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The second edition appeared in 1986, with total content filling more than 2400 pages spread over three separate volumes. Although it was criticized for lack of cross-referencing and noticeable differences in writing styles due to a higher number of contributors, Miller's Anesthesia soon became the "standard encyclopedic textbook of anesthesia". [1]
Anesthesiology, anaesthesiology or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. [1] It encompasses anesthesia, intensive care medicine, critical emergency medicine, and pain medicine. [2]
The purpose of anesthesia can be distilled down to three basic goals or endpoints: [2]: 236 hypnosis (a temporary loss of consciousness and with it a loss of memory.In a pharmacological context, the word hypnosis usually has this technical meaning, in contrast to its more familiar lay or psychological meaning of an altered state of consciousness not necessarily caused by drugs—see hypnosis).
General anaesthesia (UK) or general anesthesia (US) is medically induced loss of consciousness that renders a patient unarousable even by painful stimuli. [5] It is achieved through medications, which can be injected or inhaled, often with an analgesic and neuromuscular blocking agent .
To determine the depth of anesthesia, the anesthetist relies on a series of physical signs of the patient. In 1847, John Snow (1813–1858) [1] and Francis Plomley [2] attempted to describe various stages of general anesthesia, but Guedel in 1937 described a detailed system which was generally accepted. [3] [4] [5]
General anesthesia does not always require the anesthetic machine, tested daily, as basic equipment. Anesthesia machines may differ in appearance, size and degree of sophistication but generally speaking, they consist of sections for: ventilation; Peripheral Nerve Stimulator; space for monitoring equipment; accessories; storage space; worktop
High flow anesthesia supplies fresh gas flow which approximates the patient’s minute ventilation, which is usually about 3 to 6 litres per minute in a normal adult. Low flow anesthesia supplies fresh gas flow of less than half the patient's minute ventilation of the patient, which is usually less than 3.0 litres per minute in a normal adult.
The Meyer-Overton correlation for anaesthetics. A nonspecific mechanism of general anaesthetic action was first proposed by Emil Harless and Ernst von Bibra in 1847. [9] They suggested that general anaesthetics may act by dissolving in the fatty fraction of brain cells and removing fatty constituents from them, thus changing activity of brain cells and inducing anaesthesia.