Anesthesia usually involves a loss of memory and awareness, along with insensitivity to painful stimuli, during a surgical procedure. Many drugs aid anesthesiologists in the management and comfort of their patients during the perioperative period. These compounds vary in their chemical and physical characteristics and in their usual routes of administration. There are inhalational agents, including volatile liquids and gases, and intravenously administered drugs.
While many of the individual compounds produce anesthesia, each one's unique pharmacokinetic and pharmacological characteristics will determine the way the practitioner uses the agent. This chapter focuses on these characteristics so that their influence on the anes thesiologist's choice of anesthetic technique will be understood.
Contemporary anesthetic management requires (1) rapid loss of consciousness, which eliminates awareness, memory of pain, anxiety, and stress throughout the surgical period; (2) a level of analgesia sufficient to abolish the reflex reactions to pain, such as muscular movement and cardiovascular stimulation; (3) minimal and reversible influence on vital physiological functions, such as those performed by the cardiovascular and respiratory systems; (4) relaxation of skeletal muscle to facilitate endotracheal intubation, provide the surgeon ready access to the operative field, and reduce the dose of anesthetic required to produce immobility; (5) lack of operating room safety hazards, such as flammability and explosiveness; and (6) prompt patient recovery to psychomotor competence, facilitating the clinician's assessment of the patient and the patient's ability to become physiologically self-supporting.
While none of the anesthetic drugs discussed in this chapter possesses all of the features required for ideal anesthetic management (a summary of these features is presented in Table 25.1), the patient's needs are usually met with the use of anesthetic drugs and/or adjunctive agents, such as neuromuscular blocking drugs, opioids, and vasoactive substances. Balanced anesthesia is a term used to describe the multidrug approach to managing the patient's anesthetic needs. Balanced anesthesia takes advantage of each drug's beneficial effects while minimizing each agent's adverse qualities.
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