Emergency
Drugs in
Anesthesia
Hassam Zulfiqar
Anesthesiology Resident
Moderator: Dr Adnan Mustafa
ATROPINE
• Atropine is a muscarinic receptor antagonist.
• It has the fastest onset and shortest duration of action of available
antimuscarinic drugs, though its action is prolonged at extremes of age.
• It is widely distributed, crossing the placenta freely, and the large volume of
distribution (~200 litres) is responsible for the rapid initial reduction in plasma
concentration with a subsequent half-life of several hours.
• It penetrates the CNS and its use has been associated with confusion in
elderly patients.
A 58-year-old patient is brought to the
emergency room with the following symptoms:
miosis, abdominal cramping, salivation, loss of
bowel and bladder control, bradycardia, ataxia,
and skeletal muscle weakness.
The most likely diagnosis is
A. Central anticholinergic syndrome
B. Malignant neuroleptic syndrome
C. Anticholinesterase poisoning
D. Serotonin syndrome
ADRENALINE
• Directly acting sympathomimetic
• Interacts with both alpha and
beta receptors
• At low dose: predominant beta
effect
• At high dose: predominant alpha
mediated vasoconstriction
• Various strengths of adrenaline are available.
• Check strength carefully, preferred strength is 1:10 000 Adrenaline
(epinephrine) = 1 mg in 10mL or 100mcg/ml (pre-filled syringe).
• The other available strength is 1:1000 Adrenaline (epinephrine) = 1
mg in 1mL.
• 1: 100 000 will be 10 mcg/ml ( Pediatrics)
• 1: 200 000 will be 5 mcg/ml ( Local anesthetics with adrenaline)
A 33-year-old, 70-kg patient is brought to the operating room for resection
of an anterior pituitary prolactin-secreting tumor. Anesthesia is induced
with sevoflurane, nitrous oxide, and oxygen. The patient is intubated and
nitrous oxide is discontinued. Anesthesia is maintained with 1.2 minimum
alveolar concentration (MAC) sevoflurane in oxygen. The surgeon plans to
inject epinephrine into the nasal mucosa to minimize bleeding.
What is the maximum volume of a 1:100,000 epinephrine solution that can
be administered safely to this patient without producing ventricular
arrhythmias?
• A. 55 mL
• B. 45 mL
• C. 35 mL
• D. 25 mL
Ephedrine
• Ephedrine is a direct and indirect
sympathomimetic amine.
• As a direct effect, ephedrine activates
alpha-adrenergic and beta-adrenergic
receptors.
• As an indirect effect, it inhibits
norepinephrine reuptake and increases
the release of norepinephrine from
vesicles in nerve cells.
• Metaraminol acts through peripheral vasoconstriction by acting as a pure alpha-1
adrenergic receptor agonist, consequently increasing systemic blood pressure
(both systolic & diastolic)
Metaraminol • Another effect of Metaraminol is that it releases norepinephrine from its storage
sites indirectly.
• Clinical use: As for phenylephrine; severe hypotension associated with a normal or
fast heart rate.
Which of the following drugs or interventions will cause the LEAST
increase in heart rate in the transplanted denervated heart?
A. Glucagon
B. Atropine
C. Isoproterenol
D. Norepinephrine
Succinylcholin
e
Dantrolene
HYPOTENSION
Perioperative Anaphylaxis
A 9-year-old boy weighing 40kg is undergoing an appendicectomy. He
became severely hypotensive 5 minutes after the administration of an
antibiotic. He developed a rash all over his body. His blood pressure is
65/45mmHg, his heart rate is 140 per minute and he has weak central
pulses.
The most appropriate dose and route of administering adrenaline is:
a. 0.1ml/kg of 1:10 000 adrenaline IV.
b. 0.1ml/kg of 1:100 000 adrenaline IV.
c. 0.1ml/kg of 1:1000 adrenaline IV.
d. 0.1ml/kg of 1:10 000 adrenaline IM.
e. 0.1ml/kg of 1: 20 000 adrenaline IM
BRONCHOSPASM
MALIGNANT HYPERTHERMIA
LOCAL ANESTHESIA SYSTEMIC TOXICITY (LAST)
A 70-year-old man is scheduled for a knee arthroplasty. Prior to
induction of general anaesthesia a femoral nerve block is performed
using a nerve stimulator. Soon after injection of 20ml of 0.5%
bupivacaine, he became unresponsive. He is unconscious and has no
palpable carotid pulse. CPR is commenced.
Which one of the following best describes the specific treatment in this
scenario?
a. 1ml/kg of 10% lipid emulsion over 1 minute.
b. 1.5ml/kg of 20% lipid emulsion over 1 minute.
c. 1.5ml/kg of 20% lipid emulsion over 10 minutes.
d. 1ml/kg of 10% lipid emulsion over 5 minute.
e. 1.5ml/kg of 10% lipid emulsion over 2 minutes.
Thank you
