General anaesthesia in the context of Neuromuscular blocking agent

A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened, fails to respond normally to painful stimuli, light, or sound, lacks a normal sleep-wake cycle and does not initiate voluntary actions. The person may experience respiratory and circulatory problems due to the body's inability to maintain normal bodily functions. People in a coma often require extensive medical care to maintain their health and prevent complications such as pneumonia or blood clots. Coma patients exhibit a complete absence of wakefulness and are unable to consciously feel, speak or move. Comas can be the result of natural causes, or can be medically induced, for example, during general anesthesia.

Clinically, a coma can be defined as the consistent inability to follow a one-step command. For a patient to maintain consciousness, the components of wakefulness and awareness must be maintained. Wakefulness is a quantitative assessment of the degree of consciousness, whereas awareness is a qualitative assessment of the functions mediated by the cerebral cortex, including cognitive abilities such as attention, sensory perception, explicit memory, language, the execution of tasks, temporal and spatial orientation and reality judgment. Neurologically, consciousness is maintained by the activation of the cerebral cortex—the gray matter that forms the brain's outermost layer—and by the reticular activating system (RAS), a structure in the brainstem.

General anaesthetics (or anesthetics) are often defined as compounds that induce a loss of consciousness in humans or loss of righting reflex in animals. Clinical definitions are also extended to include an induced coma that causes lack of awareness to painful stimuli, sufficient to facilitate surgical applications in clinical and veterinary practice. General anaesthetics do not act as analgesics and should also not be confused with sedatives. General anaesthetics are a structurally diverse group of compounds whose mechanisms encompass multiple biological targets involved in the control of neuronal pathways. The precise workings are the subject of some debate and ongoing research.

General anesthetics elicit a state of general anesthesia. It remains somewhat controversial regarding how this state should be defined. General anesthetics, however, typically elicit several key reversible effects: immobility, analgesia, amnesia, unconsciousness, and reduced autonomic responsiveness to noxious stimuli.

Malignant hyperthermia (MH) is a type of severe reaction that occurs in response to particular medications used during general anesthesia, among those who are susceptible. Symptoms include muscle rigidity, fever, and a fast heart rate. Complications can include muscle breakdown and high blood potassium. Most people who are susceptible to MH are generally unaffected when not exposed to triggering agents.

Exposure to triggering agents (certain volatile anesthetic agents or succinylcholine) can lead to the development of MH in those who are susceptible. Susceptibility can occur due to at least six genetic mutations, with the most common one being of the RYR1 gene. These genetic variations are often inherited in an autosomal dominant manner. The condition may also occur as a new mutation or be associated with a number of inherited muscle diseases, such as central core disease.

An intensivist, also known as a critical care doctor, is a medical practitioner who specializes in the care of critically ill patients, most often in the intensive care unit (ICU). Intensivists can be internists or internal medicine sub-specialists (most often pulmonologists), anaesthesiologists, emergency medicine physicians, paediatricians (including neonatologists), or surgeons who have completed a fellowship in critical care medicine. The intensivist must be competent not only in a broad spectrum of conditions among critically ill patients but also with the technical procedures and equipment used in the intensive care setting such as airway management, rapid sequence induction of anaesthesia, maintenance and weaning of sedation, central venous and arterial catheterisation, point of care ultrasound, renal replacement therapy and management of mechanical ventilators.

Spinal anaesthesia (or spinal anesthesia), also called spinal block, subarachnoid block, intradural block and intrathecal block, is a form of neuraxial regional anaesthesia involving the injection of a local anaesthetic with or without an opioid into the subarachnoid space. Usually a single-shot dose is administrered through a fine needle, alternatively continuous spinal anaesthesia through a intrathecal catheter can be performed. It is a safe and effective form of anesthesia usually performed by anesthesiologists that can be used as an alternative to general anesthesia commonly in surgeries involving the lower extremities and surgeries below the umbilicus. The local anesthetic with or without an opioid injected into the cerebrospinal fluid provides locoregional anaesthesia: true anaesthesia, motor, sensory and autonomic (sympathetic) blockade.Administering analgesics (opioid, alpha2-adrenoreceptor agonist) in the cerebrospinal fluid without a local anaesthetic produces locoregional analgesia: markedly reduced pain sensation (incomplete analgesia), some autonomic blockade (parasympathetic plexi), but no sensory or motor block.Locoregional analgesia, due to mainly the absence of motor and sympathetic block may be preferred over locoregional anaesthesia in some postoperative care settings.The tip of the spinal needle has a point or small bevel. Recently, pencil point needles have been made available (Whitacre, Sprotte, Gertie Marx and others).

Nitrogen narcosis (also known as narcosis while diving, inert gas narcosis, raptures of the deep, Martini effect) is a reversible alteration in consciousness that occurs while diving at depth. It is caused by the anesthetic effect of certain gases at high partial pressure. The Greek word νάρκωσις (narkōsis), "the act of making numb", is derived from νάρκη (narkē), "numbness, torpor", a term used by Homer and Hippocrates. Narcosis produces a state similar to drunkenness (alcohol intoxication), or nitrous oxide inhalation. It can occur during shallow dives, but does not usually become noticeable at depths less than 30 metres (98 ft).

Except for helium and probably neon, all gases that can be breathed have a narcotic effect, although widely varying in degree. The effect is consistently greater for gases with a higher lipid solubility, and although the mechanism of this phenomenon is still not fully clear, there is good evidence that the two properties are mechanistically related. As depth increases, the mental impairment may become hazardous. Divers can learn to cope with some of the effects of narcosis, but it is impossible to develop a tolerance. Narcosis can affect all ambient pressure divers, although susceptibility varies widely among individuals and from dive to dive. The main modes of underwater diving that deal with its prevention and management are scuba diving and surface-supplied diving at depths greater than 30 metres (98 ft).