BScNINTRAVENOUS ANESTHETICS.pptx

BScNINTRAVENOUS ANESTHETICS.pptx

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