anxiolysis and more sedative in children of preschool age. Oral clonidine can take up to 45 minutes to take full effect, The drawbacks of clonidine include 601:. Commonly used medications can also interact with anaesthetics, and failure to disclose such usage can increase the risk during the operation. Inaccurate timing of last meal can also increase the risk for aspiration of food, and lead to serious complications. 585:, medical and surgical history, current medications, exercise capacity, and fasting time. Thorough and accurate preoperative evaluation is crucial for the effective safety of the anesthetic plan. For example, a patient who consumes significant quantities of 807:

in 1937, describes four stages of anaesthesia. Despite newer anaesthetic agents and delivery techniques, which have led to more rapid onset of—and recovery from—anaesthesia (in some cases bypassing some of the stages entirely), the principles remain.

1258:. Generally, full mechanical ventilation is only used if a very deep state of general anaesthesia is to be induced for a major procedure, and/or with a profoundly ill or injured patient. That said, induction of general anaesthesia usually results in 3863:

Ruetzler K, Li K, Chhabada S, Maheshwari K, Chahar P, Khanna S, et al. (May 2022). "Sugammadex Versus Neostigmine for Reversal of Residual Neuromuscular Blocks After Surgery: A Retrospective Cohort Analysis of Postoperative Side Effects".

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could result in involuntary responses from the patient (such as movement or muscle contractions) that may make an operation extremely difficult. Thus, for many procedures, general anaesthesia is required from a practical perspective.

572:(PA). The signaling molecule activated TWIK-related K+ channels (TREK-1), a channel involved in anesthesia. PLD fruit flies were shown to resist anesthesia, the results established a membrane mediated target for inhaled anesthetics. 724:, which reduce the burden of arrhythmias after cardiac surgery. However, evidence also has shown an association of increased adverse events with beta-blockers in non-cardiac surgery. Anaesthesiologists may administer one or more 653:, but these can be advantageous in patients with hypertension and tachycardia. Another commonly used alpha-2 adrenergic agonist is dexmedetomidine, which is commonly used to provide a short term sedative effect (<24 hours). 859:, the skeletal muscles relax, vomiting stops. Respiratory depression and cessation of eye movements are the hallmarks of this stage. The patient is unconscious and ready for surgery. This stage is divided into four planes: 845:. Because the combination of spastic movements, vomiting, and irregular respiration may compromise the patient's airway, rapidly acting drugs are used to minimize time in this stage and reach Stage 3 as fast as possible. 1104:

significant heart or lung disease, the critically ill, and those undergoing major procedures such as cardiac or transplant surgery, or when large blood loss is expected. It involves placing a special type of plastic

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and mortality. An outgrowth of this committee, the Anesthesia Patient Safety Foundation, was created in 1985 as an independent, nonprofit corporation with the goal "that no patient shall be harmed by anesthesia".

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that renders a patient unarousable even with painful stimuli. This effect is achieved by administering either intravenous or inhalational general anaesthetic medications, which often act in combination with an

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Zhang X, Wang D, Shi M, Luo Y (April 2017). "Efficacy and Safety of Dexmedetomidine as an Adjuvant in Epidural Analgesia and Anesthesia: A Systematic Review and Meta-analysis of Randomized Controlled Trials".

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and mechanical ventilation in critically ill patients. Depending on the procedure, general anaesthesia may be optional or required. Regardless of whether a patient may prefer to be unconscious or not, certain

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The rare but major complication of general anaesthesia is malignant hyperthermia. All major hospitals should have a protocol in place with an emergence drug cart near the OR for this potential complication.

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release, risk for hypothermia, and induce lactic acidosis. A number of techniques are used to reduce shivering, such as warm blankets, or wrapping the patient in a sheet that circulates warmed air, called a

4499:"Effectiveness of active and passive warming for the prevention of inadvertent hypothermia in patients receiving neuraxial anesthesia: A systematic review and meta-analysis of randomized controlled trials" 2054: 534:

receptors. General anesthesia was hypothesized to either enhance the inhibitory transmission or reduce the excitatory transmission of neuro signaling. Most volatile anesthetics have been found to be a GABA

1405:, causes muscles to contract when it is released from nerve endings. Muscle paralytic drugs work by preventing acetylcholine from attaching to its receptor. Paralysis of the muscles of respiration—the 3740:"SponTaneous Respiration using IntraVEnous anaesthesia and Hi-flow nasal oxygen (STRIVE Hi) maintains oxygenation and airway patency during management of the obstructed airway: an observational study" 1569:

Emergence is the return to baseline physiologic function of all organ systems after the cessation of general anaesthetics. This stage may be accompanied by temporary neurologic phenomena, such as

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is still controversial. Theories need to explain the function of anaesthesia in animals and plants. To induce unconsciousness, anaesthetics have myriad sites of action and affect the

1375:, introduced in the 1940s, which has now been superseded by drugs with fewer side effects and, generally, shorter duration of action. Muscle relaxation allows surgery within major 4166:

Rajpal S, Gordon DB, Pellino TA, Strayer AL, Brost D, Trost GR, et al. (April 2010). "Comparison of perioperative oral multimodal analgesia versus IV PCA for spine surgery".

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and intubation are both very stimulating. The process of induction blunts the response to these maneuvers while simultaneously inducing a near-coma state to prevent awareness.

235:. Spontaneous ventilation is often inadequate during the procedure and intervention is often necessary to protect the airway. General anaesthesia is generally performed in an 3950:"Guidelines for the safe practice of total intravenous anaesthesia (TIVA): Joint Guidelines from the Association of Anaesthetists and the Society for Intravenous Anaesthesia" 1601:. The proposed mechanism is based on the observation that the spinal cord recovers at a faster rate than the brain. This results in uninhibited spinal reflexes manifested as 6031: 1305:. Some of the methods to prevent eye injury during general anesthesia includes taping the eyelids shut, use of eye ointments, and specially designed eye protective goggles. 1152:: Almost all circuits have an alarm in case oxygen delivery to the patient is compromised. The alarm goes off if the fraction of inspired oxygen drops below a set threshold. 4312:

Olsen RM, Aasvang EK, Meyhoff CS, Dissing Sorensen HB (October 2018). "Towards an automated multimodal clinical decision support system at the post anesthesia care unit".

1099:: There are two methods of measuring the patient's blood pressure. The first, and most common, is non-invasive blood pressure (NIBP) monitoring. This involves placing a 868:

The pupillary light reflex is lost; and the process is marked by complete relaxation of abdominal and intercostal muscles. Ideal level of anesthesia for most surgeries.

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General anaesthesia has many purposes and is routinely used in almost all surgical procedures. An appropriate surgical anesthesia should include the following goals:

4983:"Effect of Intraoperative Handovers of Anesthesia Care on Mortality, Readmission, or Postoperative Complications Among Adults: The HandiCAP Randomized Clinical Trial" 3707: 1004:

may be chosen when intravenous access is difficult to obtain (e.g., children), when difficulty maintaining the airway is anticipated, or when the patient prefers it.

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Dote K, Ikemune K, Desaki Y, Nandate H, Konisi A, Yorozuya T, Makino H (January 2017). "Two Japanese Pioneers in Anesthesiology: Seishū Hanaoka and Gendai Kamada".

3210:"Effect of preoperative oral midazolam sedation on separation anxiety and emergence delirium among children undergoing dental treatment under general anesthesia" 2065: 1126:

typically have monitors to measure the percentage of inhalational anaesthetic agents used as well as exhalation concentrations. These monitors include measuring

2826:"Institutional preparedness to prevent and manage anaesthesia-related 'can't intubate, can't oxygenate' events in Australian and New Zealand teaching hospitals" 1293:(incomplete eye closure) in 59% of people. In addition, tear production and tear-film stability are reduced, resulting in corneal epithelial drying and reduced 6076: 893:

depression, resulting in a cessation of respiration and potential cardiovascular collapse. This stage is lethal without cardiovascular and respiratory support.

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Baldini G (2022). Enhanced recovery protocols & optimization of perioperative outcomes. Butterworth IV J.F., & Mackey D.C., & Wasnick J.D.(Eds.),

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Pre-oxygenation or denitrogenation to fill lungs with 100% oxygen to permit a longer period of apnea during intubation without affecting blood oxygen levels

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mechanism that could account for the activation of an ion channel remained elusive until recently. A study from 2020 demonstrated that inhaled anesthetics (

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Alderson P, Campbell G, Smith AF, Warttig S, Nicholson A, Lewis SR, et al. (Cochrane Anaesthesia, Critical and Emergency Care Group) (June 2014).

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Woll, Kellie A.; Zhou, Xiaojuan; Bhanu, Natarajan V.; Garcia, Benjamin A.; Covarrubias, Manuel; Miller, Keith W.; Eckenhoff, Roderic G. (August 2018).

779:, pre-operative preparation video, and guided imagery relaxation therapy, etc. These techniques are particularly useful for children and patients with 4260:"The Effect of Transversus Abdominis Plane Block for Analgesia in Patients Undergoing Liver Transplantation: A Systematic Review and Meta-Analysis" 713:

properties. Recovery is more rapid after premedication with melatonin than with midazolam, and there is also a reduced incidence of post-operative

1301:(in which the eyeball turns upward during sleep, protecting the cornea) is also lost. Careful management is required to reduce the likelihood of 4209:

Schnabel A, Reichl SU, Weibel S, Zahn PK, Kranke P, Pogatzki-Zahn E, Meyer-Frießem CH, et al. (Cochrane Anaesthesia Group) (October 2019).

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and delirium. Melatonin has been shown to have a similar effect in reducing perioperative anxiety in adult patients compared to benzodiazepine.

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Instead of receiving continuous deep sedation, such as via benzodiazepines, dying patients may choose to be completely unconscious as they die.

1514:. At present, TCI is not permitted in the United States, but a syringe pump delivering a specific rate of medication is commonly used instead. 2875:"Comparison of forces acting on maxillary incisors during tracheal intubation with different laryngoscopy techniques: a blinded manikin study" 1673:. The patient presses a button to activate a syringe device and receive a preset dose or "bolus" of the drug, usually a strong opioid such as 1613:

stimulant, is somewhat effective in abolishing postoperative shivering. Cardiovascular events such as increased or decreased blood pressure,

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are placed on the patient's skin to monitor heart rate and rhythm. This may also help the anaesthesiologist to identify early signs of heart

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Roth, Dominik; Pace, Nathan L.; Lee, Anna; Hovhannisyan, Karen; Warenits, Alexandra-Maria; Arrich, Jasmin; Herkner, Harald (15 May 2018).

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Wattchow D, Heitmann P, Smolilo D, Spencer NJ, Parker D, Hibberd T, et al. (May 2021). "Postoperative ileus-An ongoing conundrum".

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Manning, Alexander N.; Bezzo, Leah K.; Hobson, Jamie K.; Zoeller, Justine E.; Brown, Courtney A.; Henderson, Kristin J. (October 2020).

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Zhang, Youyi; Ye, Fei; Zhang, Tongtong; Lv, Shiyun; Zhou, Liping; Du, Daohai; Lin, He; Guo, Fei; Luo, Cheng; Zhu, Shujia (August 2021).

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immediately after surgery can help accelerate the timing of hospital discharge, but does not reduce the development of paralytic ileus.

6026: 4357:"Perioperative hyperoxia and post-operative cardiac complications in adults undergoing non-cardiac surgery: Systematic review protocol" 1625:. Responding and following verbal command, is a criterion commonly utilized to assess the patient's readiness for tracheal extubation. 382:

Two enormous leaps occurred in the late 19th century, which together allowed the transition to modern surgery. An appreciation of the

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Moody, Olivia A.; Zhang, Edlyn R.; Vincent, Kathleen F.; Kato, Risako; Melonakos, Eric D.; Nehs, Christa J.; Solt, Ken (1 May 2021).

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or in a dedicated anaesthetic room adjacent to the theatre. General anaesthesia may also be conducted in other locations, such as an

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and arousal circuits linked with unconsciousness, and some anaesthetics potentially able to activate specific sleep-active regions.

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of surgery to a far more acceptable rate than in previous eras. Concurrent with these developments were the significant advances in

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Approved by the ASA House of Delegates on October 21, 1986, last amended on October 20, 2010, and reaffirmed on December 13, 2020

1302: 1276: 885:, occurs when too much anaesthetic medication is given relative to the amount of surgical stimulation and the patient has severe 740:

to prevent postoperative nausea and vomiting. NSAIDs are commonly used analgesic premedication agent, and often reduce need for

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Most general anaesthetics are induced either intravenously or by inhalation. Commonly used intravenous induction agents include

61: 5974: 829:, is the period following loss of consciousness and marked by excited and delirious activity. During this stage, the patient's 485: 3846:

Eger, Edmond I II; Saidman, Lawrence J.; Westhorpe, Rod N., eds. (2014). The Wondrous Story of Anaesthesia. Springer. p. 438.

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Blessberger H, Kammler J, Domanovits H, Schlager O, Wildner B, Azar D, et al. (Cochrane Anaesthesia Group) (March 2018).

2630:"Anesthetic considerations for lung resection: preoperative assessment, intraoperative challenges and postoperative analgesia" 320:

Attempts at producing a state of general anaesthesia can be traced throughout recorded history in the writings of the ancient

6036: 4102: 3851: 3071:"Preoperative anxiety in preschool children: A randomized clinical trial comparing midazolam, clonidine, and dexmedetomidine" 2123: 1802: 5132: 5350: 4041:

Absalom, Anthony R.; Glen, John Iain B.; Zwart, Gerrit J. C.; Schnider, Thomas W.; Struys, Michel M. R. F. (January 2016).

492:(CNS) at multiple levels. General anaesthesia commonly interrupts or changes the functions of CNS components including the 68: 42: 6066: 5877: 5642: 5460: 4031:

Elterman KG, Mallampati SR, Kaye AD, Urman RDPostoperative alterations in taste and smell. Anesth Pain Med. 2014;4:e18527

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is common. Apart from causing discomfort and exacerbating pain, shivering has been shown to increase oxygen consumption,

1662: 4853:. McGraw Hill. https://accessmedicine-mhmedical-com.ezproxy.med.ucf.edu/content.aspx?bookid=3194&sectionid=266524617 5954: 5753: 5323: 5964: 5872: 5387: 2973:"Clonidine in paediatric anaesthesia: review of the literature and comparison with benzodiazepines for premedication" 638: 375:. However, despite all this progress, surgery remained a treatment of last resort. Largely because of the associated 108: 75: 3069:

Bromfalk, Åsa; Myrberg, Tomi; Walldén, Jakob; Engström, Åsa; Hultin, Magnus (November 2021). Cravero, Joseph (ed.).

2916:"Airway physical examination tests for detection of difficult airway management in apparently normal adult patients" 1902:"Preoperative Interventions for Alcohol and Other Recreational Substance Use: A Systematic Review and Meta-Analysis" 5827: 5505: 3997:

Baker JJ, Öberg S, Rosenberg J (December 2017). "Loss of Smell and Taste After General Anesthesia: A Case Report".

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prepared with medications that are expected to be used during an operation under general anaesthesia maintained by

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characteristics also contributed to this trend. Finally, standardized training programs for anaesthesiologists and

414:, a Japanese surgeon, became the first person on record to successfully perform surgery using general anaesthesia. 6005: 5959: 5781: 5475: 3126:

Henry RG, Raybould TP, Romond K, Kouzoukas DE, Challman SD (March 2018). "Clonidine as a preoperative sedative".

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The eyes roll, then become fixed; eyelid and swallow reflexes are lost. Still have regular spontaneous breathing;

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Rasouli, Mohammed R.; Kavin, Michelle; Stache, Stephen; Mahla, Michael E.; Schwenk, Eric S. (February 2020).

2732:"Incidences and factors associated with perioperative cardiac arrest in trauma patients receiving anesthesia" 1722:, or other α2-agonists, anticholinergics, central nervous system stimulants, or corticosteroids may be used. 309: 5548: 1686: 1670: 772: 557: 516: 232: 1413:

of the chest—requires that some form of artificial respiration be implemented. Because the muscles of the

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has been found to be effective as an anaesthetic premedication in both adults and children because of its

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are the most commonly used class of drugs for premedication. The most commonly utilized benzodiazepine is

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is often used, although there are alternative devices that can assist respiration, such as face masks or

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from ordered lipid domains in the plasma membrane, which led to the production of the signaling molecule

501: 288:. The optimal combination of anesthetics for any given patient and procedure is typically selected by an 1483:). Inhaled anaesthetic agents are also frequently supplemented by intravenous analgesic agents, such as 593:

could be undermedicated during the procedure if they fail to disclose this fact, and this could lead to

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In the 20th century, the safety and efficacy of general anaesthesia was improved by the routine use of

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Other medications are occasionally used to treat side effects or prevent complications. They include

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Schieren M, Kleinschmidt J, Schmutz A, Loop T, Staat M, Gatzweiler KH, et al. (December 2019).

1577:(impaired production or comprehension of speech), or focal impairment in sensory or motor function. 1179:

exhaled by the patient in percent or mmHg, allowing the anaesthesiologist to assess the adequacy of

5913: 5867: 5733: 5624: 5604: 5343: 3022:"Premedication with clonidine is superior to benzodiazepines. A meta analysis of published studies" 1848:"General anaesthesia in end-of-life care: extending the indications for anaesthesia beyond surgery" 1706: 1578: 1426: 1286: 1180: 1135: 1001: 974: 830: 546: 277: 175: 1669:. Sometimes, opioid medication is administered by the patient themselves using a system called a 1211:, or other systems may be used to verify the depth of anaesthesia. This reduces the likelihood of 410:

which led to the development of general anaesthesia and the control of pain. On 14 November 1804,

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is the most commonly used agent for inhalational induction, because it is less irritating to the

946: 780: 671:, which is characterized by a rapid onset and short duration. Midazolam is effective in reducing 524: 508:. Current theories on the anaesthetized state identify not only target sites in the CNS but also 349: 248: 239:

to allow surgical procedures that would otherwise be intolerably painful for a patient, or in an

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are also common during emergence from general anaesthesia, as are respiratory symptoms such as

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Hedenstierna G, Edmark L (September 2015). "Effects of anesthesia on the respiratory system".

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Mushambi MC, Jaladi S (June 2016). "Airway management and training in obstetric anaesthesia".

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Nimmo AF, Absalom AR, Bagshaw O, Biswas A, Cook TM, Costello A, et al. (February 2019).

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Approved by the House of Delegates on October 25, 2005, and last amended on October 17, 2018

1805:. This committee was tasked with determining and reducing the causes of anaesthesia-related 5903: 5837: 5832: 5766: 5743: 5647: 5267:"Safe duration of postoperative monitoring for malignant hyperthermia susceptible patients" 4686: 2582: 2519: 1778: 1777:

Mortality directly related to anaesthetic management is very uncommon but may be caused by

1476: 1298: 938: 923: 804: 761: 594: 244: 4211:"Adductor canal blocks for postoperative pain treatment in adults undergoing knee surgery" 3472:"Non-pharmacological interventions for assisting the induction of anaesthesia in children" 8: 6125: 5761: 5619: 5609: 5500: 5490: 5455: 5450: 5394: 5336: 5222:

Kim KS, Kriss RS, Tautz TJ (December 2019). "Malignant Hyperthermia: A Clinical Review".

3568:"Anesthesia for the patient with a recently diagnosed concussion: think about the brain!" 3020:

Dahmani S, Brasher C, Stany I, Golmard J, Skhiri A, Bruneau B, et al. (April 2010).

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is also fairly common and can be clinically significant because it causes an increase in

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Basics of Anesthesia, 5th Edition Authors: Robert K. Stoelting & Ronald D. Miller

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Li, Guohua; Warner, Margaret; Lang, Barbara H.; Huang, Lin; Sun, Lena S. (April 2009).

4832: 4758: 4709: 4674: 4523: 4498: 4474: 4441: 4422: 4337: 4284: 4259: 4235: 4210: 4191: 4143: 4118: 4080: 3979: 3889: 3764: 3739: 3689: 3600: 3567: 3496: 3471: 3442: 3407: 3383: 3358: 3334: 3309: 3244: 3209: 3151: 3108: 3051: 3002: 2948: 2915: 2855: 2806: 2758: 2731: 2707: 2680: 2656: 2629: 2605: 2570: 2551: 2483: 2448: 2385: 2352: 2300: 2275: 2216: 2191: 2172: 1984: 1959: 1928: 1901: 1874: 1847: 1730: 1646: 1570: 1433:

drugs to minimize side effects. Examples of skeletal muscle relaxants in use today are

1410: 1207: 962: 842: 586: 261: 1371:, is an integral part of modern anaesthesia. The first drug used for this purpose was 5949: 5776: 5771: 5662: 5589: 5495: 5288: 5251: 5239: 5204: 5110: 5061: 5020: 5002: 4962: 4944: 4902: 4884: 4836: 4824: 4785: 4750: 4714: 4655: 4614: 4573: 4528: 4479: 4461: 4414: 4378: 4329: 4325: 4289: 4240: 4183: 4148: 4098: 4072: 4064: 4014: 3971: 3930: 3893: 3881: 3847: 3769: 3681: 3676: 3659: 3640: 3605: 3587: 3548: 3540: 3536: 3501: 3447: 3429: 3388: 3339: 3290: 3285: 3268: 3249: 3231: 3190: 3182: 3143: 3112: 3100: 3092: 3055: 3043: 3038: 3021: 2994: 2989: 2972: 2953: 2935: 2896: 2859: 2847: 2798: 2763: 2712: 2661: 2610: 2555: 2543: 2535: 2488: 2470: 2429: 2390: 2372: 2305: 2256: 2221: 2176: 2164: 2129: 2119: 2033: 1989: 1933: 1879: 1794: 1692: 1518: 1418: 1231: 1225: 1090: 985: 903: 890: 613: 605: 569: 442: 422: 293: 236: 157: 141: 4341: 4084: 3983: 3693: 3359:"Perioperative beta-blockers for preventing surgery-related mortality and morbidity" 3006: 2810: 1076:. Typically lead II and V5 are monitored for arrhythmias and ischemia, respectively. 604:

An important aspect of pre-anaesthetic evaluation is an assessment of the patient's

411: 5939: 5728: 5688: 5401: 5278: 5231: 5194: 5100: 5092: 5051: 5010: 4994: 4952: 4934: 4892: 4876: 4816: 4762: 4742: 4704: 4694: 4645: 4604: 4563: 4559: 4555: 4518: 4514: 4510: 4469: 4453: 4426: 4406: 4368: 4321: 4279: 4271: 4230: 4226: 4222: 4195: 4175: 4138: 4130: 4054: 4006: 3961: 3920: 3873: 3829: 3800: 3759: 3751: 3671: 3632: 3595: 3579: 3532: 3491: 3487: 3483: 3437: 3419: 3378: 3374: 3370: 3329: 3325: 3321: 3280: 3239: 3221: 3155: 3135: 3082: 3033: 2984: 2943: 2931: 2927: 2886: 2837: 2790: 2753: 2743: 2702: 2692: 2651: 2641: 2600: 2590: 2527: 2478: 2460: 2421: 2380: 2364: 2295: 2287: 2248: 2211: 2203: 2156: 2023: 1979: 1971: 1923: 1913: 1869: 1859: 1823: 1398: 1100: 753: 720:

Another example of anaesthetic premedication is the preoperative administration of

438: 434: 289: 4410: 3820:

Nair PN, White E (2014). "Care of the eye during anaesthesia and intensive care".

3520: 2160: 1718:. If the shivering cannot be managed with external warming devices, drugs such as 837:

may become irregular. In addition, there may be uncontrolled movements, vomiting,

195: 5693: 5568: 5528: 5315:

An article at University of Bristol providing interesting facts about chloroform.

5136: 4880: 4699: 4179: 4059: 4042: 4010: 3877: 3660:"Neurocirculatory responses to sevoflurane in humans. A comparison to desflurane" 2794: 2368: 2291: 2028: 2011: 1801:

appointed the Anesthesia Patient Safety and Risk Management Committee within the

1719: 1554: 1550: 1458: 1430: 1239: 680: 654: 582: 565: 493: 426: 285: 265: 181: 5328: 4457: 4134: 3833: 2679:

Izumo W, Higuchi R, Yazawa T, Uemura S, Shiihara M, Yamamoto M (December 2019).

2425: 1654: 1234:, and sometimes a regular breathing pattern due to the effects of anaesthetics, 296:(depending on local practice and law), in consultation with the patient and the 5801: 5796: 5708: 5363: 5283: 5266: 4923:"Anesthesia interventions that alter perioperative mortality: a scoping review" 3925: 3805: 3788: 2697: 2575:

Proceedings of the National Academy of Sciences of the United States of America

2531: 2252: 1696: 1633: 1598: 1590: 1586: 1176: 1131: 1113: 1081: 757: 710: 664: 509: 399: 337: 146: 5235: 5199: 5182: 4939: 4865:"Epidemiology of Anesthesia-related Mortality in the United States, 1999–2005" 4746: 3636: 3424: 3408:"Non-pharmacologic Approaches in Preoperative Anxiety, a Comprehensive Review" 2133: 6119: 5923: 5811: 5713: 5538: 5006: 4948: 4888: 4465: 4068: 3934: 3591: 3544: 3433: 3235: 3226: 3186: 3096: 2939: 2539: 2474: 2433: 2376: 1918: 1710: 1666: 1526: 1446: 1394: 1290: 1243: 1139: 1109: 737: 609: 531: 357: 333: 253: 223: 4275: 2646: 2595: 1417:

are also paralysed, the airway usually needs to be protected by means of an

5786: 5614: 5599: 5292: 5243: 5208: 5114: 5065: 5056: 5039: 5024: 4998: 4966: 4906: 4828: 4754: 4718: 4659: 4618: 4577: 4532: 4483: 4418: 4382: 4333: 4293: 4244: 4187: 4152: 4076: 4018: 3975: 3885: 3773: 3644: 3609: 3505: 3451: 3392: 3343: 3294: 3253: 3194: 3170: 3147: 3104: 3047: 2998: 2957: 2900: 2851: 2802: 2767: 2730:

Siriphuwanun V, Punjasawadwong Y, Saengyo S, Rerkasem K (18 October 2018).

2716: 2681:"Evaluation of preoperative risk factors for postpancreatectomy hemorrhage" 2665: 2614: 2547: 2507: 2492: 2394: 2309: 2260: 2225: 2192:"Asepsis and bacteriology: a realignment of surgery and laboratory science" 2168: 2037: 1993: 1975: 1937: 1883: 1806: 1725:

In many cases, opioids used in general anaesthesia can cause postoperative

1542: 1538: 1230:

Anaesthetized patients lose protective airway reflexes (such as coughing),

1042: 993: 871:

Full diaphragm paralysis and irregular shallow abdominal respiration occur.

598: 482: 403: 341: 5096: 3685: 3552: 2465: 5990: 5698: 5652: 5440: 5319:

Australian & New Zealand College of Anaesthetists Monitoring Standard

4609: 4593:"Predicting the efficacy of convection warming in anaesthetized children" 4592: 4591:

Stanger R, Colyvas K, Cassey JG, Robinson IA, Armstrong P (August 2009).

4548:"Thermal insulation for preventing inadvertent perioperative hypothermia" 3755: 2748: 2729: 1786: 1715: 1650: 1614: 1561:

are sometimes given to prevent inflammation and infection, respectively.

1558: 1546: 1502:

In the 1990s, a novel method of maintaining anaesthesia was developed in

1434: 1376: 1337: 1321: 1313: 1190: 1171: 1005: 966: 729: 706: 650: 646: 505: 364: 353: 189: 5265:

Pollock N, Langtont E, Stowell K, Simpson C, McDonnell N (August 2004).

5159: 3214:

Journal of International Society of Preventive & Community Dentistry

2207: 1900:

Budworth L, Prestwich A, Lawton R, Kotzé A, Kellar I (4 February 2019).

1183:. MmHg is usually used to allow the provider to see more subtle changes. 552:

The chemical structure and properties of anesthetics, as first noted by

5738: 5533: 5359: 4650: 4633: 3966: 3949: 2891: 2874: 2842: 2825: 1864: 1594: 1530: 1462: 1454: 1450: 1442: 1438: 1351: 1143: 1086: 934: 919: 834: 765: 749: 733: 725: 698: 561: 430: 407: 387: 5135:. Narberth, Pennsylvania: Physician's News Digest, Inc. Archived from 4820: 4373: 4356: 3909:"Pharmacology of anaesthetic agents I: intravenous anaesthetic agents" 3583: 3139: 3087: 3070: 205: 4778:"Post-operative shivering, causes, prevention and treatment (letter)" 1737: 1682: 1522: 1346: 1333: 1069: 989: 915: 907: 886: 690: 668: 630: 395: 325: 300:, dentist, or other practitioner performing the operative procedure. 281: 273: 228: 3406:

Wang, Rulin; Huang, Xin; Wang, Yuan; Akbari, Masod (11 April 2022).

3356: 1163:

indicates failure of the circuit to achieve a given pressure during

933:

Anaesthetic agents may be administered by various routes, including

24: 5683: 5382: 4311: 1846:

Takla, A; Savulescu, J; Wilkinson, DJC; Pandit, JJ (October 2021).

1782: 1767: 1678: 1674: 1606: 1492: 1488: 1480: 1387:, without the need for very deep anaesthesia, and also facilitates 1342: 1327: 1294: 1073: 1028: 1022: 997: 981: 930:

where extrication of the patient may be impossible or impractical.

927: 745: 702: 694: 642: 542: 497: 469:

Paralysis (skeletal muscle relaxation and normal muscle relaxation)

130: 1242:. To maintain an open airway and regulate breathing, some form of 360:, while their European counterparts also made important advances. 4673:

Zhang J, Zhang X, Wang H, Zhou H, Tian T, Wu A (22 August 2017).

4258:

Sharma A, Goel AD, Sharma PP, Vyas V, Agrawal SP (October 2019).

2569:

Pavel MA, Petersen EN, Wang H, Lerner RA, Hansen SB (June 2020).

1622: 1574: 1503: 1380: 1317: 1105: 776: 538: 391: 372: 368: 356:, scientists and other scholars made significant advances in the 329: 297: 269: 4442:"Postanaesthetic shivering – from pathophysiology to prevention" 4119:"Postanaesthetic shivering - from pathophysiology to prevention" 3310:"Melatonin for preoperative and postoperative anxiety in adults" 3171:"Dexmedetomidine Dosing to Prevent Pediatric Emergence Delirium" 1691:

In the recovery unit, many vital signs are monitored, including

1605:

activity (shivering). This theory is supported by the fact that

2872: 1771: 1658: 1602: 1582: 1534: 1484: 1414: 1384: 1372: 1235: 1127: 771:

Non-pharmacologic preanaesthetic interventions include playing

741: 541:, although the site of action on the receptor remains unknown. 6032:

American Society of Anesthesia Technologists & Technicians

4806: 3470:

Manyande A, Cyna AM, Yip P, Chooi C, Middleton P (July 2015).

3068: 5264: 3793:

Continuing Education in Anaesthesia, Critical Care & Pain

3308:

Madsen BK, Zetner D, Møller AM, Rosenberg J (December 2020).

2508:"Structural basis of ketamine action on human NMDA receptors" 2353:"The Neural Circuits Underlying General Anesthesia and Sleep" 2276:"General Anesthetics and Neurotoxicity: How Much Do We Know?" 1845: 1726: 1429:

drugs, which are administered in combination with muscarinic

1259: 838: 523:

anesthesia. Potential protein-mediated molecular targets are

321: 4590: 4545: 4395: 3913:

Continuing Education in Anaesthesia Critical Care & Pain

3862: 3125: 2627: 2012:"Anaphylaxis and anesthesia: controversies and new insights" 1899: 4979: 4496: 3307: 3266: 2009: 1479:

agent, or by administering intravenous medication (usually

376: 5996:

Helsinki Declaration for Patient Safety in Anaesthesiology

5843:

Effects of early-life exposures to anesthesia on the brain

4165: 3019: 2970: 2628:

Lederman D, Easwar J, Feldman J, Shapiro V (August 2019).

390:

techniques in surgery. Antisepsis, which soon gave way to

6047:

Association of Anaesthetists of Great Britain and Ireland

5040:"Pulmonary aspiration of gastric contents in anaesthesia" 4919: 4631: 4497:

Shaw CA, Steelman VM, DeBerg J, Schweizer ML (May 2017).

4354: 3947: 3168: 5162:. Indianapolis, IN: Anesthesia Patient Safety Foundation 4208: 4040: 2678: 2238: 2010:

Dewachter P, Mouton-Faivre C, Emala CW (November 2009).

1729:, even after non-abdominal surgery. Administration of a 1246:

is inserted after the patient is unconscious. To enable

264:

may be administered, with the overall goal of achieving

5324:

Royal College of Anaesthetists Patient Information page

4632:

Wagner K, Swanson E, Raymond CJ, Smith CE (June 2008).

3738:

Booth AW, Vidhani K, Lee PK, Thomsett CM (March 2017).

3737: 3565: 3267:

Naguib M, Gottumukkala V, Goldstein PA (January 2007).

2971:

Bergendahl H, Lönnqvist PA, Eksborg S (February 2006).

2913: 2568: 1461:. Novel neuromuscular blockade reversal agents such as 6077:

European Society of Anaesthesiology and Intensive Care

3625:

Best Practice & Research. Clinical Anaesthesiology

2147:

Toledo-Pereyra LH (June 2015). "Medical Renaissance".

4399:

The Journal of Maternal-Fetal & Neonatal Medicine

2350: 1363:(here under trade name Robinul), reducing secretions 4355:

Petersen C, Wetterslev J, Meyhoff CS (August 2018).

4257: 3469: 135:

Equipment used for anaesthesia in the operating room

6062:

Australian and New Zealand College of Anaesthetists

3996: 3525:

Electroencephalography and Clinical Neurophysiology

3405: 2446: 2410:"Mechanisms of action of general anaesthetic drugs" 661:agents may be also used in uncooperative children. 556:, suggest they could target the plasma membrane. A 49:. Unsourced material may be challenged and removed. 4851:Morgan & Mikhail's Clinical Anesthesiology, 7e 4672: 4446:Romanian Journal of Anaesthesia and Intensive Care 4264:Turkish Journal of Anaesthesiology and Reanimation 4123:Romanian Journal of Anaesthesia and Intensive Care 3622: 3521:"Anesthesia effects: auditory brain-stem response" 3269:"Melatonin and anesthesia: a clinical perspective" 2273: 2113: 965:, the agents are transported to their biochemical 476: 386:led rapidly to the development and application of 5358: 5126: 5124: 5037: 4862: 4043:"Target-Controlled Infusion: A Mature Technology" 3786: 1367:Paralysis, or temporary muscle relaxation with a 1034:Switching from oxygen to a mixture of oxygen and 6117: 3657: 2571:"Studies on the mechanism of general anesthesia" 1637:Anaesthetized patient in postoperative recovery. 4731: 3465: 3463: 3461: 2005: 2003: 1789:. These in turn may result from malfunction of 222:(US) is a method of medically inducing loss of 5121: 3906: 2823: 2780: 2505: 2146: 2118:(Ninth ed.). Philadelphia, PA: Elsevier. 1895: 1893: 5344: 5221: 1960:"The Stages and Signs of General Anaesthesia" 1475:carefully controlled mixture of oxygen and a 902:General anaesthesia is usually induced in an 679:in children. It also provides mild sedation, 5724:Intraoperative neurophysiological monitoring 5157: 5130: 4168:Journal of Spinal Disorders & Techniques 3458: 2325:"Plants, Like People, Succumb to Anesthesia" 2000: 1953: 1951: 1949: 1947: 457:Hypnosis/Unconsciousness (loss of awareness) 5038:Engelhardt T, Webster NR (September 1999). 4769: 4552:The Cochrane Database of Systematic Reviews 4215:The Cochrane Database of Systematic Reviews 3708:"Standards for Basic Anesthetic Monitoring" 3476:The Cochrane Database of Systematic Reviews 3363:The Cochrane Database of Systematic Reviews 3314:The Cochrane Database of Systematic Reviews 2920:The Cochrane Database of Systematic Reviews 1890: 1841: 1839: 1263:breathing to ensure adequate gas exchange. 1015:As an example sequence of induction drugs: 786: 486:mechanism of action of general anaesthetics 6027:American Association of Nurse Anesthetists 5351: 5337: 3780: 3658:Ebert TJ, Muzi M, Lopatka CW (July 1995). 3518: 3260: 1747: 1193:or fever, and to allow early detection of 575: 129: 6072:International Anesthesia Research Society 5679:ASA physical status classification system 5282: 5198: 5180: 5104: 5081:"Maternal death from aspiration asphyxia" 5055: 5014: 4956: 4938: 4896: 4775: 4708: 4698: 4649: 4608: 4567: 4522: 4473: 4372: 4283: 4234: 4142: 4058: 3965: 3924: 3822:Anaesthesia & Intensive Care Medicine 3819: 3804: 3763: 3675: 3599: 3495: 3441: 3423: 3382: 3333: 3284: 3243: 3225: 3207: 3086: 3037: 2988: 2947: 2890: 2841: 2757: 2747: 2706: 2696: 2655: 2645: 2604: 2594: 2482: 2464: 2414:Anaesthesia & Intensive Care Medicine 2384: 2299: 2215: 2027: 1983: 1944: 1927: 1917: 1873: 1863: 1308: 1048: 775:, music therapy, aromatherapy, hypnosis 612:. The condition of teeth and location of 109:Learn how and when to remove this message 5424:Combined spinal and epidural anaesthesia 3907:Khan KS, Hayes I, Buggy DJ (June 2014). 1836: 1632: 1312: 1025:for systemic analgesia during intubation 865:Corneal and laryngeal reflexes are lost; 795: 515:Two non-exclusionary mechanisms include 6057:Association of Veterinary Anaesthetists 2407: 2322: 2274:Jevtovic-Todorovic V (September 2016). 2189: 2055:"Position on Monitored Anesthesia Care" 1303:eye injuries during general anaesthesia 1297:protection. The protection afforded by 1277:Eye injuries during general anaesthesia 16:Medically induced loss of consciousness 6118: 5078: 2109: 637:. It reduces postoperative shivering, 6037:American Society of Anesthesiologists 5332: 4439: 4307: 4305: 4303: 4116: 4112: 4110: 3715:American Society of Anesthesiologists 3519:Smith, D.I.; Mills, J.H. (May 1989). 2736:Risk Management and Healthcare Policy 2107: 2105: 2103: 2101: 2099: 2097: 2095: 2093: 2091: 2089: 2062:American Society of Anesthesiologists 2049: 2047: 1957: 1803:American Society of Anesthesiologists 1663:non steroidal anti-inflammatory drugs 1641:Postoperative pain is managed in the 1628: 6042:Anaesthesia Trauma and Critical Care 4440:Lopez, Maria Bermudez (April 2018). 3813: 1661:, as well as other medications like 1466:reversal of neuromuscular blockade. 1219: 1108:in an artery, usually in the wrist ( 460:Analgesia (loss of response to pain) 425:techniques. Significant advances in 47:adding citations to reliable sources 18: 6067:Australian Society of Anaesthetists 5975:Physicians' assistant (anaesthesia) 5878:Postoperative residual curarization 4361:Acta Anaesthesiologica Scandinavica 3026:Acta Anaesthesiologica Scandinavica 2977:Acta Anaesthesiologica Scandinavica 2824:Rehak A, Watterson LM (June 2020). 629:One commonly used premedication is 466:Immobility (loss of motor reflexes) 13: 5955:Operating department practitioners 5181:Baldo BA, Rose MA (January 2020). 4809:Neurogastroenterology and Motility 4725: 4666: 4625: 4584: 4539: 4490: 4389: 4348: 4300: 4107: 2086: 2044: 1657:medication. Patients may be given 14: 6137: 5965:Certified anesthesia technologist 5873:Postoperative nausea and vomiting 5388:Procedural sedation and analgesia 5303: 4314:Computers in Biology and Medicine 3787:Contractor S, Hardman JG (2006). 2783:Current Opinion in Anesthesiology 1270: 926:, ambulance, or at the site of a 639:postoperative nausea and vomiting 6099: 6090: 6089: 5506:Transverse abdominis plane block 4326:10.1016/j.compbiomed.2018.07.018 3677:10.1097/00000542-199507000-00011 3572:Korean Journal of Anesthesiology 3286:10.1111/j.1600-079X.2006.00384.x 3208:El Batawi, Hisham Yehia (2015). 3039:10.1111/j.1399-6576.2009.02207.x 2990:10.1111/j.1399-6576.2006.00940.x 2685:Langenbeck's Archives of Surgery 2634:Annals of Translational Medicine 2408:Lambert, David G. (1 May 2020). 2149:Journal of Investigative Surgery 2114:Michael A. Gropper, ed. (2020). 1695:, heart rhythm and respiration, 1281:General anaesthesia reduces the 620: 292:, or another provider such as a 23: 6100: 6006:History of neuraxial anesthesia 5960:Certified anesthesia technician 5782:Double-lumen endobronchial tube 5643:Blood–gas partition coefficient 5476:Intravenous regional anesthesia 5258: 5215: 5174: 5151: 5072: 5031: 4973: 4913: 4856: 4843: 4800: 4638:Canadian Journal of Anaesthesia 4433: 4251: 4202: 4159: 4091: 4034: 4025: 3990: 3941: 3900: 3856: 3840: 3731: 3700: 3651: 3616: 3559: 3512: 3399: 3350: 3301: 3201: 3162: 3119: 3062: 3013: 2964: 2907: 2866: 2817: 2774: 2723: 2672: 2621: 2562: 2499: 2440: 2401: 2344: 2316: 2267: 1120:Agent concentration measurement 564:and isoflurane) could displace 477:Biochemical mechanism of action 34:needs additional citations for 6052:Royal College of Anaesthetists 6011:History of tracheal intubation 5658:Minimum alveolar concentration 5595:Anesthesia provision in the US 5271:Anaesthesia and Intensive Care 5187:British Journal of Anaesthesia 5044:British Journal of Anaesthesia 4597:British Journal of Anaesthesia 4560:10.1002/14651858.CD009908.pub2 4515:10.1016/j.jclinane.2017.01.005 4503:Journal of Clinical Anesthesia 4227:10.1002/14651858.CD012262.pub2 3744:British Journal of Anaesthesia 3488:10.1002/14651858.CD006447.pub3 3375:10.1002/14651858.CD004476.pub3 3326:10.1002/14651858.CD009861.pub3 2932:10.1002/14651858.CD008874.pub2 2232: 2183: 2140: 1521:to treat high blood pressure; 1491:or a fentanyl derivative) and 1469: 316:History of tracheal intubation 1: 6001:History of general anesthesia 5513:Total intravenous anaesthesia 5461:Inferior alveolar nerve block 5407:Continuous wound infiltration 5133:"Improving anesthesia safety" 4411:10.1080/14767058.2018.1458835 2323:Frazier J (26 January 2018). 2241:Journal of Anesthesia History 2161:10.3109/08941939.2015.1054747 1829: 1791:anaesthesia-related equipment 1553:to treat allergic reactions. 1529:to treat low blood pressure; 1058:evaluated during anesthetic. 310:History of general anesthesia 5564:Neuromuscular-blocking drugs 4881:10.1097/aln.0b013e31819b5bdc 4700:10.1371/journal.pone.0183154 4180:10.1097/BSD.0b013e3181cf07ee 4060:10.1213/ANE.0000000000001009 4011:10.1213/XAA.0000000000000612 3878:10.1213/ANE.0000000000005842 3537:10.1016/0013-4694(89)90047-3 2795:10.1097/ACO.0000000000000309 2369:10.1213/ANE.0000000000005361 2292:10.1016/j.anclin.2016.04.001 2029:10.1097/ALN.0b013e3181bbd443 1766:from the operation, such as 1671:patient controlled analgesic 1564: 897: 827:excitement or delirium stage 773:cognitive behavioral therapy 445:emerged during this period. 367:saw significant advances in 233:neuromuscular blocking agent 7: 5899:Critical emergency medicine 4735:Clinical Drug Investigation 4458:10.21454/rjaic.7518.251.xum 4135:10.21454/rjaic.7518.251.xum 3834:10.1016/j.mpaic.2013.11.008 3789:"Injury during anaesthesia" 2426:10.1016/j.mpaic.2020.02.006 1817: 1038:once intubation is complete 1031:for sedation for intubation 825:Stage 2, also known as the 722:beta adrenergic antagonists 502:reticular activating system 10: 6142: 5945:Anesthesiologist assistant 5807:Relative analgesia machine 5284:10.1177/0310057X0403200407 3412:Frontiers in Public Health 3273:Journal of Pineal Research 2698:10.1007/s00423-019-01830-w 2532:10.1038/s41586-021-03769-9 2253:10.1016/j.janh.2016.12.002 1751: 1573:(acute mental confusion), 1508:target controlled infusion 1274: 1223: 855:In Stage 3, also known as 635:alpha-2 adrenergic agonist 626:required during the case. 448: 313: 307: 303: 276:, loss of reflexes of the 6085: 6019: 5983: 5932: 5886: 5853:Local anesthetic toxicity 5820: 5752: 5671: 5635: 5582: 5521: 5370: 5236:10.1016/j.aan.2019.08.003 5200:10.1016/j.bja.2019.08.010 4940:10.1186/s13643-018-0863-x 4747:10.1007/s40261-016-0477-9 3637:10.1016/j.bpa.2015.08.008 3425:10.3389/fpubh.2022.854673 3128:Special Care in Dentistry 1643:anaesthesia recovery unit 1425:at the end of surgery by 1136:inhalational anaesthetics 1097:Blood pressure monitoring 781:intellectual disabilities 202: 188: 174: 163: 152: 140: 128: 123: 5868:Postanesthetic shivering 5734:Neuromuscular monitoring 5625:Rapid sequence induction 5554:Inhalational anesthetics 4047:Anesthesia and Analgesia 3926:10.1093/bjaceaccp/mkt039 3866:Anesthesia and Analgesia 3806:10.1093/bjaceaccp/mkl004 3227:10.4103/2231-0762.155728 2357:Anesthesia and Analgesia 1958:Hewer CL (August 1937). 1919:10.3389/fpsyg.2019.00034 1744:the health care system. 1707:Postanesthetic shivering 1287:orbicularis oculi muscle 1157:circuit disconnect alarm 1089:saturation with oxygen ( 1002:Inhalational anaesthesia 787:Anesthesia and the brain 547:NMDA receptor antagonist 463:Amnesia (loss of memory) 278:autonomic nervous system 5919:Oral sedation dentistry 5909:Intensive care medicine 5863:Perioperative mortality 5719:Guedel's classification 5466:Intercostal nerve block 5312:The molecular lifesaver 5085:British Medical Journal 5079:Parker RB (July 1956). 4276:10.5152/tjar.2019.60251 4117:Lopez MB (April 2018). 2647:10.21037/atm.2019.03.67 2596:10.1073/pnas.2004259117 2190:Schlich T (July 2012). 1964:British Medical Journal 1906:Frontiers in Psychology 1760:perioperative mortality 1754:Perioperative mortality 1748:Perioperative mortality 1599:systemic blood pressure 1389:endotracheal intubation 1187:Temperature measurement 1175:measures the amount of 1036:inhalational anesthetic 881:Stage 4, also known as 839:suspension of breathing 815:Stage 1, also known as 801:Guedel's classification 576:Preoperative evaluation 249:endotracheal intubation 5970:Anaesthetic technician 5858:Malignant hyperthermia 5224:Advances in Anesthesia 4999:10.1001/jama.2022.9451 2280:Anesthesiology Clinics 1976:10.1136/bmj.2.3996.274 1638: 1512:malignant hyperthermia 1403:neuromuscular junction 1364: 1361:Glycopyrronium bromide 1309:Neuromuscular blockade 1256:laryngeal mask airways 1248:mechanical ventilation 1202:Electroencephalography 1195:malignant hyperthermia 1165:mechanical ventilation 1049:Physiologic monitoring 961:. Once they enter the 659:atypical antipsychotic 490:central nervous system 394:, reduced the overall 384:germ theory of disease 156:Facilitating surgery, 5792:Laryngeal mask airway 5636:Scientific principles 5605:Dogliotti's principle 5481:Occipital nerve block 5446:Brachial plexus block 5158:Stoelting RK (2010). 5131:Guadagnino C (2000). 5097:10.1136/bmj.2.4983.16 4782:Update in Anaesthesia 2466:10.1096/fj.201701347R 1781:of gastric contents, 1701:core body temperature 1636: 1369:neuromuscular blocker 1316: 1213:anaesthesia awareness 1010:tracheobronchial tree 796:Stages of anaesthesia 762:histamine antagonists 595:anaesthesia awareness 545:is a non-competitive 314:Further information: 168:Anaesthesia awareness 58:"General anaesthesia" 5838:Drug-induced amnesia 5833:Anesthesia awareness 5767:Anesthetic vaporizer 5744:Thyromental distance 5648:Concentration effect 5522:Pharmacologic agents 5491:Pudendal nerve block 5160:"Foundation History" 5057:10.1093/bja/83.3.453 4784:(15). Archived from 3999:A&A Case Reports 3075:Pediatric Anesthesia 2749:10.2147/rmhp.s178950 1779:pulmonary aspiration 1619:cardiac dysrhythmias 1477:volatile anaesthetic 1124:anaesthetic machines 924:emergency department 857:surgical anaesthesia 805:Arthur Ernest Guedel 673:preoperative anxiety 280:, and in some cases 245:emergency department 43:improve this article 5762:Anaesthetic machine 5620:Tracheal intubation 5610:Intravenous therapy 5549:General anesthetics 5501:Sciatic nerve block 5456:Femoral nerve block 5451:Fascia iliaca block 5429:Epidural anesthesia 5395:Twilight anesthesia 4691:2017PLoSO..1283154Z 2587:2020PNAS..11713757P 2581:(24): 13757–13766. 2524:2021Natur.596..301Z 2330:Scientific American 2208:10.1017/mdh.2012.22 2116:Miller's anesthesia 2071:on 11 November 2022 1793:or, more commonly, 1762:is attributable to 1506:, Scotland. Called 1411:intercostal muscles 1356:neuromuscular block 1101:blood pressure cuff 1065:electrocardiography 1012:than other agents. 912:intensive care unit 685:anterograde amnesia 443:nurse anaesthetists 421:and other advanced 419:tracheal intubation 241:intensive care unit 216:General anaesthesia 124:General anaesthesia 5848:Emergence delirium 5828:Allergic reactions 5704:Entropy monitoring 5486:Paracervical block 5471:Interpleural block 5434:Spinal anaesthesia 5419:Neuraxial blockade 4927:Systematic Reviews 4776:English W (2002). 4651:10.1007/BF03021491 4610:10.1093/bja/aep160 3967:10.1111/anae.14428 3756:10.1093/bja/aew468 2892:10.1111/anae.14815 2843:10.1111/anae.14909 1865:10.1111/anae.15459 1647:regional analgesia 1639: 1629:Postoperative care 1571:agitated emergence 1427:anticholinesterase 1365: 1208:entropy monitoring 1161:low pressure alarm 1150:Oxygen measurement 963:circulatory system 843:pupillary dilation 677:separation anxiety 597:or intraoperative 431:anaesthetic agents 373:surgical technique 294:nurse anaesthetist 220:general anesthesia 6113: 6112: 5950:Nurse anesthetist 5777:Bronchial blocker 5772:Arterial catheter 5663:Second gas effect 5590:Airway management 5559:Local anesthetics 5496:Retrobulbar block 5139:on 15 August 2010 4993:(24): 2403–2412. 4821:10.1111/nmo.14046 4405:(19): 3153–3159. 4374:10.1111/aas.13123 4103:978-0-443-06801-0 3852:978-1-4614-8440-0 3584:10.4097/kja.19272 3140:10.1111/scd.12269 3088:10.1111/pan.14279 3081:(11): 1225–1233. 2885:(12): 1563–1571. 2518:(7871): 301–305. 2453:The FASEB Journal 2125:978-0-323-61264-7 1970:(3996): 274–276. 1858:(10): 1308–1315. 1824:Local anaesthesia 1799:Ellison C. Pierce 1693:oxygen saturation 1519:antihypertensives 1419:endotracheal tube 1299:Bell's phenomenon 1283:tonic contraction 1252:endotracheal tube 1226:Airway management 1220:Airway management 986:sodium thiopental 977:nervous systems. 904:operating theatre 570:phosphatidic acid 558:membrane-mediated 554:Meyer and Overton 517:membrane-mediated 423:airway management 237:operating theater 213: 212: 170:, overdose, death 158:terminal sedation 119: 118: 111: 93: 6133: 6103: 6102: 6093: 6092: 5940:Anesthesiologist 5729:Mallampati score 5689:Bispectral index 5529:Anticholinergics 5353: 5346: 5339: 5330: 5329: 5297: 5296: 5286: 5262: 5256: 5255: 5219: 5213: 5212: 5202: 5178: 5172: 5171: 5169: 5167: 5155: 5149: 5148: 5146: 5144: 5128: 5119: 5118: 5108: 5076: 5070: 5069: 5059: 5035: 5029: 5028: 5018: 4977: 4971: 4970: 4960: 4942: 4917: 4911: 4910: 4900: 4860: 4854: 4847: 4841: 4840: 4804: 4798: 4797: 4795: 4793: 4773: 4767: 4766: 4729: 4723: 4722: 4712: 4702: 4670: 4664: 4663: 4653: 4629: 4623: 4622: 4612: 4588: 4582: 4581: 4571: 4543: 4537: 4536: 4526: 4494: 4488: 4487: 4477: 4437: 4431: 4430: 4393: 4387: 4386: 4376: 4367:(7): 1014–1019. 4352: 4346: 4345: 4309: 4298: 4297: 4287: 4255: 4249: 4248: 4238: 4206: 4200: 4199: 4163: 4157: 4156: 4146: 4114: 4105: 4095: 4089: 4088: 4062: 4038: 4032: 4029: 4023: 4022: 3994: 3988: 3987: 3969: 3945: 3939: 3938: 3928: 3904: 3898: 3897: 3872:(5): 1043–1053. 3860: 3854: 3844: 3838: 3837: 3817: 3811: 3810: 3808: 3784: 3778: 3777: 3767: 3735: 3729: 3728: 3723: 3721: 3712: 3704: 3698: 3697: 3679: 3655: 3649: 3648: 3620: 3614: 3613: 3603: 3563: 3557: 3556: 3516: 3510: 3509: 3499: 3467: 3456: 3455: 3445: 3427: 3403: 3397: 3396: 3386: 3354: 3348: 3347: 3337: 3320:(12): CD009861. 3305: 3299: 3298: 3288: 3264: 3258: 3257: 3247: 3229: 3205: 3199: 3198: 3166: 3160: 3159: 3123: 3117: 3116: 3090: 3066: 3060: 3059: 3041: 3017: 3011: 3010: 2992: 2968: 2962: 2961: 2951: 2911: 2905: 2904: 2894: 2870: 2864: 2863: 2845: 2821: 2815: 2814: 2778: 2772: 2771: 2761: 2751: 2727: 2721: 2720: 2710: 2700: 2676: 2670: 2669: 2659: 2649: 2625: 2619: 2618: 2608: 2598: 2566: 2560: 2559: 2503: 2497: 2496: 2486: 2468: 2459:(8): 4172–4189. 2444: 2438: 2437: 2405: 2399: 2398: 2388: 2363:(5): 1254–1264. 2348: 2342: 2341: 2339: 2337: 2320: 2314: 2313: 2303: 2271: 2265: 2264: 2236: 2230: 2229: 2219: 2187: 2181: 2180: 2144: 2138: 2137: 2111: 2084: 2083: 2078: 2076: 2070: 2064:. Archived from 2059: 2051: 2042: 2041: 2031: 2022:(5): 1141–1150. 2007: 1998: 1997: 1987: 1955: 1942: 1941: 1931: 1921: 1897: 1888: 1887: 1877: 1867: 1843: 1615:rapid heart rate 1399:neurotransmitter 1240:muscle relaxants 1215:and of overdose. 641:, and emergence 566:phospholipase D2 521:protein-mediated 286:skeletal muscles 206:edit on Wikidata 198: 184: 133: 121: 120: 114: 107: 103: 100: 94: 92: 51: 27: 19: 6141: 6140: 6136: 6135: 6134: 6132: 6131: 6130: 6116: 6115: 6114: 6109: 6081: 6015: 5979: 5928: 5882: 5816: 5748: 5694:Body mass index 5667: 5631: 5578: 5544:Benzodiazepines 5517: 5366: 5357: 5306: 5301: 5300: 5263: 5259: 5220: 5216: 5179: 5175: 5165: 5163: 5156: 5152: 5142: 5140: 5129: 5122: 5091:(4983): 16–19. 5077: 5073: 5036: 5032: 4978: 4974: 4918: 4914: 4861: 4857: 4848: 4844: 4805: 4801: 4791: 4789: 4774: 4770: 4730: 4726: 4685:(8): e0183154. 4671: 4667: 4630: 4626: 4589: 4585: 4554:(6): CD009908. 4544: 4540: 4495: 4491: 4438: 4434: 4394: 4390: 4353: 4349: 4310: 4301: 4256: 4252: 4207: 4203: 4164: 4160: 4115: 4108: 4096: 4092: 4039: 4035: 4030: 4026: 4005:(12): 346–348. 3995: 3991: 3946: 3942: 3905: 3901: 3861: 3857: 3845: 3841: 3818: 3814: 3785: 3781: 3736: 3732: 3719: 3717: 3710: 3706: 3705: 3701: 3656: 3652: 3621: 3617: 3564: 3560: 3517: 3513: 3482:(7): CD006447. 3468: 3459: 3404: 3400: 3369:(3): CD004476. 3355: 3351: 3306: 3302: 3265: 3261: 3206: 3202: 3167: 3163: 3124: 3120: 3067: 3063: 3018: 3014: 2969: 2965: 2926:(5): CD008874. 2912: 2908: 2871: 2867: 2822: 2818: 2779: 2775: 2728: 2724: 2677: 2673: 2626: 2622: 2567: 2563: 2504: 2500: 2445: 2441: 2406: 2402: 2349: 2345: 2335: 2333: 2321: 2317: 2272: 2268: 2237: 2233: 2196:Medical History 2188: 2184: 2145: 2141: 2126: 2112: 2087: 2074: 2072: 2068: 2057: 2053: 2052: 2045: 2008: 2001: 1956: 1945: 1898: 1891: 1844: 1837: 1832: 1820: 1756: 1750: 1720:dexmedetomidine 1631: 1567: 1555:Glucocorticoids 1551:diphenhydramine 1472: 1459:succinylcholine 1431:anticholinergic 1358: 1349: 1340: 1331: 1325: 1311: 1279: 1273: 1228: 1222: 1051: 967:sites of action 900: 803:, described by 798: 789: 756:agents such as 728:agents such as 681:sympathicolysis 665:Benzodiazepines 655:Dexmedetomidine 623: 583:body mass index 578: 537: 528: 510:neural networks 494:cerebral cortex 479: 451: 439:pharmacodynamic 435:pharmacokinetic 318: 312: 306: 266:unconsciousness 209: 194: 180: 136: 115: 104: 98: 95: 52: 50: 40: 28: 17: 12: 11: 5: 6139: 6129: 6128: 6111: 6110: 6108: 6107: 6097: 6086: 6083: 6082: 6080: 6079: 6074: 6069: 6064: 6059: 6054: 6049: 6044: 6039: 6034: 6029: 6023: 6021: 6017: 6016: 6014: 6013: 6008: 6003: 5998: 5993: 5987: 5985: 5981: 5980: 5978: 5977: 5972: 5967: 5962: 5957: 5952: 5947: 5942: 5936: 5934: 5930: 5929: 5927: 5926: 5921: 5916: 5911: 5906: 5901: 5896: 5894:Cardiothoracic 5890: 5888: 5887:Subspecialties 5884: 5883: 5881: 5880: 5875: 5870: 5865: 5860: 5855: 5850: 5845: 5840: 5835: 5830: 5824: 5822: 5818: 5817: 5815: 5814: 5809: 5804: 5802:Magill forceps 5799: 5797:Laryngeal tube 5794: 5789: 5784: 5779: 5774: 5769: 5764: 5758: 5756: 5750: 5749: 5747: 5746: 5741: 5736: 5731: 5726: 5721: 5716: 5711: 5709:Fick principle 5706: 5701: 5696: 5691: 5686: 5681: 5675: 5673: 5669: 5668: 5666: 5665: 5660: 5655: 5650: 5645: 5639: 5637: 5633: 5632: 5630: 5629: 5628: 5627: 5617: 5612: 5607: 5602: 5597: 5592: 5586: 5584: 5580: 5579: 5577: 5576: 5571: 5566: 5561: 5556: 5551: 5546: 5541: 5539:Butyrophenones 5536: 5531: 5525: 5523: 5519: 5518: 5516: 5515: 5510: 5509: 5508: 5503: 5498: 5493: 5488: 5483: 5478: 5473: 5468: 5463: 5458: 5453: 5448: 5438: 5437: 5436: 5431: 5426: 5416: 5415: 5414: 5409: 5399: 5398: 5397: 5392: 5391: 5390: 5374: 5372: 5368: 5367: 5364:anesthesiology 5356: 5355: 5348: 5341: 5333: 5327: 5326: 5321: 5316: 5305: 5304:External links 5302: 5299: 5298: 5277:(4): 502–509. 5257: 5214: 5173: 5150: 5120: 5071: 5050:(3): 453–460. 5030: 4972: 4912: 4875:(4): 759–765. 4869:Anesthesiology 4855: 4842: 4799: 4788:on 29 May 2011 4768: 4741:(4): 343–354. 4724: 4665: 4644:(6): 358–363. 4624: 4603:(2): 275–282. 4583: 4538: 4489: 4432: 4388: 4347: 4299: 4270:(5): 359–366. 4250: 4201: 4174:(2): 139–145. 4158: 4106: 4090: 4033: 4024: 3989: 3960:(2): 211–224. 3940: 3919:(3): 100–105. 3899: 3855: 3839: 3812: 3779: 3750:(3): 444–451. 3730: 3699: 3664:Anesthesiology 3650: 3631:(3): 273–284. 3615: 3558: 3531:(5): 422–428. 3511: 3457: 3398: 3349: 3300: 3259: 3200: 3181:(5): 359–364. 3161: 3118: 3061: 3032:(4): 397–402. 3012: 2983:(2): 135–143. 2963: 2906: 2865: 2836:(6): 767–774. 2816: 2789:(3): 261–267. 2773: 2722: 2691:(8): 967–974. 2671: 2620: 2561: 2498: 2439: 2420:(5): 235–237. 2400: 2343: 2315: 2286:(3): 439–451. 2266: 2231: 2202:(3): 308–334. 2182: 2155:(3): 127–130. 2139: 2124: 2085: 2043: 2016:Anesthesiology 1999: 1943: 1889: 1834: 1833: 1831: 1828: 1827: 1826: 1819: 1816: 1752:Main article: 1749: 1746: 1697:blood pressure 1630: 1627: 1591:cardiac output 1587:carbon dioxide 1566: 1563: 1471: 1468: 1379:, such as the 1310: 1307: 1275:Main article: 1272: 1271:Eye management 1269: 1244:breathing tube 1232:airway patency 1224:Main article: 1221: 1218: 1217: 1216: 1198: 1184: 1177:carbon dioxide 1168: 1153: 1147: 1132:carbon dioxide 1117: 1114:femoral artery 1094: 1082:pulse oximetry 1077: 1068:(ECG or EKG): 1050: 1047: 1040: 1039: 1032: 1026: 1020: 899: 896: 895: 894: 879: 875: 874: 873: 872: 869: 866: 863: 853: 847: 846: 823: 820: 813: 797: 794: 788: 785: 758:metoclopramide 711:anticonvulsant 622: 619: 577: 574: 535: 532:NMDA glutamate 526: 478: 475: 471: 470: 467: 464: 461: 458: 450: 447: 433:with improved 412:Hanaoka Seishū 352:. During the 308:Main article: 305: 302: 247:to facilitate 211: 210: 203: 200: 199: 192: 186: 185: 178: 172: 171: 165: 161: 160: 154: 150: 149: 144: 138: 137: 134: 126: 125: 117: 116: 31: 29: 22: 15: 9: 6: 4: 3: 2: 6138: 6127: 6124: 6123: 6121: 6106: 6098: 6096: 6088: 6087: 6084: 6078: 6075: 6073: 6070: 6068: 6065: 6063: 6060: 6058: 6055: 6053: 6050: 6048: 6045: 6043: 6040: 6038: 6035: 6033: 6030: 6028: 6025: 6024: 6022: 6020:Organizations 6018: 6012: 6009: 6007: 6004: 6002: 5999: 5997: 5994: 5992: 5989: 5988: 5986: 5982: 5976: 5973: 5971: 5968: 5966: 5963: 5961: 5958: 5956: 5953: 5951: 5948: 5946: 5943: 5941: 5938: 5937: 5935: 5931: 5925: 5924:Pain medicine 5922: 5920: 5917: 5915: 5912: 5910: 5907: 5905: 5902: 5900: 5897: 5895: 5892: 5891: 5889: 5885: 5879: 5876: 5874: 5871: 5869: 5866: 5864: 5861: 5859: 5856: 5854: 5851: 5849: 5846: 5844: 5841: 5839: 5836: 5834: 5831: 5829: 5826: 5825: 5823: 5821:Complications 5819: 5813: 5812:Tracheal tube 5810: 5808: 5805: 5803: 5800: 5798: 5795: 5793: 5790: 5788: 5785: 5783: 5780: 5778: 5775: 5773: 5770: 5768: 5765: 5763: 5760: 5759: 5757: 5755: 5751: 5745: 5742: 5740: 5737: 5735: 5732: 5730: 5727: 5725: 5722: 5720: 5717: 5715: 5714:Goldman index 5712: 5710: 5707: 5705: 5702: 5700: 5697: 5695: 5692: 5690: 5687: 5685: 5682: 5680: 5677: 5676: 5674: 5670: 5664: 5661: 5659: 5656: 5654: 5651: 5649: 5646: 5644: 5641: 5640: 5638: 5634: 5626: 5623: 5622: 5621: 5618: 5616: 5613: 5611: 5608: 5606: 5603: 5601: 5598: 5596: 5593: 5591: 5588: 5587: 5585: 5581: 5575: 5572: 5570: 5567: 5565: 5562: 5560: 5557: 5555: 5552: 5550: 5547: 5545: 5542: 5540: 5537: 5535: 5532: 5530: 5527: 5526: 5524: 5520: 5514: 5511: 5507: 5504: 5502: 5499: 5497: 5494: 5492: 5489: 5487: 5484: 5482: 5479: 5477: 5474: 5472: 5469: 5467: 5464: 5462: 5459: 5457: 5454: 5452: 5449: 5447: 5444: 5443: 5442: 5439: 5435: 5432: 5430: 5427: 5425: 5422: 5421: 5420: 5417: 5413: 5410: 5408: 5405: 5404: 5403: 5400: 5396: 5393: 5389: 5386: 5385: 5384: 5381: 5380: 5379: 5376: 5375: 5373: 5369: 5365: 5361: 5354: 5349: 5347: 5342: 5340: 5335: 5334: 5331: 5325: 5322: 5320: 5317: 5314: 5313: 5308: 5307: 5294: 5290: 5285: 5280: 5276: 5272: 5268: 5261: 5253: 5249: 5245: 5241: 5237: 5233: 5229: 5225: 5218: 5210: 5206: 5201: 5196: 5192: 5188: 5184: 5177: 5161: 5154: 5138: 5134: 5127: 5125: 5116: 5112: 5107: 5102: 5098: 5094: 5090: 5086: 5082: 5075: 5067: 5063: 5058: 5053: 5049: 5045: 5041: 5034: 5026: 5022: 5017: 5012: 5008: 5004: 5000: 4996: 4992: 4988: 4984: 4976: 4968: 4964: 4959: 4954: 4950: 4946: 4941: 4936: 4932: 4928: 4924: 4916: 4908: 4904: 4899: 4894: 4890: 4886: 4882: 4878: 4874: 4870: 4866: 4859: 4852: 4846: 4838: 4834: 4830: 4826: 4822: 4818: 4815:(5): e14046. 4814: 4810: 4803: 4787: 4783: 4779: 4772: 4764: 4760: 4756: 4752: 4748: 4744: 4740: 4736: 4728: 4720: 4716: 4711: 4706: 4701: 4696: 4692: 4688: 4684: 4680: 4676: 4669: 4661: 4657: 4652: 4647: 4643: 4639: 4635: 4628: 4620: 4616: 4611: 4606: 4602: 4598: 4594: 4587: 4579: 4575: 4570: 4565: 4561: 4557: 4553: 4549: 4542: 4534: 4530: 4525: 4520: 4516: 4512: 4508: 4504: 4500: 4493: 4485: 4481: 4476: 4471: 4467: 4463: 4459: 4455: 4451: 4447: 4443: 4436: 4428: 4424: 4420: 4416: 4412: 4408: 4404: 4400: 4392: 4384: 4380: 4375: 4370: 4366: 4362: 4358: 4351: 4343: 4339: 4335: 4331: 4327: 4323: 4319: 4315: 4308: 4306: 4304: 4295: 4291: 4286: 4281: 4277: 4273: 4269: 4265: 4261: 4254: 4246: 4242: 4237: 4232: 4228: 4224: 4220: 4216: 4212: 4205: 4197: 4193: 4189: 4185: 4181: 4177: 4173: 4169: 4162: 4154: 4150: 4145: 4140: 4136: 4132: 4128: 4124: 4120: 4113: 4111: 4104: 4100: 4094: 4086: 4082: 4078: 4074: 4070: 4066: 4061: 4056: 4052: 4048: 4044: 4037: 4028: 4020: 4016: 4012: 4008: 4004: 4000: 3993: 3985: 3981: 3977: 3973: 3968: 3963: 3959: 3955: 3951: 3944: 3936: 3932: 3927: 3922: 3918: 3914: 3910: 3903: 3895: 3891: 3887: 3883: 3879: 3875: 3871: 3867: 3859: 3853: 3849: 3843: 3835: 3831: 3827: 3823: 3816: 3807: 3802: 3798: 3794: 3790: 3783: 3775: 3771: 3766: 3761: 3757: 3753: 3749: 3745: 3741: 3734: 3727: 3716: 3709: 3703: 3695: 3691: 3687: 3683: 3678: 3673: 3669: 3665: 3661: 3654: 3646: 3642: 3638: 3634: 3630: 3626: 3619: 3611: 3607: 3602: 3597: 3593: 3589: 3585: 3581: 3577: 3573: 3569: 3562: 3554: 3550: 3546: 3542: 3538: 3534: 3530: 3526: 3522: 3515: 3507: 3503: 3498: 3493: 3489: 3485: 3481: 3477: 3473: 3466: 3464: 3462: 3453: 3449: 3444: 3439: 3435: 3431: 3426: 3421: 3417: 3413: 3409: 3402: 3394: 3390: 3385: 3380: 3376: 3372: 3368: 3364: 3360: 3353: 3345: 3341: 3336: 3331: 3327: 3323: 3319: 3315: 3311: 3304: 3296: 3292: 3287: 3282: 3278: 3274: 3270: 3263: 3255: 3251: 3246: 3241: 3237: 3233: 3228: 3223: 3219: 3215: 3211: 3204: 3196: 3192: 3188: 3184: 3180: 3176: 3172: 3165: 3157: 3153: 3149: 3145: 3141: 3137: 3133: 3129: 3122: 3114: 3110: 3106: 3102: 3098: 3094: 3089: 3084: 3080: 3076: 3072: 3065: 3057: 3053: 3049: 3045: 3040: 3035: 3031: 3027: 3023: 3016: 3008: 3004: 3000: 2996: 2991: 2986: 2982: 2978: 2974: 2967: 2959: 2955: 2950: 2945: 2941: 2937: 2933: 2929: 2925: 2921: 2917: 2910: 2902: 2898: 2893: 2888: 2884: 2880: 2876: 2869: 2861: 2857: 2853: 2849: 2844: 2839: 2835: 2831: 2827: 2820: 2812: 2808: 2804: 2800: 2796: 2792: 2788: 2784: 2777: 2769: 2765: 2760: 2755: 2750: 2745: 2741: 2737: 2733: 2726: 2718: 2714: 2709: 2704: 2699: 2694: 2690: 2686: 2682: 2675: 2667: 2663: 2658: 2653: 2648: 2643: 2639: 2635: 2631: 2624: 2616: 2612: 2607: 2602: 2597: 2592: 2588: 2584: 2580: 2576: 2572: 2565: 2557: 2553: 2549: 2545: 2541: 2537: 2533: 2529: 2525: 2521: 2517: 2513: 2509: 2502: 2494: 2490: 2485: 2480: 2476: 2472: 2467: 2462: 2458: 2454: 2450: 2443: 2435: 2431: 2427: 2423: 2419: 2415: 2411: 2404: 2396: 2392: 2387: 2382: 2378: 2374: 2370: 2366: 2362: 2358: 2354: 2347: 2332: 2331: 2326: 2319: 2311: 2307: 2302: 2297: 2293: 2289: 2285: 2281: 2277: 2270: 2262: 2258: 2254: 2250: 2246: 2242: 2235: 2227: 2223: 2218: 2213: 2209: 2205: 2201: 2197: 2193: 2186: 2178: 2174: 2170: 2166: 2162: 2158: 2154: 2150: 2143: 2135: 2131: 2127: 2121: 2117: 2110: 2108: 2106: 2104: 2102: 2100: 2098: 2096: 2094: 2092: 2090: 2082: 2067: 2063: 2056: 2050: 2048: 2039: 2035: 2030: 2025: 2021: 2017: 2013: 2006: 2004: 1995: 1991: 1986: 1981: 1977: 1973: 1969: 1965: 1961: 1954: 1952: 1950: 1948: 1939: 1935: 1930: 1925: 1920: 1915: 1911: 1907: 1903: 1896: 1894: 1885: 1881: 1876: 1871: 1866: 1861: 1857: 1853: 1849: 1842: 1840: 1835: 1825: 1822: 1821: 1815: 1811: 1808: 1804: 1800: 1796: 1792: 1788: 1784: 1780: 1775: 1773: 1769: 1765: 1764:complications 1761: 1755: 1745: 1741: 1739: 1735: 1732: 1728: 1723: 1721: 1717: 1712: 1711:catecholamine 1708: 1704: 1702: 1698: 1694: 1689: 1688: 1684: 1680: 1676: 1672: 1668: 1667:acetaminophen 1664: 1660: 1656: 1652: 1648: 1644: 1635: 1626: 1624: 1620: 1616: 1612: 1608: 1604: 1600: 1596: 1592: 1588: 1585:consumption, 1584: 1580: 1576: 1572: 1562: 1560: 1556: 1552: 1548: 1544: 1540: 1536: 1532: 1528: 1527:phenylephrine 1524: 1520: 1515: 1513: 1509: 1505: 1500: 1496: 1494: 1490: 1486: 1482: 1478: 1467: 1464: 1460: 1456: 1452: 1448: 1447:cisatracurium 1444: 1440: 1436: 1432: 1428: 1422: 1420: 1416: 1412: 1408: 1404: 1401:found at the 1400: 1396: 1395:Acetylcholine 1392: 1390: 1386: 1382: 1378: 1377:body cavities 1374: 1370: 1362: 1357: 1353: 1348: 1344: 1339: 1336:, in case of 1335: 1330:, a hypnotic 1329: 1323: 1319: 1315: 1306: 1304: 1300: 1296: 1292: 1291:lagophthalmos 1288: 1284: 1278: 1268: 1264: 1261: 1257: 1253: 1249: 1245: 1241: 1237: 1233: 1227: 1214: 1210: 1209: 1204: 1203: 1199: 1196: 1192: 1188: 1185: 1182: 1178: 1174: 1173: 1169: 1166: 1162: 1158: 1154: 1151: 1148: 1145: 1141: 1140:nitrous oxide 1137: 1133: 1129: 1125: 1121: 1118: 1115: 1111: 1110:radial artery 1107: 1102: 1098: 1095: 1092: 1088: 1084: 1083: 1078: 1075: 1071: 1067: 1066: 1061: 1060: 1059: 1056: 1046: 1044: 1037: 1033: 1030: 1027: 1024: 1021: 1018: 1017: 1016: 1013: 1011: 1007: 1003: 999: 995: 991: 987: 983: 978: 976: 972: 968: 964: 960: 956: 952: 948: 947:intramuscular 944: 940: 936: 931: 929: 925: 921: 917: 913: 909: 905: 892: 888: 884: 880: 877: 876: 870: 867: 864: 861: 860: 858: 854: 851: 850: 849: 844: 840: 836: 832: 828: 824: 821: 818: 814: 811: 810: 809: 806: 802: 793: 784: 782: 778: 774: 769: 767: 763: 759: 755: 754:gastrokinetic 751: 747: 743: 739: 738:dexamethasone 735: 731: 727: 723: 718: 716: 712: 708: 704: 700: 696: 692: 688: 686: 682: 678: 674: 670: 666: 662: 660: 656: 652: 648: 644: 640: 636: 632: 627: 621:Premedication 618: 615: 614:dental crowns 611: 607: 602: 600: 596: 592: 591:illicit drugs 588: 584: 573: 571: 567: 563: 559: 555: 550: 548: 544: 540: 533: 529: 522: 518: 513: 511: 507: 503: 499: 495: 491: 487: 484: 474: 468: 465: 462: 459: 456: 455: 454: 446: 444: 440: 436: 432: 428: 424: 420: 415: 413: 409: 405: 401: 397: 393: 389: 385: 380: 378: 374: 370: 366: 361: 359: 358:Eastern world 355: 351: 347: 343: 339: 335: 331: 327: 323: 317: 311: 301: 299: 295: 291: 287: 283: 279: 275: 271: 267: 263: 260:A variety of 258: 255: 250: 246: 242: 238: 234: 230: 225: 224:consciousness 221: 217: 207: 201: 197: 193: 191: 187: 183: 179: 177: 173: 169: 166: 164:Complications 162: 159: 155: 151: 148: 145: 143: 139: 132: 127: 122: 113: 110: 102: 99:February 2015 91: 88: 84: 81: 77: 74: 70: 67: 63: 60: – 59: 55: 54:Find sources: 48: 44: 38: 37: 32:This article 30: 26: 21: 20: 5787:Gas cylinder 5672:Measurements 5615:Laryngoscopy 5600:Bronchoscopy 5377: 5311: 5310:Chloroform: 5274: 5270: 5260: 5227: 5223: 5217: 5193:(1): 44–62. 5190: 5186: 5176: 5164:. Retrieved 5153: 5141:. Retrieved 5137:the original 5088: 5084: 5074: 5047: 5043: 5033: 4990: 4986: 4975: 4930: 4926: 4915: 4872: 4868: 4858: 4850: 4845: 4812: 4808: 4802: 4790:. Retrieved 4786:the original 4781: 4771: 4738: 4734: 4727: 4682: 4678: 4668: 4641: 4637: 4627: 4600: 4596: 4586: 4551: 4541: 4506: 4502: 4492: 4452:(1): 73–81. 4449: 4445: 4435: 4402: 4398: 4391: 4364: 4360: 4350: 4317: 4313: 4267: 4263: 4253: 4218: 4214: 4204: 4171: 4167: 4161: 4129:(1): 73–81. 4126: 4122: 4093: 4053:(1): 70–78. 4050: 4046: 4036: 4027: 4002: 3998: 3992: 3957: 3953: 3943: 3916: 3912: 3902: 3869: 3865: 3858: 3842: 3825: 3821: 3815: 3799:(2): 67–70. 3796: 3792: 3782: 3747: 3743: 3733: 3725: 3718:. 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Retrieved 2066:the original 2061: 2019: 2015: 1967: 1963: 1909: 1905: 1855: 1851: 1812: 1783:asphyxiation 1776: 1757: 1742: 1724: 1705: 1690: 1687:nerve block. 1645:(PACU) with 1640: 1589:production, 1568: 1543:bronchospasm 1539:laryngospasm 1516: 1501: 1497: 1473: 1423: 1397:, a natural 1393: 1366: 1280: 1265: 1229: 1206: 1200: 1186: 1170: 1160: 1156: 1149: 1119: 1112:) or groin ( 1096: 1079: 1062: 1052: 1043:Laryngoscopy 1041: 1014: 994:methohexital 979: 951:subcutaneous 932: 922:department, 901: 882: 856: 848: 826: 816: 799: 790: 770: 719: 689: 675:, including 663: 657:and certain 628: 624: 603: 599:hypertension 579: 551: 514: 480: 472: 452: 416: 404:pharmacology 381: 362: 319: 290:anaesthetist 259: 254:pain stimuli 219: 215: 214: 147:Anaesthetics 105: 96: 86: 79: 72: 65: 53: 41:Please help 36:verification 33: 5991:ACE mixture 5933:Professions 5754:Instruments 5699:Capnography 5653:Fink effect 5534:Antiemetics 5441:Nerve block 5166:8 September 5143:8 September 4792:8 September 3954:Anaesthesia 3720:10 November 2879:Anaesthesia 2830:Anaesthesia 2742:: 177–187. 2640:(15): 356. 1852:Anaesthesia 1795:human error 1787:anaphylaxis 1768:haemorrhage 1716:bair hugger 1651:transdermal 1617:, or other 1559:antibiotics 1547:epinephrine 1470:Maintenance 1435:pancuronium 1338:hypotension 1322:sevoflurane 1191:hypothermia 1189:to discern 1181:ventilation 1172:Capnography 1080:Continuous 1063:Continuous 1006:Sevoflurane 943:intravenous 831:respiration 730:ondansetron 651:bradycardia 647:hypotension 519:and direct 506:spinal cord 483:biochemical 365:Renaissance 354:Middle Ages 326:Babylonians 190:MedlinePlus 6126:Anesthesia 5739:Pain scale 5583:Techniques 5360:Anesthesia 4933:(1): 218. 4509:: 93–104. 3578:(1): 3–7. 3418:: 854673. 2336:26 January 2134:1124935549 2075:6 November 1830:References 1734:antagonist 1655:parenteral 1595:heart rate 1531:salbutamol 1463:sugammadex 1455:mivacurium 1451:atracurium 1443:vecuronium 1439:rocuronium 1352:Atracurium 1289:, causing 1144:isoflurane 1091:hypoxaemia 1087:hemoglobin 1070:Electrodes 1055:monitoring 935:inhalation 920:cardiology 835:heart rate 766:famotidine 750:sufentanil 734:droperidol 726:antiemetic 699:anxiolytic 562:chloroform 427:monitoring 408:physiology 388:antiseptic 69:newspapers 5914:Obstetric 5904:Geriatric 5574:Sedatives 5252:207899269 5230:: 35–51. 5007:1538-3598 4949:2046-4053 4889:0003-3022 4837:227235118 4466:2392-7518 4320:: 15–21. 4069:1526-7598 3935:1743-1816 3894:245907059 3828:: 40–43. 3592:2005-7563 3545:0013-4694 3434:2296-2565 3236:2231-0762 3187:2162-5239 3113:237197251 3097:1155-5645 3056:205430269 2940:1469-493X 2860:207944753 2556:236496390 2540:1476-4687 2475:0892-6638 2434:1472-0299 2377:1526-7598 2177:207482973 1807:morbidity 1738:alvimopan 1683:oxycodone 1649:or oral, 1579:Shivering 1565:Emergence 1533:to treat 1523:ephedrine 1493:sedatives 1487:(usually 1407:diaphragm 1347:analgesia 1334:Ephedrine 1295:lysosomal 1074:ischaemia 990:etomidate 975:autonomic 939:injection 916:radiology 908:endoscopy 898:Induction 891:medullary 887:brainstem 817:induction 715:agitation 707:analgesic 691:Melatonin 669:Midazolam 631:clonidine 400:mortality 396:morbidity 334:Egyptians 330:Assyrians 322:Sumerians 282:paralysis 274:analgesia 229:analgesic 142:Specialty 6120:Category 6095:Category 5684:Baricity 5383:Sedation 5293:15675210 5244:31677658 5209:31653394 5115:13329366 5066:10655918 5025:35665794 4967:30497505 4907:19322941 4829:33252179 4755:27812971 4719:28829798 4679:PLOS ONE 4660:18566199 4619:19541677 4578:24895945 4569:11227344 4533:28372696 4484:29756066 4419:29683007 4383:29664117 4342:51955389 4334:30092398 4294:31572985 4245:31684698 4188:20375829 4153:29756066 4085:41023659 4077:26516798 4019:28767470 3984:53107969 3976:30378102 3886:35020636 3774:28203745 3694:24335733 3645:26643094 3610:31257815 3506:26171895 3452:35480569 3393:29533470 3344:33319916 3295:17198534 3254:25992332 3195:32990204 3148:29364538 3105:34403548 3048:20085541 3007:25797363 2999:16430532 2958:29761867 2901:31448404 2852:31709522 2811:27527932 2803:26844863 2768:30425598 2717:31650216 2666:31516902 2615:32467161 2548:34321660 2493:29505303 2395:33857967 2310:27521190 2261:28160985 2226:23002302 2169:26065591 2038:19858877 1994:20780832 1938:30778307 1884:33878803 1818:See also 1736:such as 1731:μ-opioid 1679:fentanyl 1675:morphine 1623:dyspnoea 1607:doxapram 1489:fentanyl 1481:propofol 1343:Fentanyl 1328:Propofol 1318:Syringes 1053:Several 1029:Propofol 1023:Fentanyl 998:ketamine 982:propofol 928:disaster 883:overdose 764:such as 746:fentanyl 744:such as 703:sedative 695:hypnotic 643:delirium 543:Ketamine 498:thalamus 429:and new 218:(UK) or 6105:Outline 5984:History 5569:Opioids 5412:Topical 5378:General 5106:2034767 5016:9167439 4958:6267894 4898:2697561 4763:5512397 4710:5567500 4687:Bibcode 4524:5381733 4475:5931188 4427:5039625 4285:6756312 4236:6814953 4196:5319313 4144:5931188 3765:5409133 3686:7605024 3601:7000285 3553:2469566 3497:8935979 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