Drugs in Neuroanesthesia

The complex interplay between the effects of drugs and physiological variables, such as arterial carbon dioxide (CO2) tension, body temperature and arterial blood pressure, during clinical neuroanesthesia makes the interpretation of experimental data from the use of particular drugs in isolation difficult. However, in most cases, the administration of a combination of agents, together with manipulation of mechanical ventilation, fluid therapy and temperature, will allow the anesthesiologist to produce the physiological conditions required for optimal surgery. The basis of general anesthesia is to establish the 'triad' of hypnosis (or amnesia), muscle relaxation and suppression of sympathetic reflexes (or analgesia). Each aspect of this triad may be achieved with a variety of drugs and, in order to minimize dose-dependent adverse effects, combinations of agents are generally used. Neuroanesthetic agents will therefore be discussed here under the headings of "sedatives/hypnotics" (including volatile anesthetics), "neuromuscular blocking drugs" (muscle relaxants) and "opioids" (analgesics).

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