Penthrox® (Methoxyflurane)
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Statement on Safe Use of Propofol 2019
Statement on Safe Use of Propofol Committee of Origin: Ambulatory Surgical Care (Approved by the ASA House of Delegates on October 27, 2004, and amended on October 23, 2019) Because sedation is a continuum, it is not always possible to predict how an individual patient will respond. Due to the potential for rapid, profound changes in sedative/anesthetic depth and the lack of antagonist medications, agents such as propofol require special attention. Even if moderate sedation is intended, patients receiving propofol should receive care consistent with that required for deep sedation. The Society believes that the involvement of an anesthesiologist in the care of every patient undergoing anesthesia is optimal. However, when this is not possible, non-anesthesia personnel who administer propofol should be qualified to rescue* patients whose level of sedation becomes deeper than initially intended and who enter, if briefly, a state of general anesthesia.** • The physician responsible for the use of sedation/anesthesia should have the education and training to manage the potential medical complications of sedation/anesthesia. The physician should be proficient in airway management, have advanced life support skills appropriate for the patient population, and understand the pharmacology of the drugs used. The physician should be physically present throughout the sedation and remain immediately available until the patient is medically discharged from the post procedure recovery area. • The practitioner administering propofol for sedation/anesthesia should, at a minimum, have the education and training to identify and manage the airway and cardiovascular changes which occur in a patient who enters a state of general anesthesia, as well as the ability to assist in the management of complications. -
Callistephin Enhances the Protective Effects of Isoflurane on Microglial Injury Through Downregulation of Inflammation and Apoptosis
802 MOLECULAR MEDICINE REPORTS 20: 802-812, 2019 Callistephin enhances the protective effects of isoflurane on microglial injury through downregulation of inflammation and apoptosis LILI ZHAO, SHIBIAO CHEN, TIANYIN LIU, XIUHONG WANG, HAIJIN HUANG and WEICHENG LIU Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China Received June 18, 2018; Accepted March 15, 2019 DOI: 10.3892/mmr.2019.10282 Abstract. Microglia are the major immune cells in the central enhanced the effects of isoflurane. Callistephin may therefore nervous system. Microglial activation can be beneficial or constitute a candidate drug agent that may target inflammatory detrimental depending on the stimuli and the physiopathological and growth regulatory signaling pathways, thus ameliorating environment. Microglial activation is involved in a variety certain aspects of neurodegenerative diseases. of neurodegenerative disorders. Different anesthetic agents have exhibited diverse effects on microglial activation and Introduction the engulfment process. The anthocyanin callistephin has been demonstrated to have antioxidant and anti‑inflammatory Microglial cells are the major immune cell in the central properties, and these were assessed in the present study, with a nervous system (CNS), responding against types of endog- focus on its effect on microglial activation. Mouse microglial enous and exogenous stimuli, including infection by bacteria, cells C8-4B were treated with 100 ng/µl lipopolysaccharide viruses, prions and β-amyloid plaques (1). Microglia are (LPS) and 1 ng/µl interferon-γ. Cells were subsequently treated activated upon exposure to different stimuli and, depending with 2% isoflurane, 100 µM callistephin or both. LPS promoted on the environmental context, this may be beneficial or detri- apoptosis in C8-B4 cells, and this was reduced following mental to the functionality and physiology of the CNS (2). -
Intravenous Sedation and Preparing for Your Procedure
Oral and Maxillofacial Surgery Intravenous sedation and preparing for your procedure Information for patients Please ensure that you read this leaflet before you come to hospital for your operation What is sedation? Sedation is a way of using drugs (sedatives) to make you feel relaxed and sleepy during your procedure. We will give you your sedatives through an injection into a vein. Sedation is not a general anaesthetic and you will not be unconscious. You may not remember much of what happens during the procedure and directly afterwards. This is quite normal. Local anaesthetic will be given once you have been sedated. Do not drive, operate machinery or sign important documents for at least 24 hours after your procedure. You must make sure that you have a responsible adult with you who can stay in the department for a couple of hours and take you home by car or taxi. Someone must also stay with you for at least 24 hours after your procedure. Your procedure will be cancelled if you do not bring someone with you who can do this. Preparation for your procedure and what to bring with you • Patients having a procedure under sedation must follow the current fasting guidelines for general anaesthesia. You must not eat or drink for 6 hours before your procedure but you may have water up to 2 hours before. If you do eat or drink after these times your surgery will be cancelled. • Avoid alcohol for 24 hours before your procedure. • Bring with you a list of any medication or drugs you are taking. -
Moderate Sedation Study Guide 11-17-10
PROCEDURE RELATED SEDATION Outline I Introduction II Definitions: The 5 Levels of Sedation and Anesthesia III Emergency Procedures, Critical Care Areas and Policy Exclusions IV The Pre-Sedation Assessment V NPO: The Timing of Eating and Drinking before Sedation VI Review of Some Agents Used for Sedation VII Orders for Procedure Related Sedation VIII Environmental Requirements and Monitoring During Sedation IX Post-Procedure Monitoring and the PAR Score X Discharge Criteria and Concluding Post-Procedure Monitoring 1 PROCEDURE RELATED SEDATION Lance Brown, MD, MPH I. Introduction The purpose of this tutorial is to familiarize the reader with the Loma Linda University Medical Center Policy M-86 for Procedure Related Sedation. Procedure related sedation is used to make necessary medical procedures as comfortable as possible for patients and to facilitate the performance of necessary medical procedures by health care providers (typically physicians). It is important for health care providers performing procedure related sedation to be familiar with the pharmacologic characteristics of the agents being used, to understand the risk factors for complications related to procedure related sedation, and to individually plan the sedation for each patient. Each health care practitioner privileged to provide procedure related sedation takes responsibility for both the comfort and safety of the patients in their care. II. Definitions At Loma Linda University Medical Center, we have defined five distinct levels of sedation and anesthesia. Familiarity with the definitions of these levels of sedation is important for safely providing procedure related sedation and for complying with the policy of the Medical Center. It must be recognized, however, that sedation occurs along a continuum and that individual patients may have different degrees of sedation for a given dose and route of medication. -
Pharmacology – Inhalant Anesthetics
Pharmacology- Inhalant Anesthetics Lyon Lee DVM PhD DACVA Introduction • Maintenance of general anesthesia is primarily carried out using inhalation anesthetics, although intravenous anesthetics may be used for short procedures. • Inhalation anesthetics provide quicker changes of anesthetic depth than injectable anesthetics, and reversal of central nervous depression is more readily achieved, explaining for its popularity in prolonged anesthesia (less risk of overdosing, less accumulation and quicker recovery) (see table 1) Table 1. Comparison of inhalant and injectable anesthetics Inhalant Technique Injectable Technique Expensive Equipment Cheap (needles, syringes) Patent Airway and high O2 Not necessarily Better control of anesthetic depth Once given, suffer the consequences Ease of elimination (ventilation) Only through metabolism & Excretion Pollution No • Commonly administered inhalant anesthetics include volatile liquids such as isoflurane, halothane, sevoflurane and desflurane, and inorganic gas, nitrous oxide (N2O). Except N2O, these volatile anesthetics are chemically ‘halogenated hydrocarbons’ and all are closely related. • Physical characteristics of volatile anesthetics govern their clinical effects and practicality associated with their use. Table 2. Physical characteristics of some volatile anesthetic agents. (MAC is for man) Name partition coefficient. boiling point MAC % blood /gas oil/gas (deg=C) Nitrous oxide 0.47 1.4 -89 105 Cyclopropane 0.55 11.5 -34 9.2 Halothane 2.4 220 50.2 0.75 Methoxyflurane 11.0 950 104.7 0.2 Enflurane 1.9 98 56.5 1.68 Isoflurane 1.4 97 48.5 1.15 Sevoflurane 0.6 53 58.5 2.5 Desflurane 0.42 18.7 25 5.72 Diethyl ether 12 65 34.6 1.92 Chloroform 8 400 61.2 0.77 Trichloroethylene 9 714 86.7 0.23 • The volatile anesthetics are administered as vapors after their evaporization in devices known as vaporizers. -
An Overview on “Stages of Anesthesia and Some Novel General Anesthetics Drug”
Rohit Jaysing Bhor. et al. /Asian Journal of Research in Chemistry and Pharmaceutical Sciences. 5(4), 2017, 132-140. Review Article ISSN: 2349 – 7106 Asian Journal of Research in Chemistry and Pharmaceutical Sciences Journal home page: www.ajrcps.com AN OVERVIEW ON “STAGES OF ANESTHESIA AND SOME NOVEL GENERAL ANESTHETICS DRUG” Rohit Jaysing Bhor *1 , Bhadange Shubhangi 1, C. J. Bhangale 1 1* Department of Pharmaceutical Chemistry, PRES’s College of Pharmacy Chincholi, Tal-Sinner, Dist-Nasik, Maharashtra, India. ABSTRACT Anesthesia is a painless performance of medical producers. There are both major and minor risks of anesthesia. Anesthesia is a state of temporary induced loss of sensation or awareness. It gives analgesia i.e. relief from pain or prevention of pain and paralysis. General anaesthesia is a medically induced state of unconsciousness. It gives loss of protective reflux. It is carried out to allow medical procedures or medical surgery. It can be classified into 3 types like Intravenous Anesthetics Drug; Miscellaneous Drug; and Inhalational anesthetic Drug. Sodium thiopental is an ultra-short-acting barbiturate and has been used commonly in the induction phase of anesthesia. Methohexital is an example of barbiturates derivatives. It is classified as short-acting, and has a rapid onset of action. KEYWORDS Anesthesia, Sodium thiopental, Methohexital and Propofol. Author for Correspondence: INTRODUCTON Anesthesia is a state of temporary induced loss of sensation or awareness. It gives analgesia i.e. relief 1 Rohit Jaysing Bhor, from pain or prevention of pain and paralysis . A patient under the effects of anesthetic drug is known Department of Pharmaceutical Chemistry, as anesthetized. -
Effects of Alfaxalone Or Propofol on Giant-Breed Dog Neonates Viability
animals Article Effects of Alfaxalone or Propofol on Giant-Breed Dog Neonates Viability During Elective Caesarean Sections Monica Melandri 1, Salvatore Alonge 1,* , Tanja Peric 2, Barbara Bolis 3 and Maria C Veronesi 3 1 Società Veterinaria “Il Melograno” Srl, 21018 Sesto Calende, Varese, Italy; [email protected] 2 Department of Agricultural, Food, Environmental and Animal Sciences, University of Udine, 33100 Udine, Italy; [email protected] 3 Department of Veterinary Medicine, Università degli Studi di Milano, 20100 Milan, Italy; [email protected] (B.B.); [email protected] (M.C.V.) * Correspondence: [email protected]; Tel.: +39-392-805-8524 Received: 20 September 2019; Accepted: 7 November 2019; Published: 13 November 2019 Simple Summary: Nowadays, thanks to the increased awareness of owners and breeders and to the most recent techniques available to veterinarians, the management of parturition, especially of C-sections, has become a topic of greater importance. Anesthesia is crucial and must be targeted to both the mother and neonates. The present study aimed to evaluate the effect of the induction agent alfaxalone on the vitality of puppies born from elective C-section, in comparison to propofol. After inducing general anesthesia for elective C-section, puppies from the mothers induced with alfaxalone had higher 5-min Apgar scores than those induced with propofol. The concentration of cortisol in fetal fluids collected at birth is neither influenced by the anesthetic protocol used, nor does it differ between amniotic and allantoic fluids. Nevertheless, the cortisol concentration in fetal fluids affects the relationship between anesthesia and the Apgar score: the present study highlights a significant relationship between the anesthetic protocol used and Apgar score in puppies, and fetal fluids cortisol concentration acts as a covariate of this relationship. -
Visualizing Anesthesia-Induced Vasodilation of Cerebral Vasculature Using Multi-Exposure Speckle Imaging
bioRxiv preprint doi: https://doi.org/10.1101/2020.06.26.174227; this version posted June 29, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY 4.0 International license. Visualizing anesthesia-induced vasodilation of cerebral vasculature using multi-exposure speckle imaging Colin T. Sullendera, Lisa M. Richardsa, Fei Heb, Lan Luanb,c, Andrew K. Dunna,* aDepartment of Biomedical Engineering, University of Texas at Austin, 107 W. Dean Keeton Street Stop C0800, Austin, Texas, 78712, United States bDepartment of Electrical and Computer Engineering, Rice University, 6100 Main Street, Houston, TX, 77005, United States cDepartment of Bioengineering, Rice University, 6100 Main Street, Houston, TX, 77005, United States Abstract. Anesthetized animal models are used extensively during neurophysiological and behavioral studies despite systemic effects from anesthesia that undermine both accurate interpretation and translation to awake human physi- ology. In this paper, we characterize the impact of isoflurane on cerebral blood flow (CBF) during the induction of general anesthesia in awake mice using multi-exposure speckle imaging (MESI). We highlight the large anatomical changes caused by the vasodilatory inhalant with wide-field imagery and quantify the cortical hemodynamics with MESI across multiple subjects and imaging sessions. Compared to the awake state, we measured, on average, an 18% increase in surface vessel diameter accompanied by a 135% increase in vascular flux and 92% increase in parenchyma perfusion. These large alterations to the cortical vasculature and CBF are unrepresentative of normal physiology and provide further evidence that neuroscience experiments would benefit from transitioning to un-anesthetized awake animal models. -
Pharmacological Classification of the Abuse-Related Discriminative
Ashdin Publishing Journal of Drug and Alcohol Research ASHDIN Vol. 3 (2014), Article ID 235839, 10 pages publishing doi:10.4303/jdar/235839 Research Article Pharmacological Classification of the Abuse-Related Discriminative Stimulus Effects of Trichloroethylene Vapor Keith L. Shelton and Katherine L. Nicholson Department of Pharmacology and Toxicology, School of Medicine, Virginia Commonwealth University, P.O. Box 980613, Richmond, VA 23298, USA Address correspondence to Keith L. Shelton, [email protected] Received 10 December 2013; Revised 2 January 2014; Accepted 27 January 2014 Copyright © 2014 Keith L. Shelton and Katherine L. Nicholson. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Inhalants are distinguished as a class primarily based upon common means of administration suggests a homogeneity of a shared route of administration. Grouping inhalants according to mechanism and behavioral effects that may be scientifically their abuse-related in vivo pharmacological effects using the drug unwarranted. As an illustration of the inadequacy of this discrimination procedure has the potential to provide a more relevant classification scheme to the research and treatment community. simplistic taxonomic approach, consider the fact that if a Mice were trained to differentiate the introceptive effects of the similar system was applied to other common drugs of abuse, trichloroethylene vapor from air using an operant procedure. then tobacco, crack cocaine, and marijuana would be treated Trichloroethylene is a chlorinated hydrocarbon solvent once used as a single category. Instead, other classes of abused drugs as an anesthetic as well as in glues and other consumer products. -
Post-Intubation Analgesia and Sedation
POST-INTUBATION ANALGESIA AND SEDATION August 2012 J Pelletier Intubated patients experience pain and anxiety Mechanical ventilation, endotracheal tube Blood draws, positioning, suctioning Surgical procedures, dressing changes Awareness during neuromuscular blockade Invasive catheters Loss of control Unrelieved pain and anxiety cause adverse effects Self-injury and removal of life-sustaining devices Increased endogenous catecholamines Sleep deprivation, anxiety, and delirium Impaired post-ICU psychological recovery Emotional and posttraumatic effects Ventilator dysynchrony Immunosuppression Treating pain and anxiety improves outcomes Use of pain and sedation scales in critically ill patients allows: precise dosing reduced medication side effects reduced ICU and hospital length of stay shorter duration of mechanical ventilation Analgesics should be provided first, then anxiolysis If you were intubated, how much lorazepam or midazolam, and fentanyl would you want per hour? Intubated ED patients receive inadequate analgesia and sedation Retrospective study, tertiary ED 50% received no analgesia, 30% received no anxiolytic Of patients receiving postintubation vecuronium, 96% received either no or inadequate anxiolysis or analgesia Overall, 3 of 4 patients received no or inadequate analgesia and an equivalent number received no or inadequate anxiolysis Bonomo 2007 Analgesia: opioids Bind CNS and peripheral tissue receptors Mu-1 receptors: analgesia Mu-2 receptors: respiratory depression, vomiting, constipation, and -
The Cardiovascular and Respiratory Effects of Isoflurane-Nitrous Oxide Anaesthesia
THE CARDIOVASCULAR AND RESPIRATORY EFFECTS OF ISOFLURANE-NITROUS OXIDE ANAESTHESIA WILLIAM M. DOLAN, M.D.S, WENDELL C. STEVENS, M.D.,O EDMOND I. EGER, II, M.D.,* TnOlX~AS H. CROMWELL, M.D,, c* MICHAEL J. HALSEY, PH.D.,C* THOMAS F. SHAKESPEAlqE, Ik~.D.,c* AND RONALD D. MILLER, M.D. c* INTRODUCTION ISOFLURAnE (Forane| 1 chloro-2-2-2 trifluoroethyl, difluoromethyl ether), is a halogenated ether currently being evaluated for use as an inhalational anaesthetic. Its favourable properties include non-flammability, 1 relatively low blood and fat solubilities (blood-gas and oil-gas partitions of 1.4 and 99, respectively), 1,2 mole- cular stability resulting in resistance to dehydrohalogenation and hepatic meta- bolism, 1,~ lack of sensitization of the heart to catecholamines, 4 and favourable depression of neuromuscular function and potentiation of muscle relaxants. ~ However, isoflurane can produce profound depression of ventilation and blood pressure. ~ Since the concurrent use of nitrous oxide with halothane attenuates the hypotension and ventilatory depression caused by halothane, s,'~,l~ we asked whether nitrous oxide would produce similar changes towards awake values dur- ing isoflurane anaesthesia. METHODS We studied the cardiovascular and respiratory effects of anaesthesia with iso- flurane and 70 per cent nitrous oxide in eight healthy, unpremedicated volun- teers. The volunteers were 25 --4- 1 (SD) years of age and were informed of the purposes, procedures, and hazards of the study. The protocol was approved by the Committee on Human Experimentation of the University of California, San Francisco. A normal medical history, physical examination, chest roentgenogram, complete blood count, serum glutamic oxaloacetic transanainase and lactic de- hydrogenase were required before a volunteer was accepted for anaesthesia. -
Synthetic Method for Fluoromethylation Of
Europäisches Patentamt *EP001286941B1* (19) European Patent Office Office européen des brevets (11) EP 1 286 941 B1 (12) EUROPEAN PATENT SPECIFICATION (45) Date of publication and mention (51) Int Cl.7: C07C 43/12, C07C 41/16, of the grant of the patent: C07C 41/22, C07C 41/28, 20.07.2005 Bulletin 2005/29 C07C 41/52, C07C 43/313 (21) Application number: 01939633.2 (86) International application number: PCT/US2001/017348 (22) Date of filing: 30.05.2001 (87) International publication number: WO 2001/092193 (06.12.2001 Gazette 2001/49) (54) SYNTHETIC METHOD FOR FLUOROMETHYLATION OF HALOGENATED ALCOHOLS VERFAHREN ZUR FLUORMETHYLIERUNG VON HALOGENIERTEN ALKOHOLEN PROCEDE DE SYNTHESE DE FLUOROMETHYLATION D’ALCOOLS HALOGENES (84) Designated Contracting States: (72) Inventors: AT BE CH CY DE DK ES FI FR GB GR IE IT LI LU • BIENIARZ, Christopher MC NL PT SE TR Highland Park, IL 60035 (US) Designated Extension States: • RAMAKRISHNA, Kornepati, V. RO SI Libertyville, IL 60048 (US) (30) Priority: 01.06.2000 US 587421 (74) Representative: Modiano, Guido, Dr.-Ing. et al Modiano, Josif, Pisanty & Staub, (43) Date of publication of application: Baaderstrasse 3 05.03.2003 Bulletin 2003/10 80469 München (DE) (73) Proprietor: Abbott Laboratories (56) References cited: Abbott Park, IL 60064-6050 (US) EP-A- 0 822 172 GB-A- 1 250 928 Note: Within nine months from the publication of the mention of the grant of the European patent, any person may give notice to the European Patent Office of opposition to the European patent granted. Notice of opposition shall be filed in a written reasoned statement.