Skip to main content
Anesthesia Progress logoLink to Anesthesia Progress
. 1984 Jun;31(3):116–123.

General Anesthetics: A Comparative Review of Pharmacodynamics

Stephen B Milam
PMCID: PMC2235804  PMID: 6591844

Abstract

General anesthetics, in addition to eliminating the perception of stimuli, profound physiologic effects in other systems including the cardiovascular and respiratory systems. A thorough knowledge of the pharmacodynamics and pharmacokinetics of each agents as well as an understanding of the patient's physiologic reserve will allow the anesthetist to reasonably predict the response to a given drug. The ability to forecast patient responses imparts control over an anesthetic technique which contributes to the overall safety of the procesure. This paper reviews pharmacodynamics of general anesthetic agents commonly used in dentistry

Full text

PDF
116

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abel R. M., Staroscik R. N., Reis R. L. The effects of diazepam (Valium) on left ventricular function and systemic vascular resistance. J Pharmacol Exp Ther. 1970 Jun;173(2):364–370. [PubMed] [Google Scholar]
  2. Allen G. D., Kennedy W. F., Jr, Tolas A. G., Gebrig J. D. Comparative cardiovascular effects of general anesthesia for outpatient oral surgery. J Oral Surg. 1968 Dec;26(12):784–789. [PubMed] [Google Scholar]
  3. BLACK G. W., LINDE H. W., DRIPPS R. D., PRICE H. L. Circulatory changes accompanying respiratory acidosis during halothane (fluothane) anaesthesia in man. Br J Anaesth. 1959 Jun;31:238–246. doi: 10.1093/bja/31.6.238. [DOI] [PubMed] [Google Scholar]
  4. Barclay A., Houlton P. C., Downing J. W. Total intravenous anaesthesia: a technique using flunitrazepam, ketamine, muscle relaxants and controlled ventilation of the lung. Anaesthesia. 1980 Mar;35(3):287–290. doi: 10.1111/j.1365-2044.1980.tb05098.x. [DOI] [PubMed] [Google Scholar]
  5. Beech A. D., Lytle J. J. Continuous transcutaneous oxygen tension monitoring during ultralight general anesthesia for oral surgery. J Oral Maxillofac Surg. 1982 Sep;40(9):559–565. doi: 10.1016/0278-2391(82)90283-x. [DOI] [PubMed] [Google Scholar]
  6. Bidwai A. V., Stanley H. T., Graves C. L., Kawamura R., Sentker C. R. The effects of ketamine on cardiovascular dynamics during halothane and enflurane anesthesia. Anesth Analg. 1975 Sep-Oct;54(5):588–592. doi: 10.1213/00000539-197509000-00005. [DOI] [PubMed] [Google Scholar]
  7. Boralessa H., Holdcroft A. Methohexitone or etomidate for induction of dental anaesthesia. Can Anaesth Soc J. 1980 Nov;27(6):578–583. doi: 10.1007/BF03006891. [DOI] [PubMed] [Google Scholar]
  8. Bovill J. G., Coppel D. L., Dundee J. W., Moore J. Current status of ketamine anaesthesia. Lancet. 1971 Jun 19;1(7712):1285–1288. doi: 10.1016/s0140-6736(71)91794-6. [DOI] [PubMed] [Google Scholar]
  9. Buhrow J. A., Bastron R. D. A comparative study of vasoconstrictors and determination of their safe dose under halothane anesthesia. J Oral Surg. 1981 Dec;39(12):934–937. [PubMed] [Google Scholar]
  10. Condouris G. A., Ortiz J., Lyness W. Cardiac arrhythmias produced by bretylium in cats anesthetized with halothane. Eur J Pharmacol. 1979 Apr 1;55(1):93–97. doi: 10.1016/0014-2999(79)90151-1. [DOI] [PubMed] [Google Scholar]
  11. Corssen G., Gutierrez J., Reves J. G., Huber F. C., Jr Ketamine in the anesthetic management of asthmatic patients. Anesth Analg. 1972 Jul-Aug;51(4):588–596. [PubMed] [Google Scholar]
  12. Cromwell T. H., Eger E. I., 2nd, Stevens W. C., Dolan W. M. Forane uptake, excretion, and blood solubility in man. Anesthesiology. 1971 Oct;35(4):401–408. doi: 10.1097/00000542-197110000-00017. [DOI] [PubMed] [Google Scholar]
  13. DOMINO E. F., CHODOFF P., CORSSEN G. PHARMACOLOGIC EFFECTS OF CI-581, A NEW DISSOCIATIVE ANESTHETIC, IN MAN. Clin Pharmacol Ther. 1965 May-Jun;6:279–291. doi: 10.1002/cpt196563279. [DOI] [PubMed] [Google Scholar]
  14. Dobson M. B. Anaesthesia with ketamine and thiopentone for short surgical procedures: with reference to anaesthesia in developing countries. Anaesthesia. 1978 Mar;33(3):268–270. doi: 10.1111/j.1365-2044.1978.tb08366.x. [DOI] [PubMed] [Google Scholar]
  15. Eger E. I., 2nd Isoflurane: a review. Anesthesiology. 1981 Nov;55(5):559–576. doi: 10.1097/00000542-198111000-00014. [DOI] [PubMed] [Google Scholar]
  16. Eisele J. H., Smith N. T. Cardiovascular effects of 40 percent nitrous oxide in man. Anesth Analg. 1972 Nov-Dec;51(6):956–963. [PubMed] [Google Scholar]
  17. Erbguth P. H., Reiman B., Klein R. L. The influence of chlorpromazine, diazepam, and droperidol on emergence from ketamine. Anesth Analg. 1972 Sep-Oct;51(5):693–700. [PubMed] [Google Scholar]
  18. Figallo E. M., Casali H., McKenzie R., Tantisira B., Wadhwa R. K., Taylor F. H. Ketamine as the sole anaesthetic agent for laparoscopic sterilization. The effects of premedication on the frequency of adverse clinical reactions. Br J Anaesth. 1977 Nov;49(11):1159–1165. doi: 10.1093/bja/49.11.1159. [DOI] [PubMed] [Google Scholar]
  19. Fine J., Finestone S. C. Sensory disturbances following ketamine anesthesia: recurrent hallucinations. Anesth Analg. 1973 May-Jun;52(3):428–430. [PubMed] [Google Scholar]
  20. Fourcade H. E., Stevens W. C., Larson C. P., Jr, Cromwell T. H., Bahlman S. H., Hickey R. F., Halsey M. J., Eger E. I., 2nd The ventilatory effects of Forane, a new inhaled anesthetic. Anesthesiology. 1971 Jul;35(1):26–31. doi: 10.1097/00000542-197107000-00008. [DOI] [PubMed] [Google Scholar]
  21. Helmers J. H., Adam A. A., Giezen J. Pain and myoclonus during induction with etomidate. A double-blind, controlled evaluation of the influence of droperidol and fentanyl. Acta Anaesthesiol Belg. 1981;32(2):141–147. [PubMed] [Google Scholar]
  22. Hickey R. F., Fourcade H. E., Eger E. I., 2nd, Larson C. P., Jr, Bahlman S. H., Stevens W. C., Gregory G. A., Smith N. T. The effects of ether, halothane, and Forane on apneic thresholds in man. Anesthesiology. 1971 Jul;35(1):32–37. doi: 10.1097/00000542-197107000-00009. [DOI] [PubMed] [Google Scholar]
  23. Hirshman C. A., Bergman N. A. Halothane and enflurane protect against bronchospasm in an asthma dog model. Anesth Analg. 1978 Nov-Dec;57(6):629–633. [PubMed] [Google Scholar]
  24. Hirshman C. A., Downes H., Farbood A., Bergman N. A. Ketamine block of bronchospasm in experimental canine asthma. Br J Anaesth. 1979 Aug;51(8):713–718. doi: 10.1093/bja/51.8.713. [DOI] [PubMed] [Google Scholar]
  25. Ikram H., Rubin A. P., Jewkes R. F. Effect of diazepam on myocardial blood flow of patients with and without coronary artery disease. Br Heart J. 1973 Jun;35(6):626–630. doi: 10.1136/hrt.35.6.626. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Joas T. A., Stevens W. C., Eger E. I., 2nd Electroencephalographic seizure activity in dogs during anaesthesia. Br J Anaesth. 1971 Aug;43(8):739–745. doi: 10.1093/bja/43.8.739. [DOI] [PubMed] [Google Scholar]
  27. Johnston R. R., Eger EI I. I., Wilson C. A comparative interaction of epinephrine with enflurane, isoflurane, and halothane in man. Anesth Analg. 1976 Sep-Oct;55(5):709–712. doi: 10.1213/00000539-197609000-00021. [DOI] [PubMed] [Google Scholar]
  28. Knill R. L., Gelb A. W. Ventilatory responses to hypoxia and hypercapnia during halothane sedation and anesthesia in man. Anesthesiology. 1978 Oct;49(4):244–251. doi: 10.1097/00000542-197810000-00004. [DOI] [PubMed] [Google Scholar]
  29. Knill R. L., Manninen P. H., Clement J. L. Ventilation and chemoreflexes during enflurane sedation and anaesthesia in man. Can Anaesth Soc J. 1979 Sep;26(5):353–360. doi: 10.1007/BF03006447. [DOI] [PubMed] [Google Scholar]
  30. Koehntop D. E., Liao J. C., Van Bergen F. H. Effects of pharmacologic alterations of adrenergic mechanisms by cocaine, tropolone, aminophylline, and ketamine on epinephrine-induced arrhythmias during halothane-nitrous oxide anesthesia. Anesthesiology. 1977 Feb;46(2):83–93. doi: 10.1097/00000542-197702000-00001. [DOI] [PubMed] [Google Scholar]
  31. LOEHNING R. W., CZORNY V. P. Halothane-induced hypotension and the effect of vasopressors. Can Anaesth Soc J. 1960 Jul;7:304–309. doi: 10.1007/BF03028161. [DOI] [PubMed] [Google Scholar]
  32. Lam A. M., Clement J. L., Chung D. C., Knill R. L. Respiratory effects of nitrous during enflurane anesthesia in humans. Anesthesiology. 1982 Apr;56(4):298–303. doi: 10.1097/00000542-198204000-00012. [DOI] [PubMed] [Google Scholar]
  33. Lanning C. F., Harmel M. H. Ketamine anesthesia. Annu Rev Med. 1975;26:137–141. doi: 10.1146/annurev.me.26.020175.001033. [DOI] [PubMed] [Google Scholar]
  34. Lebowitz P. W., Cote M. E., Daniels A. L., Martyn J. A., Teplick R. S., Davison J. K., Sunder N. Cardiovascular effects of midazolam and thiopentone for induction of anaesthesia in ill surgical patients. Can Anaesth Soc J. 1983 Jan;30(1):19–23. doi: 10.1007/BF03007711. [DOI] [PubMed] [Google Scholar]
  35. Liang H. S., Liang H. G. Minimizing emergence phenomena: subdissociative dosage of ketamine in balanced surgical anesthesia. Anesth Analg. 1975 May-Jun;54(3):312–316. doi: 10.1213/00000539-197505000-00009. [DOI] [PubMed] [Google Scholar]
  36. Lilburn J. K., Moore J., Dundee J. W. Attempts to attenuate the cardiostimulatory effects of ketamine. Anaesthesia. 1978 Jun;33(6):499–505. doi: 10.1111/j.1365-2044.1978.tb08385.x. [DOI] [PubMed] [Google Scholar]
  37. Lo J. N., Cumming J. F. Interaction between sedative premedicants and ketamine in man in isolated perfused rat livers. Anesthesiology. 1975 Sep;43(3):307–312. doi: 10.1097/00000542-197509000-00007. [DOI] [PubMed] [Google Scholar]
  38. Meinck H. M., Möhlenhof O., Kettler D. Neurophysiological effects of etomidate, a new short-acting hypnotic. Electroencephalogr Clin Neurophysiol. 1980 Dec;50(5-6):515–522. doi: 10.1016/0013-4694(80)90019-x. [DOI] [PubMed] [Google Scholar]
  39. Meyer B. H., Hugo J. M. Etomidate as anaesthetic induction agent in open-heart surgery. S Afr Med J. 1980 Nov 8;58(19):759–761. [PubMed] [Google Scholar]
  40. Michenfelder J. D., Cucchiara R. F. Canine cerebral oxygen consumption during enflurane anesthesia and its modification during induced seizures. Anesthesiology. 1974 Jun;40(6):575–580. doi: 10.1097/00000542-197406000-00012. [DOI] [PubMed] [Google Scholar]
  41. Miller R. D., Eger E. I., 2nd, Stevens W. C., Gibbons R. Pancuronium-induced tachycardia in relation to alveolar halothane, dose of pancuronium, and prior atropine. Anesthesiology. 1975 Mar;42(3):352–355. doi: 10.1097/00000542-197503000-00019. [DOI] [PubMed] [Google Scholar]
  42. Morgan M., Loh L., Singer L., Moore P. H. Ketamine as the sole anaesthetic agent for minor surgical procedures. Anaesthesia. 1971 Apr;26(2):158–159. doi: 10.1111/j.1365-2044.1971.tb04756.x. [DOI] [PubMed] [Google Scholar]
  43. Oduntan S. A., Gool R. Y. Clinical trial of ketamine (CI-581): a preliminary report. Can Anaesth Soc J. 1970 Jul;17(4):411–416. doi: 10.1007/BF03004705. [DOI] [PubMed] [Google Scholar]
  44. Penrose B. H. Aspiration pneumonitis following ketamine induction for general anesthesia. Anesth Analg. 1972 Jan-Feb;51(1):41–43. [PubMed] [Google Scholar]
  45. Perel A., Davidson J. T. Recurrent hallucinations following ketamine. Anaesthesia. 1976 Oct;31(8):1081–1083. doi: 10.1111/j.1365-2044.1976.tb11948.x. [DOI] [PubMed] [Google Scholar]
  46. Prakash O., Dhasmana K. M., Verdouw P. D., Saxena P. R. Cardiovascular effects of etomidate with emphasis on regional myocardial blood flow and performance. Br J Anaesth. 1981 Jun;53(6):591–599. doi: 10.1093/bja/53.6.591. [DOI] [PubMed] [Google Scholar]
  47. Reder B. S., Trapp L. D., Troutman K. C. Ketamine suppression of chemically induced convulsions in the two-day-old white leghorn cockerel. Anesth Analg. 1980 Jun;59(6):406–409. [PubMed] [Google Scholar]
  48. Rehder K., Mallow J. E., Fibuch E. E., Krabill D. R., Sessler A. D. Effects of isoflurane anesthesia and muscle paralysis on respiratory mechanics in normal man. Anesthesiology. 1974 Nov;41(5):477–485. doi: 10.1097/00000542-197411000-00013. [DOI] [PubMed] [Google Scholar]
  49. Richards C. D., White A. E. The actions of volatile anaesthetics on synaptic transmission in the dentate gyrus. J Physiol. 1975 Oct;252(1):241–257. doi: 10.1113/jphysiol.1975.sp011142. [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Safwat A. M., Daniel D. Grand mal seizure after fentanyl administration. Anesthesiology. 1983 Jul;59(1):78–78. doi: 10.1097/00000542-198307000-00018. [DOI] [PubMed] [Google Scholar]
  51. Sarnquist F. H., Mathers W. D., Brock-Utne J., Carr B., Canup C., Brown C. R. A bioassay for a water-soluble benzodiazepine against sodium thiopental. Anesthesiology. 1980 Feb;52(2):149–153. [PubMed] [Google Scholar]
  52. Schwartz D. A., Horwitz L. D. Effects of ketamine on left ventricular performance. J Pharmacol Exp Ther. 1975 Aug;194(2):410–414. [PubMed] [Google Scholar]
  53. Smith R. A., Winter P. M., Smith M., Eger E. I., 2nd Convulsions in mice after anesthesia. Anesthesiology. 1979 Jun;50(6):501–504. doi: 10.1097/00000542-197906000-00005. [DOI] [PubMed] [Google Scholar]
  54. Stirt J. A., Berger J. M., Roe S. D., Ricker S. M., Sullivan S. F. Halothane-induced cardiac arrhythmias following administration of aminophylline in experimental animals. Anesth Analg. 1981 Jul;60(7):517–520. [PubMed] [Google Scholar]
  55. Stirt J. A., Sullivan S. F. Aminophylline. Anesth Analg. 1981 Aug;60(8):587–602. [PubMed] [Google Scholar]
  56. Thomas V. J., Kyriakou K. P., Thurlow A. C. Cardiac arrhythmias during outpatient dental anaesthesia: a comparison of controlled ventilation with and without halothane. Br J Anaesth. 1978 Dec;50(12):1243–1245. doi: 10.1093/bja/50.12.1243. [DOI] [PubMed] [Google Scholar]
  57. Thurlow A. C. Cardiac dysrhythmias in outpatient dental anaesthesia in children. The effect of prophylactic intravenous atropine. Anaesthesia. 1972 Oct;27(4):429–435. doi: 10.1111/j.1365-2044.1972.tb08249.x. [DOI] [PubMed] [Google Scholar]
  58. Tucker W. K., Rackstein A. D., Munson E. S. Comparison of arrhythmic doses of adrenaline, metaraminol, ephedrine and phenylephrine during isoflurane and halothant anaesthesia in dogs. Br J Anaesth. 1974 Jun;46(6):392–396. doi: 10.1093/bja/46.6.392. [DOI] [PubMed] [Google Scholar]
  59. Vanik P. E., Davis H. S. Cardiac arrhythmias during halothane anesthesia. Anesth Analg. 1968 May-Jun;47(3):299–307. [PubMed] [Google Scholar]
  60. Vinik H. R., Reves J. G., Greenblatt D. J., Abernethy D. R., Smith L. R. The pharmacokinetics of midazolam in chronic renal failure patients. Anesthesiology. 1983 Nov;59(5):390–394. doi: 10.1097/00000542-198311000-00005. [DOI] [PubMed] [Google Scholar]
  61. Wanna H. T., Gergis S. D. Procaine, lidocaine, and ketamine inhibit histamine-induced contracture of guinea pig tracheal muscle in vitro. Anesth Analg. 1978 Jan-Feb;57(1):25–27. doi: 10.1213/00000539-197801000-00005. [DOI] [PubMed] [Google Scholar]
  62. Waxman K., Shoemaker W. C., Lippmann M. Cardiovascular effects of anesthetic induction with ketamine. Anesth Analg. 1980 May;59(5):355–358. [PubMed] [Google Scholar]
  63. White P. F. Comparative evaluation of intravenous agents for rapid sequence induction--thiopental, ketamine, and midazolam. Anesthesiology. 1982 Oct;57(4):279–284. doi: 10.1097/00000542-198210000-00005. [DOI] [PubMed] [Google Scholar]
  64. White P. F. Use of continuous infusion versus intermittent bolus administration of fentanyl or ketamine during outpatient anesthesia. Anesthesiology. 1983 Oct;59(4):294–300. doi: 10.1097/00000542-198310000-00005. [DOI] [PubMed] [Google Scholar]
  65. White P. F., Way W. L., Trevor A. J. Ketamine--its pharmacology and therapeutic uses. Anesthesiology. 1982 Feb;56(2):119–136. doi: 10.1097/00000542-198202000-00007. [DOI] [PubMed] [Google Scholar]
  66. Williams H. D., Sone L., Jr Cardiac arrhythmias during coronary-artery operations with halothane or enflurane anesthesia. Anesthesiology. 1979 Jun;50(6):551–553. doi: 10.1097/00000542-197906000-00020. [DOI] [PubMed] [Google Scholar]
  67. Winter P. M., Bruce D. L., Bach M. J., Jay G. W., Eger E. I., 2nd The anesthetic effect of air at atmospheric pressure. Anesthesiology. 1975 Jun;42(6):658–661. doi: 10.1097/00000542-197506000-00003. [DOI] [PubMed] [Google Scholar]
  68. Yelavich P. M., Holmes C. M. Etomidate: a foreshortened clinical trial. Anaesth Intensive Care. 1980 Nov;8(4):479–483. doi: 10.1177/0310057X8000800417. [DOI] [PubMed] [Google Scholar]
  69. Zahed B., Miletich D. J., Ivankovich A. D., Albrecht R. F., Toyooka E. T. Arrhythmic doses of epinephrine and dopamine during halothane, enflurane, methoxyflurane, and fluroxene anesthesia in goats. Anesth Analg. 1977 Mar-Apr;56(2):207–210. doi: 10.1213/00000539-197703000-00008. [DOI] [PubMed] [Google Scholar]
  70. Zsigmond E. K., Matsuki A., Kothary S. P., Jallad M. Arterial hypoxemia caused by intravenous ketamine. Anesth Analg. 1976 May-Jun;55(3):311–314. doi: 10.1213/00000539-197605000-00005. [DOI] [PubMed] [Google Scholar]

Articles from Anesthesia Progress are provided here courtesy of American Dental Society of Anesthesiology

RESOURCES