Other General Anesthetics

Inhalation of other general anesthetics susceptible to abuse, such as ether and chloroform, appears to be limited to health professionals who have easy access to these compounds and who tend to use these dtugs in isolation. Recreational and social use of these substances has been somewhat limited by their high flammability and by frequent and intense undesirable adverse effects at moderate doses. It has been suggested that the abuse of ether or chloroform alone is a rare phenomenon (Delteil et al. 1974 Deniker et al. 1972), occurring usually in the context of dependence on othet substances, particularly alcohol (Krenz et al. 2003). 

Intoxication delirium may occur with solvents, nitrous oxide (Sterman and Coyle 1983), ether, or other general anesthetics (Delteil et al. 1974). However, to our knowledge, there are no reports describing delirium associated with nitrite intoxication. The description of delirium presented here derives mainly from what has been observed during solvent intoxication. 

Alcohol is similar to other general anesthetics in that it depresses the CNS. Clinically, however, it may appear to be a stimulant because it first suppresses... 

Propofol Propofol has been relatively free of acute side effects other than those associated with its mechanism of action. Continuous infusions lasting greater than 10 days in ICUs have demonstrated no significant apparent toxicities. Propofol is not recommended for obstetrics, including cesarean section deliveries. It crosses the placenta, and as with other general anesthetic agents, may be associated with neonatal depression. Propofol is not recommended for use in nursing mothers because it is excreted in human milk, and the effects of oral absorption of small amounts of propofol in newborn and infants are not known. 

Other general anesthetics (propofol) Negative inotropic effect Ca + channel blockade Altered Ca " homeostasis, /i-adrenergic receptor sensitization... 

Diethyl ether was the first general anesthetic used. The dentist Dr. William Morton is credited with its introduction in the 1800s. Diethyl ether functions as an anesthetic by interacting with the central nervous system. It appears that diethyl ether (and many other general anesthetics) functions by accumulating in the lipid material of the nerve cells, thereby interfering with nerve impulse transmission. This results in analgesia, a lessened perception of pain. 

Ketamine is used as a sole anesthetic agent for diagnostic and surgical procedures that do not require skeletal muscle relaxation. It is best suited for short procedures, but it can be used with additional doses for longer procedures. It is also used for the induction of anesthesia prior to the administration of other general anesthetics and to supplement low-potency agents, such as nitrous oxide. 

The respiratory effects of ketamine are perhaps the best indication for its use. Induction doses of ketamine produce small and transient decreases in minute ventilation, but respiratory depression is less severe than with other general anesthetics. Ketamine is a potent bronchodilator due to its indirect sympathomimetic activity and perhaps some direct bronchodilating activity. Thus, ketamine is particularly well suited for anesthetizing patients at high risk for bronchospasm. 

Minor alterations in hepatic dysfunction also occur more commonly after halothane administration than other general anesthetics now in common use (Wright et al. 1975). Nonetheless, when jaundice occurs after halothane use, the prognosis is serious. In a review by Little in 1968 the mortality rate was calculated to be 35% in the 400 patients who had developed this complication. When death occurs, it is usually due to hepatic failure with coma. Obesity, early onset of jaundice after anesthesia, and associated blood coagulation abnormalities are more likely to be associated with a fatal outcome. If recovery occurs, it is almost always complete. In... 

Anesthetics fall into two major categories, general and local. General anesthetics are usually administered to accomplish three ends insensitivity to pain (analgesia), loss of consciousness, and muscle relaxation. Cases, such as nitrous oxide and cyclopropane, as well as volatile liquids, such as ether, are administered by inhalation, but other general anesthetics, such as barbiturates, are injected intravenously. 

Wioland, N., and Bonaventure, N. 1985. Photopic c-wave in the chicken ERG sensitivity to sodium azide, epinephrine, sodium iodate, barbiturates, and other general anesthetics. Doc. Oohthal. 60 407-412. 

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