Key Points ▪ Perioperative risk is multifactorial and may occur as a result of anesthesia-, surgery-, and/or patient-specific factors. ▪ Anesthesia-related (and surgery-related) risk is typically defined as morbidity and mortality occurring within 30 days of surgery, although events that…
Key Points ▪ Local anesthetics block voltage-gated sodium channels and thereby interrupt initiation and propagation of impulses in axons, but they have a wide variety of other biologic actions, desirable and undesirable. ▪ Currently available local anesthetics are of two…
Key Points ▪ Appropriate reversal of a nondepolarizing neuromuscular blockade is essential to avoid adverse patient outcomes. Complete recovery of muscle strength should be present, and the residual effects of neuromuscular blocking drugs (NMBDs) should be fully pharmacologically reversed (or…
Key Points ▪ Two different populations of nicotinic acetylcholine receptors exist at the mammalian neuromuscular junction. In the adult, the nicotinic acetylcholine receptor at the postsynaptic (muscular) membrane is composed of α 2 βδε subunits, while the fetal (immature) receptor…
Key Points ▪ The pharmacokinetics of anesthetic drugs are described by multicompartment models. Accurate intravenous drug delivery requires adjusting the maintenance infusion rates to take into account the accumulation of the drug in the peripheral tissues. ▪ Biophase is the…
Key Points ▪ With a better understanding of pain pathways and mechanisms, it has been recognized that ion channels play an important role in the transduction, transmission, and modulation of nociceptive signals. This opens a new avenue of developing novel…
Key Points ▪ Opioids are a vital part of providing the analgesic component of anesthesia and often form the foundation for postoperative pain management. ▪ Opioids suppress pain by targeting multiple sites throughout the nervous system including action in brain,…
Key Points ▪ The introduction of thiopental into clinical practice in 1934 marked the beginning of modern intravenous (IV) anesthesia. Today, IV anesthetics are used for induction and maintenance of anesthesia and sedation in a wide variety of circumstances. ▪…
Key Points ▪ The modern anesthesia workstation has evolved into a complex device with a number of safety features. However, if there is any possibility that the workstation or the breathing circuit is a potential cause of difficulty with ventilation…
Key Points ▪ Inhaled anesthetics affect every part of physiology of the lungs and their pulmonary pharmacology is complex. ▪ Volatile anesthetics produce bronchodilation through decreases in cytoplasmic ionized calcium concentration and/or a reduction in calcium sensitivity of airway smooth…