Author: Jürgen Schüttler, Helmut Schwilden
Publisher: Springer
Date: January 2008
Pages: 498
Description:
Some important constraints of anesthesia must be taken into consideration when the pharmacological properties of modern anesthetics are discussed. The most important of these could be that the target effect be achieved preferably within seconds, at most within a few minutes. Similarly, offset of drug action should be achieved within minutes rather hours. The target effects, such as unconsciousness, are potentially life-threatening, as are the side effects of modern anesthetics, such as respiratory and cardiovascular depression. Finally, the patient's purposeful responses are not available to guide drug dosage, because, either the patient is unconscious, or more problematically, the patient is aware but unable to communicate pain because of neuromuscular blockade.
These constraints were already recognised 35 years ago. Today "general anesthesia" is commonly considered a collection of neurophysiologically very different states, achieved by a multitude of very different drugs (delivered not only by inhalation) acting on a plethora of subcellular structures. Unconsciousness and absence of pain are always included in this collection of different states.
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