| Anesthesia,
loss of sensation, especially the sensation of touch. It
can be general (affecting the entire body and usually
accompanied by loss of consciousness) or local (affecting
limited areas of the body). The condition may be the
result of damage to nerves or nerve centers by disease or
injury, or it may be intentionally induced by the
administration of drugs for the prevention or relief of
pain.
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History of Anesthetics
Of the few anesthetic agents known to the
ancients, opium and hemp (see Cannabis) were the most important.
Both were taken by ingestion or by burning the drug and inhaling
the smoke. Nitrous oxide (see Nitrogen), discovered by the
British chemist Sir Humphry Davy about 1800, was first used as an
anesthetic in 1844 by the American dentist Horace Wells. In 1842
the American surgeon Crawford Long successfully used ethyl ether
as a general anesthetic during surgery. He failed to publish his
findings, however, and credit for the discovery of the anesthetic
properties of ether was given to the American dentist William
Morton, who in 1846 publicly demonstrated its use during a tooth
extraction. In 1847 the British physician Sir James Simpson
discovered the anesthetic properties of chloroform. Many other
general anesthetics have since been discovered. Ether and
chloroform have been largely abandoned because of their dangerous
side effects and flammability. Some anesthetics act by depressing
the central nervous system (barbiturates, halothane), whereas
others induce amnesia and dissociation (nitrous oxide,
enflurane).

General Anesthesia
Surgical anesthesia (complete general anesthesia,
characterized by muscular paralysis sufficient to permit surgical
manipulation) is produced by inhalation anesthetics: gases or
volatile liquids such as cyclopropane, nitrous oxide, halothane,
and enflurane. The anesthetic, usually mixed with oxygen, is
either inhaled or administered into the windpipe through a tube.
Modern anesthesia almost always involves a combination of agents.
Before administering the inhalation anesthetic, the
anesthesiologist might give intravenously a short-acting
barbiturate such as pentobarbital or sodium pentothal (more
properly called thiopental sodium or thiopentone), or an
antianxiety drug such as diazepam, to induce unconsciousness. A
narcotic analgesic such as meperidine or fentanyl may be used in
addition. To allow use of smaller amounts of the inhalation
anesthetic, special muscle-paralyzing drugs are given. These
include tubocurarine, gallamine, and succinylcholine. The
combination of a narcotic, a barbiturate, a muscle-paralyzing
drug, and nitrous oxide is called balanced anesthesia. Because
muscular activity is prevented in all these procedures, the
anesthesiologist must induce breathing in the patient
mechanically.
Surgical anesthesia must continue throughout the operation, but
prolonged anesthetization can kill, paralyzing first the
respiratory system and then the heart. The correct level is
maintained by constant monitoring of the patient's condition and
increasing or decreasing the dosage as needed.
Thiopental sodium in small doses is sometimes used in psychiatry
because it allows patients to talk uninhibitedly. This quality
has also given the drug some value in law enforcement as a
"truth serum." See also Scopolamine.

Local Anesthesia
Some surgical procedures do not require total muscular
relaxation and can be performed using local anesthetics, which
temporarily block nerve conduction without damaging nerve fibers.
Local anesthesia is produced by injecting into the tissues to be
affected a solution of a natural alkaloid such as cocaine, the
oldest of all local anesthetics, or a synthetic agent such as
procaine, widely known under the trade name Novocain, or
lidocaine (Xylocaine).
Block anesthesia, a much more extensive local anesthesia, is
produced by injecting the agent into a nerve trunk, next to a
nerve, or all around the operative field, thereby deadening the
entire area. The best-known block anesthesia is probably the
spinal block, produced by injecting an anesthetic into the spinal
canal.
A mild local anesthesia, useful in many minor dental and medical
procedures, can be produced by numbing the tissues with cold,
either by applying ice or by spraying with a volatile liquid such
as ethyl chloride.