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High concentrations of enflurane may cause spike-and-wave activity

and muscle twitching, but this effect is unique to this drug.

nitrous oxide has low anesthetic potency (ie, a high
M!", it exerts marked analgesic and amnestic actions
#nflurane and halothane are
myocardial depressants that decrease cardiac output, whereas
isoflurane, desflurane, and sevoflurane cause peripheral vasodilation.
$itrous oxide has the smallest effect
on respiration. Most inhaled anesthetics are bronchodilators, but
desflurane is a pulmonary irritant and may cause bronchospasm.
%he pungency of enflurane causing breath-holding limits its use
in anesthesia induction
&rolonged exposure to nitrous oxide decreases
methionine synthase activity and may lead to megaloblastic anemia.
'antrolene is indicated for the treatment of malignant hyperthermia
life-threatening condition, with supportive management
Neuroleptanesthesia is a state of analgesia and amnesia is produced
when fentanyl is used with droperidol and nitrous oxide
(ecovery from the actions of remifentanil
is faster than recovery from other opioids used in anesthesia
because of its rapid metabolism by blood and tissue esterases
&ropofol has antiemetic
%his imida)ole derivative affords rapid induction with minimal
change in cardiac function or respiratory rate and has a short duration
of action. %he drug is not analgesic, and its primary advantage
is in anesthesia for patients with limited cardiac or respiratory
reserve. #tomidate may cause pain and myoclonus on in*ection
and nausea postoperatively. &rolonged administration may cause
adrenal suppression
%his centrally acting +,-adrenergic agonist has analgesic and
hypnotic actions when used intravenously
This can be accomplished by administration of a vasoconstrictor
(usually an -agonist sympathomimetic) with the local
anesthetic agent. Cocaine is an important exception because it has
intrinsic sympathomimetic action due to its inhibition of norepinephrine
reuptake into nerve terminals. The longer-acting agents
(eg, bupivicaine, ropivicaine, tetracain) are also less dependent on the
coadministration of vasoconstrictors
etabolism of ester local anesthetics is carried out by plasma
cholinesterases (pseudocholinesterases) and is very rapid for procaine
(half-life, !"# min), slower for cocaine, and very slow for tetracaine).
The amides are metaboli$ed in the liver, in part by cytochrome %&'(
*ll local anesthetics are capable of producing a spectrum of
central e+ects, including light-headedness or sedation, restlessness,
nystagmus, and tonic-clonic convulsions.(,-.-T/)
0ith the exception of cocaine, all local anesthetics are vasodilators.
The (,)isomer,
levobupivicaine, is less cardiotoxic.
0hen cocaine is
used as a drug of abuse, its cardiovascular toxicity includes severe
hypertension with cerebral hemorrhage, cardiac arrhythmias, and
myocardial infarction.
%rilocaine is metaboli$ed to products that include o-toluidine,
an agent capable of converting hemoglobin to methemoglobin
The ester-type local anesthetics are metaboli$ed
to products that can cause antibody formation in some
1rugs that are metaboli$ed (eg, mivacurium, by plasma cholinesterase)
or eliminated in the bile (eg, vecuronium) have shorter durations
of action (!("#( min) than those eliminated by the kidney (eg,
metocurine, pancuronium, pipecuronium, and tubocurarine), which
usually have durations of action of less than 2' min
)n addition to hepatic metabolism, atracurium clearance involves rapid
breakdown (3ofmann elimination) to form laudanosine and
other products. *t high blood levels, laudanosine may cause sei$ures.
Cisatracurium, a stereoisomer of atracurium, is also inactivated spontaneously
but forms less laudanosine and currently is one of the most
commonly used muscle relaxants in clinical practice.
4f the available nondepolari$ing drugs,
rocuronium (5("!#( s) has the most rapid onset time
,uccinylcholine is metaboli$ed by
cholinesterase (butyrylcholinesterase or pseudocholinesterase) in the
liver and plasma. )t has a duration of action of only a few minutes if
given as a single dose