Anaesthesia administration

Tan HL, Liew QY, Loo S, Hawkins R Severe hyperphosphatemia and associated electrolyte and metabolic derangement following the administration of sodium phosphate for bowel preparation. Anaesthesia 2002 57 478-483. 

Thiopentone sodium is usually given as 92.5 percent solution, initially 100 to 150 mg over 10-15 seconds and repeated if necessary depending upon the patient s response after 20-30 seconds. On repeated administration the extracerebral sites are gradually filled up and lower doses produces anaesthesia which lasts longer. 

It is indicated for preoperative sedation, conscious sedation prior to short diagnostic or endoscopic procedures, induction of general anaesthesia prior to administration of other anaesthetic agents. 

The era of modern general anaesthesia dawned in 1846 with the first administration of diethyl ether by William Morton to a patient in Massachusetts General Hospital. One year later it was followed by Simpson s demonstration of the effects of chloroform in Edinburgh. Since that time the dominance of the inhalation route of administration as a means of providing general anaesthesia combined with safe control of the airway has not been seriously challenged. 

Intra-arterial injection of thiopentone is a serious complication as crystals of the thiobarbiturate can form in the arterioles and capillaries, causing intense pain, vasoconstriction, thrombosis, and even tissue necrosis. Accidental intra-arterial injections should be treated promptly with intra-arterial administration of a vasodilator (papaverine 20 mg) and lignocaine (lidocaine) Note leave the needle/cannula in the artery), as well as a regional anaesthesia-induced sympathectomy (stellate ganglion block, brachial plexus block) and anticoagulation with intravenous heparin. The risk of ischaemic damage is much higher with a 5% solution and the use of this concentration is not recommended. 

Onset of anaesthesia is as rapid though not as smooth as after thiopentone administration, but recovery is more rapid with methohexitone and occurs within 2-5 minutes through redistribution. Drowsiness persists for much longer as the drug is slowly metabolised in the liver. While methohexitone has been reported to cause occasional EEG seizure-like activity in epileptics the drug also possesses anticonvulsant properties. 

Totai intravenous anaesthesia (TIVA) as propofoi shows minimai cumuiation with repeated administration or foiiowing infusion, it is the hypnotic agent of choice for TIVA. 

Prilocaine is suitable for most types of local anaesthetic block but is not suitable for epidural use in obstetrics because of the need for repeat administration. Its main uses are for infiltration anaesthesia and intravenous regional anaesthesia where its low toxicity makes it the drug of choice. Levobupivacaine... 

Clove oil is used as a safe anaesthetic for aquatic research. Tricaine or MS-222, the only anaesthetic registered in North America, is a very effective anaesthetic for several fish species but its application in the field is limited because the US Food and Drug Administration guidelines demand a 21-day withdrawal period after exposure to MS-222 before the fish enters the food chain. In this context, clove oil is found to be an alternative to MS-222 for use as a fish anaesthetic. Exposure of channel catfish (Ictalurus punctatus) to clove oil at a concentration of 100mg/l induced anaesthesia within 1 min. The fish recovered from a 10 min period of anaesthesia within 4 min after removal from the anaesthetic solution. 

Burns R, McCrae AF, Tiplady B. A comparison of target-controlled with patient-controlled administration of propofol combined with midazolam for sedation during dental surgery. Anaesthesia 2003 58 170-6. 

Toyota K, Sakura S, Saito Y, Ozasa H, Uchida H. The effect of pre-operative administration of midazolam on the development of intra-operative hypothermia. Anaesthesia 2004 59 116-21. 

DONEPEZIL SUXAMETHONIUM Possible t efficacy of suxamethonium Suxamethonium is metabolized by cholinesterase parasympatho-mimetics inhibit cholinesterase and so prolong the action of suxamethonium Avoid co-administration. Ensure that the effects of suxamethonium have worn off before administering a parasympathomimetic to reverse non-depolarizing muscle relaxants. A careful risk-benefit analysis should be made before considering the use of suxamethonium for emergency anaesthesia in patients taking parasympathomimetics. The short half-life of edrophonium means that it can be used to diagnose suspected dual block with suxamethonium... 

Direct measurement of blood pressure requires insertion of a cannula into an artery and generally a vein, respectively, to allow blood pressure and heart rate to be monitored, and also the administration of drugs. The animal is allowed to recover from anaesthesia, and the cardiovascular parameters are monitored in the conscious animal via the arterial cannula. 

Advantages are that drugs as gases can be rapidly taken up or eliminated, giving the close control that has marked the use of this route in general anaesthesia from its earliest days. Self-administration is practicable. Aerosols and powders provide... 

Dosage and administration. For the maintenance of anaesthesia, nitrous oxide must always be mixed with at least 30% oxygen. For analgesia, a concentration of 50% nitrous oxide with 50% oxygen usually suffices. 

Similar to Voltaren Emulgel, oily droplets of an eutectic mixture of lidocaine and prilocaine are dispersed in a hydrogel to provide local anaesthesia of the skin for injections and surgical treatment (Emla cream). A further possibility is the dermal administration of a liposome dispersion as a spray (Heparin PUR ratiopharm Spriihgel). After administration, water and isopropyl alcohol evaporate partially to result in an increase of concentration and thereby in a transition from the initial liposome dispersion to a lamellar liquid crystal. The therapeutic effect thus appears to be influenced favorably by the presence of lecithins alone, rather than by the degree of dispersion of liposomes. 

Lynas AG, Clarke RS, Fee JP, Reid JE. Factors that influence cutaneous reactions following administration of thiopentone and atracurium. Anaesthesia 1988 43(10) 825-8. 

Eldor J, Hoffman B, Davidson JT. Prolonged bradycardia and hypotension after neostignune administration m a patient receivmg atenolol. Anaesthesia 1987 42(12) 1294-7. 

Kuczkowski KM. Respiratory arrest in a parturient following intrathecal administration of fentanyl and bupivacaine as part of a combined spinal-epidural analgesia for labour. Anaesthesia 2002 57(9) 939 0. 

Tammisto T, Airaksinen M. Increase of creatine kinase activity in serum as sign of muscular injury caused by intermittently administred suxamethonium during halothane anaesthesia. Br J Anaesth 1966 38(7) 510-15. 

McLoughlin C, Nesbitt GA, Howe JP. Suxamethonium induced myalgia and the effect of pre-operative administration of oral aspirin. A comparison with a standard treatment and an untreated group. Anaesthesia 1988 43(7) 565-7. 

Manataki AD, Arnaoutoglou HM, Tefa LK, Glatzounis GK, Papadopoulos GS. Continuous propofol administration for suxamethonium-induced postoperative myalgia. Anaesthesia 1999 54(5) 419-22. 

Baurain M, Barvais L, d Hollander A, Hennart D. Impairment of the antagonism of vecuronium-induced paralysis and intra-operative disopyramide administration. Anaesthesia 1989 44(l) 34-6. 

NIshlyama T, Hirasaki A. Effects of sevoflurane anaesthesia on renal function-duration of administration and area under the curve and rate of decrease of serum inorganic fluoride. Eur J Anaesthesiol 1995 12(5) 477-82. 

Local anaesthetics Lidocaine hydrochloride Minims Lignocaine and Fluorescein Local anaesthesia POM medicine for administration (not for sale or supply)... 

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