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To induce general anesthesia, propofol is the drug used almost exclusively, having largely replaced sodium thiopental. [13]It is often administered as part of an anesthesia maintenance technique called total intravenous anesthesia, using either manually programmed infusion pumps or computer-controlled infusion pumps in a process called target controlled infusion (TCI).
Total intravenous anesthesia (TIVA) refers to the intravenous administration of anesthetic agents to induce a temporary loss of sensation or awareness. The first study of TIVA was done in 1872 using chloral hydrate , [ 1 ] and the common anesthetic agent propofol was licensed in 1986.
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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
General anesthesia is usually considered safe; however, there are reported cases of patients with distortion of taste and/or smell due to local anesthetics, stroke, nerve damage, or as a side effect of general anesthesia. [46] [47] At the end of surgery, administration of anaesthetic agents is discontinued.
[9] [10] These features can be desirable for endoscopic procedures such as esophagogastroduodenoscopy, colonoscopy, bronchoscopy, as well as for some surgical procedures done under local or regional anesthesia. Propofol is further metabolised to propofol glucuronide (34.8%) and quinol glucuronide. [11]
SponTaneous Respiration using IntraVEnous anaesthesia and High-flow nasal oxygen (STRIVE Hi) is an open airway technique that uses an upwards titration of propofol which maintains ventilation at deep levels of anaesthesia. It has been used in airway surgery as an alternative to tracheal intubation. [99]
The BIS is an electroencephalogram-derived multivariant scale that, when a drug such a propofol is used, correlates with the metabolic rate of glucose. [15] Both loss of consciousness and awakening from anesthesia are correlated with this scale. [16] The efficacy of BIS index monitoring is not without controversy. [17]