tailieunhanh - CLINICAL PHARMACOLOGY 2003 (PART 20)

The administration of general anaesthetics and neuromuscular blocking drugs is generally confined to trained specialists. Nevertheless, nonspecialists are involved in perioperative care and will benefit from an understanding of how these drugs act. Doctors from a variety of specialties use local anaesthetics and the pharmacology of these drugs is discussed in detail. General anaesthesia Pharmacology of anaesthetics Inhalation anaesthetics Intravenous anaesthetics Muscle relaxants: neuromuscular blocking drugs Local anaesthetics Obstetric analgesia and anaesthesia Anaesthesia in patients already taking drugs Anaesthesia in the diseased, the elderly and children; sedation in intensive therapy units could operate for the first time with careful deliberation | 18 SECTION 4 Anaesthesia and neuromuscular block SYNOPSIS The administration of general anaesthetics and neuromuscular blocking drugs is generally confined to trained specialists. Nevertheless nonspecialists are involved in perioperative care and will benefit from an understanding of how these drugs act. Doctors from a variety of specialties use local anaesthetics and the pharmacology of these drugs is discussed in detail. General anaesthesia Pharmacology of anaesthetics Inhalation anaesthetics Intravenous anaesthetics Muscle relaxants neuromuscular blocking drugs Local anaesthetics Obstetric analgesia and anaesthesia Anaesthesia in patients already taking drugs Anaesthesia in the diseased the elderly and children sedation in intensive therapy units could operate for the first time with careful deliberation. The problem of inducing quick safe and easily reversible unconsciousness for any desired length of time in man only began to be solved in the 1840s when the long-known substances nitrous oxide ether and chloroform were introduced in rapid succession. The details surrounding the first use of surgical anaesthesia were submerged in bitter disputes on priority following an attempt to take out a patent for ether. The key events around this time were 1842 W. E. Clarke of Rochester New York administered for a dental extraction. However this event was not made widely known at the time. 1844 Horace Wells a dentist in Hartford Connecticut introduced nitrous oxide to produce anaesthesia during dental extraction. 1846 On October 16 William Morton a Boston dentist successfully demonstrated the anaesthetic properties of ether. 1846 On December 21 Robert Liston performed the first surgical operation in England under ether General anaesthesia Until the mid-19th century such surgery as was possible had to be undertaken at tremendous speed. Surgeons did their best for terrified patients by using alcohol opium hyoscine 1 or cannabis. With the introduction of general