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Question migrated from World Building SE.

(For fictional use only, of course :) )

I am looking for an anasthetic which fulfills the following criteria:

  • very strong effect, induces a comatose state in a very short period of time
  • quickly wears off (30 minutes~) with only minor impediments to the recipent upon awakening.
  • Can be 'partially blocked' or delayed by the intake of some medicine or other substance (which needs to be not too uncommon). Maybe some receptors for the anasthetic are blocked by the substance or something similar. Ideally this would result in the recipent falling into a dream-like state for some minutes before the real effect kicks in.

Does the anasthetic have to be made up, or does something like this actually exist?

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  • $\begingroup$ better off on health SE perhaps $\endgroup$ – rg255 Jul 7 '15 at 10:46
  • $\begingroup$ Maybe this is obvious, but please note that a “comatose state” is going to require endotracheal intubation + ventilation in order to be anything approaching safe. $\endgroup$ – Susan Jul 7 '15 at 14:00
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Xenon. It is like an ideal anaesthetic. See here.

Xenon is an interesting anesthetic as it appears to lack negative inotropicy and vasodilatation, giving great advantages to both patients with limited cardiovascular reserve or those who require hemodynamic stability. It has low toxicity and is not teratogenic. Xenon gives rapid induction and recovery, due to its low blood/gas partition coefficient (0.15), and has a MAC of 63%. Several vitro studies showed that Xenon may protect neural cells against ischaemic injury. Its low blood solubility can take to diffusion hypoxia if Xenon is not substituted by 100% oxygen at the end of anesthesia. It has been shown that, compared to other anesthetic regimens, Xenon anesthesia produces the highest regional blood flow in the brain, liver, kidney and intestine. In conclusion, the most important positive effects of Xenon are cardiovascular stability, cerebral protection and favourable pharmacokinetics. Negative points are high cost and the limited number of ventilators supplying Xenon.

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  • $\begingroup$ Wow, Thanks! This seem to cover #1 / #2 really good. But what about #3? Could there be a substance to partially block / delay the effect of xenon? $\endgroup$ – openend Jul 7 '15 at 9:56
  • $\begingroup$ @openend I guess if oxygen/air content is increased, it should delay xenon mediated anaestheia. But this is just like reducing its effective concentration. $\endgroup$ – WYSIWYG Jul 7 '15 at 10:02
  • $\begingroup$ Would something like using an asthma-inhaler be able to work this way? $\endgroup$ – openend Jul 7 '15 at 10:09
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    $\begingroup$ That's a good question, I'll just go for it. Just striving for some 'realism' :) And I hope the reader will notice, if certain facts can be verified. $\endgroup$ – openend Jul 7 '15 at 11:00
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    $\begingroup$ Well I might have to add there are good story without reseach, but the problem is when you have something, that is easy to research, wrong, which will break the immersion for the reader. $\endgroup$ – openend Jul 7 '15 at 17:10
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Propofol: a widely used i.v. anesthetic with GABA agonistic properties. It has to be given continuously i.v. When stopped, effects wear off in minutes, and recovery is without serious side effects and little nausea. Induction is quick (minutes or less) since it is administered i.v. Aminophylline (theophylline ethylenediamine), an adenosine receptor antagonist, antagonizes its effects (Sakurai et al., 2008).

Sufentanil: an opioid. Like propofol, when administered i.v. it is fast acting (onset after 6 minutes) and its effects wear off in ~30 min. Because of its short half life, recovery is fast with few side effects (Mendel, 2014). Full opiate antagonists like naloxone, or partial antagonists like buprenorphine can be used to counteract opioid anesthesia. Note that more common opioids, including heroin, morphine and fentanyl are longer-acting (say hours after injection) and probably not what you are after.

Ketamine: an NMDA receptor antagonist. It is only used in animal surgeries nowadays, and it is not used for human anesthesia anymore. I mention ketamine only because its effects last for about 30 min after oral ingestion, and it's onset is very rapid (within a minute i.v.). Its side effects include delirium and hallucinations up to 24 hours after use. These side effects are pretty serious and reason for its ban in human anesthesia. I am not aware of antagonists of ketamine action. Theoretically spoken, NMDA receptor agonists would do the job, but that is a pretty dangerous class of drugs and mostly applied experimentally as far as I know.

References
- Mendel J Clin Anesth (2014); 26: S1–S7
- Sakurai et al., J Anesth (2008); 22:86–8

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