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Category: Oxford Handbook Of Anaesthesia

Monoamine oxidase inhibitors (MAOI) Used for refractory depression. These drugs inhibit the oxidative metabolism of catecholamines at central sites. Older MAOIs were non-selective (inhibiting both MAO-A and MAOB oxidase enzymes) and irreversible. Newer types are selective for the MAO-A enzyme and cause reversible inhibition (reversible inhibitor of monoamine oxidase A or ‘RIMA’). MAO-A preferentially deaminates […]

Selective serotonin reuptake inhibitors (SSRI) Introduced in 1987 these are now the most commonly prescribed antidepressant drugs. They are highly selective for inhibitors of serotonin reuptake and are considerably less toxic than tricyclics. Cardiovascular side-effects are rare. Bradycardias have occasionally been reported and, in patients with coronary artery disease, SSRIs may precipitate coronary artery vasoconstriction. […]

Lithium Lithium carbonate is used for the treatment of bipolar depression. It resembles sodium, will permeate voltage-sensitive ion channels, and may accumulate inside cells causing partial depolarization. It may interact with anaesthetic agents that have their effects on sodium channels. Where levels are above the therapeutic range there may be prolonged recovery from barbiturates and […]

Tricyclic antidepressants Used for treating severe or endogenous depression. May also be used to treat panic disorders, neuralgia, and nocturnal enuresis in children. Properties include alpha 1 antagonist, anticholinergic, antidopaminergic, and antihistaminic effects. Side-effects include antimuscarinic (dry mouth, blurred vision, constipation, tachycardia), alpha 1 blockade (hypotension), plus other effects such as hyponatraemia (possibly due to […]

General considerations Approximately 20% of people in the United Kingdom suffer from psychiatric ill health and approximately 1% will have a major disorder. Many of these people may present for surgery, either for coexisting disease or as a result of deliberate self-harm. Psychiatric disorders often coexist with alcohol or drug abuse (see pp. 220, 222). […]

Malignant hyperthermia Jane Halsall Aetiology Malignant hyperthermia (MH) is a disorder of skeletal muscle, inherited as an autosomal dominant condition. It is associated with loss of normal Ca2+ homeostasis at some point in the excitation-contraction coupling system. An abnormality anywhere along this complex process can cause the clinical features seen in MH. This explains why […]

Motor neurone disease (amyotrophic lateral sclerosis) This is a degenerative disorder of upper and lower motor neurones in the spinal cord. It manifests initially with weakness, atrophy, and fasciculation of peripheral muscles (usually those of the hand) and progresses to axial and bulbar weakness. Progression is relentless, with death from respiratory failure usually occurring within […]

Guillain Barré syndrome Guillain Barre syndrome is an immune-mediated progressive demyelination disorder characterized by acute or subacute proximal skeletal muscle paralysis. The syndrome is often preceded by limb paraesthesia/back pain and in more than half of affected patients by a viral illness. No single viral agent has been implicated. One-third of patients will require ventilatory […]

Muscular dystrophy The muscular dystrophies comprise a range of congenital muscular disorders characterized by progressive weakness of affected muscle groups. They can be classified according to inheritance: X-linked: Duchenne’s Becker’s. Autosomal recessive: limb-girdle childhood congenital. Autosomal dominant: facioscapulohumeral oculopharyngeal. Duchenne’s muscular dystrophy This is the most common and the most severe form. Clinical features Sex-linked […]

Multiple sclerosis Multiple sclerosis is an acquired disease of the central nervous system characterized by demyelinated plaques within the brain and spinal cord. The onset of symptoms usually occurs in early adulthood with 20–30% following a benign course and 5% a rapid deterioration. It is most common in geographical clusters within Europe, North America, and […]

Dystrophia myotonica1 Dystrophia myotonica (myotonic dystrophy, myotonia atrophica) is the most common of the dystonias (1 in 20 000), the others being myotonia congenita and paramyotonia. It is an autosomal dominant trait, presenting in the second or third decade of life. The disease leads to a persistent contraction of skeletal muscle following stimulation and is […]

Myasthenia gravis Myasthenia gravis is caused by autoimmune disruption of postsynaptic acetylcholine receptors at the neuromuscular junction. In symptomatic patients up to 80% of functional receptors are lost, leading to weakness and marked fatigability. The disease may occur at any age but is most common in young adult women. It may be associated with thymus […]

Anaesthesia in spinal cord lesions There are approximately 40 000 patients in the United Kingdom with spinal cord injuries. Most are young adults who may present for a variety of surgical interventions. Fertility in affected females approaches that of the non-injured population and obstetric services are regularly required. Pathophysiology of spinal cord injury Spinal shock […]

Parkinson’s disease Parkinsonism is a syndrome characterized by: tremor, akinesia, rigidity, and postural instability. The aetiology of Parkinson’s disease is unknown, but Parkinsonism may be precipitated by drugs (especially neuroleptic agents), or be post-traumatic/postencephalitic. Pathophysiology Parkinsonism is due to an imbalance of the mutually antagonistic dopaminergic and cholinergic systems of the basal ganglia. Pigmented cells […]

Cerebrovascular disease Cerebrovascular disease is manifest by either global cerebral dysfunction (multi-infarct dementia) or focal ischaemic disorder ranging from transient ischaemic attack to major stroke. Stroke is the third leading cause of death in the industrialized world (after heart disease and cancer). Cerebrovascular disease is associated with hypertension, diabetes, obesity, and smoking. The incidence rises […]

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