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BScNINTRAVENOUS ANESTHETICS.pptx

Pharmacology

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INTRAVENOUS ANESTHETICS
DR.FOUZIA
THIOPENTAL
1-Ultrashort acting Barbiturate
2-For induction
Pharmacological effects:
CNS depression (sedation to general anesthesia)
↓ Cerebral blood flow , ↓ICP
↓ in arterial BP
Respiratory depression
THIOPENTAL
Clinical uses:
1-Induction (less than 30sec)
2-Methohexital per rectum(mentally retarded ,uncooperative pediatric)
Adverse effects:
1-Intra-arterial injection : Pain, vasoconstriction & gangrene.
2-Respiratory depression
3-Laryngospasm or bronchospasm
4-Peripheral vasodilation
Contraindicated in acute intermittent porphyria
PROPOFOL
1-Induction and maintenance of anesthesia (30-40 sec)
2-Vasodilation
3-Bronchodilation
4-Hypnosis but no analgesic effect
5- ↓cerebral blood flow and ICP
6-Antiemetic effect
PROPOFOL
Clinical uses:
1-Induction and maintenance
2-Total I/V anesthesia with opioids
3-Sedation of patients in ICU
4-Short procedures (endoscopy, colonoscopy)
5-Low dose for postoperative nausea and vomiting
Adverse effects:
1-Profound hypotension
2-Respiratory depression
3-Pain at injection site
KETAMINE
1-Analgesia
2-“dissociative anesthesia”
3-Blocks NMDA-R in CNS, ↓ excitatory effects of glutamate.
4-↑ cerebral blood flow↑ ICP
5-↑ BP, heart rate, and cardiac output
6-Bronchodilation
7-Airway reflexes are maintained
8- I/V, I/M, oral, rectal, epidural routes
Ad

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BScNINTRAVENOUS ANESTHETICS.pptx

  • 2. THIOPENTAL 1-Ultrashort acting Barbiturate 2-For induction Pharmacological effects: CNS depression (sedation to general anesthesia) ↓ Cerebral blood flow , ↓ICP ↓ in arterial BP Respiratory depression
  • 3. THIOPENTAL Clinical uses: 1-Induction (less than 30sec) 2-Methohexital per rectum(mentally retarded ,uncooperative pediatric) Adverse effects: 1-Intra-arterial injection : Pain, vasoconstriction & gangrene. 2-Respiratory depression 3-Laryngospasm or bronchospasm 4-Peripheral vasodilation Contraindicated in acute intermittent porphyria
  • 4. PROPOFOL 1-Induction and maintenance of anesthesia (30-40 sec) 2-Vasodilation 3-Bronchodilation 4-Hypnosis but no analgesic effect 5- ↓cerebral blood flow and ICP 6-Antiemetic effect
  • 5. PROPOFOL Clinical uses: 1-Induction and maintenance 2-Total I/V anesthesia with opioids 3-Sedation of patients in ICU 4-Short procedures (endoscopy, colonoscopy) 5-Low dose for postoperative nausea and vomiting Adverse effects: 1-Profound hypotension 2-Respiratory depression 3-Pain at injection site
  • 6. KETAMINE 1-Analgesia 2-“dissociative anesthesia” 3-Blocks NMDA-R in CNS, ↓ excitatory effects of glutamate. 4-↑ cerebral blood flow↑ ICP 5-↑ BP, heart rate, and cardiac output 6-Bronchodilation 7-Airway reflexes are maintained 8- I/V, I/M, oral, rectal, epidural routes
  • 7. CLINICAL USES OF KETAMINE 1- Dissociative anesthesia – cataleptic state Analgesia, catatonia, amnesia, hypnosis, eyes open but unresponsive to painful stimuli, respiring spontaneously 2- Short surgical procedures (Analgesia) 3-I/V anesthetic of choice in A-Children B-Old persons with poor CVS reserves C-Septic shock, Cardiogenic shock, Bleeding D- COPD 4-Arthritic pain (Topical)
  • 8. ADVERSE EFFECTS OF KETAMINE 1-IHD-avoided 2-Emergence delirium During recovery  hallucinations, illusions and dream like state Hallucinations, nightmares and delirium may last up to 24 hrs. 3-I/V injection  Necrosis, Thrombophlebitis, nerve damage 4-Intrarterial injection Vasospasm gangrene 5-↑ IOP, ICP, BP , HR 6- Contraindicated in head injuries
  • 9. BENZODIAZEPINES 1-Sedation and anterograde amnesia 2-Muscle relaxing and anticonvulsant property Clinical uses: 1- Intraoperative sedation 2- Part of general anesthesia 3- Pre-anesthetic medication 4- Day care surgery
  • 10. NEUROLEPT ANALGESIA/ANESTHESIA Neurolept-Analgesia: Droperidol + Fentanyl Deep sedation and analgesia (endoscopy) Neurolept-Anesthesia N2O + Fentanyl + Droperidol (Neuroleptanalgesia + Unconsciousness= Neurolept anesthesia)
  • 11. PREANESTHETIC MEDICATIONS It refers to use of drugs before anesthesia to make it pleasant and safe. 1-Sedative/Hypnotics/Anxiolytics BZD, Barbiturates 2-Opioid analgesics 3- Antiemetics 4-Anti histamines 5-Anticholinergics 6-Proton pump inhibitors / H2 antagonists
  • 12. PREANESTHETIC MEDICATIONS 1-Sedatives/Hypnotics/Antianxiety drugs BZD Diazepam, Lorazepam, Midazolam ↓ anxiety, make the person relax and drowsy, with amnesia Barbiturates More depressant effect on CVS, respiration, used less 2-OPIOIDS Morphine, Pethidine , Fentanyl Analgesia during procedure and post operative
  • 13. PREANESTHETIC MEDICATIONS 3- Antiemetics Metoclopramide Antihistamines: Promethazine 5HT3 Receptor Blockers: Ondansetron ↑ gastric emptying, prevent nausea, vomiting 4-Anti-histamines Promethazine Sedative, Antiemetic and Anticholinergic Properties
  • 14. PREANESTHETIC MEDICATIONS 5-Anticholinergics Atropine, Hyoscine ↓Salivary and bronchial secretions, Hyoscine  amnesia and antiemetic effect 6-Proton pump inhibitors/ H2 blockers Omeprazole ,Pantoprazole/ Ranitidine ,Famotidine Given night before and in the morning ↓ its gastric acid ,↓ chances of regurgitation

Editor's Notes

  1. Methohexital (3times more potent than thiopental
  2. Patient is disassociated from surroundings, appears awake but cannot perceive what is going on around him, so called dissociative anesthesia.
  3. 2-To avoid this BZD administered( diazepam or midazolam)
  4. Patient remains responsive to simple commands and questions but does not respond to painful stimuli or retain memory of procedure.