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Encyclopedia > Anesthesia

Anesthesia or anaesthesia (see spelling differences) has traditionally meant the condition of having the perception of pain and other sensations blocked. This allows patients to undergo surgery and other procedures without the distress and pain they would otherwise experience. It comes from the Greek roots an-, "not, without" and aesthētos, "perceptible, able to feel". The word was coined by Oliver Wendell Holmes, Sr. in 1846. American and British English spelling differences are one aspect of American and British English differences. ... For other uses, see Pain (disambiguation). ... It has been suggested that this article or section be merged with Sensation and perception psychology. ... A cardiothoracic surgeon performs a mitral valve replacement at the Fitzsimons Army Medical Center. ... Oliver Wendell Holmes Sr. ... 1846 was a common year starting on Thursday (see link for calendar). ...


Today, the term general anesthesia in its most general form can include:

Contents

This article or section does not adequately cite its references or sources. ... Consciousness is a quality of the mind generally regarded to comprise qualities such as subjectivity, self-awareness, sentience, sapience, and the ability to perceive the relationship between oneself and ones environment. ... Professor Charcot was well-known for showing, during his lessons at the Salpêtrière hospital, hysterical woman patients – here, his favorite patient, Blanche (Marie) Wittman, supported by Joseph Babiński. ... Unconsciousness is the absence of consciousness. ... Amnesia or amnæsia (from Greek ) (see spelling differences) is a condition in which memory is disturbed. ... For other uses, see Memory (disambiguation). ... Drugs can block neuromuscular transmission etiher by acting presynaptically, to inhibit ACh synthesis or release, or by acting postsynaptically, the latter being the site of action ofa ll of the clincally important drugs. ...

Types

There are several forms of anesthesia:

  • General: anesthesia resulting in amnesia, with a loss of protective airway reflexes. While usually administered with inhalational agents, general anesthesia can be achieved with intravenous agents, such as propofol. Amnesia is the main characteristic, while analgesia and muscle relaxation may be present, to varying degrees.
  • Regional: Loss of pain sensation, with varying degrees of muscle relaxation, in certain regions of the body. Administered with local anesthesia to peripheral nerve bundles, such as the brachial plexus in the neck. Examples include the interscalene block for shoulder surgery, axillary block for wrist surgery, and femoral nerve block for leg surgery. While traditionally administered as a single injection, newer techniques involve placement of indwelling catheters for continuous or intermittent administration of local anesthetics.
    • Spinal: aka "Sub Arachnoid Block" Refers to a regional block resulting from a small volume of local anesthetics being injected into the spinal canal. The spinal canal is covered by the dura mater, through which the spinal needle enters. The spinal canal contains cerebrospinal fluid and the spinal cord. The sub arachnoid block is usually injected between the 4th and 5th lumbar vertebrae, because the spinal cord usually stops at the 1st lumbar vertebra, while the canal continues to the sacral vertebrae. It results in a loss of pain sensation and muscle strength, usually up to the level of the chest (nipple line or 4th thoracic dermatome).
    • Epidural: Regional block resulting from an injection of a large volume of local anesthetic into the epidural space. The epidural space is a potential space that lies underneath the ligamenta flava, and outside the dura mater (outside layer of the spinal canal). This is basically an injection around the spinal canal.
  • Local anesthesia is similar to regional anesthesia, but exerts its effect on a smaller area of the body.

Not all surgical procedures require anesthetic. Sometimes no anesthetic is required, and conscious sedation is used, which does not result in loss of consciousness or significant analgesia, but frequently produces a degree of amnesia, and relaxes the patient. Amnesia or amnæsia (from Greek ) (see spelling differences) is a condition in which memory is disturbed. ... A reflex action or reflex is a biological control system linking stimulus to response and mediated by a reflex arc. ... Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ... Propofol is a short-acting intravenous anesthetic agent used for the induction of general anesthesia in adult patients and pediatric patients older than 3 years of age; maintenance of general anesthesia in adult patients and pediatric patients older than 2 months of age; and sedation in medical contexts, such as... The Femoral Nerve supplies innervation the anterior portion of the leg. ... The Arachnoid mater is one of the three layers of the meninges, interposed between the dura mater and the pia mater and separated from the pia mater by the subarachnoid space. ... The spinal canal is the space in vertebrae through which the spinal cord passes. ... The dura mater (from the Latin hard mother), or pachymeninx, is the tough and inflexible outermost of the three layers of the meninges surrounding the brain. ... Cerebrospinal fluid (CSF), Liquor cerebrospinalis, is a clear bodily fluid that occupies the subarachnoid space in the brain (the space between the skull and the cerebral cortex—more specifically, between the arachnoid and pia layers of the meninges). ... The Spinal cord nested in the vertebral column. ... In anatomy, lumbar is an adjective that means of or pertaining to the abdominal segment of the torso, between the diaphragm and the sacrum (pelvis). ... A diagram of a thoracic vertebra. ... This article or section may be confusing or unclear for some readers, and should be edited to rectify this. ... Dermatomic area (also known as a dermatome) is an area of skin that is supplied by a single pair of dorsal roots. ... The epidural space is a part of the human spine which is very close to the spinal cord, lying just outside the dura mater. ... In anatomy, potential space refers to a gap that can exist because two adjacent features are not tightly adjoined, but does not appear during normal functioning. ... The ligamenta flava connect the laminæ of adjacent vertebræ, from the axis to the first segment of the sacrum. ... Local anesthesia is any technique to render part of the body insensitive to pain without affecting consciousness. ... Sedation is a medical procedure involving administration of sedative drugs, generally to facilitate a medical procedure, such as endoscopy, vasectomy, or minor surgery with local anaesthesia. ...


According to a 1999 report from the Institute of Medicine, anesthesia care today is nearly 50 times safer than it was 20 years ago.


History

Anesthesia was used by the Incas. Shamans chewed coca leaves and drilled holes in the heads of their patients (to let the bad spirits escape) while spitting into the wounds they'd inflicted. The mixture of resin and saliva numbed the site allowing hours of drilling.[citation needed] 18th century French illustration of trepanation Trepanation (also known trepanning, trephination, trephining or burr hole) is a form of surgery in which a hole is drilled or scraped into the skull, thus exposing the dura mater in order to treat health problems related to intracranial diseases, though in the modern...


Also, Dioscorides, for example, reports potions being prepared from opium and mandragora as surgical anesthetics. Pedanius Dioscorides (ca. ... Opium is a narcotic produced from opium poppies. ... Species Mandragora autumnalis Mandragora officinarum Mandragora turcomanica Mandragora caulescens Mandrake is the common name for members of the plant genus Mandragora belonging to the nightshades family (Solanaceae). ...


In the East, in the 10th century work Shahnameh, the author describes a caesarean section performed on Rudaba when giving birth, in which a special wine agent was prepared by a Zoroastrian priest, and used to produce unconsciousness for the operation. Although largely mythical in content, the passage does at least illustrate knowledge of anesthesia in ancient Persia. Shahnameh Scenes from the Shahnameh carved into reliefs at Tus, where Ferdowsi is buried. ... A caesarean section (AE cesarean section), or c-section, is a form of childbirth in which a surgical incision is made through a mothers abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies. ... Rudaba or Roodabeh (رودابه in Persia) was Daughter of Mehrab Kaboli. ... A glass of red wine This article is about the alcoholic beverage. ... Zoroastrianism (Avestan Daênâ Vañuhi the good religion)[1][2] is the religion and philosophy based on the teachings ascribed to the prophet Zoroaster (Zarathustra, Zartosht). ... For other uses of this term see: Persia (disambiguation) The Persian Empire is the name used to refer to a number of historic dynasties that have ruled the country of Persia (Iran). ...


Non-pharmacological methods

Hypnotism and acupuncture have a long history of use as anesthetic techniques. In China, Taoist medical practitioners developed anesthesia by means of acupuncture. Chilling tissue (e.g. with ice) can temporarily cause nerve fibers (axons) to stop conducting sensation, while hyperventilation can cause brief alteration in conscious perception of stimuli including pain (see Lamaze). Hypnosurgery is the term given to an operation where the patient is sedated using hypnotherapy rather than traditional anaesthetics. ... Acupuncture (from Lat. ... For other uses of the words tao and dao, see Dao (disambiguation). ... Acupuncture (from Lat. ... Snowflakes by Wilson Bentley, 1902 Ice is the name given to any one of the 14 known solid phases of water. ... An axon or nerve fiber, is a long, slender projection of a nerve cell, or neuron, that conducts electrical impulses away from the neurons cell body or soma. ... In medicine, hyperventilation (or hyperpnea) is the state of breathing faster or deeper (hyper) than necessary, and thereby reducing the carbon dioxide concentration of the blood below normal. ... The Lamaze Technique is a natural childbirth technique developed in the 1940s by French obstetrician Dr. Fernand Lamaze as an alternative to the use of medical intervention during labor. ...


In modern anesthetic practice, these techniques are seldom employed.


Herbal derivatives

The first herbal anesthesia was administered in prehistory. Opium and Cannabis were two of the most important herbs used. They were ingested or smoked. Alcohol was also used, its vasodilatory properties being unknown. In early America preparations, datura, with the active ingredient scopolamine, was used, as was coca. In Medieval Europe various preparations of mandrake were tried as was henbane (hyoscyamine). Dioscorides’ Materia Medica, c. ... It has been suggested that this article or section be merged with Prehistoric man. ... Opium is a narcotic produced from opium poppies. ... Look up Cannabis in Wiktionary, the free dictionary. ... Ethanol, also known as ethyl alcohol, drinking alcohol or grain alcohol, is a flammable, colorless, slightly toxic chemical compound with a distinctive perfume-like odor, and is the alcohol found in alcoholic beverages. ... The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... Species See text below Datura is a genus of 12-15 species of flowering plants belonging to the family Solanaceae. ... Scopolamine, also known as hyoscine, is a tropane alkaloid drug obtained from plants of the family Solanaceae (nightshades), such as henbane or jimson weed (Datura species). ... Binomial name Erythroxylum coca Lam. ... Medieval Times outside of Chicago This is the article on the Medieval Times dinner theater chain. ... This article is 150 kilobytes or more in size. ... Species Mandragora autumnalis Mandragora officinarum Mandragora turcomanica Mandragora caulescens Mandrake root redirects here. ... Binomial name Hyoscyamus niger L. Henbane (Hyoscyamus niger) is a plant of the family Solanaceae that originated in Eurasia. ... Hyoscyamine is a chemical compound, a tropane alkaloid it is the levo-isomer to atropine. ...


In 1804, the Japanese surgeon Hanaoka Seishū performed general anaesthesia for the operation of a breast cancer (mastectomy), by combining Chinese herbal medicine know-how and Western surgery techniques learned through "Rangaku", or "Dutch studies". His patient was a 60-year-old woman called Kan Aiya.[1] He used a compound he called Tsusensan, based on the plants Datura metel, Aconitum and others. 1804 was a leap year starting on Sunday (see link for calendar). ... Hanaoka Seishu (1760-1835). ... Anesthesia (AE), also anaesthesia (BE), is the process of blocking the perception of pain and other sensations. ... In medicine, mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. ... A cardiothoracic surgeon performs a mitral valve replacement at the Fitzsimons Army Medical Center. ... Rangaku (蘭学) or Dutch Learning was the method by which Japan kept abreast of Western technology and medicine in the period when the country was closed to foreigners, 1641-1853, because of the Tokugawa shogunates policy of national isolation (sakoku). ... Species See text below Datura is a genus of 12-15 species of flowering plants belonging to the family Solanaceae. ... This article is about the herb sometimes known as wolfsbane. ...


Early gases and vapours

Contemporary re-enactment of Morton's October 16, 1846, ether operation; daguerrotype by Southworth & Hawes.

In the West, the development of effective anesthetics in the 19th century was, with Listerian techniques, one of the keys to successful surgery. Henry Hill Hickman experimented with carbon dioxide in the 1820s. The anaesthetic qualities of nitrous oxide (isolated in 1773 by Joseph Priestley) were discovered by the British chemist Humphry Davy about 1799 when he was an assistant to Thomas Beddoes, and reported in a paper in 1800. But initially the medical uses of this so-called "laughing gas" were limited - its main role was in entertainment. It was used on 30 September 1846 for painless tooth extraction upon patient Eben Frost by American dentist William Thomas Green Morton. Horace Wells Connecticut, a travelling dentist, had demonstrated it the previous year 1845, at Massachusetts General Hospital. Wells made a mistake, in choosing a particularly sturdy male volunteer, and the patient suffered considerable pain. This lost the colourful Wells any support. Later the patient told Wells he screamed in shock and not in pain. A subsequently drunk Wells died in jail, by cutting his femoral artery, after allegedly assaulting a prostitute with sulphuric acid. Image File history File links Download high resolution version (1536x1212, 925 KB) Re-enactment of the first operation under anesthesia (ether). ... Image File history File links Download high resolution version (1536x1212, 925 KB) Re-enactment of the first operation under anesthesia (ether). ... October 16 is the 289th day of the year (290th in leap years). ... 1846 was a common year starting on Thursday (see link for calendar). ... Southworth & Hawes was an early photographic firm in Boston, 1843-1863. ... Alternative meaning: Nineteenth Century (periodical) (18th century — 19th century — 20th century — more centuries) As a means of recording the passage of time, the 19th century was that century which lasted from 1801-1900 in the sense of the Gregorian calendar. ... Joseph Lister, 1st Baron Lister, OM , FRS (5 April 1827 – 10 February 1912) was an English surgeon who promoted the idea of sterile surgery while working at the Glasgow Royal Infirmary. ... Henry Hill Hickman, 1800-1830 Hickman was born to tenant farmers in 1800. ... Carbon dioxide is a chemical compound composed of one carbon and two oxygen atoms. ... Nationalistic independence movements helped reshape the world during this decade: Greece gains independence from the Ottoman Empire in the Greek War of Independence (1821-1827). ... R-phrases S-phrases Supplementary data page Structure and properties n, εr, etc. ... Joseph Frederick Priestley is often credited for the discovery of oxygen. ... Sir Humphry Davy, 1st Baronet, FRS (17 December 1778 – 29 May 1829) was an esteemed British chemist and physicist. ... 1799 was a common year starting on Tuesday (see link for calendar). ... Thomas Beddoes (April 13, 1760 - December 24, 1808), English physician and scientific writer, was born at Shiffnall in Shropshire. ... // ON MAY 5 1853 MR.FADER HAD SEX WITH A MAN NAME MR WIEN THEN THEY HAD SON NAMEDMRS COTURE AND MR MANOOGIAN WENT INTO MRS HASKELLS OFFICE NAKED AND DANCED AROUND AND MASTERBATED ON HER CHEST AND SHE LICKED IT OFF THEN THEY HAD ORAL SEEX WITH NAPLOEAN OF... September 30 is the 273rd day of the year (274th in leap years) in the Gregorian calendar. ... 1846 was a common year starting on Thursday (see link for calendar). ... X-rays can reveal if a person has cavities Dentistry is the practical application of knowledge of dental science (the science of placement, arrangement, function of teeth) to human beings. ... It has been suggested that this article be split into multiple articles. ... 1845 was a common year starting on Wednesday (see link for calendar). ... Massachusetts General Hospital (often abbreviated to Mass General or just MGH) is a teaching hospital of Harvard Medical School and biomedical research facility in Boston, Massachusetts. ...


Another dentist, William E. Clarke, performed an extraction in January 1842 using a different chemical, diethyl ether (discovered by Valerius Cordus in 1540). In March 1842 in Danielsville, Georgia, Dr. Crawford Long was the first to use anaesthesia during an operation, giving it to a boy (John Venables) before excising a cyst from his neck; however, he did not publicize this information until later. 1842 was a common year starting on Saturday (see link for calendar). ... Diethyl ether, also known as ether and ethoxyethane, is a clear, colorless, and highly flammable liquid with a low boiling point and a characteristic smell. ... Year 1540 was a leap year starting on Thursday (link will display the full calendar) of the Julian calendar. ... Danielsville is a city located in Madison County, Georgia. ... Crawford Long. ...


On October 16, 1846, another dentist, William Thomas Green Morton, invited to the Massachusetts General Hospital, performed the first public demonstration of diethyl ether (then called sulfuric ether) as an anesthetic agent, for a patient (Edward Gilbert Abbott) undergoing an excision of a vascular tumour from his neck. In a letter to Morton shortly thereafter, Oliver Wendell Holmes, Sr. proposed naming the procedure anæsthesia. October 16 is the 289th day of the year (290th in leap years). ... 1846 was a common year starting on Thursday (see link for calendar). ... William Thomas Green Morton (August 9, 1819 - July 15, 1868) was responsible for the first successful public demonstration of ether as an inhalation anesthetic. ... Oliver Wendell Holmes Sr. ...

Anesthesia pioneer Crawford W. Long
Anesthesia pioneer Crawford W. Long

Despite Morton's efforts to keep "his" compound a secret, which he named "Letheon" and for which he received a US patent, the news of the discovery and the nature of the compound spread very quickly to Europe in late 1846. Here, respected surgeons, including Liston, Dieffenbach, Pirogoff, and Syme undertook numerous operations with ether. An American born physician, Boott who had travelled to London, encouraged a leading dentist, Mr James Robinson, to perform a dental procedure on a Miss Lonsdale. This was the first case of an operator-anaesthetist. On the same day, Saturday 19 December 1846 in Dumfries Royal Infirmary, Scotland, A Dr Scott used ether for a surgical procedure. The first use of anaesthesia in the southern hemisphere took place in Launceston, Tasmania, that same year. Ether has a number of drawbacks, such as its tendency to induce vomiting and its flammability. In England it was quickly replaced with chloroform. Image File history File linksMetadata CrawfordLong. ... Image File history File linksMetadata CrawfordLong. ... Ether is the general name for a class of chemical compounds which contain an ether group — an oxygen atom connected to two (substituted) alkyl groups. ... Vomiting (also throwing up or emesis) is the forceful expulsion of the contents of ones stomach through the mouth and sometimes the nose. ... A symbol for flammable chemicals Flammability is the ease with which a substance will ignite, causing fire or combustion. ... For the song Chloroform by Spoon, see A Series of Sneaks Chloroform, also known as trichloromethane and methyl trichloride, is a chemical compound with formula CHCl3. ...


Discovered in 1831, the use of chloroform in anaesthesia is usually linked to James Young Simpson, who, in a wide-ranging study of organic compounds, found chloroform's efficacy on 4 November 1847. Its use spread quickly and gained royal approval in 1853 when John Snow gave it to Queen Victoria during the birth of Prince Leopold. Unfortunately, chloroform is not as safe an agent as ether, especially when administered by an untrained practitioner (medical students, nurses and occasionally members of the public were often pressed into giving anaesthetics at this time). This led to many deaths from the use of chloroform which (with hindsight) might have been preventable. The first fatality directly attributed to chloroform anaesthesia (Hannah Greener) was recorded on 28 January 1848. Leopold I 1831 (MDCCCXXXI) was a common year starting on Saturday (see link for calendar). ... James Young Simpson James Young Simpson Sir James Young Simpson, (June 7, 1811 born in Bathgate, West Lothian, died May 6, 1870), was a Scottish doctor and important figure in the history of medicine. ... November 4 is the 308th day of the year (309th in leap years) in the Gregorian Calendar, with 57 days remaining. ... 1847 was a common year starting on Friday (see link for calendar). ... 1853 was a common year starting on Saturday (see link for calendar). ... Dr. John Snow John Snow (1813 - 1858) was a British physician and a leader in the adoption of anaesthesia and medical hygiene, and is often considered one of the fathers of epidemiology for his work in tracing the source of a cholera outbreak in Soho, Westminster, England in 1854. ... Victoria Queen of the United Kingdom of Great Britain and Ireland, Empress of India Victoria (Alexandrina Victoria) (24 May 1819–22 January 1901) was a Queen of the United Kingdom, reigning from 20 June 1837 until her death. ... Prince Leopold, Duke of Albany (Leopold George Duncan Albert) (7 April 1853 – 28 March 1884), was a member of the British Royal Family, a son of Queen Victoria. ... A medical school or faculty of medicine is a tertiary educational institution or part of such an institution that teaches medicine. ... Nurses is a television sitcom that ran on NBC from 1991 to 1994. ... January 28 is the 28th day of the year in the Gregorian calendar. ... Year 1848 (MDCCCXLVIII) was a leap year starting on Saturday (link will display the full calendar) of the Gregorian Calendar (or a leap year starting on Monday of the 12-day slower Julian calendar). ...


John Snow of London published articles from May 1848 onwards 'On Narcotism by the Inhalation of vapours' in the London Medical Gazette. Snow also involved himself in the production of equipment needed for inhalational anaesthesia.


The surgical amphitheatre at Massachusetts General Hospital, or "ether dome" still exists today, although it is used for lectures and not surgery. The public can visit the amphitheater on weekdays when it is not in use.


Early local anesthetics

The first effective local anesthetic was cocaine. Isolated in 1859, it was first used by Karl Koller, at the suggestion of Sigmund Freud, in ophthalmic surgery in 1884. Before that doctors had used a salt and ice mix for the numbing effects of cold, which could only have limited application. Similar numbing was also induced by a spray of ether or ethyl chloride. A number of cocaine derivatives and safer replacements were soon produced, including procaine (1905), Eucaine (1900), Stovaine (1904), and lidocaine (1943). Cocaine (or crack in its freebase form) is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. ... 1859 (MDCCCLIX) is a common year starting on Saturday of the Gregorian calendar (or a common year starting on Monday of the Julian calendar). ... Karl Koller (1857-1944} was an Austrian ophthalmologist who began his medical career as a surgeon at the Vienna General Hospital, and was a colleague of Sigmund Freud. ... Sigmund Freud (born Sigismund Schlomo Freud) May 6, 1856 – September 23, 1939; (IPA pronunciation: [] in German, [] in English) was a Jewish-Austrian neurologist and psychiatrist who co-founded the psychoanalytic school of psychology. ... 1884 (MDCCCLXXXIV) is a leap year starting on Tuesday (click on link to calendar) of the Gregorian calendar (or a leap year starting on Thursday of the 12-day-slower Julian calendar). ... For other uses of the name Novocaine and other spellings thereof, see Novocaine (disambiguation). ... 1905 (MCMV) was a common year starting on Sunday (link will display the full calendar). ... Year 1900 (MCM) was an exceptional common year starting on Monday (link will display the full calendar) of the Gregorian calendar, but a leap year starting on Saturday of the Julian calendar. ... 1904 (MCMIV) was a leap year starting on a Friday (see link for calendar). ... Lidocaine (INN) (IPA: ) or lignocaine (former BAN) (IPA: ) is a common local anesthetic and antiarrhythmic drug. ... 1943 (MCMXLIII) was a common year starting on Friday (the link is to a full 1943 calendar). ...


Opioids were first used by Racoviceanu-Piteşti, who reported his work in 1901. An opioid is a chemical substance that has a morphine-like action in the body. ... 1901 (MCMI) was a common year starting on Tuesday (link will display calendar) of the Gregorian calendar (or a common year starting on Wednesday of the 13-day-slower Julian calendar). ...


Anesthesia providers

Physicians specialising in peri-operative care, development of an anesthetic plan, and the administration of anesthetics are known in the UK as anaesthetists, and, in the U.S., as anesthesiologists. All anaesthetics in the UK, Australia, New Zealand and Japan are administered by physicians, however nurse anesthetists also administer anesthesia in 109 nations.[2] In the US, about 35% of anesthetics are provided by physicians in solo practice, about 55% are provided by ACTs with anesthesiologists medically directing CRNAs, and about 10% are provided by CRNAs in solo practice. [3] [4] [5] [6]


Physician Anesthesiologists / Anaesthetists

In the U.S., the training of a physician anesthesiologist typically consists of 4 years of college, 4 years of medical school, 1 year of internship, and 3 years of residency. According to the American Society of Anesthesiologists, Anesthesiologists provide or participate in more than 90 percent of the 40 million anesthetics delivered annually. [7] An anesthesiologist (American English), or anaesthetist (British English), is a medical doctor trained to administer anesthesia and manage patients medically before, during, and after surgery. ...


In the UK this training lasts a minimum of seven years after the awarding of a medical degree and two years of basic residency, and takes place under the supervision of the Royal College of Anaesthetists. In Australia and New Zealand, it lasts five years after the awarding of a medical degree and a minimum of two years of basic residency, under the supervision of the Australian and New Zealand College of Anaesthetists. Most trainees have done additional years as residents in critical care prior to acceptance into the training program due to its competitive nature. The training program consists of 12 modules covering the breadth and depth of anaesthesia, with a minimum of 3 months spent in an intensive care unit. Completion of the training program and success in the primary, then the final examinations lead to admission into the Diploma of Fellowship of the Royal Australian and New Zealand College of Anaesthetists (FANZCA). The Royal College of Anaesthetists is the professional body responsible for the specialty of anaesthesia throughout the United Kingdom. It sets standards in anaesthesia, critical care, pain management, and for the training of anaesthetists and those practising critical care physicians. ...


Other countries have similar systems, including Ireland (the Faculty of Anaesthetists of the Royal College of Surgeons in Ireland), Canada and South Africa.


In the UK, completion of the examinations set by the Royal College of Anaesthetists leads to award of the Diploma of Fellowship of the Royal College of Anaesthetists (FRCA). In the US, completion of the written and oral Board examinations by a physician anesthesiologist allows one to be called "Board Certified" or a "Diplomate" of the American Board of Anesthesiology. The Doctor by Samuel Luke Fildes This article is about the term physician, one type of doctor; for other uses of the word doctor see Doctor. ... An anesthesiologist (American English), or anaesthetist (British English), is a medical doctor trained to administer anesthesia and manage patients medically before, during, and after surgery. ...


Other specialties within medicine are closely affiliated to anaesthetics. These include intensive care medicine and pain medicine. Specialists in these disciplines have usually done some training in anaesthetics. The role of the anaesthetist is changing. It is no longer limited to the operation itself. Many anaesthetists consider themselves to be peri-operative physicians, and will involve themselves in optimizing the patient's health before surgery (colloquially called "work-up"), performing the anaesthetic, following up the patient in the post anesthesia care unit and post-operative wards, and ensuring optimal analgesia throughout. Intensive Care Medicine or critical care medicine is a branch of medicine concerned with the provision of life support or organ support systems in patients who are critically ill who usually also require intensive monitoring. ... Pain medicine is a branch of anaesthetics concerned with the treatment of acute and chronic pain. ... A post anesthesia care unit, often abbreviated PACU, is a vital part of hospitals, ambulatory care centers, and other medical facilities. ... For other uses of painkiller, see painkiller (disambiguation) An analgesic (colloquially known as painkiller) is any member of the diverse group of drugs used to relieve pain. ...


Nurse Anesthetists

In the United States, advanced practice nurses specializing in the provision of anesthesia are known as Nurse anesthetists (CRNAs). According to the American Association of Nurse Anesthetists, CRNAs provide 27 million hands-on anesthetics each year, roughly two thirds of the US total. CRNAs start school with a bachelors degree and at least 1 year of critical care nursing experience, and gain a masters degree in nurse anesthesia before passing the Certification Exam. The average CRNA student has 5-7 years of nursing experience before entering an anesthesia program.[8] + - CRNAs may work with podiatrists, dentists, anesthesiologists, surgeons, obstetricians and other professionals requiring their services. CRNAs administer anesthesia in all types of surgical cases, and are able to apply all the accepted anesthetic techniques -- general, regional, local, or sedation. Nurse Anesthetists are licensed to practice anesthesia independently, as well as in Anesthesia Care Teams, which are led by a physician anesthetist.[9] CRNAs may also practice in parallel with their physician colleagues in certain institutions, both types of provider caring for their own patients independently and consulting whenever collaboration is appropriate to patient outcome. A nurse anesthetist (AE) is a registered nurse educated and trained to administer anesthesia. ...


Nurse anesthetists provide anesthesia services in many rural hospitals in the USA where there are no practicing anesthesiologists.


Anesthesia assistants

The term anesthesia assistant identifies individuals in various countries who assist in the provision of anesthesia under the direction of a physician.


In the United Kingdom, personnel known as ODPs (operating department practitioners) or Anaesthetic nurses provide support to the physician anesthetist. Please wikify (format) this article or section as suggested in the Guide to layout and the Manual of Style. ...


In the USA, Anesthesiologist Assistants are another group who participate in anesthetic care. They earn a masters degree and practice under physician supervision in sixteen states through licensing, certification or physician delegation[10]. In New Zealand, anaesthetic technicians complete a course of study recognized by the New Zealand Association of Anaesthetic Technicians and Nurses. In Australia, anaesthetic nurses / technicians assist the anaesthetist have a background of perioperative, anaesthetic or critical care nursing certificate or graduate diploma.


Anesthetic agents

Local anesthetics

Local anesthetics are agents which prevent transmission of nerve impulses without causing unconsciousness. They act by binding to fast sodium channels from within (in an open state). Local anesthetics can be either ester or amide based. For other uses of the name Novocaine and other spellings thereof, see Novocaine (disambiguation). ... Cocaine (or crack in its freebase form) is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. ... Lidocaine (INN) (IPA: ) or lignocaine (former BAN) (IPA: ) is a common local anesthetic and antiarrhythmic drug. ... Chemical structure of prilocaine Prilocaine (IPA: ) is a local anesthetic of the amino amide type. ... Bupivacaine (rINN) (IPA: ) is a local anaesthetic drug belonging to the amino amide group. ... Levobupivacaine (rINN) (IPA: ) is a local anaesthetic drug belonging to the amino amide group. ... Ropivacaine (1-propyl-2’,6’-pipecoloxylidide; Naropin®) is a long-acting local anesthetic given by injection to reduce the sensation of pain. ... Cinchocaine (or Dibucaine) is an amide local anesthetic. ... Sodium channels are integral membrane proteins that exist in a cells plasma membrane and regulate the flow of sodium (Na+) ions into it. ... General formula of a carboxylate ester. ... Amide functional group In chemistry, an amide is one of two kinds of compounds: - the organic functional group characterized by a carbonyl group (C=O) linked to a nitrogen atom (N), or a compound that contains this functional group (pictured to the right); or - a particular kind of nitrogen anion. ...


Ester local anesthetics (eg. procaine, amethocaine, cocaine) are generally unstable in solution and fast acting, and allergic reactions are common.


Amide local anesthetics (eg. lidocaine, prilocaine, bupivicaine, levobupivacaine, ropivacaine and dibucaine) are generally heat stable, with a long shelf life (around 2 years). They have a slower onset and longer half life than ester anaesthetics, and are usually racemic mixtures, with the exception of levobupivacaine (which is S(-) -bupivacaine) and ropivacaine (S(-)-ropivacaine). These agents are generally used within regional and epidural or spinal techniques, due to their longer duration of action which provides adequate analgesia for surgery, labor and symptomatic relief. In chemistry, a racemate is a mixture of equal amounts of left- and right-handed stereoisomers of a chiral molecule. ...


Only preservative free local anesthetic agents may be injected intrathecally. A preservative is a natural or synthetic chemical that is added to products such as foods, pharmaceuticals, paints, biological samples, etc. ... Intrathecal: Delivered into the spinal canal (intrathecal space surrounding the spinal cord), as in a spinal anaesthesia. ...


Adverse effects of local anaesthesia

Local anesthetic drugs are toxic to the heart (where they cause arrhythmia) and brain (where they may cause unconsciousness and seizures). Arrhythmias may be resistant to defibrillation and other standard treatments, and may lead to loss of heart function and death. A cardiac arrhythmia, also called cardiac dysrhythmia, is a disturbance in the regular rhythm of the heartbeat. ... This article is about the medical condition. ... Typical view of the defibrillator operator. ...


The first evidence of local anesthetic toxicity involves the nervous system, including agitation, confusion, dizziness, blurred vision, tinnitus, a metallic taste in the mouth, and nausea that can quickly progress to seizures and cardiovascular collapse.


Direct infiltration of local anesthetic into skeletal muscle will cause temporary paralysis of the muscle. A top-down view of skeletal muscle Skeletal muscle is a type of striated muscle, attached to the skeleton. ...


Toxicity can occur with any local anesthetic as an individual reaction by that patient. Possible toxicity can be tested with pre-operative procedures to avoid toxic reactions during surgery.


Current inhaled general anesthetic agents

Volatile agents are specially formulated organic liquids that evaporate readily into vapors, and are given by inhalation for induction and/or maintenance of general anesthesia. The ideal anesthetic vapor or gas should be non-flammable, non-explosive, lipid soluble, should possess low blood gas solubility, have no end organ (heart, liver, kidney) toxicity or side effects, should not be metabolized and should be non-irritant when inhaled by patients. R-phrases S-phrases Supplementary data page Structure and properties n, εr, etc. ... Halothane vapour is an inhalational general anaesthetic. ... Structural formula of enflurane Enflurane (2-chloro-1,1,2,-trifluoroethyl-difluomethyl ether) is a halogenated ether that was commonly used for inhalational anesthesia during the 1970s and 1980s. ... Structural formula of isoflurane Isoflurane (1-chloro-2,2,2-trifluoroethyl difluoromethyl ether) is a halogenated ether used for inhalation anesthesia. ... Sevoflurane (2, 2, 2-trifluoro-1-(trifluoromethyl) ethyl ether), also called fluoromethyl, is a halogenated ether used for induction and maintenance of general anesthesia. ... Desflurane is a highly flourinated ether used for maintenance of general anaesthesia. ... General Name, Symbol, Number xenon, Xe, 54 Chemical series noble gases Group, Period, Block 18, 5, p Appearance colorless Atomic mass 131. ...


No anesthetic vapor currently in use meets all these requirements. The vapors in current use are halothane, isoflurane, desflurane and sevoflurane. Nitrous oxide is a common adjuvant gas, making it one of the most long-lived drugs still in current use. Halothane vapour is an inhalational general anaesthetic. ... Structural formula of isoflurane Isoflurane (1-chloro-2,2,2-trifluoroethyl difluoromethyl ether) is a halogenated ether used for inhalation anesthesia. ... Desflurane is a highly flourinated ether used for maintenance of general anaesthesia. ... Sevoflurane (2, 2, 2-trifluoro-1-(trifluoromethyl) ethyl ether), also called fluoromethyl, is a halogenated ether used for induction and maintenance of general anesthesia. ... R-phrases S-phrases Supplementary data page Structure and properties n, εr, etc. ...


In theory, any anesthetic vapor can be used for induction of general anesthesia. However, most of the halogenated vapors are irritating to the airway, perhaps leading to coughing, laryngospasm and overall difficult inductions. Commonly used agents for inhalational induction include sevoflurane and halothane. All of the modern vapors can be used alone or in combination with other medications to maintain anesthesia (nitrous oxide is not potent enough to be used as a sole agent).


Currently research into the use of xenon as an anesthetic is underway, but the gas is very expensive to produce and requires special equipment for delivery, as well as special monitoring and scavenging of waste gas. General Name, Symbol, Number xenon, Xe, 54 Chemical series noble gases Group, Period, Block 18, 5, p Appearance colorless Atomic mass 131. ...


Volatile agents are frequently compared in terms of potency, which is inversely proportional to the minimum alveolar concentration. Potency is directly related to lipid solubility. This is known as the Meyer-Overton hypothesis. However, certain pharmacokinetic properties of volatile agents have become another point of comparison. Most important of those properties is known as the blood:gas partition coefficient. This concept refers to the relative solubilty of a given agent in blood. Those agents with a lower blood solubility (i.e. a lower blood:gas partition coefficient, e.g. desflurane) give the anesthesia provider greater rapidity in titrating the depth of anesthesia, and permit a more rapid emergence from the anesthetic state upon discontinuing their administration. In fact, newer volatile agents (e.g. sevoflurane, desflurane) have been popular not due to their potency [minimum alveolar concentration], but due to their versatility for a faster emergence from anesthesia, thanks to their lower blood:gas partition coefficient. Minimum alveolar concentration or MAC is a concept anaesthetists use to compare the strengths of anaesthetic vapours; in simple terms, it is defined as the minimal concentration of the vapour in the lungs that is needed to prevent physical response to a noxious stimulus in 50% of subjects. ...


Current IV general or sedative agents

Sodium thiopental (also called sodium pentothal (™ of Abbott Laboratories), thiopental (or thiopentone) sodium) is a rapid-onset, short-acting barbiturate general anesthetic. ... Methohexital is a short-acting intravenous anaesthetic induction agent, that is, used to commence anaesthesia. ... Propofol is a short-acting intravenous anesthetic agent used for the induction of general anesthesia in adult patients and pediatric patients older than 3 years of age; maintenance of general anesthesia in adult patients and pediatric patients older than 2 months of age; and sedation in medical contexts, such as... Etomidate is a short acting intravenous anaesthetic agent used for the induction of general anaesthesia and for sedation for short procedures such as reduction of dislocated joints and cardioversion. ... Ketamine is a general dissociative anesthetic for human and veterinary use. ... Diazepam (IPA: ), marketed under brand names Valium, Stesolid, Diazemuls, Seduxen, Bosaurin, Diapam, Antenex, Ducene and Apozepam)[1] is a drug which is a benzodiazepine derivative. ... Midazolam (marketed under brand names Versed®, Hypnovel®, Dormicum® and Dormonid®, pronounced ) is a drug which is a benzodiazepine derivative. ... Lorazepam (marketed under the brand names Ativan®, Temesta®, Tavor®) is a drug which is a benzodiazepine derivative. ...

Muscle relaxants

Suxamethonium chloride (also known as succinylcholine, or scoline) is a white crystalline substance, it is odourless and highly soluble in water. ... Vecuronium Bromide is a muscle relaxant in the category of non depolarising neuromuscular blocking agents. ... Rocuronium is a non-depolarizing (that is, it does not cause initial stimulation of muscles before weakening them) neuromuscular blocker used in modern anaesthesia, to aid and enable endotracheal intubation, which is often necessary to assist in the controlled ventilation of unconscious patients during surgery and sometimes in intensive care. ... Pancuronium bromide is a chemical compound, used in medicine with the brand name Pavulon® (Organon Pharmaceuticals). ... This article or section does not cite its references or sources. ... Mivacurium is a bisbenzylisoquinolinium based neuromuscular blocker or muscle relaxant. ... Atracurium is a neuromuscular-blocking drug or muscle relaxant in the category non-depolarising neuromuscular blocking agents, used in anaesthesia to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation. ... Cisatracurium is a muscle relaxant in the quaternary ammonium compound family. ... Strychnos toxifera by Koehler 1887 This page is about the plant. ... Gallamine is a non-depolarising muscle relaxant. ...

Adverse effects of muscle relaxants

Succinylcholine may cause hyperkalemia if given to burn patients, or paralysed (quadraplegic, paraplegic) patients. The mechanism is reported to be through upregulation of acetylcholine receptors in those patient populations. Succinylcholine may also trigger malignant hyperthermia in susceptible patients. Malignant hyperthermia (MH or MHS for malignant hyperthermia syndrome, or malignant hyperpyrexia due to anesthesia) is a life-threatening condition resulting from a genetic sensitivity of skeletal muscles to volatile anaesthetics and depolarizing neuromuscular blocking drugs that occurs during or after anaesthesia. ...


Another potentially disturbing adverse effect is anesthesia awareness. In this situation, patients paralyzed with muscle relaxants may awaken during their anesthesia. If this fact is missed by the anaesthesia provider, the patient may be aware of their surroundings, but be incapable of moving or communicating that fact. Neurological monitors are becoming increasingly available which may help decrease the incidence of awareness. Most of these monitors use proprietary algorithms to determine whether any individual 'should' be unable to form memory. Despite the widespread marketing of these devices many case reports exist in which awareness under anesthesia has occurred despite apparently adequate anesthesia as measured by the neurologic monitor. Anesthesia awareness, or intra-operative awareness occurs during general anesthesia, when a patient is paralyzed with muscle relaxants but not enough general anesthetic or analgesic to prevent consciousness or, more importantly, the sensation of pain and the recall of events. ...


Opioid analgesics

  • Naloxone, although chemically similar to some analgesics, is not a painkiller and reverses the effects of morphine-like agents.

Morphine (INN) (IPA: ) is a highly potent opiate analgesic drug and is the principal active agent in opium and the prototypical opiate. ... Heroin or diamorphine (INN) (colloquially referred to as junk, babania, horse, golden brown, smack, black tar, big H, lady H, dope, skag, juice, diesel, etc. ... Heroin ((INN) Diacetylmorphine , (BAN) diamorphine) is a semi-synthetic opioid. ... Codeine (INN) or methylmorphine is an opiate used for its analgesic, antitussive and antidiarrheal properties. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... Alfentanil (Alfenta) is a parenteral short-acting opioid painkiller, used for anaesthesia in surgery. ... Sufentanil is a drug that belongs to the class of drugs known as the opioid analgesic drugs. ... Remifentanil is a potent ultra short-acting synthetic opioid analgesic drug. ... Pethidine (INN) or meperidine (USAN) (also referred to as: isonipecaine; lidol; operidine; pethanol; piridosal; Algil®; Alodan®; Centralgin®; Demerol®; Dispadol®; Dolantin®; Dolestine®; Dolosal®; Dolsin®; Mefedina®) is a fast-acting opioid analgesic drug. ... Methadone is a synthetic opioid, used medically as an analgesic and in the treatment of narcotic addiction. ... Not to be confused with oxytocin. ... Naloxone is a drug used to counter the effects of opioid overdose, for example heroin and morphine overdose. ...

Anesthetic equipment

In modern anesthesia, a wide variety of medical equipment is desirable depending on the necessity for portable field use, surgical operations or intensive care support. Anesthesia practitioners must possess a comprehensive and intricate knowledge of the production and use of various medical gases, anaesthetic agents and vapours, medical breathing circuits and the variety of anaesthetic machines (including vaporizers, ventilators and pressure gauges) and their corresponding safety features, hazards and limitations of each piece of equipment, for the safe, clinical competence and practical application for day to day practice. An anaesthetic machine The anaesthetic machine (or anesthesia machine in America) is used by anaesthetists to support the administration of anaesthesia. ...


Anesthetic monitoring

Patients being treated under general anesthetics must be monitored continuously to ensure the patient's safety. This will generally include monitoring of heart rate (via ECG), oxygen saturation (via pulse oximetry), blood pressure, inspired and expired gases (for oxygen, nitrous oxide, carbon dioxide, and volatile agents), and may also include monitoring of temperature, arterial blood pressure and waveforms, central venous pressure, cerebral activity (via EEG), neuromuscular activity (via peripheral nerve stimulation monitoring), cardiac output, and urine output. In addition, the operating room's environment must be monitored for temperature and humidity and for buildup of exhaled inhalational anesthetics which might impair the function of operating room personnel. Heart rate is used to describe the frequency of the cardiac cycle. ... ECG may also refer to the East Coast Greenway Lead II An Electrocardiogram (ECG or EKG, abbreviated from the German Elektrokardiogramm) is a graphic produced by an electrocardiograph, which records the electrical voltage in the heart in the form of a continuous strip graph. ... Oxygen saturation is a relative measure of the amount of oxygen that is dissolved or carried in a given medium. ... Pulse oximetry is a non-invasive method which allows health care providers to monitor the oxygenation of a patients blood. ... A sphygmomanometer, a device used for measuring blood pressure. ... General Name, Symbol, Number oxygen, O, 8 Chemical series Nonmetals, chalcogens Group, Period, Block 16, 2, p Appearance colorless (gas) very pale blue (liquid) Atomic mass 15. ... R-phrases S-phrases Supplementary data page Structure and properties n, εr, etc. ... Carbon dioxide is a chemical compound composed of one carbon and two oxygen atoms. ... Thermoregulation is the ability of an organism to keep its body temperature within certain boundaries, even when temperature surrounding is very different. ... Blood pressure is the pressure exerted by the blood on the walls of the blood vessels. ... Central venous pressure (CVP) describes the pressure of blood in the thoracic vena cava, near the right atrium of the heart. ... EEG can mean: Electroencephalography - the method and science of recording and interpreting traces of brain electrical activity as recorded from the skull surface or the device used to record such traces Emperor Entertainment Group - A Hong Kong entertainment company. ... Cardiac output is the volume of blood being pumped by the heart, in particular a ventricle in a minute. ... Inhalational anaesthetics are gases or vapours possessing anaesthetic qualities. ...


References

  1. ^ Utopian surgery: Early arguments against anaesthesiain surgery, dentistry and childbirth
  2. ^ Nurse anestheisa worldwide: pratice, education and regulation (PDF). International Federation of Nurse Anesthetists. Retrieved on 2007-02-08.
  3. ^ Is Physician Anesthesia Cost-Effective? (html). Anesth Analg (2007-02-01). Retrieved on 2007-02-15.
  4. ^ When do anesthesiologists delegate? (html). Med Care (2007-02-01). Retrieved on 2007-02-15.
  5. ^ Surgical mortality and type of anesthesia provider (html). AANA (2007-02-25). Retrieved on 2007-02-25.
  6. ^ Anesthesia Providers, Patient Outcomes, and Cost (pdf). Anesth Analg (2007-02-25). Retrieved on 2007-02-25.
  7. ^ ASA Fast Facts: Anesthesiologists Provide Or Participate In 90 Percent Of All Annual Anesthetics (html). ASA. Retrieved on 2007-03-22.
  8. ^ Television conferencing: Is it as effective as "in person" lectures for nurse anesthesia education? (PDF). AANA Journal (2006-02-01). Retrieved on 2007-02-05.
  9. ^ Anethesiology Care Team (html). durhamregional.org. Retrieved on 2007-02-11.
  10. ^ Five facts about AAs (HTML). American Academy of Anesthesiologist Assistants. Retrieved on 2007-02-08.

2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the Anno Domini (common) era. ... February 8 is the 39th day of the year in the Gregorian Calendar. ... 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the Anno Domini (common) era. ... February 1 is the 32nd day of the year in the Gregorian Calendar. ... 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the Anno Domini (common) era. ... February 15 is the 46th day of the year in the Gregorian Calendar. ... 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the Anno Domini (common) era. ... February 1 is the 32nd day of the year in the Gregorian Calendar. ... 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the Anno Domini (common) era. ... February 15 is the 46th day of the year in the Gregorian Calendar. ... 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the Anno Domini (common) era. ... February 25 is the 56th day of the year in the Gregorian Calendar. ... 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the Anno Domini (common) era. ... February 25 is the 56th day of the year in the Gregorian Calendar. ... 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the Anno Domini (common) era. ... February 25 is the 56th day of the year in the Gregorian Calendar. ... 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the Anno Domini (common) era. ... February 25 is the 56th day of the year in the Gregorian Calendar. ... 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the Anno Domini (common) era. ... March 22 is the 81st day of the year in the Gregorian Calendar (82nd in leap years). ... For the Manfred Mann album, see 2006 (album). ... February 1 is the 32nd day of the year in the Gregorian Calendar. ... 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the Anno Domini (common) era. ... February 5 is the 36th day of the year in the Gregorian Calendar. ... 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the Anno Domini (common) era. ... February 11 is the 42nd day of the year in the Gregorian Calendar. ... 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the Anno Domini (common) era. ... February 8 is the 39th day of the year in the Gregorian Calendar. ...

External links


  Results from FactBites:
 
MedlinePlus: Anesthesia (370 words)
Regional anesthesia: blocks pain in an area of the body, such an arm or leg.
Epidural anesthesia, which is sometimes used during childbirth, is a type of regional anesthesia.
The type of anesthesia your doctor chooses depends on many factors.
Anesthesia-Topic Overview (1104 words)
Anesthesia is the use of medications and close monitoring to provide comfort and maintain vital life functions during surgery or other medical procedures.
Your anesthesia specialist, whether it is an anesthesiologist or a nurse anesthetist, is responsible for your comfort and safety during your surgery.
Anesthesia is used to relax (sedate) you, block pain sensations (analgesia and anesthesia), induce sleepiness or forgetfulness (amnesia), or make you unconscious for your surgery.
  More results at FactBites »

 
 

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