Inhalational anesthetics have been used to induce and maintain general anaesthesia for more than 150 years. These anaesthetic agents are commonly used in the surgical and clinical practice solely and as a conjugant with other anaesthetics. Since inhalational anaesthetic agents develop amnesia, loss of awareness, and reduce reactions to painful surgical stimuli, they are an essential part of general anaesthesia. The choice of anaesthetic agent is based on the procedure's duration and type, patient characteristics, the attending anaesthesiologist’s preferences, and occasionally on institutional protocols. These medications are administered to the patient through the anesthetic circuit using a special vaporizer. The purpose of this research is to review the available information about inhalation anaesthetics: types, mechanism of action and adverse effects. Nitrous oxide is one of the earliest anaesthetic agents while isoflurane, sevoflurane, and desflurane are three commonly used inhalational anaesthetics. The low-solubility inhalation anaesthetics desflurane and sevoflurane have several clinical advantages over isoflurane, including rapid induction and faster recovery after prolonged treatment. However, isoflurane can sometimes be used effectively enough to match the induction and recovery times of other drugs. Inhalation anaesthetics work by suppressing inhibitory signals such as chloride channels and potassium channels and enhancing excitatory signals such as acetylcholine, muscarinic and nicotinic receptors, glutamate and serotonin in the central nervous system. Certain side effects including nausea, vomiting, malignant hyperthermia, post-operative cognitive impairment is associated with their use. More research is needed to further enhance the safety profile of available inhalation anaesthetics and can further lead to discovery of new, safe anaesthetics.
Magnetic resonance imaging (MRI) is extensively used for the diagnostic purposes. Patients who undergo MRI usually spend 30 to 45 minutes in a magnetically confined, loud environment. Therefore, in order to obtain high-quality diagnostic images, the majority of children and agitated adults need anaesthesia or sedation to remain calm and in position. The success of sedation for MRIs has typically been evaluated based on both the safety of the procedure and its efficacy. It can be challenging to keep the patient's respiration and hemodynamic steady while achieving the profound sedation level required to stop them from moving. The purpose of this research is to review the available information about drug selection for sedation in MRI. For painless diagnostic MRI, a single sedative or anaesthetic drug without analgesia is safer than a cocktail of several sedatives. Various commonly used drugs for sedation are dexmedetomidine, ketamine, chloral hydrate, midazolam, pentobarbital among others. Each drug has its own efficacy and safety profile along with certain side effects. It is critically important for the physician to choose the sedative drug appropriately. Drugs used for sedative purposes should have some definite characteristics including quick onset of action, wide therapeutic window, predictable duration among certain others. Dexmedetomidine, which preserves respiratory drive, and propofol, which has a high effectiveness and quick recovery, are currently chosen for children having an ambulatory MRI. Also, the combination of these drugs is used to sedate patients. Research in future can significantly contribute to defining elaborated criteria for selection of drugs since the available literature is scarce and limited mainly to paediatric population studies.
The COVID-19 pandemic has forced many countries to pose an emergency to contain the contamination and prevent the further spread of the infection. In this context, many societies and research papers were published to optimize guidelines and protocols for patients undergoing surgery and subsequent intubation. Accordingly, infection control is a critical approach to reduce the rate of contamination and risk of catching infections for suspected and confirmed COVID-19 patients. As a result, various guidelines were discussed in the current literature review, including guidelines to the patient, healthcare workers, operating room, anesthesia equipment, and patient transportation. For instance, healthcare workers can protect themselves from catching infections by wearing personal protective equipment and conducting adequate disinfection measures following each operation, in addition to the proper disposal of the contaminated objects. Strictly following these protocols should be done to reduce the risk of contamination in the operating room and enhance the outcomes of the patients and healthcare workers.
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