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PREANESTHETIC MEDICATION

PREANESTHETIC MEDICATION Abstract In a consideration of the chemical agents to be used in preparing a patient for an operation, three factors are of importance: 1. Which anesthetic agent (basis) is to be used? 2. Which of the nonvolatile agents (adjuvants) should be used to produce the preanesthetic depression of the central nervous system? 3. Which agents (correctives) should be used to prevent or counteract certain undesirable side reactions produced in the patient by the main anesthetic agent to be employed? It is a discussion of the agents used as adjuvants and correctives and the reaction of the body to their administration that is to follow. ADJUVANTS FOR DEPRESSION OF THE CENTRAL NERVOUS SYSTEM The almost universal custom of producing moderate depression of the central nervous system in patients before administration of the major anesthetic agent is based in part on the following points:1. The production of a quiet mental state before References 1. Kleindorfer, G. B., and Halsey, J. T.: A Study of the Relative Efficiency as "Basal Anesthetics" of Avertin, Amytal, Chloral, Dial, and Iso Propyl-Allyl Barbituric Acid , J. Pharmacol. & Exper. Therap. 43:449-456, 1931. 2. Stormont, M. F.; Lampe, I., and Barlow, O. W.: A Comparison of the Premedication Values of Several Barbituric Acid Derivatives in Relation to Nitrous Oxide Anesthesia , J. Pharmacol. & Exper. Therap. 39:165-175, 1930. 3. Seevers, M. H.; Meek, W. J.; Rovenstine, E. A., and Stiles, J. A.: A Study of Cyclopropane Anesthesia with Especial Reference to Gas Concentrations, Respiratory and Electrocardiographic Changes , J. Pharmacol. & Exper. Therap. 51:1-17, 1934. 4. Robbins, B. H.; Baxter, J. H., Jr., and Fitzhugh, O. G.: Studies of Cyclopropane: V. The Effect of Morphine, Barbital and Amytal upon the Concentration of Cyclopropane in the Blood Required for Anesthesia and Respiratory Arrest , J. Pharmacol. & Exper. Therap. 65:136-142, 1939. 5. Seevers, M. H., and Pfeiffer, C. C.: A Study of the Analgesia, Subjective Depression, and Euphoria Produced by Morphine, Heroine, Dilaudid, and Codeine in the Normal Human Subject , J. Pharmacol. & Exper. Therap. 56:166-187, 1936. 6. Butler, T. C., and Bush, M. T.: The Metabolic Fate of N-Methyl Barbituric Acids , J. Pharmacol. & Exper. Therap. 65:205-213, 1939. 7. Bush, M. T., and Butler, T. C.: The Metabolic Fate of N-Substituted Derivatives of Barbital , J. Pharmacol. & Exper. Therap. 68:278-283, 1940. 8. Lundy, J. S., and Osterberg, A. E.: Review of the Literature on the Derivatives of Barbituric Acid , Proc. Staff Meet., Mayo Clin. 4:386-416, 1929. 9. Tatum, A. L.: The Present Status of the Barbiturate Problem , Physiol. Rev. 19:472-502, 1939 10. The Pharmacology of Barbiturates , Ann. Rev. Physiol. 2:359-370, 1940. 11. Lehman, G., and Knoefel, P. K.: A Pharmacologic Study of Trichlorethanol , Am. J. M. Sc. 197:638-646, 1939. 12. Molitor, H., and Robinson, H.: Studies on the Pharmacological Properties of Trichlorethanol , Anesth. & Analg. 17:258-263, 1938. 13. Leake, C. D.: Chemical Adjuncts to General Anesthesia , California & West. Med. 33:714-717, 1930. 14. Guedel, A. E.: Inhalation Anesthesia , New York, The Macmillan Company, 1937. 15. Waters, R. M.: Pain Relief for Children , Am. J. Surg. 39:470-475, 1938. 16. McGuigan, H.: The Effect of Small Doses of Atropin on the Heart Rate , J. A. M. A. 76:1338-1340 ( (May 14) ) 1921. 17. Harris, I.: The Action of Digitalis and Atropine on the Peripheral Blood Pressure , Lancet 1:1072-1074, 1921. 18. Kochman, M.: Beiträge zur Wirkung des Scopolamin HBr , Arch. internat. de pharmacodyn. et de thérap. 12:90-128, 1904. 19. Platz, O.: Wirkung des Atropins auf Puls und Blutdruck , Ztschr. f. d. ges. exper. Med. 28:81-89, 1922. 20. Sturgis, C. C.; Wearn, J. T., and Tompkins, E. H.: Effects of the Injection of Atropine on the Pulse Rate, Blood Pressure and Basal Metabolism in Cases of Effort Syndrome , Am. J. M. Sc. 158:496-502, 1919. 21. Robbins, B. H., and Baxter, J. H., Jr.: Unpublished data. 22. Robbins, B. H.: Effects of Various Anesthetics on Salivary Secretion , J. Pharmacol. & Exper. Therap. 54:426-432, 1935. 23. Clement, F. W.: Nitrous Oxide-Oxygen Anesthesia , Philadelphia, Lea & Febiger, 1939. 24. Shafer, G. D.; Underwood, F. J., and Gaynor, E. P.: The Action of Amytal in Impairing Vagus Cardiac Inhibitory Effects , Am. J. Physiol. 91:461-466, 1930. 25. Meek, W. J.; Hathaway, H. R., and Orth, O. S.: Effects of Ether, Chloroform and Cyclopropane on Cardiac Automaticity , J. Pharmacol. & Exper. Therap. 61:240-252, 1937. 26. Robbins, B. H., and Baxter, J. H., Jr.: Studies of Cyclopropane: III. The Relation of Electrocardiographic Changes to the Arterial Concentrations of Oxygen, Carbon Dioxide and Cyclopropane in Dogs Anesthetized with Cyclopropane , J. Pharmacol. & Exper. Therap. 61:162-174, 1937. 27. Robbins, B. H.; Baxter, J. H., Jr., and Fitzhugh, O. H.: Studies of Cyclopropane: The Use of Barbiturates in Preventing Cardiac Irregularities Under Cyclopropane or Morphine and Cyclopropane Anesthesia , Ann. Surg. 110:84-93, 1939. 28. Robbins, B. H., and Baxter, J. H., Jr.: Studies of Cyclopropane: VIII. The Effect of Premedication with Morphine or Amytal upon the Heart Rate, Rhythm and Blood Pressure in Dogs Under Cyclopropane Anesthesia , J. Pharmacol. & Exper. Therap. 68:85-95, 1940. 29. Robbins, B. H.; Fitzhugh, O. G., and Baxter, J. H., Jr.: Studies of Cyclopropane: VII. An Analysis of the Factors Controlling the Heart Rate in Dogs Anesthetized with Cyclopropane or Ether After Premedication with Morphine , J. Pharmacol. & Exper. Therap. 66:206-215, 1939 30. Action of Morphine in Slowing the Pulse , Robbins J. Pharmacol. & Exper. Therap. 66:216-223, 1939. 31. Morphine or Barbiturates Before Cyclopropane? Annotations , Lancet 2:704, 1939. 32. Rovenstine, E. A., and Cullen, S. C.: The Anesthetic Management of Patients with a Hyperactive Carotid Sinus Reflex , Surgery 6:167-176, 1939. 33. Weiss, S., and Baker, J. P.: The Carotid Sinus Reflex in Health and Disease , Medicine 12:297-354, 1933. 34. Reid, L. C., and Brace, D. E.: Irritation of the Respiratory Tract and Its Effect upon the Heart , Surg., Gynec. & Obst. 70:157-162, 1940. 35. Weiss, S., and Ferris, E. B.: Adams-Stokes Syndrome with Transient Complete Heart Block of Vago-Vagal Reflex Origin , Arch. Int. Med. 54:931-951 ( (Dec.) ) 1934. 36. Guedel, A. E., and Knoefel, P. K.: Ventricular Fibrillation in Anesthesia , Am. J. Surg. 34:496-499, 1936. 37. Shaw, J. L.; Steele, B. F., and Lamb, C. A.: Effect of Anesthesia on Blood Oxygen: Study of Effect of Spinal Anesthesia on Oxygen in Arterial and Venous Blood , Arch. Surg. 35:503-511 ( (Sept.) ) 1937. 38. Tatum, A. L.; Atkinson, A. J., and Collins, K. H.: Acute Cocaine Poisoning, Its Prophylaxis and Treatment in Laboratory Animals , J. Pharmacol. & Exper. Therap. 26:325-335, 1925. 39. Knoefel, P. K.; Herwick, R. P., and Lovenhart, A. S.: The Prevention of Acute Intoxication from Local Anesthetics , J. Pharmacol. & Exper. Therap. 39:397-411, 1930. 40. Meek, W. J., and Seevers, M. H.: The Cardiac Irregularities Produced by Ephedrine and a Protective Action of Sodium Barbital , J. Pharmacol. & Exper. Therap. 51:287-307, 1934. 41. Cunningham, R. L., and Bieter, R. N.: Experiments on the Potentiation of Procaine Spinal Anesthesia in the Rabbit , J. Pharmacol. & Exper. Therap. 66:410-422, 1939. 42. Blalock, A.: Cardiac Output in Dogs During Ether Anesthesia , Arch. Surg. 14:732-751 ( (March) ) 43. 921-933 (April) 44. 978-990 (May) 1927. 45. McClure, R. D.; Hartman, F. W.; Schnedorf, J. G., and Schelling, V.: Anoxia , Ann. Surg. 110:835-850, 1939. 46. Searles, P. W.: The Effect of Ether and Sodium Amytal Anesthesia on the Blood , Am. J. Surg. 41:399-404, 1938.Crossref 47. Quastel, J. H., and Wheatley, A. H. M.: Narcosis and Oxidations of the Brain , Proc. Roy. Soc., London, s.B 112:60-79, 1932Crossref 48. Narcotics and Brain Oxidations: Reversibility of Narcotic Action in Vitro , Biochem. J. 28:1521-1529, 1934. 49. Jowett, M., and Quastel, J. H.: Effects of Narcotics on Tissue Oxidation , Biochem. J. 31:565-578, 1937. 50. Jowett, M.: The Action of Narcotics on Brain Respiration , J. Physiol. 92:322-335, 1938. 51. Kennedy, W. P.: Sodium Salt of C-C-Cyclohexenyl-Methyl-N-Methyl Barbituric Acid (Evipan) Anesthesia in Laboratory Animals , J. Pharmacol. & Exper. Therap. 50:347-353, 1934. 52. Wortis, S. B.: Respiratory Metabolism of Excised Brain Tissue: II. The Effects of Some Drugs on Brain Oxidation , Arch. Neurol. & Psychiat. 33:1022-1029 ( (May) ) 1935. 53. Groce, E. C., and Pierce, I. H.: Effect of Morphine on the Oxygen Consumption of Brain Tissue in the Rat , J. Pharmacol. & Exper. Therap. 53:156-168, 1935. 54. Schideman, F. E., and Seevers, M. H.: Some Effects of Morphine on the Respiration of Brain, Spinal Cord and Skeletal Muscle in Vitro, J. Pharmacol. & Exper. Therap., to be published. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

PREANESTHETIC MEDICATION

Archives of Surgery , Volume 40 (6) – Jun 1, 1940

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American Medical Association
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Copyright © 1940 American Medical Association. All Rights Reserved.
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0004-0010
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1538-3644
DOI
10.1001/archsurg.1940.04080050007002
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Abstract

Abstract In a consideration of the chemical agents to be used in preparing a patient for an operation, three factors are of importance: 1. Which anesthetic agent (basis) is to be used? 2. Which of the nonvolatile agents (adjuvants) should be used to produce the preanesthetic depression of the central nervous system? 3. Which agents (correctives) should be used to prevent or counteract certain undesirable side reactions produced in the patient by the main anesthetic agent to be employed? It is a discussion of the agents used as adjuvants and correctives and the reaction of the body to their administration that is to follow. ADJUVANTS FOR DEPRESSION OF THE CENTRAL NERVOUS SYSTEM The almost universal custom of producing moderate depression of the central nervous system in patients before administration of the major anesthetic agent is based in part on the following points:1. The production of a quiet mental state before References 1. Kleindorfer, G. B., and Halsey, J. T.: A Study of the Relative Efficiency as "Basal Anesthetics" of Avertin, Amytal, Chloral, Dial, and Iso Propyl-Allyl Barbituric Acid , J. Pharmacol. & Exper. Therap. 43:449-456, 1931. 2. Stormont, M. F.; Lampe, I., and Barlow, O. W.: A Comparison of the Premedication Values of Several Barbituric Acid Derivatives in Relation to Nitrous Oxide Anesthesia , J. Pharmacol. & Exper. Therap. 39:165-175, 1930. 3. Seevers, M. H.; Meek, W. J.; Rovenstine, E. A., and Stiles, J. A.: A Study of Cyclopropane Anesthesia with Especial Reference to Gas Concentrations, Respiratory and Electrocardiographic Changes , J. Pharmacol. & Exper. Therap. 51:1-17, 1934. 4. Robbins, B. H.; Baxter, J. H., Jr., and Fitzhugh, O. G.: Studies of Cyclopropane: V. The Effect of Morphine, Barbital and Amytal upon the Concentration of Cyclopropane in the Blood Required for Anesthesia and Respiratory Arrest , J. Pharmacol. & Exper. Therap. 65:136-142, 1939. 5. Seevers, M. H., and Pfeiffer, C. C.: A Study of the Analgesia, Subjective Depression, and Euphoria Produced by Morphine, Heroine, Dilaudid, and Codeine in the Normal Human Subject , J. Pharmacol. & Exper. Therap. 56:166-187, 1936. 6. Butler, T. C., and Bush, M. T.: The Metabolic Fate of N-Methyl Barbituric Acids , J. Pharmacol. & Exper. Therap. 65:205-213, 1939. 7. Bush, M. T., and Butler, T. C.: The Metabolic Fate of N-Substituted Derivatives of Barbital , J. Pharmacol. & Exper. Therap. 68:278-283, 1940. 8. Lundy, J. S., and Osterberg, A. E.: Review of the Literature on the Derivatives of Barbituric Acid , Proc. Staff Meet., Mayo Clin. 4:386-416, 1929. 9. Tatum, A. L.: The Present Status of the Barbiturate Problem , Physiol. Rev. 19:472-502, 1939 10. The Pharmacology of Barbiturates , Ann. Rev. Physiol. 2:359-370, 1940. 11. Lehman, G., and Knoefel, P. K.: A Pharmacologic Study of Trichlorethanol , Am. J. M. Sc. 197:638-646, 1939. 12. Molitor, H., and Robinson, H.: Studies on the Pharmacological Properties of Trichlorethanol , Anesth. & Analg. 17:258-263, 1938. 13. Leake, C. D.: Chemical Adjuncts to General Anesthesia , California & West. Med. 33:714-717, 1930. 14. Guedel, A. E.: Inhalation Anesthesia , New York, The Macmillan Company, 1937. 15. Waters, R. M.: Pain Relief for Children , Am. J. Surg. 39:470-475, 1938. 16. McGuigan, H.: The Effect of Small Doses of Atropin on the Heart Rate , J. A. M. A. 76:1338-1340 ( (May 14) ) 1921. 17. Harris, I.: The Action of Digitalis and Atropine on the Peripheral Blood Pressure , Lancet 1:1072-1074, 1921. 18. Kochman, M.: Beiträge zur Wirkung des Scopolamin HBr , Arch. internat. de pharmacodyn. et de thérap. 12:90-128, 1904. 19. Platz, O.: Wirkung des Atropins auf Puls und Blutdruck , Ztschr. f. d. ges. exper. Med. 28:81-89, 1922. 20. Sturgis, C. C.; Wearn, J. T., and Tompkins, E. H.: Effects of the Injection of Atropine on the Pulse Rate, Blood Pressure and Basal Metabolism in Cases of Effort Syndrome , Am. J. M. Sc. 158:496-502, 1919. 21. Robbins, B. H., and Baxter, J. H., Jr.: Unpublished data. 22. Robbins, B. H.: Effects of Various Anesthetics on Salivary Secretion , J. Pharmacol. & Exper. Therap. 54:426-432, 1935. 23. Clement, F. W.: Nitrous Oxide-Oxygen Anesthesia , Philadelphia, Lea & Febiger, 1939. 24. Shafer, G. D.; Underwood, F. J., and Gaynor, E. P.: The Action of Amytal in Impairing Vagus Cardiac Inhibitory Effects , Am. J. Physiol. 91:461-466, 1930. 25. Meek, W. J.; Hathaway, H. R., and Orth, O. S.: Effects of Ether, Chloroform and Cyclopropane on Cardiac Automaticity , J. Pharmacol. & Exper. Therap. 61:240-252, 1937. 26. Robbins, B. H., and Baxter, J. H., Jr.: Studies of Cyclopropane: III. The Relation of Electrocardiographic Changes to the Arterial Concentrations of Oxygen, Carbon Dioxide and Cyclopropane in Dogs Anesthetized with Cyclopropane , J. Pharmacol. & Exper. Therap. 61:162-174, 1937. 27. Robbins, B. H.; Baxter, J. H., Jr., and Fitzhugh, O. H.: Studies of Cyclopropane: The Use of Barbiturates in Preventing Cardiac Irregularities Under Cyclopropane or Morphine and Cyclopropane Anesthesia , Ann. Surg. 110:84-93, 1939. 28. Robbins, B. H., and Baxter, J. H., Jr.: Studies of Cyclopropane: VIII. The Effect of Premedication with Morphine or Amytal upon the Heart Rate, Rhythm and Blood Pressure in Dogs Under Cyclopropane Anesthesia , J. Pharmacol. & Exper. Therap. 68:85-95, 1940. 29. Robbins, B. H.; Fitzhugh, O. G., and Baxter, J. H., Jr.: Studies of Cyclopropane: VII. An Analysis of the Factors Controlling the Heart Rate in Dogs Anesthetized with Cyclopropane or Ether After Premedication with Morphine , J. Pharmacol. & Exper. Therap. 66:206-215, 1939 30. Action of Morphine in Slowing the Pulse , Robbins J. Pharmacol. & Exper. Therap. 66:216-223, 1939. 31. Morphine or Barbiturates Before Cyclopropane? Annotations , Lancet 2:704, 1939. 32. Rovenstine, E. A., and Cullen, S. C.: The Anesthetic Management of Patients with a Hyperactive Carotid Sinus Reflex , Surgery 6:167-176, 1939. 33. Weiss, S., and Baker, J. P.: The Carotid Sinus Reflex in Health and Disease , Medicine 12:297-354, 1933. 34. Reid, L. C., and Brace, D. E.: Irritation of the Respiratory Tract and Its Effect upon the Heart , Surg., Gynec. & Obst. 70:157-162, 1940. 35. Weiss, S., and Ferris, E. B.: Adams-Stokes Syndrome with Transient Complete Heart Block of Vago-Vagal Reflex Origin , Arch. Int. Med. 54:931-951 ( (Dec.) ) 1934. 36. Guedel, A. E., and Knoefel, P. K.: Ventricular Fibrillation in Anesthesia , Am. J. Surg. 34:496-499, 1936. 37. Shaw, J. L.; Steele, B. F., and Lamb, C. A.: Effect of Anesthesia on Blood Oxygen: Study of Effect of Spinal Anesthesia on Oxygen in Arterial and Venous Blood , Arch. Surg. 35:503-511 ( (Sept.) ) 1937. 38. Tatum, A. L.; Atkinson, A. J., and Collins, K. H.: Acute Cocaine Poisoning, Its Prophylaxis and Treatment in Laboratory Animals , J. Pharmacol. & Exper. Therap. 26:325-335, 1925. 39. Knoefel, P. K.; Herwick, R. P., and Lovenhart, A. S.: The Prevention of Acute Intoxication from Local Anesthetics , J. Pharmacol. & Exper. Therap. 39:397-411, 1930. 40. Meek, W. J., and Seevers, M. H.: The Cardiac Irregularities Produced by Ephedrine and a Protective Action of Sodium Barbital , J. Pharmacol. & Exper. Therap. 51:287-307, 1934. 41. Cunningham, R. L., and Bieter, R. N.: Experiments on the Potentiation of Procaine Spinal Anesthesia in the Rabbit , J. Pharmacol. & Exper. Therap. 66:410-422, 1939. 42. Blalock, A.: Cardiac Output in Dogs During Ether Anesthesia , Arch. Surg. 14:732-751 ( (March) ) 43. 921-933 (April) 44. 978-990 (May) 1927. 45. McClure, R. D.; Hartman, F. W.; Schnedorf, J. G., and Schelling, V.: Anoxia , Ann. Surg. 110:835-850, 1939. 46. Searles, P. W.: The Effect of Ether and Sodium Amytal Anesthesia on the Blood , Am. J. Surg. 41:399-404, 1938.Crossref 47. Quastel, J. H., and Wheatley, A. H. M.: Narcosis and Oxidations of the Brain , Proc. Roy. Soc., London, s.B 112:60-79, 1932Crossref 48. Narcotics and Brain Oxidations: Reversibility of Narcotic Action in Vitro , Biochem. J. 28:1521-1529, 1934. 49. Jowett, M., and Quastel, J. H.: Effects of Narcotics on Tissue Oxidation , Biochem. J. 31:565-578, 1937. 50. Jowett, M.: The Action of Narcotics on Brain Respiration , J. Physiol. 92:322-335, 1938. 51. Kennedy, W. P.: Sodium Salt of C-C-Cyclohexenyl-Methyl-N-Methyl Barbituric Acid (Evipan) Anesthesia in Laboratory Animals , J. Pharmacol. & Exper. Therap. 50:347-353, 1934. 52. Wortis, S. B.: Respiratory Metabolism of Excised Brain Tissue: II. The Effects of Some Drugs on Brain Oxidation , Arch. Neurol. & Psychiat. 33:1022-1029 ( (May) ) 1935. 53. Groce, E. C., and Pierce, I. H.: Effect of Morphine on the Oxygen Consumption of Brain Tissue in the Rat , J. Pharmacol. & Exper. Therap. 53:156-168, 1935. 54. Schideman, F. E., and Seevers, M. H.: Some Effects of Morphine on the Respiration of Brain, Spinal Cord and Skeletal Muscle in Vitro, J. Pharmacol. & Exper. Therap., to be published.

Journal

Archives of SurgeryAmerican Medical Association

Published: Jun 1, 1940

References