BRIEF REVIEW ON ANAESTHETIC DRUGS

Keywords

Anaesthesia; anaesthetic; Brain; Bupivacaine; Benzodiazepines; General anaesthetics

Introduction

An anesthetic is a drug that gives rise to anesthesia (temporary stage of unconsciousness). Anesthetic can also be defined as any agent that produces a local or general loss of sensation, including pain. Anesthetics achieve this consequence by acting on the brain, central nervous system (CNS) peripheral nervous system (PNS) to prevent responses to sensory stimulation. The unresponsive state thus induced is known as anesthesia [1-5].

Types of anesthetics

Generally anesthetics are classified in two categories namely

1. Local anesthesia

2. General anesthesia.

Local anesthetics

Local anesthesia induces loss of sensation by reversibly blocking transmission of nerve impulses along the nerves in a small part of the body which is to be operated. Local anesthesia’s numbs part of the body without loss of consciousness where the patient is awake and alert [6-8].

Local anesthetics are classified as:

In general so many local anesthetics are in practice. Some of them are briefly explained below. Based on their efficiency and side effects these anesthetics are elucidated [8-10].

Bupivacaine

Bupivacaine is a local anesthetic drug that blocks the conduction of nerve impulses which sends pain signals to brain. Bupivacaine reduces the flow of sodium in and out nerves. This blockage leads first to a loss of sensation of pain, then temperature, touch, deep pressure.it is used as a local (in only one area) anesthetic.

Bupivacaine is used as an anesthetic to produce numbness during labor, surgery, dental or certain medical procedures [10-14].

Side effects of Bupivacaine:

Some of the side effects are listed below which can lead to medical emergency. So it is better to get medical help whenever you feel discomfort.

Feeling anxious, bewildered or like you might pass out; problems with speech or vision; convulsions; weak pulse; Back pain; weak or shallow breathing; fast heart rate [15-16].

Cocaine

Cocaine is a powerful addictive stimulant drug made from the leaves of the coca plant. Cocaine in olden days was used as numbing agent to reduce the pain in nose and mouth surgery. Currently it is used for nasal, eye and lacrimal duct surgery. In this case dissolved cocaine is soaked into a ball of cotton wool, which is placed in the nostril for the 8–15 minutes immediately before performing the procedure. [17-23]

Side effects of cocaine

Excessive exposure to cocaine leads to addiction and adversely fatal effects. Cocaine affects the body in a variety of ways. It narrows blood vessels, dilates pupils, increases body temperature, heart rate, and blood pressure, headaches and gastrointestinal complications such as abdominal pain and nausea [23-29]. Most seriously, people who get addicted to cocaine can suffer heart attacks or strokes, which may lead to sudden death. These deaths are often a result of the cardiac arrest followed by an arrest of breathing [30-36].

Levobupivacine

Levobupivacaine is recently introduced amino amide local anesthetic that is same with respect to structure of bupivacaine. Frequent Studies have indicated that levobupivacaine is well tolerated and has an efficacy reciprocal to bupivacaine for both anesthesia and analgesia. Levobupivacaine is associated less with central nervous system and cardiac toxicity in proportion to bupivacaine when equal concentrations were compared [37,38].

Side effects of levobupivacaine

Exposure to excessive quantities of bupivacaine mainly leads to adverse consequences in central nervous system (CNS) and cardiovascular effects. The effects may include CNS excitation (nervousness, dizziness, blurred vision, seizures, drowsiness, loss of consciousness and respiratory depression [39].

Lidocaine

Lidocaine is a local anesthetic used to induce anesthesia in a local region of the body to relieve from pain. Lidocaine alters signal conduction in neurons by blocking the fast voltage-gated Na+ channels in the neuronal cell membrane which is responsible for signal propagation. These merely don’t prevent signals send to the brain but before they begin it is prevented. Lidocaine is used to attain relieve from itching, burning, pain from skin inflammations. It is also injected as a dental anesthetic, or used as a local anesthetic for minor surgery [40-45].

General anesthetic

A general anesthetic is a drug that has the capacity to bring about a reversible loss of consciousness. Anesthetists administer these drugs to induce or maintain general anesthesia to facilitate surgery by relieving pain. Drugs used to induce anesthesia are given in vapors or gases (in inhalational form) or in injection (intravenously) [46].

General anesthetics are further classified into inhaled agents and intravenous agents (non-opioid) [47,48].

Inhaled agents

Desflurane

Desflurane is a halogenated drug, belongs to the group of medicines termed as general anesthetics is used to induce general anesthesia (loss of consciousness) before and during surgery to relieve from pain. Mostly desflurane is given to patient in vapor form by inhalation technique. It has low solubility levels in blood and tissues [49,50].

Side Effects of desflurane

As all drugs or medicines have some side effects, so it is necessary to take desflurane dose in appropriate amount to avoid any side effects. Excess exposure to desflurane causes some side effects which are listed below.

Runny nose; tender, swollen glands in the neck; tightness in the chest; trouble breathing; trouble swallowing; voice changes; etc. [51].

Isoflurane

ISOFLURANE is a halogenated, non-inflammable, vaporizing anesthetic drug which induces and maintains general anesthesia by depression of the central nervous system (CNS) and results in loss of consciousness. Isoflurane comes under group of medicines known as general anesthetic. It is an inhalation anesthetic having a mildly pungent, musty, ethereal odor [52].

Side effects of isoflurane

As all drugs or medicines have some side effects, so it is necessary to take desflurane dose in appropriate amount to avoid any side effects. Excess exposure to desflurane causes some side effects which are listed below [53].

Excess use of isoflurane in individuals may give rise to some side effects such as in infants and young children may lead to significant neurodegeneration; respiratory depression, hypotension and arrhythmias. Shivering, nausea, vomiting and ileus have been observed in the postoperative period [54].

Nitrous oxide

Nitrous oxide is commonly known as laughing gas, N2O. It is used in surgery and dentistry for its anesthetic and analgesic effects. Nitrous oxide is in a volatile form and administered by inhalation [55]. As a general anesthetic, it is very weak to induce anesthesia so it is not used as a single agent. So it is used in combination with other general inhalational gases.it is mostly used in pediatric dental procedures [56-58].

Side effects of Nitrous oxide

Excess use of nitrous oxide in individuals may give rise to some side effects such as the incidence of nausea and vomiting increases with the duration of anesthesia. The gas is a powerful analgesic in concentrations above 20%. It decreases myocardial contractility in vitro; It expands air-filled cavities because it is 40 times as soluble as nitrogen it can also cause the expansion of gas-containing bowel [59-60].

Intravenous agents (non-opioids)

There are many drugs that can be used intravenously to produce anesthesia. These non-opioid drugs are administered into the veins to induce anesthesia [61].

Benzodiazepines

Benzodiazepines are intravenous (non-opioids) class of drugs primarily used for inducing general anesthesia. The exact mechanism of action of benzodiazepines is not clear, but they appear to work by affecting neurotransmitters in the brain. It suppresses the activity of nerves. Benzodiazepine slows down the activity of the central nervous system and the information processing (messages) travelling between the brain and the body [62].

Diazepam

Diazepam is intravenous non-opioid substance belongs to a class of medicines termed as benzodiazepines. It is a medicine which helps to treat feelings of anxiety by making people feel less agitated and less tense.

It is given intravenously for short period of time but effect of these drug prolong to few hours or days. It makes subject to feel sleepy [63].

Side effects of diazepam

Excess exposure of nitrous oxide in individuals may give rise to some side effects such as memory problems; drowsiness; tired feeling blurred vision; double vision; new or worsening seizures; etc. [64].

Ketamine

Ketamine is a drug used mainly for inducing and maintaining anesthesia.it is provided to the patient intravenously. It works in the brain to inhibit painful sensations. It acts on central nervous system by suppressing transmission of signals. Ketamine is used to put you to sleep for surgery to avoid pain and discomfort which may occur during surgical procedure. Ketamine does not produce muscular relaxation [65-73].

Side effects of ketamine

Excess of ketamine use leads to some possible common side effects which are mentioned below Severe allergic reactions (rash; hives; itching; abnormal breathing; tightness in the chest;); behavior changes; confusion; difficult, frequent, or painful urination; double vision; fainting; fast, slow, or irregular heartbeat; hallucinations; drowsiness; It also tends to raise heart rate and intracranial and intraocular pressure etc. [73-79].

Midazolam

Midazolam is a benzodiazepine sedative drug used to induce general anesthesia for the person who is undergoing a minor surgery, dental procedures. Midazolam is intravenously administered for induction of general anesthesia prior to administration of other anesthetic agents [80-82].

It acts on central nervous system as depressant and suppresses the signals from the brain to body by inducing general anesthesia to avoid pain and discomfort during surgery [83].

Side effects of midazolam

Long-term use of benzodiazepines can leads to long-lasting deficits of memory, blurred vision, abnormal blood pressure, asthma, nausea, vomiting, headache, etc. [85].

Propofol

Propofol is a non-opioid intravenous anesthetic agent used to induce general anesthesia. propofol is the generic name for Diprivan an injectable drug.

Propofol is used to put people to sleep before surgery to prevent pain and discomfort which may occur during surgical procedures. The deaths of two celebrities, Joan Rivers (comedian) and Michael Jackson (king of pop, an American singer), have been linked to misuse of propofol. So it is better to make use of Propofol health care workers who can determine your proper dosage [86-88].

Side effects of propofol

Some common side effects of propofol are mild itching or rash; fast or slow heart rate; slight burning or stinging around the IV needle and some severe bad effects are a light-headed feeling (like you might pass out) even after feeling awake; weak or shallow breathing; severe pain or discomfort where the injection is given [89-90].

Etomidate

Etomidate is a non-opioid intravenous agent used to Induce general anesthesia and with other medications to provide anesthesia during short surgeries.

Etomidate is a hypnotic agent and intravenously given to induce or maintain sleep during and after surgery.it was one of the most frequently used sedative hypnotic agents for maintaining sedative consciousness [91].

Side effects of etomidate

Pain at the injection site; eye movement; skeletal muscle movements (e.g. myoclonic) [92].

Intravenous opioids

Intravenous Opioids are routinely used to deal with moderate to severe pain occurred during surgical or other medical procedures. Opioids are the world's oldest known drugs in practice which functions by binding to opioid receptors [93].

Buprenorphine

Buprenorphine is a narcotic analgesic given intravenously to the patients to induce anesthesia to relieve from pain during surgery. It functions by suppressing the pain signals induced from brain to the body during surgery to decrease pain [94].

Side effects of buprenorphine

These are the possible side effects of Buprenorphine Constipation; dizziness; drowsiness; headache; nausea; sweating; vomiting; Severe allergic reactions; difficulty in breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; anxiety; dark urine; abnormal heartbeat [95].

Morphine

Morphine is an intravenous opioids anesthetic substance used to induce anesthesia to avoid pain and discomfort during surgical or medical procedures. Morphine is used as general anesthesia; a substance that puts you to sleep if you need to have a surgery to avoid pain. Morphine is one of the most potent pain relievers [96].

Side effects of morphine

Like everything else, too much of morphine is not good.it has some side effects. It can cause constipation; slow heart rate; lead to cardiac arrest; sighing can cause blood pressure to fall; feel faint; things look blurred; shortness of breath [97].

Fentanyl

Fentanyl is a narcotic opioid used to prevent pain raised during surgical procedure. It is a potent pain reliever administered intravenously to induce anesthesia [98].

Side effects of fentanyl

Excess exposure to fentanyl cause some side effects such as respiratory depression, apnea, rigidity, and bradycardia; hypertension, hypotension, dizziness, blurred vision, nausea, emesis, diaphoresis, pruritus, urticarial, laryngospasm [99].

Remifentanyl

Remifentanyl is a narcotic opioid used to prevent pain raised during surgical procedure. It is a pain reliever administered intravenously to induce anesthesia. It is Unique, very short-acting opioid, rapidly cleared by blood and tissue esterase. Remifentanil provides fast, clear-headed recovery. Recovery with remifentanil is more rapid than with fentanyl [100].

Side effects of remifentanyl

Hives, difficult breathing, swelling of your face, lips, tongue, or throat nausea, vomiting, shivering dizziness, vision problems, itching, sweating.

Muscle relaxants

Muscle relaxants are medicines that block transference of nerve impulses to the muscles referred as neuromuscular blocking agents. It is used during anesthesia administered to the patient intravenously but do not do not provide pain relief. It temporarily causes the paralysis of the affected skeletal muscles [101].

Atracurium

Atracurium is an intermediate-acting neuromuscular blocking agent. It functions by blocking the signals between your nerves and your muscles to facilitate medical procedure.it are given before general anesthesia to keep your body still during surgery. It is muscle relaxant in the category of non-depolarizing neuromuscular-blocking drugs administered intravenously to facilitate endotracheal intubation [102].

Side effects of atracurium

The possible side effects of atracurium are Histamine release, reflex tachycardia; cutaneous flush Bronchospasm; and Laudanosine; etc [103].

Cisatracurium

Cisatracurium is an intermediate-acting neuromuscular blocking agent. It is muscle relaxant in the category of non-depolarizing neuromuscular-blocking drugs administered intravenously. It functions by blocking the signals between your nerves and your muscles to facilitate medical procedure.it is given before general anesthesia to keep your body still during surgery It induces muscle relaxation to facilitate endotracheal intubation, mechanical ventilation [104].

Side effects of Cisatracurium

The possible side effects of cisatracurium are such as slow heart rate; dizziness; flushing (warmth, redness, or tingly feeling) [105].

Conclusion

Anesthesia is a very safe and reliable technique to avoid pain and discomfort during and after surgery. There are many techniques for the application and delivery of anesthetics to induce anesthesia and most of them are effective and in practice safely. However, as we have learned, there are some risks and possible side effects. So it is better to have anesthesia and anesthetics under medical expert’s supervision to avoid complications.

References

1. Singh TK, et al.Unilateral Spinal Anaesthesia for Lower Limb Orthopaedic Surgery Using Low Dose Bupivacaine with Fentanyl or Clonidine: A Randomised Control Study. J Anesth Clin Res. 2014;5:484.
2. Ataro G and Bernard M.Effectiveness of Caudal Epidural Block using Bupivacaine with Neostgmine for Pediatric Lower Extremity Orthopedic Surgery in Cure Ethiopia Children’s Hospital. J Anesth Clin.(2014);Res 5:479.
3. Obi AO.Low Dose Spinal Saddle Block Anesthesia (With 1.5 Mg Bupivacaine) For Transrectal Prostate Biopsy-Experience with 120 Cases.J Anesth Clin Res.2014;5:469
4. Karaca F, et al. Assessment of the Effect of Intrathecal Low Dose Levobupivacaine or Bupivacaine Combined with Fentanyl in Patients Undergoing Cesarean Section. J Anesth.(2014 );Clin Res5:465.
5. Hadley RM and Dine AP. Where is the Evidence? A Critical Review of Bias in the Reporting of Clinical Data for Exparel: A Liposomal Bupivacaine Formulation.J Clinic Res.(2014);Bioeth5:189.
6. Lauretti GR et al.Transdermal Ketamine and S(+)-Ketamine as Adjuvants Following OrthopaedicSurgery under Bupivacaine Spinal Anaesthesia.J Phys Chem Biophys.(2014);4:154.
7. Khatun S et al.A Clinical Study of Trigeminal Neuralgia with Incredible Pain, Satisfaction with Quality Pain Management.J Pain Relief.2013; S3:002.
8. Harjai M.et al.Optimization of Bupivacaine Induced Subarachnoid Block by Clonidine: Effect of Different Doses of Oral Clonidine.J Anesth Clin.2013;Res5:382.
9. Karnawat R.et al.Comparison of Effect of Epidural Bupivacaine, Epidural Bupivacaine Plus Fentanyl and Epidural Bupivacaine Plus Clonidine on Postoperative Analgesia after Hip Surgery.J Anesth Clin Res.2013;4:373.
10. Annamalai A.Can Intravenous Dexmedetomidine Prolong Bupivacaine Intrathecal Spinal Anesthesia?J Anesth Clin Res;4:372.
11. Beyaz SG and Eman A.Comparison of Caudal Levobupivacaine versus Levobupivacaine plus Morphine Mixture for Postoperative Pain Management in Children.J Anesthe Clinic Res.2012;4:278.
12. Mansour NA et al.Ropivacaine versus Bupivacaine in Postoperative Pain Control.J Biotechnol Biomater.2012;2:137.
13. Manaa E.Local Anesthetic Irrigation and Postoperative Pain in Patients Undergoing Breast Augmentation.J Anesthe Clinic.2011;Res2:151
14. Tomar GS et al.AComparative Study of Two Different Doses of Fentanyl Added to Bupivacaine for Intermittent Epidural Labor Analgesia:A Prospective Randomized Double BlindStudy.J Anesthe Clinic Res.2011;2:145.
15. Dabbagh A,The Effect of Intrathecal Bupivacaine Plus Sufentanil on Intraoperative Hemodynamics During Elective Coronary Artery Bypass Surgery. J Anesthe Clinic Res.2011;2:139.
16. Hanna M and Sloan P.A Comparison of Levobupivacaine and Ropivacaine for Interscalene and Femoral Nerve Blocks: A Randomized,Double- Blind,Prospective Clinical Trial.J Anesthe Clinic Res.2011;2:135.
17. Macdonald S et al.Factors Related to Simultaneous Cocaine and Alcohol Use for Clients in Treatment.J Alcohol Drug Depend.2015;3:193.
18. Vuppala PK and Vangara KK.Novel Treatment Strategies for Cocaine and Opioid Abuse.J Bioequiv Availab.2014;6:e48
19. Sternat T et al.Hedonic Tone: A Bridge between the Psychobiology of Depression and its Comorbidities.J Depress Anxiety.2014;3:147.
20. Asha.CXR of Pneumomediastinum and Subcutaneous Emphysema Following Cocaine ‘Snorting’.Emerg Med (Los Angel).2015;5:i104
21. Simonetti JA et al.Pulmonary Function in HIV-Infected Recreational Drug Users in the Era of Anti-Retroviral Therapy.J AIDS Clin.2014;Res 5: 365
22. Shoji H.Physical Separation of Motion into Three Categories for Evaluating the Behavioral Effects of Drugs in Mice.Int J Neurorehabilitation.2014;1:120.
23. Nejtek VA.Diffusion Tensor Imaging in Bipolar Disorder with Cocaine Dependence vs. a Healthy Control:Preliminary Findings.Brain Disord Ther.2014;3:142
24. Ray S.Enhanced Cue Reactivity to Cocaine Cues in Non-treatment Seeking Cocaine Smokers.J Alcohol Drug Depend.2014; 2:169.
25. Levesque A et al.Psychological Distress Increases Needle Sharing among Cocaine users:Results from the COSMO Study.J Addict Res Ther.2014;S10:003.
26. Lane SD et al.Comparison of Caffeine and d-amphetamine in Cocaine-Dependent Subjects:Differential Outcomes on Subjective and Cardiovascular Effects, Reward Learning, and Salivary Paraxanthine.J Addict Res Ther.2014;5:176.
27. Vuppala PK and Vangara KK.Novel Treatment Strategies for Cocaine and Opioid Abuse.J Bioequiv Availab.2014;6:e48
28. Sternat T et al.Hedonic Tone: A Bridge between the Psychobiology of Depression and its Comorbidities.J Depress Anxiety.2014;3: 147
29. O’Connor G et al.Dangers of Cocaine Ingestion in MELAS Syndrome. Emergency Med.2013;3:145.
30. James MH et al.Insights for Developing Pharmacological Treatments for Psychostimulant Relapse Targeting Hypothalamic Peptide Systems.J Addict Res Ther.2013; S4:008.
31. Yang HJ et al.The Anticonvulsant Tiagabine Inhibits Cocaine’s Rewarding Effects, but has No Effect on Reinstatement of Cocaine-Seeking Behavior in Rats.Biochem& Pharmacol.2013;S1:005
32. Crits-Christoph P et al.Measuring Outcome in the Treatment of Cocaine Dependence. J Alcoholism Drug Depend.2013;1:108.
33. Ray S.Neurocognitive Mechanisms in Cocaine Users.J Alcoholism Drug Depend.2013;1:e102.
34. Perez G et al.Peptides Binding Cocaine: A Strategy to Design Biomimetic Receptors.J Proteomics Bioinform.2013;6:015-022.
35. Malek A.Effects of Prenatal Cocaine Exposure on Human Pregnancy and Postpartum. Pharmaceut Anal Acta.2013;3:191.
36. Ismael F and Baltieri DA.Role of Two Clusters of Cocaine-Dependent Outpatients in Treatment Retention.J Addict Res Ther.2013;3:136.
37. Karaca F et al. Assessment of the Effect of Intrathecal Low Dose Levobupivacaine or Bupivacaine Combined with Fentanyl in Patients Undergoing Cesarean Section.J Anesth Clin Res.2013;5: 465.
38. Beyaz SG and Eman A.Comparison of Caudal Levobupivacaine versus Levobupivacaine plus Morphine Mixture for Postoperative Pain Management in Children.J Anesthe Clinic Res.2013;4:278.
39. Hanna M and Sloan PA.Comparison of Levobupivacaine and Ropivacaine for Interscalene and Femoral Nerve Blocks:A Randomized, Double- Blind, Prospective Clinical Trial. J Anesthe Clinic Res.2011;2:135.
40. Abdullah WA et al.Articaine (4%) Buccal Infiltration versus Lidocaine (2%) Inferior Alveolar Nerve Block for Mandibular Teeth Extraction in Patients on Warfarin Treatment.J Anesth Clin Res.2014;5:434.
41. Lalenoh DC et al.Brain Protection Effect of Lidocaine Measured By Interleukin-6 and Phospholipase A2 Concentration in Epidural Haematoma with Moderate Head Injury Patient.J Anesth Clin Res.2014;5:388.
42. Abdelwahab NS et al.Determination of Thiomersal, Lidocaine and Phenylepherine in their Ternary Mixture.J Chromatograph Separat Techniq.2014;4:199.
43. Dhadwal N et al.Tolerability and Efficacy of Long-Term Lidocaine Trigger Point Injections in Patients with Chronic Myofascial Pain. Int J Phys Med Rehabil.2013;S1: 004.
44. Hwangbo JW et al.Successful Finding of Local Anesthetics for a Girl with Local Lidocaine Anaphylaxis.Pediat Therapeut.2013;3:143.
45. Imaizumi U et al.Effects of Lidocaine on Ischemia/Reperfusion Injury in In vivo Rabbit Hearts.J Anesth Clin Res.2012;3:261.
46. Manaa E .Local Anesthetic Irrigation and Postoperative Pain in Patients Undergoing Breast Augmentation.J Anesthe Clinic Res.2011;2:151.
47. Van Noord BA et al.Opioid Resistant Pain Successfully Managed with Magnesium, Lidocaine and Ketorolac in the Post-Anesthesia Care Unit: A Case Series.J Anesthe Clinic Res.2011;3:196.
48. Vandse R,et al. Randomized Double Blind Control Study Comparing the Efficacy of Intracuff Alkalinized Lidocaine to Low Dose Remifentanil Infusion in Attenuating the Endotracheal Tube Induced Emergence Phenomena.J Anesth Clin Res.2014;5:435.
49. Erkalp K et al.Accidental Hand Injury with Scalpel in the Operating Room:Do the Differences Between Desflurane with Sevoflurane Vaporizers have a Preventive Effect?.J Anesthe Clinic Res.2011;2:143
50. Keles GT et al. Balanced Anesthesia with Dexmedetomidine added Desflurane or Sevoflurane in Spinal Surgery.J Anesth Clin Res.2012;3:216.
51. Yassen K et al.Effect of Target-Controlled Infusion of Propofol-Fentanyl versus Desflurane in Cirrhotic Patients Undergoing Major Hepatic Resection with Transoesophageal Doppler Monitoring A Randomized Control Study.J Anesth Clin Res.2014;5: 485.
52. Goma HM et al.Three Dimensional Transabdominal Power Doppler Ultrasonographic Imaging of Trophoblastic Blood Flow as a Prognostic Parameter in the First Trimester after Isoflurane Fentanyl, versus Spinal Anesthesia.J Women’s Health Care.2014;3:154.
53. Lowalekar SK et al.The Progression of Isoflurane-induced Malignant Hyperthermia and Its Attenuation by Cisatracurium in a Pre-clinical Porcine Model of Heart Transplant.J Anesth Clin Res.2013;4:365.
54. Schober ME et al.Isoflurane Exposure did not Adversely Affect Recognition Memory or Decrease Hippocampal Brain Derived Neurotrophic Factor Expression in the 17 Day Old Rat Pup.J Anesth Clin Res.2013;4:362.
55. Hashida SN et al.Influence of Nitrogen Limitation and Long-Term Use of Rockwool on Nitrous Oxide Emissions in Hydroponic Systems.J Horticulture.2014 1: 113.
56. Nakao K et al.Comparison of Cuff Pressure Increase upon Nitrous Oxide Exposure in air-Q® Single Use, LMA-Supreme®, and LMA-ProSeal®; a Simulation Study.J Anesth Clin Res.2014;5:451.
57. Boriosi J.Sedation with Nitrous Oxide or “Laughing Gas”. Pediat Therapeut.2014;4:i101
58. Genthner FJ et al.Estimating Rates of Denitrification Enzyme Activity in Wetland Soils with Direct Simultaneous Quantification of Nitrogen and Nitrous Oxide by Membrane Inlet Mass Spectrometry.J Microb Biochem Technol.2013;5: 095-101..
59. Schmitz G et al.Use of Nitrous Oxide in the Emergency Department: A Review of the Literature. Emergency Med.2013;3:e131
60. Dube SK et al.Propofol Requirement during Propofol and Butorphanol Anesthesia with and without Nitrous Oxide in Short Duration Intracranial Surgeries:A Bispectral Index Guided Study.J Anesth Clin Res.2013;3:238
61. Jakimska A et al. Environmental Fate of Two Psychiatric Drugs, Diazepam and Sertraline:Phototransformation and Investigation of their Photoproducts in Natural Waters.JChromatogr Sep Tech.2014;5: 253
62. Gupta V et al.Development of Economic Herbal Based Drug Substitute from Citrus paradisi (Grape fruit) for Existing Anti-anxiety Drug Modules.Nat Prod Chem Res.2014;S1:001.
63. Backmund M et al.A RandomizedDouble-Blind Placebo Controlled Study of Methadone and Diazepam with or without Carbamazepine for Combined Opioid and Benzodiazepine Detoxification.J Clinic Toxicol.2012;2:133.
64. Bentley WE et al.Ketamine:An Update for Its Use in Complex Regional Pain Syndrome and Major Depressive Disorder.Clin Exp Pharmacol.2015;5:169.
65. Bredlau AL et al.Neurocognitive Changes after Sustained Ketamine Administration in Children with Chronic Pain.J Palliat Care Med.2015;5:215.
66. Olalekan O and Sanya OJ.NMDA R/VDR in Fish Melanocytes; Receptor Targeted Therapeutic Model and Mechanism in Parkinson’s disease.J Biomol Res Ther.2014;3:114.
67. EL-Shmaa NS and El-Baradey GF.The Efficacy of Etomidate-Fentanyl versus Dexmedetomidine-Ketamine for Procedural Sedation and Analgesia during Upper Endoscopy and Biopsy:A Prospective, Randomized Study.J Anesth Clin Res.2014;5:480.
68. Lauretti GR et al.Transdermal Ketamine and S(+)-Ketamine as Adjuvants Following Orthopaedic Surgery under Bupivacaine Spinal Anaesthesia.J Phys Chem Biophys.2014; 4:154.
69. Neri CM et al.Low-dose Ketamine for Children and Adolescents with Acute Sickle Cell Disease Related Pain: A Single Center Experience.J Anesth Clin Res.2014;5: 394.
70. Butt MN and Ahmed A.The Induction Dose of Propofol with Ketamine- Propofol and Midazolam-Propofol Co-Induction.J Anesth Clin Res.2013;4:371.
71. Neri CM et al.Low-dose Ketamine for Children and Adolescents with Acute Sickle Cell Disease Related Pain:A Single Center Experience. J Anesth Clin Res.2013;5:394.
72. Butt MN and Ahmed A.The Induction Dose of Propofol with Ketamine- Propofol and Midazolam-Propofol Co-Induction.J Anesth Clin Res.2013;4:371.
73. Badr Naga BSH and Thaher MM.Ketamine Effectiveness in Cancer Pain Management:Evidence-based Practice.J Pain Relief.2013;2:117..
74. Al-maksoud Yousef AA and Mostafa WA.The Efficacy of Preemptive Ketamine Administration in Bilateral Superficial Cervical Plexus Block After Thyroid Surgery.J Anesthe Clinic Res.2013;4:316.
75. Ayrapetyan S et al.Cell Dehydration as a Mechanism of Ketamine Analgesic and Anesthetic Effects.J Bioequiv Availab.2013;5:136-141.
76. Schwartzman RJ and et al.Ketamine as Adjunctive Anesthesia in Refractory Complex Regional Pain Syndrome Patients:A Case Series.J Clin Case Rep.2012;2:186.
77. EROL DD and KAYA C.Evaluation of Intubating Dose of Rocuronium and Propofol-Ketamine Association for Rapid Sequence Induction of General Anaesthesia for Caesarean Section in Extremely Urgent Settings. Gynecol Obstetric.2011;2:110.
78. Ebong EJ et al.Pre-Incisional Intravenous Low-Dose Ketamine Does Not Cause Pre-Emptive Analgesic Effect Following Caesarean Section under Spinal Anaesthesia.J Anesthe Clinic Res.2011;2:138.
79. Mendes FF et al.Analgesia with Low-Dose S(+)- ketamine in Laparoscopic Cholecystectomy: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.J Anesthe Clinic Res.2011;2:133.
80. Minami T et al.Safety and Effectiveness of Propofol Sedation during Endoscopic Retrograde Cholangiopancreatography.J Anesth Clin Res.2015;6:513.
81. Furutani E et al.Comparison of Pharmacokinetic Models for Hypnosis Control Based on Effect-Site Propofol Concentration to Maintain Appropriate Hypnosis.Automat Control Physiol State Func.201; 2 104.
82. Yassen K et al.Effect of Target-Controlled Infusion of Propofol-Fentanyl versus Desflurane in Cirrhotic Patients Undergoing Major Hepatic Resection with Transoesophageal Doppler Monitoring A Randomized Control Study.J Anesth Clin Res.2014;5:485.
83. Choi JJ et al.Monitored Anesthesia Care Using Target-Controlled Infusion with Propofol and Remifentanil in a Patient with Subglottic Stenosis.J Anesth Clin Res.2014;5:443.
84. Ong YY et al.Cloudy Urine after Propofol Anesthesia; A Rare Occurrence after a Routine Anesthetic.J Anesth Clin Res.2014;5:432.
85. Garewal D.Propofol Sedation for Patients Undergoing Gastrointestinal Endoscopy Procedures:Challenging Existing Paradigms in Healthcare. J Gastroint Dig Syst.2014; 4:196.
86. Campos S et al.Simultaneous Quantification of Propofol and its Non-Conjugated Metabolites in Several Biological Matrices Using Gas Chromatography/ Ion Trap – Mass Spectrometry Method.J Anal Bioanal Tech.2014;5:195.
87. Tams C and Johnson K.Prediction Variability of Combined Pharmacokinetic Pharmacodynamic Models:A Simulation Study of Propofol in Combination with Remifentanil and Fentanyl.J Anesth Clin Res.2014;5:393.
88. Feng YN et al.Hippocampal Neuron Protecting Effect of Propofol Against Hypoxia/Reoxygenation via Inducing Nerve Growth Factor.Transl Med.2014; 4:123.
89. Plaschke K et al.Surgery under Propofol Anesthesia Induced Behavioral Changes Associated With Increased Cerebral Apoptosis in Rats.J Liver.2013;2:136.
90. Butt MN and Ahmed A.The Induction Dose of Propofol with Ketamine- Propofol and Midazolam-Propofol Co-Induction.J Anesth Clin Res.2013;4:371.
91. Salim B et al.Effectiveness of Midazolam in the Prevention of Etomidate Induced Myoclonus .J Anesth Clin Res.2015;6:503.
92. EL-Shmaa NS and El-Baradey GF.The Efficacy of Etomidate-Fentanyl versus Dexmedetomidine-Ketamine for Procedural Sedation and Analgesia during Upper Endoscopy and Biopsy: A Prospective, Randomized Study.J Anesth Clin Res.2014;5:480.
93. Chern SYS et al.Perioperative Pain Management for Patients on Chronic Buprenorphine: A Case Report.J Anesth Clin Res.2012;3:250.
94. Soyka M.Buprenorphine Use and Risk of Abuse and Diversion.Adv Pharmacoepidemiol Drug Saf.2014;3:145.
95. Ishak M et al.Will the Body Temperature be Affected by Lowering Intrathecal Morphine Dose from 100 to 50 Micrograms?J Anesthe Clinic Res.2013;4:327.
96. Beyaz SG and Eman A.Comparison of Caudal Levobupivacaine versus Levobupivacaine plus Morphine Mixture for Postoperative Pain Management in Children.J Anesthe Clinic Res.2012;4:278.
97. Allan J et al.Illicit Fentanyl use in Rural Australia – An Exploratory Study. J Alcohol Drug Depend.2015;3:196.
98. Singh TK et al.Unilateral Spinal Anaesthesia for Lower Limb Orthopaedic Surgery Using Low Dose Bupivacaine with Fentanyl or Clonidine: A Randomised Control Study.J Anesth Clin Res.2014;5:484.
99. Choi JJ et al.Monitored Anesthesia Care Using Target-Controlled Infusion with Propofol and Remifentanil in a Patient with Subglottic Stenosis.J Anesth Clin Res.20145:443.
100. Karvandian K.Comparison of the Effects of Infusion of Propofol -Remifentanil with Midazolam-Remifentanil in Reducing Bleeding in Patients undergoing Middle Ear Surgery.J Anesthe Clinic Res.2012;3:201.
101. Yu B, Wang X, Helbo-Hansen HS, Huang WQ, Askeland B, et al. (2014) Sugammadex 4.0 mg kg–1 Reversal of Deep Rocuronium-Induced Neuromuscular Blockade: A Multicenter Study in Chinese and Caucasian Patients. J Anesth Clin Res 5: 408.
102. Lowalekar SK, Cao H, Lu XG, Treanor PR, Allam CK, et al. (2013) The Progression of Isoflurane-induced Malignant Hyperthermia and Its Attenuation by Cisatracurium in a Pre-clinical Porcine Model of Heart Transplant. J Anesth Clin Res 4: 365.
103. Ndorbor T, Wang Y, Huaijing D, Zhizhang D, Kolawole JA, et al. (2013) Chromatographic and Molecular Simulation Study on the Chiral Recognition of Atracurium Besylate Positional Isomers on Cellulose Tri- 3, 5-Dimethylphenycarbamate (CDMPC) Column and its Recognition Mechanism. J Chromat Separation Techniq 4: 176.
104. El-Orbany M, Joseph NJ, Salem MR (2011) Post-Tetanic Count Recovery after Cisatracurium in Elderly Patients. J Anesthe Clinic Res 2:119.
105. Ndorbor T et al.Chromatographic and Molecular Simulation Study on the Chiral Recognition of Atracurium Besylate Positional Isomers on Cellulose Tri- 3, 5-Dimethylphenycarbamate (CDMPC) Column and its Recognition Mechanism.J Chromat Separation Techniq.2013;4:176.