On the Study and Practice of Intravenous Anaesthesia [antikvár]

In recent years the study and practice of intravenous anaesthesia has gained increasing interest, both among the scientifically and more clinically oriented anaesthesiologists. The high standard of intravenous anaesthesia today has been achieved due to advances in technology, the development of shorter acting agents with less side effects and an increasing understanding of anaesthetic agent pharmacology and human (patho)physiology. Modern anaesthesia has Its roots in the early years of the 19''' century and started on the basis of inhalational anaesthesia with ether, chloroform and nitrous oxide. Later on, also Intravenous agents were used to produce the state of anaesthesia, initially with chloral hydrate, followed in the early decades of this century by barbiturates, benzodiazepines, synthetic opioids, propofol and remifentanil as the latest branches on the Intravenous tree. In contrast to the rapid developments during the first decades of this century in the inhalational anaesthetic field, resulting In sophisticated delivery and monitoring systems like vaporisers and the online measurement of the end-tidal inhalational agent concentration, most Intravenous anaesthetics were, up until recently, administered in the form of droplets on a dose per kg body weight basis, a situation which resembles the administration of Inhalational agents by the Schimmelbusch mask as was common practice In the period 1920-1940. This is, however, all rapidly changing now. Over the past two decades the knowledge on the pharmacokinetics and pharmacodynamics of intravenous anaesthetic agents has rapidly been growing. This has resulted in a better understanding of the drug dose - blood concentrations - biophase concentration -effect relationship. This body of knowledge has not been secluded within the