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1、CHAPTER16ANESTHESIOLOGYPRINCIPLES,PAINMANAGEMENT,ANDCONSCIOUSSEDATIONEdwardR.Sherwood,CourtneyG.Williams,andDonaldS.Proughcontrast,currentanesthesiapracticecombinesanumberofpharmacologicprinciplesagents,oftenincludingregionaltechniques,toachievespecificanesthesiaequipmente
2、ndpoints.Althoughinhalationalagentsremainthecoreofpatientmonitoringduringandafteranesthesiamodernanestheticcombinations,mostanesthesiologistsinitiatepreoperativeevaluationanesthesiawithintravenous(IV)inductionagentsandthenselectionofanesthetictechniquesanddrugsmaintainanes
3、thesiawithinhalationalagentssupplementedbyairwaymanagementIVopioidsandmusclerelaxants.Benzodiazepinesareoftenregionalanesthesiaaddedtoinduceanxiolysisandamnesia.conscioussedationpostanesthesiacareInhalationalAgentsacutepainmanagementTheoriginalinhalationalanesthetics—ether
4、,nitrousoxide,andchloroform—hadimportantlimitations.Subsequentdrugconclusiondevelopmenthasemphasizedinhalationalagentsthatfacilitaterapidinductionandemergenceandarenontoxic;theseincludeisoflurane,sevoflurane,anddesflurane.Althoughhalo-Therelativelybriefhistoryofanesthesiol
5、ogybeganmorethanthaneandenfluranewerealsocommonlyusedinthepast,the150yearsagowiththeadministrationofthefirstetheranes-useofbothagentshasdecreaseddramaticallyduringthelast5thetic.Throughoutmuchofitssubsequenthistory,theriskofto10years.Theimportantaspectsofeachvolatileanesth
6、eticanesthesia-relatedmortalityandmorbiditywasunacceptablycanbesummarizedintermsoftheirkeyclinicalattributeshighbecauseofprimitiveequipment,complication-pronedrugs,(Table16-1).Twoofthemostimportantcharacteristicsofandlackofadequatemonitors.However,duringthepast5inhalationa
7、lanestheticsaretheblood-gas(B-G)solubilitydecades,rapidtechnologicandpharmacologicprogresshave(partition)coefficientandtheminimumalveolarconcentra-resultedintheabilitytoprovideanesthesiasafelyforcomplextion(MAC).TheB-Gsolubilitycoefficientisameasureofthesurgicalprocedures,
8、eveninpatientswithsevereunderlyinguptakeofanagentbyblood.Ingeneral,lesssolubleagentsdisea
