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TIVA is maintained by intravenous infusion devices and assisted by electroencephalography (EEG) monitoring. These techniques facilitate the use of propofol, etomidate, ketamine, and other intravenous anesthetic agents. During or after TIVA, patients may be subjected to an elevated risk of anesthesia awareness, hyperalgesia and neurotoxicity. [2]
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]
Anesthesia is a combination of the endpoints (discussed above) that are reached by drugs acting on different but overlapping sites in the central nervous system. General anesthesia (as opposed to sedation or regional anesthesia) has three main goals: lack of movement , unconsciousness, and blunting of the stress response. In the early days of ...
[1] [7] One survey of anesthesiologists who practice intravenous regional anesthesia found that 98% used adjuvant benzodiazepines and/or opioids, with benzodiazepines always being given systemically (to the whole body and brain), whereas opioids can be given either systemically or locally (only into the limb being anesthetized). Most providers ...
Anesthesia – pharmacologically induced and reversible state of amnesia, analgesia, loss of responsiveness, loss of skeletal muscle reflexes or decreased sympathetic nervous system, or all simultaneously. This allows patients to undergo surgery and other procedures without the distress and pain they would otherwise experience.
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).
Ketamine is also used to manage pain among large animals. It is the primary intravenous anesthetic agent used in equine surgery, often in conjunction with detomidine and thiopental, or sometimes guaifenesin. [174] Ketamine appears not to produce sedation or anesthesia in snails. Instead, it appears to have an excitatory effect. [175]
Target-controlled infusion (TCI) automates the dosing of intravenous drugs during surgery.After the anesthetist sets the desired parameters in a computer and presses the start button, the system controls the infusion pump, while being monitored by the anesthetist. [1]