This document discusses various intravenous anaesthesia drugs including thiopentone sodium, propofol, ketamine, etomidate, anticholinergics, benzodiazepines, fentanyl, and dexmedetomidine. It covers their pharmacological properties, clinical uses, dosages, advantages, limitations, and precautions for administration. The document is in a question and answer format between an internal examiner and postgraduate students.
Thiopentone sodium, propofol, ketamine and etomidate are commonly used intravenous induction agents in anaesthesia. Thiopentone sodium is an ultra-short acting barbiturate that must be given intravenously. Propofol provides fast induction and recovery. Ketamine is useful for its analgesic and cardiovascular stabilizing properties. Etomidate is cardiostable but can disturb the HPA axis. Anticholinergics like atropine and glycopyrrolate are used to reduce secretions and prevent bradycardia. Benzodiazepines like midazolam, diazepam and clonazepam are used for anxiolysis, seizures and sed
These are the pharmacological agent which when administered externally , bring loss of all five modalities of sensation with reversible loss of consciousness.
Light
Sound
Taste
Temperature/
Pressure
5. Smell
Diethyl Ether :
Physical Properties :
Colourless ,volatile liq. With pungent odour.
Boil at 350 C , vapor irritant.
Exposed in air , moisture or light , it get convert to ether peroxide and acetic aldehyde , which is irritant in nature
Highly explosive.
Stored in umber colour glass bottle covered with black paper.
10-15 % in inspired air is sufficient for induction of anaesthesia which can be maintained but 4-5 % concentration.
Pharmacological Action
Only a major portion of ether is oxidized in the body and is eliminated through the lungs .
The miscibility of drug with body fluid requires large amount of drug for induction of anesthesia and induction is slow.
Ether irritate the respiratory track and enhance the mucosal secretion.
Drug may causes laryngospasm ,Ether is also known to increase heart rate, blood pressure and blood sugar. It also causes peripheral vasodilation . Ether depresses myocardial contractility.
Advt / Therapeutic effect :
Safest agent in wide margine , also unexperienced hand.
90 mg/100 ml blood Indused anaesthesia
190 mg/100 ml bloodCauses respiratory Track
Not only safe anaesthetics but good analgesic also.
It does not interfere with uterine contractility.
Does not have any effect on liver , kidney , and heat.
No special or complicated apparatus if required.
Eeconomical agent .
This document discusses various intravenous anaesthetic agents. It describes the classification of IV induction agents as barbiturates like thiopentone and methohexitone, or non-barbiturates like propofol, etomidate, ketamine and benzodiazepines. It provides details on the properties, uses, advantages and side effects of specific agents like thiopentone, propofol and etomidate. Ketamine is discussed as an agent that produces dissociative anaesthesia and has strong analgesic effects.
Organophosphorus (OP) poisoning is a major cause of morbidity and mortality in Nepal. OP compounds inhibit acetylcholinesterase, leading to accumulation of acetylcholine and overstimulation of nicotinic and muscarinic receptors. Common presentations include excessive sweating, salivation, vomiting, diarrhea, bronchospasm, bradycardia, hypotension. Treatment involves atropine to block muscarinic effects, pralidoxime to reactivate acetylcholinesterase, benzodiazepines for seizures, and supportive care. Prognosis depends on severity of cholinergic crisis, and intermediate syndrome occurring 1-4 days later can cause respiratory failure if not properly managed.
Anticholinergic drugs like atropine act by blocking acetylcholine effects on muscarinic receptors. Atropine causes various effects including tachycardia by blocking vagal tone, mydriasis and cycloplegia when applied topically to the eyes, relaxation of smooth muscles, and decreased sweat, saliva and tear production. It is used to treat conditions like intestinal spasms, asthma, motion sickness, Parkinson's disease, and as an antidote for organophosphate poisoning. Side effects include dry mouth, difficulty swallowing and talking, blurred vision, urinary retention, and fever in overdose.
This document summarizes organophosphorous (OP) poisoning. OP compounds are commonly used as agricultural insecticides and were historically developed as chemical warfare agents. They work by inhibiting the enzyme acetylcholinesterase, leading to excess acetylcholine in the body. Clinical effects range from acute cholinergic crisis to intermediate muscle weakness to delayed neuropathy. Diagnosis is based on history of exposure and clinical features. Treatment involves atropine to control muscarinic effects, pralidoxime to reactivate acetylcholinesterase, benzodiazepines for seizures, and supportive care. Prognosis depends on prompt diagnosis and treatment to prevent respiratory failure, intermediate syndrome, or delayed neuropathy.
The document discusses organophosphorus compound (OPC) poisoning, including what OPCs are, their various uses, mechanisms of toxicity, clinical manifestations, grading of severity, investigations, management with atropinization and oxime therapy, and dosage regimens for atropine treatment.
This document discusses various intravenous induction agents used in anesthesia. It describes the classification of IV induction agents as barbiturates, non-barbiturates, and newer agents. Specific agents discussed in detail include thiopentone sodium and propofol. For each drug, the document summarizes the history, pharmacology, mechanisms of action, clinical uses, dosing, and side effects. It provides an overview of the structural activity of barbiturates and the risks of accidental intra-arterial injection of thiopentone.
Thiopentone sodium, propofol, ketamine and etomidate are commonly used intravenous induction agents in anaesthesia. Thiopentone sodium is an ultra-short acting barbiturate that must be given intravenously. Propofol provides fast induction and recovery. Ketamine is useful for its analgesic and cardiovascular stabilizing properties. Etomidate is cardiostable but can disturb the HPA axis. Anticholinergics like atropine and glycopyrrolate are used to reduce secretions and prevent bradycardia. Benzodiazepines like midazolam, diazepam and clonazepam are used for anxiolysis, seizures and sed
These are the pharmacological agent which when administered externally , bring loss of all five modalities of sensation with reversible loss of consciousness.
Light
Sound
Taste
Temperature/
Pressure
5. Smell
Diethyl Ether :
Physical Properties :
Colourless ,volatile liq. With pungent odour.
Boil at 350 C , vapor irritant.
Exposed in air , moisture or light , it get convert to ether peroxide and acetic aldehyde , which is irritant in nature
Highly explosive.
Stored in umber colour glass bottle covered with black paper.
10-15 % in inspired air is sufficient for induction of anaesthesia which can be maintained but 4-5 % concentration.
Pharmacological Action
Only a major portion of ether is oxidized in the body and is eliminated through the lungs .
The miscibility of drug with body fluid requires large amount of drug for induction of anesthesia and induction is slow.
Ether irritate the respiratory track and enhance the mucosal secretion.
Drug may causes laryngospasm ,Ether is also known to increase heart rate, blood pressure and blood sugar. It also causes peripheral vasodilation . Ether depresses myocardial contractility.
Advt / Therapeutic effect :
Safest agent in wide margine , also unexperienced hand.
90 mg/100 ml blood Indused anaesthesia
190 mg/100 ml bloodCauses respiratory Track
Not only safe anaesthetics but good analgesic also.
It does not interfere with uterine contractility.
Does not have any effect on liver , kidney , and heat.
No special or complicated apparatus if required.
Eeconomical agent .
This document discusses various intravenous anaesthetic agents. It describes the classification of IV induction agents as barbiturates like thiopentone and methohexitone, or non-barbiturates like propofol, etomidate, ketamine and benzodiazepines. It provides details on the properties, uses, advantages and side effects of specific agents like thiopentone, propofol and etomidate. Ketamine is discussed as an agent that produces dissociative anaesthesia and has strong analgesic effects.
Organophosphorus (OP) poisoning is a major cause of morbidity and mortality in Nepal. OP compounds inhibit acetylcholinesterase, leading to accumulation of acetylcholine and overstimulation of nicotinic and muscarinic receptors. Common presentations include excessive sweating, salivation, vomiting, diarrhea, bronchospasm, bradycardia, hypotension. Treatment involves atropine to block muscarinic effects, pralidoxime to reactivate acetylcholinesterase, benzodiazepines for seizures, and supportive care. Prognosis depends on severity of cholinergic crisis, and intermediate syndrome occurring 1-4 days later can cause respiratory failure if not properly managed.
Anticholinergic drugs like atropine act by blocking acetylcholine effects on muscarinic receptors. Atropine causes various effects including tachycardia by blocking vagal tone, mydriasis and cycloplegia when applied topically to the eyes, relaxation of smooth muscles, and decreased sweat, saliva and tear production. It is used to treat conditions like intestinal spasms, asthma, motion sickness, Parkinson's disease, and as an antidote for organophosphate poisoning. Side effects include dry mouth, difficulty swallowing and talking, blurred vision, urinary retention, and fever in overdose.
This document summarizes organophosphorous (OP) poisoning. OP compounds are commonly used as agricultural insecticides and were historically developed as chemical warfare agents. They work by inhibiting the enzyme acetylcholinesterase, leading to excess acetylcholine in the body. Clinical effects range from acute cholinergic crisis to intermediate muscle weakness to delayed neuropathy. Diagnosis is based on history of exposure and clinical features. Treatment involves atropine to control muscarinic effects, pralidoxime to reactivate acetylcholinesterase, benzodiazepines for seizures, and supportive care. Prognosis depends on prompt diagnosis and treatment to prevent respiratory failure, intermediate syndrome, or delayed neuropathy.
The document discusses organophosphorus compound (OPC) poisoning, including what OPCs are, their various uses, mechanisms of toxicity, clinical manifestations, grading of severity, investigations, management with atropinization and oxime therapy, and dosage regimens for atropine treatment.
This document discusses various intravenous induction agents used in anesthesia. It describes the classification of IV induction agents as barbiturates, non-barbiturates, and newer agents. Specific agents discussed in detail include thiopentone sodium and propofol. For each drug, the document summarizes the history, pharmacology, mechanisms of action, clinical uses, dosing, and side effects. It provides an overview of the structural activity of barbiturates and the risks of accidental intra-arterial injection of thiopentone.
Opiod analgesics used in Dentistry by Dr. Amit T. Suryawanshi
(MDS) Facial Cosmetic Surgeon
Oral & Maxillofacial Surgeon
Dental Surgeon & Implantologist
Hair Transplant Surgeon (Germany)
Consulting Surgeon in Kolhapur, Sangli, Pune & Mumbai (India)
&
founder of
Face Art International Super speciality
at Kolhapur (India)
Organophosphate poisoning is caused by pesticides and chemical weapons inhibiting the enzyme acetylcholinesterase. This leads to accumulation of the neurotransmitter acetylcholine, overstimulating nicotinic and muscarinic receptors. Symptoms include nausea, vomiting, diarrhea, bronchoconstriction, sweating, and muscle fasciculations. Without treatment, respiratory failure and death can occur. Therapy involves atropine to block muscarinic effects, pralidoxime to reactivate acetylcholinesterase, benzodiazepines for seizures, and supportive care including ventilation. Complications can include intermediate syndrome of muscle weakness and delayed polyneuropathy.
This document provides information on general anaesthetics. It discusses what general anaesthetics are and how they work on the central nervous system. It describes the four stages of general anaesthesia: analgesia, delirium, surgical anaesthesia (which has four planes), and respiratory paralysis. Common volatile and non-volatile general anaesthetic agents are identified and some of their properties and uses are mentioned, including diethyl ether, chloroform, halothane, nitrous oxide, and thiopentone. The document also discusses ideal properties of anaesthetic agents and pre-anaesthetic medication.
This document provides information on acute poisoning, including definitions, common causes, general management approaches, and specific management for certain types of poisoning. It discusses paracetamol poisoning, organophosphorus insecticide poisoning, and opiate poisoning. For paracetamol poisoning, it outlines treatment with acetylcysteine or alternative treatments based on time since ingestion. For organophosphorus poisoning, it describes the triphasic illness and recommends atropine as the antidote. The document provides detailed guidance on assessment, monitoring, supportive care and specific treatments for acute poisoning.
Anticholinergic drugs block the effects of acetylcholine at cholinergic receptors. Atropine is a prototypical anticholinergic drug obtained from deadly nightshade plants. It acts as a competitive antagonist at muscarinic receptors. Atropine increases heart rate and reduces secretions but can cause side effects like dry mouth, constipation, blurred vision, and urinary retention. It is used as an antispasmodic, mydriatic for eye exams, and pre-anesthetic to reduce secretions. Many semisynthetic and synthetic derivatives have been developed with fewer side effects for specific conditions like asthma, peptic ulcers, and Parkinson's disease.
This document discusses various general anesthetics used in medicine including their classification, mechanisms of action, advantages, and disadvantages. It covers inhalational anesthetics like nitrous oxide, halothane, isoflurane, desflurane, and sevoflurane. It also discusses intravenous anesthetics such as thiopentone, propofol, benzodiazepines, and opioids. The document provides details on the stages of anesthesia, potency measures, and important considerations for different anesthetics.
Organophosphate poisoning occurs when organophosphate compounds such as insecticides and nerve agents inhibit the enzyme acetylcholinesterase. Symptoms range from mild effects like blurred vision and excess saliva to severe effects like respiratory failure and death. Treatment involves atropine to block acetylcholine effects and pralidoxime or obidoxime to reactivate acetylcholinesterase. Nursing care focuses on maintaining airway, breathing, circulation and preventing infection while the toxic substances are metabolized and excreted from the body. Organophosphate poisoning is a significant global health problem causing millions of hospitalizations annually.
This document discusses anticholinergic drugs, which block the effects of acetylcholine on cholinergic receptors. It classifies anticholinergic drugs as natural alkaloids like atropine and hyoscine, semisynthetic derivatives, or synthetic substitutes. The actions of these drugs include increasing heart rate, reducing secretions, relaxing smooth muscles, causing mydriasis and cycloplegia in the eyes, and stimulating or depressing the CNS. Common uses are as antispasmodics, mydriatics, pre-anesthetics, and for conditions like asthma, ulcers, and Parkinson's disease. Atropine substitutes have more selective actions and fewer side effects. Nursing considerations for
This document provides information on various analgesic, antidote, anticholinergic, and anticoagulant drugs. It discusses the classes, mechanisms of action, and examples of opioids like morphine and fentanyl used for pain management. It also summarizes antidotes like naloxone used to treat opioid overdoses. Common anticholinergic drugs that work by blocking acetylcholine are described. Finally, the document outlines various anticoagulants including heparin, warfarin, and newer oral agents used to prevent blood clotting and their indications.
The document provides information on various intravenous and inhalational drugs used in anaesthesia.
It discusses IV induction drugs like propofol, sodium thiopentone and etomidate. Propofol causes the most marked fall in blood pressure but is ideal for LMA. Sodium thiopentone directly depresses the heart but airway reflexes are better preserved than propofol. Etomidate causes the least cardiovascular depression but inhibition of adrenal function is a concern.
It also discusses the inhalational agent ketamine which provides dissociative anaesthesia and cardiovascular stability but unpleasant emergence reactions are common. The uptake and release of inhalational agents depends on alveolar gas concentration
1. The document discusses various types of poisonings including acetaminophen, organophosphates, opioids, antidepressants, and carbon monoxide. It covers the mechanisms, clinical findings, diagnosis, and management for each type.
2. Key aspects of management for all poisonings include decontamination, supportive care, and antidotes when available to counteract the poison. Specific poisonings require targeted treatments like N-acetylcysteine for acetaminophen or naloxone for opioids.
3. Differentiation of poisonings can be made based on physical findings and toxic syndromes. Outcomes depend on prompt identification and treatment of the poisoning and progression of toxic effects.
This document provides an overview of general anesthetics. It discusses the history of ether and chloroform as the first widely used anesthetics. It then covers the mechanisms of action, sites of action in the body, and cellular/molecular mechanisms of how anesthetics work. The document classifies anesthetics as inhalational agents like nitrous oxide, halothane, and isoflurane or intravenous agents like thiopental and propofol. It also discusses properties of ideal anesthetics, techniques for inhaling agents, adjunct medications, and dissociative anesthetics like ketamine. Depth of anesthesia is assessed using the Guedel classification system.
Local anesthetics are commonly used drugs that stabilize neuronal membranes and inhibit neural impulses. The most commonly used local anesthetics include lidocaine, bupivacaine, prilocaine, mepivacaine, and articaine. True allergy to local anesthetics is rare, estimated to be less than 1% of reactions. When allergic reactions occur, they are usually type I or IV hypersensitivity responses. Preservatives like PABA and methylparaben, and additives like sulfites and epinephrine, may also cause reactions. Evaluation of local anesthetic allergy involves careful history taking and consideration of various reaction types and potential cross-reactivities.
This document summarizes anti-coagulants, or blood thinners. It discusses both in vitro anti-coagulants that act by removing calcium ions and preserving blood, as well as in vivo anti-coagulants that include coumarin derivatives like dicoumarol and warfarin which inhibit vitamin K and prothrombin synthesis. Heparin is discussed as both an in vitro and in vivo anticoagulant that prevents clotting by binding to antithrombin and inhibiting coagulation factors Xa and IIa. The document covers mechanisms of action, administration, effects, toxicities and dosing of these anti-coagulant drugs.
organophosphorous poisoning management in ICUintentdoc
This document discusses organophosphorus (OP) poisoning, which is commonly caused by pesticide exposure and is a major health issue in India. It provides details on the mechanisms of action, epidemiology, clinical features, diagnosis, and management of OP poisoning. Regarding treatment, the key aspects covered include the use of atropine as the primary treatment to counteract muscarinic effects, oximes to reactivate acetylcholinesterase, and supportive care. Complications discussed include intermediate syndrome, delayed neuropathy, and delayed encephalopathy. The goals of treatment are to reduce toxin absorption, enhance elimination, and neutralize the toxin.
This document summarizes cholinergic antagonists, which are drugs that block the effects of acetylcholine in the muscarinic receptor. It discusses their structure-activity relationships, medical uses in conditions like ulcers, overactive bladder, and organophosphate poisoning. Specific antagonists are described like atropine, hyoscyamine, scopolamine, ipratropium, tiotropium, benztropine, biperiden, tropicamide, and others. Their mechanisms of action, pharmacological effects, and clinical applications are concisely outlined.
Preanaesthetic medication & general anaestheticsswarnank parmar
This document provides information on pre-anaesthetic medication, general anaesthetic agents, and their mechanisms and uses. It discusses drugs administered before anaesthesia like benzodiazepines to reduce anxiety and opioids for analgesia. It also describes the history of commonly used general anaesthetics like ether, nitrous oxide, halothane and newer intravenous agents. The stages of anaesthesia and how anaesthetic potency is measured by MAC values is summarized. Complications of general anaesthesia like respiratory depression are also mentioned.
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.
Intravenous Anaesthetics are a group of fast-acting
compounds that are used to induce a state of impaired
awareness of complete sedation.
These are drugs that, when given intravenously in an
appropriate dose, cause a rapid loss of consciousness.
This document discusses various antimuscarinic agents including atropine, scopolamine, ipratropium, glycopyrrolate, tropicamide, cyclopentolate, benztropine, trihexyphenidyl, oxybutynin, darifenacin, fesoterodine, solifenacin, and tolterodine. It describes their mechanisms of action as muscarinic receptor antagonists, therapeutic uses such as treatment of gastrointestinal, cardiovascular and respiratory conditions, and adverse effects like dry mouth and blurred vision.
The document discusses indications for ICU admission and management of critically ill COVID-19 patients. It provides criteria for ICU admission including need for mechanical ventilation, vasopressors, respiratory rate over 30, low oxygen saturation, confusion, and other organ dysfunction. It also outlines management strategies in the ICU including ventilation, vasopressors, steroids, blood products, glucose control, nutrition, and prevention of complications. Risk factors like comorbidities and laboratory values associated with worse prognosis are also mentioned.
Opiod analgesics used in Dentistry by Dr. Amit T. Suryawanshi
(MDS) Facial Cosmetic Surgeon
Oral & Maxillofacial Surgeon
Dental Surgeon & Implantologist
Hair Transplant Surgeon (Germany)
Consulting Surgeon in Kolhapur, Sangli, Pune & Mumbai (India)
&
founder of
Face Art International Super speciality
at Kolhapur (India)
Organophosphate poisoning is caused by pesticides and chemical weapons inhibiting the enzyme acetylcholinesterase. This leads to accumulation of the neurotransmitter acetylcholine, overstimulating nicotinic and muscarinic receptors. Symptoms include nausea, vomiting, diarrhea, bronchoconstriction, sweating, and muscle fasciculations. Without treatment, respiratory failure and death can occur. Therapy involves atropine to block muscarinic effects, pralidoxime to reactivate acetylcholinesterase, benzodiazepines for seizures, and supportive care including ventilation. Complications can include intermediate syndrome of muscle weakness and delayed polyneuropathy.
This document provides information on general anaesthetics. It discusses what general anaesthetics are and how they work on the central nervous system. It describes the four stages of general anaesthesia: analgesia, delirium, surgical anaesthesia (which has four planes), and respiratory paralysis. Common volatile and non-volatile general anaesthetic agents are identified and some of their properties and uses are mentioned, including diethyl ether, chloroform, halothane, nitrous oxide, and thiopentone. The document also discusses ideal properties of anaesthetic agents and pre-anaesthetic medication.
This document provides information on acute poisoning, including definitions, common causes, general management approaches, and specific management for certain types of poisoning. It discusses paracetamol poisoning, organophosphorus insecticide poisoning, and opiate poisoning. For paracetamol poisoning, it outlines treatment with acetylcysteine or alternative treatments based on time since ingestion. For organophosphorus poisoning, it describes the triphasic illness and recommends atropine as the antidote. The document provides detailed guidance on assessment, monitoring, supportive care and specific treatments for acute poisoning.
Anticholinergic drugs block the effects of acetylcholine at cholinergic receptors. Atropine is a prototypical anticholinergic drug obtained from deadly nightshade plants. It acts as a competitive antagonist at muscarinic receptors. Atropine increases heart rate and reduces secretions but can cause side effects like dry mouth, constipation, blurred vision, and urinary retention. It is used as an antispasmodic, mydriatic for eye exams, and pre-anesthetic to reduce secretions. Many semisynthetic and synthetic derivatives have been developed with fewer side effects for specific conditions like asthma, peptic ulcers, and Parkinson's disease.
This document discusses various general anesthetics used in medicine including their classification, mechanisms of action, advantages, and disadvantages. It covers inhalational anesthetics like nitrous oxide, halothane, isoflurane, desflurane, and sevoflurane. It also discusses intravenous anesthetics such as thiopentone, propofol, benzodiazepines, and opioids. The document provides details on the stages of anesthesia, potency measures, and important considerations for different anesthetics.
Organophosphate poisoning occurs when organophosphate compounds such as insecticides and nerve agents inhibit the enzyme acetylcholinesterase. Symptoms range from mild effects like blurred vision and excess saliva to severe effects like respiratory failure and death. Treatment involves atropine to block acetylcholine effects and pralidoxime or obidoxime to reactivate acetylcholinesterase. Nursing care focuses on maintaining airway, breathing, circulation and preventing infection while the toxic substances are metabolized and excreted from the body. Organophosphate poisoning is a significant global health problem causing millions of hospitalizations annually.
This document discusses anticholinergic drugs, which block the effects of acetylcholine on cholinergic receptors. It classifies anticholinergic drugs as natural alkaloids like atropine and hyoscine, semisynthetic derivatives, or synthetic substitutes. The actions of these drugs include increasing heart rate, reducing secretions, relaxing smooth muscles, causing mydriasis and cycloplegia in the eyes, and stimulating or depressing the CNS. Common uses are as antispasmodics, mydriatics, pre-anesthetics, and for conditions like asthma, ulcers, and Parkinson's disease. Atropine substitutes have more selective actions and fewer side effects. Nursing considerations for
This document provides information on various analgesic, antidote, anticholinergic, and anticoagulant drugs. It discusses the classes, mechanisms of action, and examples of opioids like morphine and fentanyl used for pain management. It also summarizes antidotes like naloxone used to treat opioid overdoses. Common anticholinergic drugs that work by blocking acetylcholine are described. Finally, the document outlines various anticoagulants including heparin, warfarin, and newer oral agents used to prevent blood clotting and their indications.
The document provides information on various intravenous and inhalational drugs used in anaesthesia.
It discusses IV induction drugs like propofol, sodium thiopentone and etomidate. Propofol causes the most marked fall in blood pressure but is ideal for LMA. Sodium thiopentone directly depresses the heart but airway reflexes are better preserved than propofol. Etomidate causes the least cardiovascular depression but inhibition of adrenal function is a concern.
It also discusses the inhalational agent ketamine which provides dissociative anaesthesia and cardiovascular stability but unpleasant emergence reactions are common. The uptake and release of inhalational agents depends on alveolar gas concentration
1. The document discusses various types of poisonings including acetaminophen, organophosphates, opioids, antidepressants, and carbon monoxide. It covers the mechanisms, clinical findings, diagnosis, and management for each type.
2. Key aspects of management for all poisonings include decontamination, supportive care, and antidotes when available to counteract the poison. Specific poisonings require targeted treatments like N-acetylcysteine for acetaminophen or naloxone for opioids.
3. Differentiation of poisonings can be made based on physical findings and toxic syndromes. Outcomes depend on prompt identification and treatment of the poisoning and progression of toxic effects.
This document provides an overview of general anesthetics. It discusses the history of ether and chloroform as the first widely used anesthetics. It then covers the mechanisms of action, sites of action in the body, and cellular/molecular mechanisms of how anesthetics work. The document classifies anesthetics as inhalational agents like nitrous oxide, halothane, and isoflurane or intravenous agents like thiopental and propofol. It also discusses properties of ideal anesthetics, techniques for inhaling agents, adjunct medications, and dissociative anesthetics like ketamine. Depth of anesthesia is assessed using the Guedel classification system.
Local anesthetics are commonly used drugs that stabilize neuronal membranes and inhibit neural impulses. The most commonly used local anesthetics include lidocaine, bupivacaine, prilocaine, mepivacaine, and articaine. True allergy to local anesthetics is rare, estimated to be less than 1% of reactions. When allergic reactions occur, they are usually type I or IV hypersensitivity responses. Preservatives like PABA and methylparaben, and additives like sulfites and epinephrine, may also cause reactions. Evaluation of local anesthetic allergy involves careful history taking and consideration of various reaction types and potential cross-reactivities.
This document summarizes anti-coagulants, or blood thinners. It discusses both in vitro anti-coagulants that act by removing calcium ions and preserving blood, as well as in vivo anti-coagulants that include coumarin derivatives like dicoumarol and warfarin which inhibit vitamin K and prothrombin synthesis. Heparin is discussed as both an in vitro and in vivo anticoagulant that prevents clotting by binding to antithrombin and inhibiting coagulation factors Xa and IIa. The document covers mechanisms of action, administration, effects, toxicities and dosing of these anti-coagulant drugs.
organophosphorous poisoning management in ICUintentdoc
This document discusses organophosphorus (OP) poisoning, which is commonly caused by pesticide exposure and is a major health issue in India. It provides details on the mechanisms of action, epidemiology, clinical features, diagnosis, and management of OP poisoning. Regarding treatment, the key aspects covered include the use of atropine as the primary treatment to counteract muscarinic effects, oximes to reactivate acetylcholinesterase, and supportive care. Complications discussed include intermediate syndrome, delayed neuropathy, and delayed encephalopathy. The goals of treatment are to reduce toxin absorption, enhance elimination, and neutralize the toxin.
This document summarizes cholinergic antagonists, which are drugs that block the effects of acetylcholine in the muscarinic receptor. It discusses their structure-activity relationships, medical uses in conditions like ulcers, overactive bladder, and organophosphate poisoning. Specific antagonists are described like atropine, hyoscyamine, scopolamine, ipratropium, tiotropium, benztropine, biperiden, tropicamide, and others. Their mechanisms of action, pharmacological effects, and clinical applications are concisely outlined.
Preanaesthetic medication & general anaestheticsswarnank parmar
This document provides information on pre-anaesthetic medication, general anaesthetic agents, and their mechanisms and uses. It discusses drugs administered before anaesthesia like benzodiazepines to reduce anxiety and opioids for analgesia. It also describes the history of commonly used general anaesthetics like ether, nitrous oxide, halothane and newer intravenous agents. The stages of anaesthesia and how anaesthetic potency is measured by MAC values is summarized. Complications of general anaesthesia like respiratory depression are also mentioned.
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.
Intravenous Anaesthetics are a group of fast-acting
compounds that are used to induce a state of impaired
awareness of complete sedation.
These are drugs that, when given intravenously in an
appropriate dose, cause a rapid loss of consciousness.
This document discusses various antimuscarinic agents including atropine, scopolamine, ipratropium, glycopyrrolate, tropicamide, cyclopentolate, benztropine, trihexyphenidyl, oxybutynin, darifenacin, fesoterodine, solifenacin, and tolterodine. It describes their mechanisms of action as muscarinic receptor antagonists, therapeutic uses such as treatment of gastrointestinal, cardiovascular and respiratory conditions, and adverse effects like dry mouth and blurred vision.
The document discusses indications for ICU admission and management of critically ill COVID-19 patients. It provides criteria for ICU admission including need for mechanical ventilation, vasopressors, respiratory rate over 30, low oxygen saturation, confusion, and other organ dysfunction. It also outlines management strategies in the ICU including ventilation, vasopressors, steroids, blood products, glucose control, nutrition, and prevention of complications. Risk factors like comorbidities and laboratory values associated with worse prognosis are also mentioned.
MODES OF VENTILATION detailed ppt presentation.pptxssuser579a28
The document discusses various modes of mechanical ventilation including mandatory minute volume ventilation (MMV). MMV aims to maintain a preset minimum minute ventilation while allowing for spontaneous breathing. It seeks to prevent issues like auto-PEEP and excessive dead space ventilation while fully ventilating in apnea. Adaptive support ventilation (ASV) is an intelligent mode that continually adjusts inspiratory pressure, mandatory breath rate, and inspiratory time on a breath-by-breath basis to adapt to the patient's needs during intubation, weaning, and extubation. Proportional assist ventilation (PAV+) uses software to estimate patient resistance and compliance and provides proportional ventilator support based on a percentage setting.
This document provides an overview of mechanical ventilation settings, modes, advantages and disadvantages of different modes, and guidelines for initiation and troubleshooting. It describes the main settings including trigger mode, respiratory rate, tidal volume, PEEP, flow rate, I:E ratio and FiO2. The main modes discussed are assist-control ventilation, pressure support ventilation, and synchronized intermittent mandatory ventilation. Guidelines for initiation focus on oxygenation, ventilation and avoiding high pressures. Troubleshooting addresses high pressures, COPD patients, synchrony issues, and acute respiratory distress syndrome.
The document discusses various aspects of mechanical ventilation including indications for use, parts of the ventilator, measurements of ventilatory mechanics, types of ventilation modes including non-invasive and invasive modes, initial ventilator settings, and criteria for weaning patients off the ventilator. It provides details on modes like volume control, pressure control, SIMV, and PSV as well as parameters to monitor and consider when setting up the ventilator for a patient and assessing readiness to wean.
TRAUMATIC BRAIN INJURY and anesthetic management.pptxssuser579a28
Traumatic brain injury (TBI) can be caused by a forceful impact or penetration of the skull. There are two main types - penetrating injuries which break the skull, and closed or blunt injuries which cause the brain to move inside the skull. TBI can lead to hematomas, contusions, diffuse axonal injury or intracranial hemorrhage depending on the location and nature of the injury in the brain. The primary injury occurs at the time of impact, while secondary injuries may develop like brain swelling, low oxygen levels, and increased pressure inside the skull in the following hours or days. Emergency treatment focuses on stabilizing the patient's breathing, blood circulation, neck immobilization and rapid evaluation for life-threatening
TURP for PG EXCEL detailed slides 2018.pptxssuser579a28
An 89-year-old male with a history of ischemic heart disease, hypertension, and sinus bradycardia requiring a pacemaker is scheduled for a transurethral resection of the prostate (TURP) for benign prostatic hyperplasia. Preoperatively, the patient will be evaluated for his cardiac status including pacemaker function, geriatric status, and history of hypertension. Investigations such as ECG, echocardiogram, and urodynamic studies will be performed. During the procedure, monitoring will include ECG, blood pressure, oxygen saturation, and temperature to watch for complications related to pacemaker or TURP syndrome. The pacemaker will be set to asynchronous mode and bipolar cautery
This document provides information on anaesthesia for laparoscopic surgery. It discusses the history of laparoscopy, advantages and disadvantages, physiological changes during pneumoperitoneum, gas choices, positioning, fluid management, complications, and special considerations for laparoscopy in infants/children and pregnancy. Key points include CO2 being the gas of choice due to its solubility, general anaesthesia typically being used, and importance of fluid management and monitoring physiological changes during the procedure.
Laparoscopic surgery involves inserting specialized tubes into the abdominal cavity to perform minimally invasive surgery. Carbon dioxide gas is used to insufflate the abdomen and create pneumoperitoneum. This causes physiological changes including increased heart rate and blood pressure due to hypercapnia and raised intra-abdominal pressure. It can also decrease lung volumes and compliance. The anesthesiologist must carefully manage ventilation and monitor for potential complications like subcutaneous emphysema, capnothorax, and venous gas embolism during laparoscopic surgery. Patient positioning, temperature control, and multimodal postoperative pain management are also important considerations for the anesthesiologist.
This document discusses inhalational anesthetic agents. It begins by defining inhalational anesthesia as the delivery of gases or vapors to the respiratory system to produce anesthesia. It then classifies both outdated and current inhalational anesthetic agents. The document goes on to discuss the pharmacokinetics of inhalational agents, including factors that affect inspired, alveolar, and arterial concentrations. It also covers concentration effects and how cardiopulmonary physiology influences uptake and distribution of anesthetic gases. In summary, the document provides an overview of inhalational anesthetic classification, mechanisms of action, and pharmacokinetics.
The document discusses various inhalational anesthetics used in veterinary medicine including their properties, mechanisms of action, advantages, and disadvantages. It describes key terms like MAC and blood:gas partition coefficients. Specific anesthetics covered include ether, halothane, methoxyflurane, enflurane, isoflurane, nitrous oxide, cyclopropane, and chloroform. Their potencies, effects on vital organs, muscle relaxation properties, and appropriate uses are summarized. Contraindications and safety concerns are also mentioned for some agents.
This scientific document presents research with the aim of studying a topic and reporting results and conclusions. It includes sections for an introduction, materials and methods, results and discussion, and conclusions. The title, authors, and their affiliations are provided.
Hyperbaric levobupivacaine was developed as a safer alternative to racemic bupivacaine for spinal anesthesia. Clinical trials found that a 0.5% hyperbaric levobupivacaine solution provided comparable efficacy to 0.5% hyperbaric bupivacaine in terms of onset and duration of sensory and motor blockade. Hyperbaric levobupivacaine also demonstrated a better safety profile with fewer adverse events reported. The addition of glucose increases the density of local anesthetics, allowing for a more predictable spinal spread under the influence of gravity compared to glucose-free solutions.
Pre-read about opioid analgesia 2006.pptssuser579a28
The document discusses opioids and their use for analgesia in children. It describes how opioids were originally derived from the opium poppy and outlines the types of opioid receptors in the body. It also summarizes different opioid drugs like morphine, codeine, fentanyl, and their effects. The document addresses misconceptions around opioid use in children and defines terms like addiction, tolerance, and withdrawal. It provides guidance on safely caring for children receiving opioids through monitoring and documentation.
This document summarizes the pharmacokinetics and pharmacodynamics of common intravenous anesthetic agents. It discusses the mechanisms of action, metabolism, and effects of propofol, thiopental, ketamine, etomidate, and barbiturates on the central nervous system, cardiovascular system, and respiratory system. It also provides information on their uses, dosages, and side effects. The document is presented by Dr. Suchetha S with Dr. Sagar S.M as moderator and Dr. Arun Kumar A as head of department.
This document discusses various intravenous anesthetic agents, focusing on sodium thiopental. It defines sodium thiopental as an ultra short-acting barbiturate used for induction of general anesthesia. The document outlines the ideal properties of intravenous anesthetic agents and describes the pharmacokinetics, pharmacodynamics, dosing, indications, and side effects of sodium thiopental. Specifically, it notes that sodium thiopental causes rapid loss of consciousness, depresses the cardiovascular and respiratory systems, and has a short duration of action due to rapid redistribution from the brain to other tissues.
1) This case discusses the challenges of managing acute pain in a hospitalized patient on chronic opioids who underwent foot amputation surgery.
2) The patient was prescribed escalating doses of opioids, including extended-release morphine up to 165mg 3 times daily as well as IV and oral hydromorphone. He developed somnolence and hypoxemia.
3) After holding the extended-release morphine, the patient's pain worsened and muscle spasms developed. He was prescribed diazepam which led to respiratory depression and an opioid/benzodiazepine overdose requiring naloxone and ICU admission.
Neuromuscular blockers (NMBs) are drugs that paralyze skeletal muscles by interfering with acetylcholine at the neuromuscular junction. The document discusses both depolarizing NMBs like succinylcholine and non-depolarizing NMBs. It provides details on the classification, mechanisms of action, pharmacokinetics, indications and contraindications of various NMBs. It also discusses factors that can alter the duration of action of non-depolarizing NMBs such as pH, temperature, age, electrolyte levels and interactions with other drugs.
Local anesthetics work by blocking sodium channels and include both ester and amide chemical structures. Ester local anesthetics like procaine are metabolized rapidly via plasma esterases while amides like lidocaine undergo hepatic metabolism. Factors like lipid solubility, pH, dose, and route of administration influence a local anesthetic's potency, onset, and duration of action as well as its systemic absorption and toxicity risk profile. The addition of vasoconstrictors can prolong a local anesthetic's effects by decreasing its rate of vascular uptake.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
3. Thiopentone Sodium
1) What are the commonly used IV induction agents?
a) Thiopentone sodium
b) Propofol
c) Ketamine
d) Etomidate.
4. 2) Thiopentone sodium belongs to which group
pharmacologically?
A) Thiopentone sodium is ultra-short acting barbiturate
which can be administered only in an IV route.
5. 3) What is the pH of Thiopentone and where is it
significant in anaesthesia ?
A) Thiopentone sodium is highly alkaline with a pH of
10.6.
Hence it should not be given just prior to the
administration of drugs with different pH, like Scoline.
• There should be adequate saline flush between the
two drugs.
6. 4) How is Thiopentone sodium available and how do you
prepare it for induction?
A) Thiopentone sodium is available as crystalline powder
in a vial with a strength of 500 mg or 1 gm. I will dilute
with normal saline to make it 25 mg per ml solution for
slow IV administration.
7. 5) What is the dose of Thiopentone sodium for
induction of anaesthesia ?
A) In a healthy adult the dose is 3-5 mg/Kg body
weight for normal induction.
• Sleep dose of Thiopentone sodium is 100mg/min
(4ml/min of a 2.5% solution). Till the patient goes to
sleep.
8. 6) What are the contraindications of Thiopentone
sodium ?
A) Bronchial asthma , Acute bronchitis , and atopic
individuals are relative contraindications in addition to
severe hypotension.
Acute Intermittent Porphyria and known allergy to
sulpha drugs are the absolute contraindications.
9. 7) What severe damage can occur by wrong
administration of Thiopentone sodium ?
A) Accidental intra-arterial administration of
thiopentone results in the following :
1.Severe pain in the area supplied by the artery.
2. Spasm of artery leading to decreased blood supply.
3.Burning sensation of the area involved.
4. Spasm of the muscles involved.
5. Cyanosis and gangrene of the distal areas.
6. Systemic hypotension leading to shock.
10. 8) What is the management of such incident?
a- Do not remove the culprit needle from the artery.
b- Inject preservative free 1% Lignocaine 5ml (50 mg) +
phenoxybenzamine (a blocker) 0.5 mg bolus or 50-
200mcg/min infusion into the artery.
c- Infuse plenty of normal saline into the site.
d- Keep the arm elevated.
e- Inj. Papavarine 40-80 mg to be given into the artery.
F – Stellate Ganglion block if required.
11. 9) What are the non-induction uses of Thiopentone
sodium clinically ?
A)
• It is a powerful agent to reduce the raised ICP.
• It is administered to manage Status Epilepticus.
• It is administered as Truth Serum in criminal cases.
• It is used as one of the drugs in TIVA for short
surgical procedures.
12. 10) What was the historical connection between
Thiopentone sodium and Pearl Harbor attack?
A) After the Pearl Harbor attack the casualties were
induced with standard doses of Thiopentone sodium
which resulted in multiple intra-op deaths due to
severe hypotension. The drug went into disrepute for
almost a decade. Later the reason for death was
identified as pre-operative hypotension and the drug
was brought back to clinical usage.
13. 11) What are the special precautions while administering
Thiopentone sodium ?
A) Thiopentone sodium should be administered very
slowly in extremes of age and the dose to be
minimized in elderly patients.
14. 12) What is the effect of Thiopentone sodium on the
fetus when administered to the pregnant mother ?
A) The effect is minimal because of the multiple
dilutions of the drug before it reaches fetal
circulation.
15. Propofol
1) What is the pharmacological composition of Propofol ?
A) Propofol is a milky white emulsion with following
composition.
• Propofol
• Egg lecithin (purified)
• Soya bean oil
• Isopropyl phenol
• Glycerol.
16. 2) What are the unique pharmacological features of
Propofol ?
A) Propofol can be administered only through IV route.
• It produces peripheral vasodilation leading to
systemic hypotension.
• Onset of action is fast and recovery time is also
short making it a very useful drug in day care
anaesthesia.
17. 3) What are the advantages of Propofol ?
A)
• Safe induction agent in known hypertensive patients.
• Very useful drug in day care anaesthesia due to its
fast in & fast out property.
• Useful in ICU sedation for short periods.
• Useful in irritable airway diseases.
18. 4) What are the precautions to be taken in Propofol
administration ?
A)
• To be administered with care in hypotensive patients.
• To be administered carefully in atopic individuals and
in patients with egg allergy.
• IV injection is painful, hence prior injection of
lignocaine is advised.
19. 5) What is Propofol infusion syndrome ?
A) It is a syndrome seen usually in ICUs , when the Propofol is used
as an infusion for sedation for prolonged periods at 4mg/kg/hr,
usually more than 48hrs. The signs and symptoms are the result
of muscle injury and release of intracellular toxic content
Acute refractory bradycardia leading to asystole in the presence
of one or more of the following
Metabolic acidosis ( base defecit > 10mmol/litre)
Rhabdomylosis Hypotension
Hyperlipidemia Tachypnea
Enlarged or fatty liver Shock
Cardiomyopathy with acute cardiac failure
Skeletal myopathy
Hyperkalemia
Lipemia
20. 6) How do you manage this syndrome ?
A)
• Stop Propofol infusion immediately.
• Rapid fluid resuscitation with normal saline.
• Inj. Furosemide to flush out the excessive drug.
• Inj. Hydrocortisone IV NOT to be given.
• Inotropic support if required.
• Hemodialysis if indicated.
21. 7) What do you know about Propofol induced sepsis ?
A) Propofol may be a potential source of systemic
sepsis as it is a favorable medium for bacterial
growth. This is commonly seen in opened and reused
Propofol vials.
22. 8) How do you prevent this sepsis ?
A)
EDTA added Propofol preparations are available in the
market which will prevent the growth of bacteria in the
vials.
Not using the partially used vials next day is a safe
practice to prevent Propofol induced sepsis.
23. KETAMINE
1) What is the pharmacological precursor for Ketamine?
Say a few words about its history?
A)
• Ketamine is phencyclidine derivative and the latter
drug was used initially as a recreational drug.
• Ketamine was introduced into clinical practice in 1970
by Corssen and Domino.
24. 2) What are the unique pharmacological actions of Ketamine?
A)
• Ketamine is a powerful analgesic agent.
• It produces rapid dissociative anaesthesia.
• It increases the heart rate and blood pressure.
• It increases IOP , ICP and IGP.
• It reduces the seizure threshold, sometimes precipitating
imminent Seizures.
• It produces hallucinations- visual, auditory and tactile- both
positive and negative also.
• Ketamine partially suppresses the pharyngeal and laryngeal
reflexes.
• Ketamine is a bronchodilator and so useful drug in bronchial
spasm or asthma.
• Ketamine increases the oral secretions , which may sometimes
lead to laryngospasm.
• Ketamine increases the skeletal muscle tone.
25. 3) What is the role of Ketamine in day-care
anaesthesia?
A) Very useful drug in TIVA because of its unique
analgesic and CVS stabilizing properties . Quick
elimination - half time is also a favorable character.
26. ETOMIDATE
1) What are the physical and pharmacological
properties of Etomidate?
A) Etomidate is usually supplied in vials as a milky white
solution or transparent liquid. It is a powerful
induction agent.
27. 2) What is the dose of Etomidate for induction?
A) 0.2 to 0.6 mg/kg, IV is the standard induction dose
of Etomidate.
28. 3) What are the advantages of Inj. Etomidate?
A) Etomidate is a drug with cardiac stability. So, can be
safely administered in cardiac patients without any
unwanted changes in blood pressure or pulse rate.
29. 4) What are the limitations of Etomidate usage?
A)
a) Etomidate is known to disturb the hypothalamus
pituitary adrenal axis.
b) It causes involuntary muscle movements and also
reduces the threshold of seizures in patients.
30. 5. What are the relative contraindications for the usage
of Etomidate in anaesthesia?
A) Hypopituitarism, Addison’s disease and known cases
of epilepsy are the relative contraindications of
Etomidate.
31. ANTI-CHOLINERGICS
1. What are the commonly used anticholinergics in
anaesthetic practice?
A) Inj Atropine or Inj Glycopyrrolate are the two
commonly used anticholinergic drugs in Anaesthesia.
32. 2. What are the indications of usage of
anticholinergics?
A)
They are used to:
• Reduce the salivary and bronchial secretions.
• To reduce the vagal tone and thus preventing the
unwanted bradycardia during anaesthesia.
• They are mild bronchodilators and hence are useful in
irritable respiratory system disorders.
33. 3. What are the disadvantages of Anticholinergics?
A)
• They produce unwanted tachycardia and hence they
must be used with caution in Tachyarrythmias,
Phaeochromocytoma or hyperthyroidism.
• They block the sweat glands, so must be avoided in
patients running high temperatures.
• They create dry mouth and dry respiratory tract
which may cause great discomfort to patients.
• Atropine being tertiary amino compound crosses the
blood brain barrier and may cause cerebral
anticholinergic syndrome especially in elders.
34. 4. What are the dosages and preparation of anticholinergics?
A)
• Atropine is available as 1ml ampoule containing 0.6 or 0.5 mg of
Atropine sulphate.
• 1mg/ml preparation is also available for ICU usage for treatment
of OP poisoning
• Dose is 0.6 – 2 mg IM/IV, not more than 10 µg/kg in children.
• Glycopyrrolate is available as 1ml ampoule containing 0.2 mg.
• Dose - 0.005 – 0.008 mg/kg body weight IV or 0.1 – 0.3 mg IM
or 1 – 2 mg oral.
35. BENZODIAZEPINES
1. What are the commonly used Benzodiazepines in the
anaesthesiology and for what purpose?
A) Midazolam, Diazepam and Clonazepam are the
frequently used benzodiazepines in anaesthesia.
Midazolam is used as an anxiolytic agent before
induction.
Diazepam is used as an anticonvulsant during an attack
of epilepsy or eclampsia.
Alprazolam is used as a mild sedative on the night
before surgery for a peaceful sleep.
36. 2. What are the pharmacological differences between
Diazepam and Midazolam?
A) Onset of action is faster, duration of action is shorter
and the elimination half life is shorter with midazolam
compared to diazepam.
Midazolam is water soluble and hence less painful when
administered intravenously, where as Diazepam is a thick
viscous liquid that causes pain in IV injection.
Diazepam is more potent anticonvulsant than midazolam
and hence it is a preferred drug in an attack of epilepsy,
but its duration of action may extend upto ~ 72 hrs.
37. 3. What are the limitations of Midazolam?
A) Benzodiazepines are not analgesic drugs and if
administered in the presence of acute pain, will cause
delirium in the patient with severe pain as they act
as antanalgesics.
38. FENTANYL
1. Why is Inj Fentanyl is a preferred Opioid chosen for
intra-op analgesia?
A) Fentanyl is a powerful synthetic opioid drug which
produces prompt and profound analgesia,is 100 times
more potent than Inj Morphine.
B) Onset of action is within 5 min and effect lasts for
4-6 hrs. Release of Histamine is minimal and hence
appearance of rash, hypotension or bronchospasm
are rare events with fentanyl.
39. 2. What is the dose of Fentanyl? Which are the chief side
effects of Fentanyl?
A) Analgesic dose of Fentanyl is 1-2 µg/kg body weight given
in IV route. Onset of action is after five minutes and peak
action is at 45 min after administration. The chief side
effect after Fentanyl is the chest wall rigidity,
hypotension and over-sedation. The side effects can be
minimized by slow administration of Fentanyl.
40. 3. What are the non anaesthetic uses of Fentanyl?
A) Fentanyl can also be used for:
• Post op analgesia.
• Post traumatic analgesia in emergency room.
• To manage acute MI.
• ICU sedation and analgesia
41. DEXMEDETOMIDINE
1.Dexmedetomidine belongs to which group
pharmacologically?
A) Dexmedetomidine belongs to α2-adrenergic agonist
group and it is different from Clonidine in the
following way: α2 stimulant 1600 times more selective
(α2/α1=1600:1) compared to Clonidine (α2/α1=220:1).
42. 2.What are the pharmacological actions of
Dexmedetomidine?
• It is mild sedative.
• It is an anti-hypertensive drug.
• It is a mild analgesic.
• It is a tranquilizer during analgesic.
• It reduces the pressor response of the laryngoscopy
and intubation in general anaesthesia.
• It maintains the heart rate.
43. 3. What are the advantages of Dexmedetomidine in
clinical use ?
A) 1. Rapid onset of action.
2. Rapid recovery from the action.
3.Arousable sedation.
4. Mild analgesia present.
5. Maintains cardiovascular stability.
6. Can be administered by IV infusion.
44. 4. What are the precautions to be taken during administration of
Dexmedetomidine?
A)
• Dexmedetomidine administration is contraindicated in patients
with severe hypotension and bradycardia.
• Sporadically few patients will develop unexpected hypertension
and tachycardia immediately after starting the
Dexmedetomidine infusion. The reason for this is the
disturbance in Nor-epinephrine re-uptake mechanism. In such
patients Dexmedetomidine to be terminated immediately and IV
Esmolol or IV Labetalol to be given to correct the situation
• Unwanted hypotension and severe bradycardia may be seen in
certain sensitive patients. Reduction of infusion rate is indicated
in such patients.
45. 5. What is the role of Dexmedetomidine in ICU care?
A) Dexmedetomidine can be administered as an infusion
for sedation in ICU with minimum side-effects. The
context sensitivity half-life of the drug is short and
hence it is a safer alternative.