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Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
Iv induction agents
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Iv induction agents

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  • 1. Moderator:Dr vijesh Presenter:Dr Nikhil M P Thiopentone Ketamine Propofol
  • 2. Chemical structure
  • 3. 0 Cl NHCH3 N O S CH3CH2 N CH3CH2CH2CH CH3 OH (CH3)2CH CH(CH3)2 Arylcyclohexylamine(phencyclidine) Thiobarbiturate Alkylphenol Ketamine Thiopentone Propofol
  • 4. Physico-chemical characteristics
  • 5. FORMULATIONS
  • 6. Propofol Thiopentone Ketamine 1%,2%,10% solution Yellow amorphous powder 500mg,1 g 1%,2% & medium,long Chain Triglycerides Clear aqueous solution sodium salts (6% sodium carbonate by wt) emulsion milky white
  • 7. Cont…. 7.5 7.6 pka - 11 3.5 TO 5.5 10.5 of 2.5% solution pH -7 lipid soluble lipid soluble lipid soluble
  • 8. Metabolism
  • 9. Ketamine liver norketamine Hydroxynorketamine excretion kidneys Thiopentone liver oxidation N-dealkylation desulfuration destruction of barbituric acid ring excretion kidneys bile <ul><li>Propofol </li></ul><ul><li>liver </li></ul><ul><li>conjugation </li></ul><ul><li>glucuronide& </li></ul><ul><li>sulfate </li></ul><ul><li>excretion </li></ul><ul><li>kidneys </li></ul>
  • 10. Cont……… absent absent Extrahepatic- lungs norketamine- 20 to 30% inactive metabolites- inactive
  • 11. Pharmacokinetics
  • 12. 10 to 20min 5 to 10 min 5 to 10 min awakening 90 to 100 s 90 to 100 s 90 to 100 s peak do do one arm brain circulation onset Ketamine Thiopentone Propofol
  • 13. redistribution redistribution Redistribution & Elimination Rapid fall in Plasma conc after single bolus
  • 14. Cont…… 3L/kg 1.5 to3L/kg 2 to 10L/kg Volume of distribution (12 to 14 ml/kg/min) (3 to 4 ml/kg/min) (20 to 30 ml/kg/min) clearance 2 to 3 hrs 7 to 17 hrs 1 to 3 hrs Elimination Half life Ketamine Thiopentone Propofol
  • 15. < 40 min < 150 min < 40 min Context Sensitive Half time (for infusions lasting upto 8 hrs) Ketamine Thiopentone Propofol
  • 16. MOA
  • 17. NMDA thalamocortical& limbic system GABA GABA Ketamine Thiopentone Propofol
  • 18. CNS
  • 19. sed sed sed ICP sed sed sed CBF sed sed (55%) sed ( 36%) CMRO2 Ketamine Thiopentone Propofol
  • 20. Cont…. Improve perfusion in incomplete cerebral ischemia <ul><li>Decresing oxygen demand </li></ul><ul><li>Preserves CPP </li></ul><ul><li>Robin hood phenomenon </li></ul><ul><li>Free radical scavenging </li></ul>Reduced infarct Size when administered immediately or 1 hr after ischemic insult Neuroprotective sed sed sed ( 30 t0 40 %) IOP ketamine thiopentone propofol
  • 21. Cont ….. + -- -- Upper airway reflexes + -- -- Emergence reactions + -- _ Dissociative anaesthesia Ketamine thiopentone propofol
  • 22. Cont…. + -- -- Nystagmus sed -- -- Skeletal muscle tone ++ -- -- Salivation& Lacrimation ketamine thiopentone propofol
  • 23. CVS
  • 24. sed sed sed Cardiac output sed sed ( 10 to 36 %) Inhibits tacycardic response to hypotension Heart rate sed sed sed (25 to 40 %) Arterial BP Ketamine Thiopentone Propofol
  • 25. RS
  • 26. + -- + Bronchodilatation sed sed sed Minute ventilation higher doses ++ ++ Dose dependant ( 25 t0 30%) Apnea Ketamine Thiopentone Propofol
  • 27. Doses
  • 28. 0.2 to0.8 mg/kg IV 2 to 4mg/kg IM 25 to 75mic/kg/min sedation 15 to 45 mic/kg/min IV–N2O 30 TO 90 mic/kg/min 50 to 150 mic/kg/min maintenance 0.5 to 2 mg/kg IV 4 to 6mg/kg IM 3 to 5 mg/kg IV 1 to 2.5 mg/kg IV induction ketamine thiopentone propofol
  • 29. Cont… -- -- 10 to 20 mg IV or 10mic/kg/min Antiemetic 0.2 to 0.8 IV -- -- Analgesia
  • 30. uses
  • 31. + -- + Sedation + + ++ Maintenance + + + Induction Ketamine Thiopentone Propofol
  • 32. Cont…… -- -- + Antiemetic + -- -- Pre-emptive analgesia + -- -- Analgesia Ketamine Thiopentone Propofol
  • 33. Cont…. -- -- + Chronic refractory headache -- + + Anticonvulsant -- -- + Antipruritic
  • 34. Side effects
  • 35. +/-- + ++ Apnea -- + ++ Hypotension -- + ++ Pain on injection Ketamine Thiopentone Propofol
  • 36. Cont…. -- ++ + Thrombophle bitis + -- -- Emergence reaction -- + + Allergic reactions -- + -- Broncho spasm
  • 37. Referances <ul><li>Millers anesthesia,6 th edition </li></ul><ul><li>Clinical anaesthesia,Barash,5 th edition </li></ul><ul><li>Stoeltings pharmacology,4 th edition </li></ul><ul><li>Clinical anaesthesiology,Morgan,4 th </li></ul><ul><li>edition </li></ul>
  • 38. thank you

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