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Anaesthesia defined (gentlemen, this is no humbug).

Abstract

Our charge was to define anaesthesia as produced by inhaled anaesthetics. A definition may be useful to an understanding of the anaesthetic state, and it may guide studies of the mechanisms by which anaesthesia is produced. All inhaled anaesthetics act on the central nervous system to produce two reversible conditions, immobility and amnesia, that define the anaesthetic state. No other reversible, clinically useful, conditions are essential to the definition. Some conditions are unmeasurable (unconsciousness), not present for all inhaled anaesthetics (relaxation), or are not present at anaesthetizing concentrations (suppression of autonomic reflexes.) One (analgesia) is unmeasurable (the anaesthetized patient cannot tell an investigator that he/she hurts or does not hurt), and surrogate measures (increases in breathing, blood pressure, and heart rate with surgery) suggest that some pain is perceived. These and myriad other changes produced by inhaled anaesthetics are side effects; they do not define anaesthesia; only immobility and amnesia supply such a definition.

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BibTeXRIS

Edmond I Eger, James M Sonner. 2006. Anaesthesia defined (gentlemen, this is no humbug).. https://doi.org/10.1016/j.bpa.2005.07.011

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The effects of isoflurane, sevoflurane, and desflurane anesthesia on neurocognitive outcome after cardiac surgery: a pilot study.

BACKGROUND: Inhalation anesthetics such as isoflurane, sevoflurane, and desflurane are widely used in clinical practice; however, there is no study for comparing these drugs in cardiac surgery with respect to postoperative cognitive outcome and S100 beta protein (S100 BP) levels. In this study, we evaluated the effect of sevoflurane, isoflurane, and desflurane anesthesia on neuropsychological outcome and S100 BP levels in patients undergoing coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB). MATERIALS AND METHODS: Forty-two male patients were prospectively randomized and classified into 3 groups according to the volatile agents used; isoflurane, sevoflurane, desflurane. All patients had a sufficient education level to participate in neuropsychological testing and a normal carotid Doppler ultrasonography. Blood samples for analysis of S100 BP were collected before anesthesia (T1), before heparinization (T2), 15 minutes into CPB (T3), following protamine administration (T4), postoperatively (T5), 24 hours after the operation (T6), postoperative day 3 (T7), and postoperative day 6 (T8). The neuropsychological tests, including Mini-Mental State Examination (MMSET) and visual-aural digit span test (VADST), were administered 1 day prior to surgery and on the third and sixth postoperative days. RESULTS: The postoperative third and sixth day MMSET scores and third day visual-written subtest scores in the sevoflurane group were significantly lower than in the isoflurane and desflurane groups (P < .05). S100 BP levels increased with the beginning of anesthesia in the sevoflurane and desflurane groups. Although S100 BP decreased to baseline levels on postoperative day 1 in the sevoflurane group, this was significantly higher on the third and sixth days postoperatively in the desflurane group (P < .05). In the isoflurane group, the S100 BP level was significantly higher than the baseline level only after CPB (P < .05). CONCLUSION: Our study suggests that isoflurane is associated with better neurocognitive functions than desflurane or sevoflurane after on-pump CABG. Sevoflurane seems to be associated with the worst cognitive outcome as assessed by neuropsychologic tests, and prolonged brain injury as detected by high S100 BP levels was seen with desflurane.

Anesthesia, Inhalation↗