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• W2165159317 abstract "The provision of general anaesthesia requires the administration of drugs to suppress movement in response to noxious stimuli and responses to autonomic stimulation of the sympathetic and parasympathetic nervous systems, to abolish awareness, and to relieve pain. Pain relief can be achieved by use of nitrous oxide as part of a balanced anaesthetic; by opioids or related drugs given intravenously or systemically; by other drugs having analgesic properties (for example, phencyclidines such as ketamine, or the NSAIDs); or by local anaesthetic agents, given topically by local infiltration to provide nerve or plexus blockade, or by the spinal route. In this review I shall consider the use of opioid drugs as part of balanced or other anaesthetic techniques for anaesthesia. The analgesic properties of morphine have been known since they were described by Theophrastus in the third century BC, but there is a continuing quest for newer and pharmacologically purer drugs that bring about analgesia without the unwanted other effects of the opium alkaloids. The first such synthetic agent was pethidine, produced in 1938; its use as part of a balanced technique using nitrous oxide was described by Neff and colleagues. 84 In 1958 Bailey and colleagues used pethidine with oxygen for cardiac surgery. 8 This led in turn to reports of the cardiovascular stability observed when large doses of morphine (0.5–1.0 mg kg � 1 ) were given to patients with compromised cardiovascular function. 74 However, the technique was not without its problems, namely intraoperative recall, failure to prevent intraoperative hypertension, histaminerelated hypotension and increased perioperative fluid requirements. In an attempt to remedy these side effects, some clinicians used even larger doses of morphine (up to 10 mg kg � 1 ), although this was found to be associated with greater haemodynamic instability. 120 Other side-effects included the potential for addiction and pronounced respiratory depression. In the course of the evaluation of alternative drugs with a greater analgesic selectivity, nalorphine was synthesized. Nalorphine not only reversed the respiratory depressant effects of morphine but also had intrinsic analgesic properties. This led to the develop" @default.
• W2165159317 created "2016-06-24" @default.
• W2165159317 creator A5061971280 @default.
• W2165159317 date "1998-07-01" @default.
• W2165159317 modified "2023-10-15" @default.
• W2165159317 title "Recent advances and developments in the clinical use of i.v. opioids during the peroperative period" @default.
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