Articles: general-anesthesia.
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To understand the cellular and molecular basis of the anaesthetic state, it is important to remember that, in the intact CNS, synapses operate within elaborate nerve networks. From the data presented above, it is evident that block of impulse conduction in presynaptic fibres does not explain the effects of most anesthetics on synaptic activity. This is not surprising since some anaesthetics, the barbiturates in particular, may both depress excitation and enhance inhibition. ⋯ The overall effect of an anaesthetic agent depends on summation of events occurring at the many individual synapses and neurones that make up the network. The effects of anaesthetics on different neuronal pathways may therefore depend on the nature of the receptors and ion channels of the cells that comprise the network. The anaesthetic state may be the result of all these actions, but the characteristics of the state may differ somewhat from agent to agent.
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Rev Esp Anestesiol Reanim · Jul 1993
Review[Evaluation of anesthetic techniques in ambulatory surgery].
Many of the surgical procedures performed in the hospital can be done on an out-patient basis, provided an appropriate anesthetic technique is applied to allow the patient to return home comfortably and safely. Choice of anesthetic technique must always be made in keeping with patient characteristics and type of surgery. Treatment of anxiety in a preoperative interview or by giving tranquilizers will be beneficial to all patients, as will reduction of gastric secretion by administration of H2 receptor blockers. ⋯ Propofol, alfentanyl, atracurium or vecuronium require the shortest recovery time. For epidural anesthesia, we use lidocaine and mepivacaine. Truncal blocks, endovenous regional anesthesia, and brachial plexus, retrobulbar and peribulbar blocks are all appropriate techniques for out-patient surgery.
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Mivacurium is a potent nondepolarising neuromuscular blocking agent which is structurally related to the benzylisoquinolinium compound, atracurium. Mivacurium has a short duration of action due to its rapid elimination by plasma cholinesterase. When administered to essentially healthy adult patients receiving nitrous oxide-narcotic anaesthesia, the recommended intubating dose (2 x ED95) usually provides clinically effective neuromuscular block for approximately 15 to 20 minutes and spontaneous recovery is 95% complete within about 25 to 30 minutes. ⋯ In summary, a single bolus dose of mivacurium can be recommended for use in adult and paediatric patients undergoing nonemergency tracheal intubation and/or during short surgical procedures. For maintenance of neuromuscular block, mivacurium can be administered as multiple bolus doses or as a continuous infusion. In particular, the lack of a significant cumulative effect renders the drug suitable for the maintenance of neuromuscular blockade during extended surgical procedures of unpredictable length.