This presentation describes the various modes of anaesthetic administration.

1. UNCONVENTIONAL MODES OFUNCONVENTIONAL MODES OF
ANAESTHETIC DRUGANAESTHETIC DRUG
ADMINISTRATIONADMINISTRATION
Dr.R.Selvakumar.,MD.,DA.,DNB.,Dr.R.Selvakumar.,MD.,DA.,DNB.,
Professor of AnaesthesiologyProfessor of Anaesthesiology
K.A.P.Viswanatham Govt Medical College ,K.A.P.Viswanatham Govt Medical College ,
Trichirapalli-IndiaTrichirapalli-India

2. Why Anaesthesia Has to be Through
Inhalational route?

3.  Volatile Chemicals possessingVolatile Chemicals possessing
anaesthetic propertyanaesthetic property
 No Complex Apparatus neededNo Complex Apparatus needed
 Late Development of ParentralLate Development of Parentral
drugs.drugs.
REASONS MAY BE..REASONS MAY BE..

4. IT BECAME CONVENTIONAL ………BECAUSEIT BECAME CONVENTIONAL ………BECAUSE
 Ease ofEase of
AdministrationAdministration
 Simple AnestheticSimple Anesthetic
ApparatusApparatus
 Betterand quickBetterand quick
ReversibilityReversibility

5. Why to go forUnconventionalWhy to go forUnconventional
Methods…..?Methods…..?

6. Unconventional Methods May……Unconventional Methods May……
 Improve PatientImprove Patient
ComplianceCompliance
 ConvenienceConvenience
 Increased Bio-Increased Bio-
AvailabilityAvailability
 Improved AnalgesicImproved Analgesic
EfficacyEfficacy

7.  Trans dermal Drug deliveryTrans dermal Drug delivery
 Trans mucosal /OralTrans mucosal /Oral
 Intra NasalIntra Nasal
 RectalRectal
 Intra ArticularIntra Articular
 InterPleuralInterPleural
 Peri neural OpioidsPeri neural Opioids
 Intra trachealIntra tracheal
WhatWhat AreAre They………..?They………..?

8.  Skin as a barrierSkin as a barrier
 Drug absorption dependsDrug absorption depends
onon
Drug concentration in theDrug concentration in the
vehiclevehicle
-Aqueous solubility-Aqueous solubility
-Oil-Waterpartition co--Oil-Waterpartition co-
efficientefficient
-Lipid solubility-Lipid solubility
-Low molecularweight-Low molecularweight
Trans dermal Drug DeliveryTrans dermal Drug Delivery

9. Trans Dermal Drug DeliveryTrans Dermal Drug Delivery
 TDFCTDFC
 NTG Skin patch.NTG Skin patch.
 EMLA creamEMLA cream

10. TDFCTDFC
Transdermal fentanyl citrateTransdermal fentanyl citrate
Skin patch has four layers :Skin patch has four layers :
a)a) Backing LayerBacking Layer
b)b) Drug reservoirDrug reservoir
c)c) Rate controlling membraneRate controlling membrane
d)d) AdhesiveAdhesive

11. TDFC-STRUCTURETDFC-STRUCTURE

12.  25, 50,75& 10025, 50,75& 100μgμg/ hour patches/ hour patches
 Elimination half-life 17Elimination half-life 17 ±± 2.3 hours2.3 hours
 Plasma level decrease slowly even after removalPlasma level decrease slowly even after removal
 Onset slowOnset slow
 Variable relationship between dose & plasma levelVariable relationship between dose & plasma level
TDFC- contd…TDFC- contd…

13.  2.5% Lignocaine +2.5 prilocaine2.5% Lignocaine +2.5 prilocaine
 Eutectic mixtureEutectic mixture
 Skin harvesting for SSGSkin harvesting for SSG
 Neonatal circumcisionNeonatal circumcision
 Canular insertionCanular insertion
EMLA CREAM

14. Can EMLA cream be used for Ear boring?Can EMLA cream be used for Ear boring?
It has to be applied as an adhesive dressing 2 hours prior
to the ear boring…

15. NTG PATCH
Easy way of administering Nitroglycerine
Variable rate of absorption

16. Transmucosal Drug DeliveryTransmucosal Drug Delivery
 ORALORAL
 TRANS NASALTRANS NASAL
 SUBLINGUALSUBLINGUAL

17. TRANSMUCOSAL - ORALTRANSMUCOSAL - ORAL
 ORAL NARCOTICSORAL NARCOTICS
 VARIABLE BIO-AVAILABILITYVARIABLE BIO-AVAILABILITY
 SUBLINGUAL BUPRENORPHINESUBLINGUAL BUPRENORPHINE
 PREMED,POSTOP & CANCER PAINPREMED,POSTOP & CANCER PAIN

18. BIO AVAILABILITY OF ORAL OPIOIDSBIO AVAILABILITY OF ORAL OPIOIDS

19. ORAL -MSTORAL -MST
-- Low Bio AvailabilityLow Bio Availability
- Delayed onset timeDelayed onset time
- 30-200mg per day30-200mg per day
- Constipation & ToleranceConstipation & Tolerance

20. ORAL – OTFCORAL – OTFC
Oral Transmucosal Fentanyl citrateOral Transmucosal Fentanyl citrate
 Sweetened lozenge on a stickSweetened lozenge on a stick
 Onset of action –5-10minOnset of action –5-10min
 200, 300,400200, 300,400μgμg unitsunits
 5-155-15μg per kgμg per kg
 50% Bio -Availability50% Bio -Availability

21. ORAL KETAMINE PREMEDICATIONORAL KETAMINE PREMEDICATION
Ketamine mixed in sweetened drinks
In a dose of 0.5-4 mg /kg

22. ♠ Large Surface areaLarge Surface area
♠ Good VascularityGood Vascularity
♠ Butorphanol –Metered dose pump sprayButorphanol –Metered dose pump spray
♠ Midazolam 0.1-02mg/kgMidazolam 0.1-02mg/kg
INTRANASAL ROUTEINTRANASAL ROUTE

23. INTRANASAL APPLICATIONSINTRANASAL APPLICATIONS
Intranasal nifedipine can be tried instead of
Sublingual application

24. NebulizationNebulization

25. • Upper Airway Nebulization with 4% lignocaineUpper Airway Nebulization with 4% lignocaine
• Fentanyl –Liposome Encapsulated formFentanyl –Liposome Encapsulated form
• Morphine in aqueous solution.Morphine in aqueous solution.
NebulizationNebulization

26. Rectal MedicationsRectal Medications
 Position Decides Bio-AvailabilityPosition Decides Bio-Availability
 Induction of anaesthesiaInduction of anaesthesia
 Post op painPost op pain
 Ketamine, Midazolam, DiazepamKetamine, Midazolam, Diazepam
 Morphine Hydrogel suppositoriesMorphine Hydrogel suppositories

27. ♣ 100mg & 12.5mg100mg & 12.5mg
♣ Postoperative pain reliefPostoperative pain relief
♣ Bottom surgeriesBottom surgeries
♣ Vaginal hysterectomyVaginal hysterectomy
♣ Circumcision, hydrocoeleCircumcision, hydrocoele
Rectal DiclofenacRectal Diclofenac

29.  Following ArthroscopyFollowing Arthroscopy
 Local AnestheticsLocal Anesthetics
 Opioids-Morphine (1-5mg)Opioids-Morphine (1-5mg)
 Ketoralac ,FentanylKetoralac ,Fentanyl
 Sufentanyl, NeostigmineSufentanyl, Neostigmine..
Intra Articular ApplicationIntra Articular Application

30.  Demonstration of Peripheral Opioid SystemDemonstration of Peripheral Opioid System
 Controversial Prolongation of LA Blocks by Opioids.Controversial Prolongation of LA Blocks by Opioids.
Perineural Application Of OpioidsPerineural Application Of Opioids

31. ♦ Local Anesthetic solution in pleural cavityLocal Anesthetic solution in pleural cavity
♦ Tuohy needle –Epidural catheterTuohy needle –Epidural catheter
♦ LA diffusing through posterior pleural membraneLA diffusing through posterior pleural membrane
♦ Dose 0.4-0.5ml/Kg (20-25ml)Dose 0.4-0.5ml/Kg (20-25ml)
♦ Post-thoracotomy pain reliefPost-thoracotomy pain relief
♦ Post cholecystectomy, Post herpetic pain.Post cholecystectomy, Post herpetic pain.
♦ Multiple rib fracture.Multiple rib fracture.
InterpleuralInterpleural AnalgesiaAnalgesia

32. Technique of Interpleural AnalgesiaTechnique of Interpleural Analgesia

33. Tumuscent AnesthesiaTumuscent Anesthesia
An easy way of releasing the scar….An easy way of releasing the scar….

34. Tumuscent AnesthesiaTumuscent Anesthesia
 Subcutaneous injection of large volume of LASubcutaneous injection of large volume of LA
 35-55mg/kg Lignocaine35-55mg/kg Lignocaine
 LiposuctionLiposuction
 Scar excisionScar excision

35. Intra tracheal AdministrationIntra tracheal Administration
 Adrenaline ,Atropine ,LignocaineAdrenaline ,Atropine ,Lignocaine
 2.5 times the normal dose2.5 times the normal dose
 During C P RDuring C P R

36. INTRA OSSEOUS ADMINISTRATIONINTRA OSSEOUS ADMINISTRATION
 For resuscitation in infants & children.For resuscitation in infants & children.
 Below the tubercle of tibia.Below the tubercle of tibia.
 18G spinal needle.18G spinal needle.
 In to the marrow cavityIn to the marrow cavity

37. ConclusionConclusion
 Have we left out any routes in the body?Have we left out any routes in the body?
 Are they really helpful?Are they really helpful?

38. CONCLUSION-CONCLUSION-Contd…Contd…
Unconventional methods definitely increaseUnconventional methods definitely increase
the versatility of the Anesthesiologistthe versatility of the Anesthesiologist..

39. WHO KNOWS…
they may turn out to be conventional
one day….!

40. THANK YOUThank You