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Published byStephen Matthews Modified over 8 years ago
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"To care for the body and its breath of life"
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”Reversible lack of awareness,"
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The practice of administering medications or gases that block the feeling of pain and other sensations, allowing medical and surgical procedures to be undertaken without causing undue discomfort to the patient.
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Thomas Green Morton: a public demonstration of ether anaesthesia in Boston, Massachusetts, on October 16, 1846.
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Procedural sedation Conscious sedation Local anaesthesia Regional anaesthesia General anaesthesia
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Cocaine (isolated 1859), used by Inca Americans for trephination (spit). Eye surgery 1884 Spinal anaesthesia 1898 Procaine (1905) Lignocaine (1943) Bupivicaine Ropivicaine
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1275 Raymond Lullus played about with some chemicals and created “sweet vitriol” Renamed by Frobenius in 1730 as ether (“heavenly”). Priestley discovered nitrous oxide in 1772. Humphry Davy experimented upon himself in 1799 – “laughing gas” Chloroform discovered by Simpson in 1831.
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Isoflurane Sevoflurane Desflurane (Halothane) (Xenon – 80%) (Nitrogen - >4bar)
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Benzodiazepines Midazolam Barbiturates Sodium thiopental Ketamine Etomidate Propofol
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“Milk of human kindness”, “white magic”, “Michael Jackson juice” Anaesthetic Sedative Antiepileptic Amnestic Antiemetic Antipruritic
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As lamented by Fallopius: “when soporifics are weak, they are useless, and when strong, they kill.”
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Adverse effects: Apnoea Hypotension Negative inotropy Vasodilatation Pain on injection Myoclonus Priapism Addiction
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“Special K”, related to PCP Anaesthetic Analgesia, antineuropathic Bronchodilator Hallucinogen More cardiovascularly stable “Preserves airway reflexes”
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Adverse effects: Hallucination/dysphoria Tachycardia/myocardial ischaemia Increased salivation Increased ICP Addiction Irritable bladder
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Depolarising: Suxamethonium Non-depolarising: Vecuronium Rocuronium Pancuronium Atracurium Cisatracurium Mivacurium
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Opioids Alfentanil Fentanyl Remifentanil Morphine Methadone Endone Oxycontin Buprenorphine
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Anti-neuropathics TCAs (nortriptyline) Antiepileptics (gabapentin) Antiarrhythmics (flecainide, lignocaine) Ketamine Others Clonidine Clonazepam Simples
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Metaraminol, ephedrine Noradrenaline, adrenaline GTN Dopamine, dobutamine Milrinone
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Blood, platelets, FFP, cryoprecipitate Recombinant factor VII
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