Iv induction agents

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Iv induction agents

  1. 1. Moderator:Dr vijesh Presenter:Dr Nikhil M P Thiopentone Ketamine Propofol
  2. 2. Chemical structure
  3. 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. 4. Physico-chemical characteristics
  5. 5. FORMULATIONS
  6. 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. 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. 8. Metabolism
  9. 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. 10. Cont……… absent absent Extrahepatic- lungs norketamine- 20 to 30% inactive metabolites- inactive
  11. 11. Pharmacokinetics
  12. 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. 13. redistribution redistribution Redistribution & Elimination Rapid fall in Plasma conc after single bolus
  14. 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. 15. < 40 min < 150 min < 40 min Context Sensitive Half time (for infusions lasting upto 8 hrs) Ketamine Thiopentone Propofol
  16. 16. MOA
  17. 17. NMDA thalamocortical& limbic system GABA GABA Ketamine Thiopentone Propofol
  18. 18. CNS
  19. 19. sed sed sed ICP sed sed sed CBF sed sed (55%) sed ( 36%) CMRO2 Ketamine Thiopentone Propofol
  20. 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. 21. Cont ….. + -- -- Upper airway reflexes + -- -- Emergence reactions + -- _ Dissociative anaesthesia Ketamine thiopentone propofol
  22. 22. Cont…. + -- -- Nystagmus sed -- -- Skeletal muscle tone ++ -- -- Salivation& Lacrimation ketamine thiopentone propofol
  23. 23. CVS
  24. 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. 25. RS
  26. 26. + -- + Bronchodilatation sed sed sed Minute ventilation higher doses ++ ++ Dose dependant ( 25 t0 30%) Apnea Ketamine Thiopentone Propofol
  27. 27. Doses
  28. 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. 29. Cont… -- -- 10 to 20 mg IV or 10mic/kg/min Antiemetic 0.2 to 0.8 IV -- -- Analgesia
  30. 30. uses
  31. 31. + -- + Sedation + + ++ Maintenance + + + Induction Ketamine Thiopentone Propofol
  32. 32. Cont…… -- -- + Antiemetic + -- -- Pre-emptive analgesia + -- -- Analgesia Ketamine Thiopentone Propofol
  33. 33. Cont…. -- -- + Chronic refractory headache -- + + Anticonvulsant -- -- + Antipruritic
  34. 34. Side effects
  35. 35. +/-- + ++ Apnea -- + ++ Hypotension -- + ++ Pain on injection Ketamine Thiopentone Propofol
  36. 36. Cont…. -- ++ + Thrombophle bitis + -- -- Emergence reaction -- + + Allergic reactions -- + -- Broncho spasm
  37. 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. 38. thank you

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