THIS PPT DESCRIBES ABOUT THIOPENTONE & PROPOFOL, THIS IS MSDE FOR DIP & B.SC OTT STUDENTS

1. IV Anesthetics
Thiopentone &
Propofol
MEGHANA C
DOTT, BOTT, M.Sc MEDICAL BIOCHEMISTRY

2. Jens
Martensson
PHYSICAL FORM :
Sodium salts (6% sodium carbonate by wt)
THIOPENTONE
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Martensson
• Dose • ED 50 = 2.2 – 2.7 mg / Kg
• Induction dose: Adults : 3-6 mg/kg given I/V over 5- 15
sec.
• Sedation dose: 0.5 to 1.5 mg/kg I/V.
• Neonates:2-3 mg/kg.
• Rectal dose:-30-50 mg/kg
• IV maintenance infusion: 50-100 mg every 10-12 min
• Most frequently admnistered I/V for induction in adults
and childern.
• It can be used rectally in case of children.
DILUTION DOSAGE OF THIOPENTONE
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4. Jens
Martensson
• Ultra short-acting barbiturate anaesthetics depress the
central nervous system (CNS) to produce hypnosis and
anaesthesia without analgesia.
• Site of action: GABA: BZD: Chloride receptor complex in
CNS
• When GABAA receptors are activated, trans-membrane
chloride conductance increases, resulting in
hyperpolarisation of post- synaptic cell membrane and
functional inhibition of post synaptic neurons.
MECHANISM OF ACTION
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Martensson
1) Induction 3 – 5 mg/Kg
2) Anticonvulsant for rapid control of status epilepticus dose
0.5 – 2 mg/kg. repeated as needed
3) Treatment of increased intracranial pressure Cerebral
vasoconstriction
4) Cerebral Protection In focal ischemia eg. Carotid
endarterectomy, thoracic aneurysm resection, profound
controlled-hypotension, Incomplete cerebral emboli.
5) Barbiturate narcosis
CLINICAL USES
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Martensson
Garlic onion taste.
Allergic reaction.
Local tissue reactions &
necrosis.
Rash,
Facial edema
Bronchospasm &
 Pain at injection site.
Cardiovascular system
Cardiovascular depression
Respiratory System-Dose
related respiratory depression
 Laryngospasm,
bronchospasm.
Central nervous system:
Emergence delirium
SIDE EFFECTS
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7. Jens
Martensson
Patient with respiratory obstruction & inadequate
airway.
Cardiovascular instability & shock.
Status asthmaticus.
Known hypersensitivity.
CONTRAINDICATIONS
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8. Jens
Martensson
• Propofol is famously called as “Milk of Amnesia”.
• Most common intravenous agent used for induction and maintenance
of Anaesthesia.
• Preferred drug in Day care surgeries.
• Also used for sedation in intubated and mechanically ventilated
patients in ICU.
• Milky white coloured , sterile , non pyrogenic ,oil in water emulsion
• Highly lipid soluble ,Slightly water soluble
• Isotonic pH- 6 to8.5
• Weak acid.
PROPOFOL
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9. Jens
Martensson
Diprivan(1%) (PROPOFOL)
10% soyabean oil,
2.25% glycerol,
1.2% egg phosphatide ,
0.005%disodium edenate.
 Ampofol(low lipid emulsion)- 5%soyabean oil, 0.6% egg
lecithin
CONTENTS
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Martensson
PROPOFOL DOSING
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Martensson
• Main Site of action - GABAa-BZD: Chloride receptor
complex in CNS
• Binding of propofol to GABAa receptor causes
prolongation of action of GABA and increased duration
of opening of chloride channel resulting in
hyperpolarization of postsynaptic cell membrane and
functional inhibition of post synaptic neurons.
• Acts on hippocampus and prefrontal cortex .
MECHANISM OF ACTION OF PROPOFOL
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12. Jens
Martensson
• Induction and maintenance of anesthesia
• Monitored anaesthesia care(mac) sedation
• Combined sedation and regional anaesthesia
• Short surgical procedure,
• ICU sedation
• Conscious sedation.
CLINICAL USES
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13. Jens
Martensson
1. Anti-emetic- 10-20 mg IV ,can be repeated every 5-
10 min or start infusion of 10 ug/kg/min.
2. Anti-pruritic- 10 mg IV is effective in the treatment
of pruritis associated with neuraxial opoids and
cholelithiasis.
3. Attenuation of bronchospasm- Hence, useful in
asthamatics.
4. Antioxidant- beneficial in acute lung injury.
NON ANESTHETIC USES
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Martensson
 AIRWAY
• Copious secretion
• Laryngospasm
 RESPIRATORY
• Apnea, respiratory depression
• Hiccough
• Bronchospasm
 CARDIOVASCULAR
• Hypotension
• Dysrhythmias, bradycardia or tachycardia
SIDE EFFECTS
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15. Jens
Martensson
CENTRAL NERVOUS SYSTEM
• Headache
• Dizziness, euphoria, confusion
• Clonic/myoclonic movements
• Seizures, disinhibition
OTHER
• Pain or burning at the injection site is common especially when the IV is in a small
peripheral
• vein
• Green urine
SIDE EFFECTS
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16. Jens
Martensson
1. Known hypersensitvity to
propofol or any of its
components.
2. Allergies to egg, egg
products, soyabeans or
soy products.
3. Disorders of fat
metabolism.
4. Untreated hypertensive,
hypovolemia
5. compromised left
ventricular function.
6. Paediatric patients <3 yrs.
7. Pregnant or lactating
mother
8. Known case of epilepsy
CONTRAINDICATIONS
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