General anesthesia and its complicationsAbhishek Roy
General anesthesia refers to the reversible loss of sensation and consciousness achieved through a combination of inhaled and intravenous drugs. It involves stages including analgesia, delirium, and surgical anesthesia. Complications may include respiratory depression, arrhythmias, nausea, and emergence delirium. Anesthesia is induced and maintained using inhalational agents like nitrous oxide, halothane, and sevoflurane or intravenous drugs like propofol and ketamine. Premedication, reversal agents, and conscious sedation techniques help optimize anesthesia outcomes and safety.
General anesthetics render patients unconscious, amnesic and cause muscle relaxation. Traditional agents included alcohol, ice and blows to the head. Modern agents include intravenous barbiturates, benzodiazepines, propofol and inhalational gases like nitrous oxide, halothane and isoflurane. These work by enhancing GABA receptors and inhibiting excitatory receptors. Local anesthetics like lidocaine and bupivacaine block sodium channels to provide analgesia without unconsciousness.
This document discusses various induction agents used in general anesthesia. It begins by defining general anesthesia and its key features. It then covers general principles of pharmacology relevant to induction agents, including their action on receptors, plasma protein binding, crossing the blood-brain barrier, and distribution to other tissues. The document classifies common intravenous induction agents and discusses in detail the properties, mechanisms, uses, and adverse effects of thiopental sodium, propofol, and etomidate.
Anesthesia drugs are also known as “anesthetics” used to induce anesthesia to avoid pain and discomfort during and after surgery. Benzodiazepines, Diazepam, Lorazepam, Midazolam, Etomidate, Ketamine, Propofol.
This document provides information on general anesthesia including:
1. It defines general anesthesia as reversible blocking of pain and sensation in the whole body or parts using pharmacology or other methods.
2. It describes the parts of general anesthesia including hypnosis, analgesia, areflexia, and muscle relaxation which must be balanced.
3. It explains the different types of general anesthesia including total intravenous anesthesia, volatile induction and maintenance anesthesia.
General anesthesia and its complicationsAbhishek Roy
General anesthesia refers to the reversible loss of sensation and consciousness achieved through a combination of inhaled and intravenous drugs. It involves stages including analgesia, delirium, and surgical anesthesia. Complications may include respiratory depression, arrhythmias, nausea, and emergence delirium. Anesthesia is induced and maintained using inhalational agents like nitrous oxide, halothane, and sevoflurane or intravenous drugs like propofol and ketamine. Premedication, reversal agents, and conscious sedation techniques help optimize anesthesia outcomes and safety.
General anesthetics render patients unconscious, amnesic and cause muscle relaxation. Traditional agents included alcohol, ice and blows to the head. Modern agents include intravenous barbiturates, benzodiazepines, propofol and inhalational gases like nitrous oxide, halothane and isoflurane. These work by enhancing GABA receptors and inhibiting excitatory receptors. Local anesthetics like lidocaine and bupivacaine block sodium channels to provide analgesia without unconsciousness.
This document discusses various induction agents used in general anesthesia. It begins by defining general anesthesia and its key features. It then covers general principles of pharmacology relevant to induction agents, including their action on receptors, plasma protein binding, crossing the blood-brain barrier, and distribution to other tissues. The document classifies common intravenous induction agents and discusses in detail the properties, mechanisms, uses, and adverse effects of thiopental sodium, propofol, and etomidate.
Anesthesia drugs are also known as “anesthetics” used to induce anesthesia to avoid pain and discomfort during and after surgery. Benzodiazepines, Diazepam, Lorazepam, Midazolam, Etomidate, Ketamine, Propofol.
This document provides information on general anesthesia including:
1. It defines general anesthesia as reversible blocking of pain and sensation in the whole body or parts using pharmacology or other methods.
2. It describes the parts of general anesthesia including hypnosis, analgesia, areflexia, and muscle relaxation which must be balanced.
3. It explains the different types of general anesthesia including total intravenous anesthesia, volatile induction and maintenance anesthesia.
general anesthesia are the drug given before surgery which have reversible effect on consciousness. discussing ideal GA, stages of GA, mechanism of action of GA, classification of drugs parenteral or inhaled.
This document provides information about different types of anesthesia. It discusses local anesthesia and general anesthesia. For general anesthesia, it describes the stages and classification into inhalation and intravenous agents. Specific agents are discussed like nitrous oxide, halothane, isoflurane, ketamine and propofol. Their properties, uses, and risks are summarized. For local anesthesia, the mechanisms of action, types of administration, advantages, and adverse effects are covered at a high level.
- Atropine is an anticholinergic drug that blocks muscarinic receptors throughout the body. It has many effects including stimulation of the central nervous system, tachycardia, dilation of the pupils, decreased secretions, and relaxation of smooth muscles.
- Atropine is rapidly absorbed and has a half-life of 3-4 hours. It is metabolized in the liver and excreted by the kidneys. High doses can cause fever, restlessness, delirium and respiratory depression.
- Other anticholinergic drugs like ipratropium, propantheline, oxybutynin, cyclopentolate and trihexyphenidyl are used for specific conditions like
IV induction drugs are used to rapidly induce anesthesia prior to other drugs being given to maintain anesthesia. The ideal IV induction drug has favorable physical, pharmacokinetic, and pharmacodynamic properties. Barbiturates like thiopental are commonly used IV induction agents that depress the central nervous system by enhancing GABA transmission. Propofol is a popular agent with a rapid onset due to high lipid solubility and redistribution, though it can cause hypotension. Ketamine is used for induction and analgesia as an NMDA receptor antagonist that produces dissociative anesthesia while maintaining respiratory drive and airway reflexes.
Intravenous induction agents are drugs that cause rapid loss of consciousness when given intravenously in an appropriate dose. The ideal IV induction drug has rapid onset and offset, minimal cardiorespiratory depression, no excitatory effects, and is safe to use across patient populations. Common IV induction agents discussed include barbiturates, propofol, ketamine, etomidate, and benzodiazepines. Each drug has unique effects on organ systems and potential complications that must be considered when selecting an agent for induction of anesthesia.
The document provides an overview of general anaesthesia. It discusses the aims and requirements of general anaesthesia including unconsciousness, analgesia, muscle relaxation and physiological stability. It describes the processes involved such as pre-medication, induction, maintenance of anaesthesia and muscle relaxation. Common intravenous agents for induction and maintenance like thiopental, propofol and ketamine are explained. Inhalational agents including nitrous oxide, halothane, sevoflurane and isoflurane are also discussed. Their properties, mechanisms of action, advantages and disadvantages are summarized.
Intravenous induction agents are drugs given intravenously to induce anesthesia rapidly. Ideal properties include water solubility, stability, rapid onset within one arm-brain circulation time, rapid redistribution and clearance with no active metabolites, minimal effects on vital organs, and a high therapeutic ratio. Common IV induction agents discussed are barbiturates, propofol, ketamine, etomidate, benzodiazepines, and opioids. Each drug has different effects on the cardiovascular, respiratory, and central nervous systems and potential complications.
This document discusses sedative and hypnotic drugs, focusing on barbiturates. It classifies barbiturates and describes their mechanism of action, pharmacological effects, kinetics, therapeutic uses, adverse effects, interactions, and compares them to benzodiazepines. It also discusses non-benzodiazepine hypnotics including zopiclone, zolpidem, zaleplon, buspirone, and chloral hydrate.
General Anaethetics & Pre-anaethetics.pptxManish Gautam
Pre-anaesthetic medication involves administering drugs before general anesthesia to make anesthesia safer for the patient. Common drugs used include anti-anxiety drugs like diazepam to reduce apprehension, sedatives/hypnotics like promethazine for its sedative and antiemetic effects, opioid analgesics like morphine for analgesia and sedation, and anticholinergics like atropine to reduce secretions. General anesthetics produce reversible unconsciousness, analgesia, amnesia, muscle relaxation and inhibition of reflexes. Common intravenous anesthetics used include thiopental for induction, propofol for its rapid onset and offset, and ketamine for its analgesic properties. Inhalational agents like
GENERAL ANAESTHETICS- 2| PRE- ANAESTHETIC MEDICATIONS| MEDICATION INTERACTION...randommail010102
In this presentation we are going to discuss the intravenous anaesthesia along with that we are going to discuss the complications and the interactions of general anesthetics.
At last we are going to discuss the pre anesthetic medication.
General anesthesia involves medications that induce unconsciousness during medical procedures. It uses a combination of intravenous drugs and inhaled gases to provide analgesia, amnesia, immobility and muscle relaxation while abolishing reflexes. There are four stages of general anesthesia - from initial analgesia and loss of consciousness to medullary paralysis where breathing and circulation cease. Inhalational anesthetics like nitrous oxide, halothane and isoflurane are administered via gas cylinders and machines and are eliminated primarily through exhalation. Intravenous drugs like thiopental and propofol are used for inducing and maintaining anesthesia while fentanyl and midazolam provide analgesia and sedation. Conscious sedation involves using these drugs at
A General Anaesthetic is a drug that produces a reversible state of unconscious with absence of pain sensation over the entire body; such agents have been described as drugs that remove the most precious human attributes ---- Conscious.
Ketamine
Brand name: KETALAR
Phencyclidine derivative
Shorting acting
Mainly used in children and elderly adults for short procedures such as burns dressing.
ABUSIVE DRUG
Is a dissociative anaesthetic as it produces a cataleptic state in which the patient appears to be awake but is detached from the environment and is unresponsive to pain.
Please also refer to other reference books for clarity.
Anesthesia involves creating a reversible state of unawareness during medical procedures. Several factors are considered when selecting an anesthetic including the procedure, patient health, and medications. The objectives of anesthesia are loss of awareness, pain relief, reduced movement, autonomic regulation, and muscle relaxation if needed. Anesthesia has stages of induction, maintenance, and recovery and depth is characterized by levels of central nervous system depression. Benefits include reduced anxiety, lack of awareness, muscle relaxation, and analgesia. Anesthetics are classified and include inhalation agents, intravenous medications, local anesthetics, neuromuscular blockers, and pre-anesthetic medications.
Intravenous anaesthetics have been used since the 1600s when wine and beer were injected into dogs. Early intravenous anaesthetics caused adverse effects. Thiopental was the first widely accepted intravenous anaesthetic due to its rapid onset and lack of excitatory effects. Ketamine and propofol were later introduced and are still commonly used today. Intravenous anaesthetics work primarily by enhancing the effects of the inhibitory neurotransmitter GABA at GABA-A receptors in the brain, causing sedation and loss of consciousness. They have rapid onset due to intravenous administration and are metabolized and eliminated primarily in the liver. Common intravenous anaesthetics include barbiturates, propofol, ketamine, benzodiazepines,
Intravenous anaesthetics have been used since the 1600s when wine and beer were injected into dogs. Early intravenous anaesthetics caused adverse effects. Thiopental was the first widely accepted intravenous anaesthetic due to its rapid onset and lack of excitatory effects. Other intravenous anaesthetics developed include ketamine, methohexital, and propofol. Propofol is now one of the most commonly used intravenous anaesthetics due to its rapid onset, short duration of action, and minimal side effects. Intravenous anaesthetics work primarily by enhancing the effects of the inhibitory neurotransmitter GABA at GABA-A receptors in the brain, causing sedation and loss of consciousness. They must have properties allowing for rapid onset,
Sedative-hypnotic drugs reduce anxiety and induce sleep by depressing activity in the central nervous system. The main classes are benzodiazepines, barbiturates, and newer non-benzodiazepine agents. Benzodiazepines have largely replaced barbiturates due to their wider therapeutic index, lower risk of interactions and dependence, and the availability of antagonists. Both benzodiazepines and barbiturates work by enhancing the effects of the inhibitory neurotransmitter GABA.
general anesthesia are the drug given before surgery which have reversible effect on consciousness. discussing ideal GA, stages of GA, mechanism of action of GA, classification of drugs parenteral or inhaled.
This document provides information about different types of anesthesia. It discusses local anesthesia and general anesthesia. For general anesthesia, it describes the stages and classification into inhalation and intravenous agents. Specific agents are discussed like nitrous oxide, halothane, isoflurane, ketamine and propofol. Their properties, uses, and risks are summarized. For local anesthesia, the mechanisms of action, types of administration, advantages, and adverse effects are covered at a high level.
- Atropine is an anticholinergic drug that blocks muscarinic receptors throughout the body. It has many effects including stimulation of the central nervous system, tachycardia, dilation of the pupils, decreased secretions, and relaxation of smooth muscles.
- Atropine is rapidly absorbed and has a half-life of 3-4 hours. It is metabolized in the liver and excreted by the kidneys. High doses can cause fever, restlessness, delirium and respiratory depression.
- Other anticholinergic drugs like ipratropium, propantheline, oxybutynin, cyclopentolate and trihexyphenidyl are used for specific conditions like
IV induction drugs are used to rapidly induce anesthesia prior to other drugs being given to maintain anesthesia. The ideal IV induction drug has favorable physical, pharmacokinetic, and pharmacodynamic properties. Barbiturates like thiopental are commonly used IV induction agents that depress the central nervous system by enhancing GABA transmission. Propofol is a popular agent with a rapid onset due to high lipid solubility and redistribution, though it can cause hypotension. Ketamine is used for induction and analgesia as an NMDA receptor antagonist that produces dissociative anesthesia while maintaining respiratory drive and airway reflexes.
Intravenous induction agents are drugs that cause rapid loss of consciousness when given intravenously in an appropriate dose. The ideal IV induction drug has rapid onset and offset, minimal cardiorespiratory depression, no excitatory effects, and is safe to use across patient populations. Common IV induction agents discussed include barbiturates, propofol, ketamine, etomidate, and benzodiazepines. Each drug has unique effects on organ systems and potential complications that must be considered when selecting an agent for induction of anesthesia.
The document provides an overview of general anaesthesia. It discusses the aims and requirements of general anaesthesia including unconsciousness, analgesia, muscle relaxation and physiological stability. It describes the processes involved such as pre-medication, induction, maintenance of anaesthesia and muscle relaxation. Common intravenous agents for induction and maintenance like thiopental, propofol and ketamine are explained. Inhalational agents including nitrous oxide, halothane, sevoflurane and isoflurane are also discussed. Their properties, mechanisms of action, advantages and disadvantages are summarized.
Intravenous induction agents are drugs given intravenously to induce anesthesia rapidly. Ideal properties include water solubility, stability, rapid onset within one arm-brain circulation time, rapid redistribution and clearance with no active metabolites, minimal effects on vital organs, and a high therapeutic ratio. Common IV induction agents discussed are barbiturates, propofol, ketamine, etomidate, benzodiazepines, and opioids. Each drug has different effects on the cardiovascular, respiratory, and central nervous systems and potential complications.
This document discusses sedative and hypnotic drugs, focusing on barbiturates. It classifies barbiturates and describes their mechanism of action, pharmacological effects, kinetics, therapeutic uses, adverse effects, interactions, and compares them to benzodiazepines. It also discusses non-benzodiazepine hypnotics including zopiclone, zolpidem, zaleplon, buspirone, and chloral hydrate.
General Anaethetics & Pre-anaethetics.pptxManish Gautam
Pre-anaesthetic medication involves administering drugs before general anesthesia to make anesthesia safer for the patient. Common drugs used include anti-anxiety drugs like diazepam to reduce apprehension, sedatives/hypnotics like promethazine for its sedative and antiemetic effects, opioid analgesics like morphine for analgesia and sedation, and anticholinergics like atropine to reduce secretions. General anesthetics produce reversible unconsciousness, analgesia, amnesia, muscle relaxation and inhibition of reflexes. Common intravenous anesthetics used include thiopental for induction, propofol for its rapid onset and offset, and ketamine for its analgesic properties. Inhalational agents like
GENERAL ANAESTHETICS- 2| PRE- ANAESTHETIC MEDICATIONS| MEDICATION INTERACTION...randommail010102
In this presentation we are going to discuss the intravenous anaesthesia along with that we are going to discuss the complications and the interactions of general anesthetics.
At last we are going to discuss the pre anesthetic medication.
General anesthesia involves medications that induce unconsciousness during medical procedures. It uses a combination of intravenous drugs and inhaled gases to provide analgesia, amnesia, immobility and muscle relaxation while abolishing reflexes. There are four stages of general anesthesia - from initial analgesia and loss of consciousness to medullary paralysis where breathing and circulation cease. Inhalational anesthetics like nitrous oxide, halothane and isoflurane are administered via gas cylinders and machines and are eliminated primarily through exhalation. Intravenous drugs like thiopental and propofol are used for inducing and maintaining anesthesia while fentanyl and midazolam provide analgesia and sedation. Conscious sedation involves using these drugs at
A General Anaesthetic is a drug that produces a reversible state of unconscious with absence of pain sensation over the entire body; such agents have been described as drugs that remove the most precious human attributes ---- Conscious.
Ketamine
Brand name: KETALAR
Phencyclidine derivative
Shorting acting
Mainly used in children and elderly adults for short procedures such as burns dressing.
ABUSIVE DRUG
Is a dissociative anaesthetic as it produces a cataleptic state in which the patient appears to be awake but is detached from the environment and is unresponsive to pain.
Please also refer to other reference books for clarity.
Anesthesia involves creating a reversible state of unawareness during medical procedures. Several factors are considered when selecting an anesthetic including the procedure, patient health, and medications. The objectives of anesthesia are loss of awareness, pain relief, reduced movement, autonomic regulation, and muscle relaxation if needed. Anesthesia has stages of induction, maintenance, and recovery and depth is characterized by levels of central nervous system depression. Benefits include reduced anxiety, lack of awareness, muscle relaxation, and analgesia. Anesthetics are classified and include inhalation agents, intravenous medications, local anesthetics, neuromuscular blockers, and pre-anesthetic medications.
Intravenous anaesthetics have been used since the 1600s when wine and beer were injected into dogs. Early intravenous anaesthetics caused adverse effects. Thiopental was the first widely accepted intravenous anaesthetic due to its rapid onset and lack of excitatory effects. Ketamine and propofol were later introduced and are still commonly used today. Intravenous anaesthetics work primarily by enhancing the effects of the inhibitory neurotransmitter GABA at GABA-A receptors in the brain, causing sedation and loss of consciousness. They have rapid onset due to intravenous administration and are metabolized and eliminated primarily in the liver. Common intravenous anaesthetics include barbiturates, propofol, ketamine, benzodiazepines,
Intravenous anaesthetics have been used since the 1600s when wine and beer were injected into dogs. Early intravenous anaesthetics caused adverse effects. Thiopental was the first widely accepted intravenous anaesthetic due to its rapid onset and lack of excitatory effects. Other intravenous anaesthetics developed include ketamine, methohexital, and propofol. Propofol is now one of the most commonly used intravenous anaesthetics due to its rapid onset, short duration of action, and minimal side effects. Intravenous anaesthetics work primarily by enhancing the effects of the inhibitory neurotransmitter GABA at GABA-A receptors in the brain, causing sedation and loss of consciousness. They must have properties allowing for rapid onset,
Sedative-hypnotic drugs reduce anxiety and induce sleep by depressing activity in the central nervous system. The main classes are benzodiazepines, barbiturates, and newer non-benzodiazepine agents. Benzodiazepines have largely replaced barbiturates due to their wider therapeutic index, lower risk of interactions and dependence, and the availability of antagonists. Both benzodiazepines and barbiturates work by enhancing the effects of the inhibitory neurotransmitter GABA.
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2. OUTLINE
• Brief history of Anaesthesia
• Definition of Anaesthesia
• Drugs Definition and classification
Premedications
Induction Agents
Muscle Relaxants
Reversal Agents
Analgesics
Local Anaethetics
• Conclusion
3. HISTORY
• WTG Morton on the 16th of October in 1846 performed the first
public demonstration of anaesthesia.
4. DEFINITION
•Anaesthesia is a branch of medicine
that deals with reversible loss of
consciousness and pain control.
5. PREMEDICATIONS
• Reduction of anxiety and pain
• Promotion of amnesia
• Reduction of secretions
• Reduction of volume and increase PH of gastric contents
• Reduction of postoperative nausea and vomiting
• Enhancing the hypnotic effects of general anaesthesia
• Reduction of vagal reflexes to intubation
• Prophylaxis against allergic reactions
7. GLYCOPYROLATE
• Anticholinergic used as premedicant
• Reduces salivary and sweat gland activity therefore used as
antisialogogue
• Used with acetylcholinesterase inhibitors to prevent muscarinic
effects
8. ATROPINE
• Used for premedication
• Used to reduce muscarinic effects of acetylcholinesterase
• Used for treatment of bradycardia and asystole
• It should be avoided in pyrexial patients
9. TYPES OF ANAESTHESIA
• General
• Regional – Neuraxial : Subarachnoid Block
Epidural Anaesthesia
Nerve Block
• Local Anaesthesia
11. INTRAVENOUS ANAESTHETICS
• These are drugs expected to cause loss of consciousness in “one arm brain circulation”
• Characteristics of Ideal Intravenous Anaesthetics
Simple preparation
Painless on administration
High potency and efficacy
Rapid and predictable offset of effect
Absence of toxic effects or adverse properties
Compactible with other agents and IV fluids
Depression of airway reflexes for intubation
Rapid metabolism and minimal hangover
14. THIOPENTONE
• This is an ultra-short acting barbiturate with a rapid onset
• Used for induction of anaesthesia and the preferred drug of use in
Neuroanesthesia because it reduces cerebral blood flow and
intracranial pressure.
• Potent anaesthetic, weak analgesic effect with little muscle relaxation
• Usually comes in 5 or10% solution and has to be constituted to 2.5%
before use.
• Causes laryngospasm and not ideal for asthmatics
• Causes respiratory and circulatory depression
15. PROPOFOL
• Usually comes as a white emulsion of 1 or 2%
• Good for induction and maintenance of anaesthesia with a
short duration of action, safe for use in day-case surgery.
• It causes pain on injection
• Causes more respiratory and cardiovascular depression than
barbiturates
• Has anti –emetic properties
16. KETAMINE
• Causes ‘dissociative’ anaesthesia, has a slow onset
• Causes amnesia without loss of consciousness
• Has analgesic properties
• Causes cardiovascular stimulation therefore it is Useful for
patients with Hypotension but no respiratory depression
17.
18. INHALATIONAL ANAESTHETICS
• Vapors used for induction and maintenance of anaesthesia.
They are delivered to the respiratory system to produce
anaesthesia.
19. PHYSICAL PROPERTIES OF AN IDEAL
INHALATIONAL ANAESTHETIC AGENT
1. Non-flammable, non-explosive at room temperature
2. Stable in light.
3. Liquid and vaporisable at room temperature i.e. low latent heat of vaporisation.
4. Stable at room temperature, with a long shelf life
5. Stable with soda lime, as well as plastics and metals
6. Environmentally friendly - no ozone depletion
7. Cheap and easy to manufacture
20. BIOLOGICAL PROPERTIES OF AN IDEAL
INHALATIONAL ANAESTHETIC AGENT
1. Pleasant to inhale, non-irritant, induces bronchodilatation
2. Low blood: gas solubility - i.e. fast onset
3. High oil: water solubility - i.e. high potency
4. Minimal effects on other systems - e.g. cardiovascular, respiratory,
hepatic, renal or endocrine
5. No biotransformation - should be excreted ideally via the lungs, unchanged
6. Non-toxic to operating theatre personnel
21. NITROUS OXIDE
• Colourless, odourless gas at room temperature
• Stored in blue cylinders
• Causes rapid induction of anaesthesia and rapid emergence.
• it has weak anesthetic and powerful analgesic effects
• Used as an adjunct to supplement other inhalationals
• Risk of bone-marrow suppression with prolonged
administration.
22. HALOTHANE
• Volatile liquid at room temperature
• Light sensitive
• High fat solubility
• Excreted unchanged through the lungs
• Stored in amber colored bottles with thymols as the
preservative
• Causes reduced myocardial contractility and cause hypotension
23. ISOFLURANE
• Has a pungent smell therefore not ideal for induction of
anaesthesia
• Causes a progressive respiratory depression and hypotension.
• Useful for cardiac anaesthesia
24. SEVOFLURANE
• It has a pleasant smell, non-irritant and good for use in
paediatrics, cardiac and neuroanaesthesia.
• Produces a fast induction and emergence.
• Fairly expensive therefore not readily used in our environment
25. MUSCLE RELAXANTS
• Divided into two
Depolarising – Suxamethonium
Non – Depolarising : Divided into 2
1. Aminosteriods – Rocuronium,
Vecuronium, Pancuronium
2. Benzylisoquinoloniums – Atracurium,
Cisatracurium,
Mivacurium.
26. SUXAMETHONIUM
• The depolarising neuromuscular blocker of choice
• It is widely used due to rapid onset and short duration of action
• Ideal for Rapid Sequence Induction
• The depolarising effect causes fasciculation and flaccid
paralysis
• Paralysis occurs one minute after administration and lasts 7 –
12minutes
• Metabolised by plasma pseudocholinesterase
27. ATRACURIUM
• An intermediate acting muscle relaxant with onset of 60 -90
seconds
• Effect lasts 20 – 30 minutes
• Causes histamine release
• The drug of choice in renal and hepatic impairment
28. PANCURONIUM
• Can be used to aid tracheal intubation after 2 – 3 minutes
• The effect lasts 40 – 60 minutes
• May increase heart rate, BP and cardiac output by vagolytic and
sympathomimetic actions.
• Elimination is delayed in renal and hepatic impairment
therefore avoided in them.
29. VECURONIUM
• Provides intubating condition in 90seconds
• Relaxation is 20 – 30 minutes but can last up to 80minutes with
a dose 250mcg/kg
• Has minimal effect on Bp and pulse
• Metabolised in the liver to an active form of 3-
deactylvecuronium
30. REVERSAL AGENTS/ANTICHOLINESTERASE
• NEOSTIGMINE
Reverses non depolarising muscle blockade
Used with atropine or glycopyrrolate to reduce the muscarinic
effects it causes
Active within 1 minute of injection and lasts up to 20 –
30minutes
32. PARACETAMOL
• Also called Acetaminophen
• Inhibits central prostaglandin synthesis and has a central
antipyretic
• Used to treat minor pain
• Rapidly absorbed with oral administration
• Side effects includes nausea, vomiting and rashes.
33. DICLOFENAC
• Useful for post-op analgesia thereby reducing requirements for
opioids
• 1mg/kg IM up to 75mg or IV over 15minutes
• Can also begiven rectally
• Could be used with caution in renal impairment and
asthsmatics
34. MORPHINE
• Used for premedication and as analgesic
• Causes CNS depression
• Induces vomiting
• Releases histamine
• Should be used with caution in renal and hepatic impairment
35. FENTANYL
• 100 times more potent than morphine
• Used for premedication, induction and sedation in ICU
• Onset is 1-2 minutes and duration of action of 20-60minutes.
• Causes post operative respiratory depression especially with
large doses
• Causes minimal histamine release or cardiovascular changes
36. LOCAL ANAESTHETICS
• Can be given in the following forms
Topical
Superficial injection ( infiltration)
Nerve Block
Intravenous
Epidural
Spinal
37. DIVISION OF LA’S
• Ester – they are hydrolysed by blood esterases with a short
half-life.
Examples include Procaine, Cocaine, Benzocaine, Tetracaine,
Chlorprocaine.
• Amides – they are metabolized in the liver and usually have a
long half-life.
Examples include Bupivacaine, Lignocaine, Ropivacaine,
Prilocaine, Articaine.
38. BUPIVACAINE
• A local anaesthetic agent of longer duration compared to
lidocaine
• For epidural anaesthesia, lasts 3-4 hours and up to 12hours for
nerve blocks
• Usually comes as 0.5%
• Also used for SAB
• Tend to cause more cardiotoxicity compared to neurotoxicity
39. LIDOCAINE
• Onset is rapid by all routes
• Usual duration of action is 1hour but increases to about 2hours
with the addition of adrenaline
• Used as a local anaesthetic, for nerve blocks, SAB and epidural
anaesthesia.
• Used to depress laryngeal and tracheal reflexes
• Causes more of neurotoxic effects when given in high doses
40.
41. QUESTIONS
• 1. which of the following will not cause respiration depression
• (a) Propofol
• (b) Ketamine
• (c) Thiopentone
• (d) Midazolam
• (e) Fentanyl
42. • 2. which of the following has a sweet smell
(a)Nitrous oxide
(b)Halothane
(c)Isoflurane
(d)Desflurane
(e)oxygen
43. • 3. which on of the following is a depolarising muscle relaxant
(a)Atracurium
(b)Pancuronium
(c)Vecuronium
(d)Suxamethonium
(e)mivacurium
44. • 4. which of the following is a good post-operative analgesic
• (a) ibuprofen
• (b) acetaminophen
• (c)diclofenac
• (d) cocodamol
• (e) lignocaine
45. • 5. which one of the following is an amide local anaesthetic
(a)Lignocaine
(b)Procaine
(c)benzocaine
(d)chloroprocaine
(e)cocaine
46. THEORY
• What are the 6 A’s of premedication
• Write short note on propofol