PHYSIOLOGICAL AND PHARMACOLOGICAL FOUNDATIONS OF GENERAL ANESTHESIA IN MODERN MEDICAL PRACTICE
Keywords:
general anesthesia, physiology, pharmacology, monitoring, clinical practiceAbstract
General anesthesia represents one of the key components of modern medical practice, enabling the performance of complex surgical and diagnostic procedures without pain and psychological trauma for the patient. It represents a controlled and reversible state of unconsciousness, analgesia, and muscle relaxation achieved through the administration of various pharmacological agents. Understanding the physiological and pharmacological foundations of general anesthesia is essential for its safe and effective implementation in clinical practice.This paper attempts to elaborate on the physiological and pharmacological foundations of general anesthesia. Special emphasis is placed on the mechanisms through which anesthetic agents affect the central nervous system, vital functions, and systemic homeostasis. The aim is to present, through scientific evidence and clinical experience, how anesthesia alters the functioning of the human body and which factors determine its effectiveness and safety. An analytical approach was applied, including a review of relevant scientific literature and an analysis of data from the Public Health Institution General Hospital Kumanovo concerning patients operated on under general anesthesia during the period from 2023 to 2024. The main results indicate that general anesthesia causes significant changes in neuronal connectivity, respiratory and cardiovascular stability, and metabolic processes. Different anesthetic agents exhibit specific profiles of action, and monitoring the depth of anesthesia is essential. Analysis of hospital data showed an increase in the number of patients undergoing surgery under general anesthesia. Additionally, proper preparation of the patient before the induction of general anesthesia is of great importance in reducing the risk of complications. Preoperative assessment includes a detailed medical history, physical examination, and evaluation of the patient’s overall health status, as well as identification of possible risk factors. The appropriate choice of anesthetic agents and techniques is made individually, depending on the type of surgical procedure, the patient’s age, and the presence of comorbidities. This individualized approach enables greater patient safety, better control of vital functions, and faster postoperative recovery.
References
Azevedo, F. A., Carvalho, L. R., Grinberg, L. T., Farfel, J. M., Ferretti, R. E., Leite, R. E., ... & Herculano‐Houzel, S. (2009). Equal numbers of neuronal and nonneuronal cells make the human brain an isometrically scaled‐up primate brain. Journal of Comparative Neurology, 513(5), 532-541.
Barker, S. J., Gamel, D. M., & Tremper, K. K. (1987). Cardiovascular effects of anesthesia and operation. Critical care clinics, 3(2), 251-268.
ClinicalGate. (2025). Central nervous system effects of the inhalation agents.
Conzen, P., & Nuscheler, M. (1996). Neue Inhalationsanästhetika. Der Anaesthesist, 45(8), 674-693.
Eisen, A. J., Kozachkov, L., Bastos, A. M., Donoghue, J. A., Mahnke, M. K., Brincat, S. L., ... & Miller, E. K. (2024). Propofol anesthesia destabilizes neural dynamics across cortex. Neuron, 112(16), 2799-2813.
Hedenstierna, G., & Edmark, L. (2015). Effects of anesthesia on the respiratory system. Best practice & research Clinical anaesthesiology, 29(3), 273-284.
Ivascu, R., Torsin, L. I., Hostiuc, L., Nitipir, C., Corneci, D., & Dutu, M. (2024). The surgical stress response and anesthesia: a narrative review. Journal of Clinical Medicine, 13(10), 3017.
Khan, J., Patel, P., & Liu, M. (2024). Desflurane. In StatPearls [Internet]. StatPearls Publishing.
Kissin, I. (2023). Antinociceptive agents as general anesthetic adjuncts: Supra-additive and infra-additive interactions. Anesthesia & Analgesia, 137(6), 1198-1207.
Krieg, N., Baumbach, P., Ceanga, I. A., Standke, A., Gräler, M. H., Claus, R. A., ... & Coldewey, S. M. (2025). Prognostic value of perioperative changes in serum primary metabolites in patients after major surgery under general anesthesia: an exploratory secondary analysis of the TAPIR trial. Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 1-12.
Li, Y., Li, F., Zheng, H., Jiang, L., Peng, Y., Zhang, Y., ... & Xu, P. (2021). Recognition of general anesthesia-induced loss of consciousness based on the spatial pattern of the brain networks. Journal of Neural Engineering, 18(5), 056039.
Mock-Ohnesorge, J., Mock, A., Hackert, T., Fröhling, S., Schenz, J., Poschet, G., ... & Weigand, M. A. (2021). Perioperative changes in the plasma metabolome of patients receiving general anesthesia for pancreatic cancer surgery. Oncotarget, 12(10), 996.
Musizza, B., & Ribaric, S. (2010). Monitoring the depth of anaesthesia. Sensors, 10(12), 10896-10935.
Radkowski, P., Szewczyk, M., Grażewicz, M., Sobolewski, K., & Onichimowski, D. (2025). Use of Muscle Relaxants in Emergency Medicine: A Review. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 31, e949876.
Sattar, Y., Wilson, J., Khan, A. M., Adnan, M., Larios, D. A., Shrestha, S., ... & Patel, N. (2018). A review of the mechanism of antagonism of N-methyl-D-aspartate receptor by ketamine in treatment-resistant depression. Cureus, 10(5).
Shan, J., Sun, L., Wang, D., & Li, X. (2015). Comparison of the neuroprotective effects and recovery profiles of isoflurane, sevoflurane and desflurane as neurosurgical pre-conditioning on ischemia/reperfusion cerebral injury. International Journal of Clinical and Experimental Pathology, 8(2), 2001.
