Injectable and Alternative

Anesthetic Techniques
• No injectable anesthetic produces all of the components of
general anesthesia without depressing some vital organ
function.
• Combinations of drugs are necessary to provide surgical
anesthesia without depressing vital functions
• The available drugs have rather selective actions within the
CNS.
• IV anesthetics generally provide only the mental depression of
the anesthetic state (other than ketamine)

• Additional analgesics;
• inhaled anesthetics, and/or muscle relaxants - provide and
maintain all of the components of general anesthesia
• Injectable drugs are used to induce an unconscious state or are
administered by repeated injection and infusion to maintain the
mental depression necessary for anesthesia

• specific and controllable compounds that provide hypnosis,

analgesia, and muscle relaxation have been developed
(e.g.,propofol).
• Total intravenous anesthesia refers to the production of general
anesthesia with injectable drugs only
Advantage of total IV Anesthesia

• facility to provide each component of anesthesia with a dose

of a specific drug.
• In contrast, inhalation anesthetics increase or decrease the
intensity of all components of anesthesia (CNS depression,
analgesia, and muscle relaxation) simultaneously, including
their unwanted side effects.
Characteristics of an ideal injectable
anesthetic d. Short duration of action
I. Physiochemical and
pharmacokinetic e. Inactivated to nontoxic
metabolites
a. Water soluble
f. Smooth emergence
b. Long shelf life
g. Absence of anaphylaxis
c. Stable when exposed to light
h. Absence of histamine release
d. Small volume required for
induction of anesthesia III. Side effects
II. Pharmacodynamics a. Absence of local toxicity
a. Minimal individual variation b. No effect on vital organ function,
except anesthetically desirable
b. Safe therapeutic ratio effects on the central nervous
c. Onset, one vein to brain system
circulation time
MOA
• The complexity of the CNS has contributed to the lack of a full
understanding of the mechanisms of action of injectable anesthetics drugs.
• No drug has a single action.
• Some theories suggest that anesthetics alter cell membranes.
• Other theories emphasize interaction with neurotransmitter-receptor-
ionophore systems.
• Considerable evidence suggests that most injectable anesthetics alter -
aminobutyric acid (GABA)–mediated neurotransmission.
• GABA is an inhibitory neurotransmitter that activates postsynaptic receptors
that, in turn, increase chloride conductance, thus hyperpolarizing and
inhibiting the neuron.
Barbiturate Drugs
Classification
• long, (Barbital)
• intermediate,( Aprobarbital)
• short, (Cyclopal )
• ultrashort.(Kemithal)

• clinical anesthesia -short or ultrashort classification, whereas

• sedation or control of convulsions- long or intermediate action.
Barbiturates
• Racemic mixtures of the barbiturates are used both as hypnotics
and as general anesthetics.
• The principal effect of a barbiturate is depression of the CNS by interference with
passage of impulses to the cerebral cortex.
• act directly on CNS neurons in a manner similar to that of the inhibitory transmitter
GABA.
• At clinical drug concentrations, barbiturates have two mechanisms of action at GABA
receptors.
1. At lower concentrations, barbiturates exert a GABA-mimetic effect by decreasing the
rate of dissociation of GABA from the GABA receptor. - produce their sedative
hypnotic effects
2. At increasing drug concentrations, barbiturates directly activate the chloride-ion
channel associated with the GABA receptor- producens their anesthetic effect
• In hypnotic doses, the barbiturates have little effect on respiration
and the basal metabolic rate, whereas,
• In anesthetic doses;
• respiration is depressed,
• cardiovascular depression, both centrally and peripherally, with a fall
in blood pressure and
• basal metabolism is depressed, resulting in lowered body
temperature.
• Overdosage produces respiratory paralysis and death.
• While gastrointestinal effects such as diarrhea or intestinal
stasis have not been reported with barbiturate administration,
thiopental has been shown to decrease the tone of the lower
esophageal sphincter in cats
• Documented breed‐associated differences in anesthetic
pharmacokinetics and pharmacodynamics are uncommon.
• However, among canine breeds, Greyhounds are relatively
deficient in the hepatic microsomal enzymes that are needed to
metabolize the thiobarbiturates.
• This deficiency, along with lean bodies and low fat stores,
potentially result in prolonged recoveries from thiopental
anesthesia when larger doses are administered
Excretion of Barbiturates
• Barbiturate anesthesia is terminated by physical redistribution,
metabolic degradation, and renal excretion
• Long-acting agents with low lipid solubility are chiefly excreted
through the kidneys.
• As much as 85% of barbital and phenobarbital may be recovered
from the urine over several days following administration.
• The short-acting barbiturates (pentobarbital, amobarbital, and
secobarbital) are destroyed principally by the liver.
• Their rapid destruction in the body accounts for their shorter action.
Barbiturates are used:

• To induce sedation and hypnosis,

• As anticonvulsants, and
• As anesthetics.
• Their use as sedatives and hypnotics in low doses has been
supplanted, in most instances, by tranquilizers.
• depress the motor cortex - treat convulsions associated with
poisoning, particularly strychnine, “running fits,” distemper
encephalitis, and overdosage of local anesthetics.
Nonbarbiturate Drugs

• Neurosteroids
• Chloral Hydrate
• Chloralose
• Urethan
• Magnesium Sulfate
• Metomidate
• Etomidate
• Propofol
• Chloral hydrate alone and in combination with magnesium sulfate and
pentobarbital sodium has been used for induction and maintenance of
anesthesia in large domestic animals (i.e., horses and cows).
• Many drugs used to depress the CNS and immobilize laboratory animals
do not find application in routine small animal clinical use.
• Among them are chloral hydrate, chloralose, urethan, metomidate, and
magnesium sulfate.
• Newer drugs, such as etomidate and propofol, have been developed to
provide short periods of unconsciousness from which recovery is rapid.
• These hypnotic drugs are most effective when given in combination
with preanesthetics and analgesics to achieve anesthesia and
analgesia.
 Propofol
• Propofol (2,6-diisopropylphenol) is unrelated to barbiturates, euganols, or
steroid anesthetics.
• It is only slightly soluble in water and is marketed as an aqueous
emulsion containing
• 10 mg of propofol,
• 100 mg of soybean oil,
• 22.5 mg of glycerol, and
• 12mg of egg lecithin/mL.
• Sodium hydroxide is added to adjust the pH. It is available in sterile glass
ampules and contains no preservatives.
• Propofol emulsion can support microbial growth and endotoxin
production
Propofol
• Propofol induces depression by enhancing the effects of the
inhibitory neurotransmitter GABA and decreasing the brain’s
metabolic activity.
• Decreases intracranial and cerebral perfusion pressures.
• It transiently depresses arterial pressure and myocardial
contractility similar to the ultra-short-acting thiobarbiturates.
• Hypotension is primarily the result of arterial and venous
vasodilation.
• Enhances the arrhythmogenic effects of epinephrine
Alternative Methods of Anesthesia and
Analgesia
• Hypothermia
• Electronarcosis and Immobilization
• Acupuncture
• Physiological Hypnosis
Hypothermia
• As the body temperature of warm-blooded animals falls, their
metabolism is reduced, and therefore the need for oxygen is
diminished.
• Oxygen uptake in dogs is reduced by approximately 50% at
30°C and 65% at 25°C
• The heart, brain, liver, or other vital organs can survive at a low
temperature for a considerably increased period when deprived
of all or a portion of their blood supply.
• Hypothermia may be artificially produced in the entire body or in
only a portion, such as the heart or head
• Three methods of whole-body cooling have been used: surface, body cavity, and
extracorporeal.
• Surface cooling is usually accomplished by directly immersing the unprotected
body in ice water or by placing the body on a mattress through which ice water is
circulated. Hyperventilation is maintained throughout the procedure to keep the
blood pH on the alkaline side of normal. This has been shown to reduce cardiac
arrhythmias and fibrillation.
• Below 28°C (82.4°F), no anesthetic is needed, and the patient is maintained on
artificial ventilation alone.
• Active cooling is stopped when approximately two-thirds of the desired temperature
fall has been accomplished.
• Otherwise, the temperature continues to drop once the desired degree of
hypothermia has been reached.
• Body cavity cooling is accomplished by pouring cold saline
solution into the open thoracic cavity.
• This method has the disadvantage of being slow and requiring
large volumes of saline solution.
• Extracorporeal cooling can be accomplished by running blood from a cannulated
artery through a heat exchanger using cold tap water as the cooling medium.
• A pump is required to force the blood through the system. Thrombosis is
prevented by administration of heparin.
• Extracorporeal cooling has been used to lower the brain temperature below that of
the general body temperature, but carries with it the dangers of hemolysis,
interference with the blood coagulation mechanism, and thrombosis.
• The most obvious advantage is that it provides the best control over body
temperature, and rewarming can be performed quickly and efficiently by running
warm water through the heat exchanger
• Hypothermia has been used for surgery of the heart and great vessels,
brain, and spinal cord, and in some other surgical procedures.
• It also has been advocated in treatment of shock, stroke, and cerebral
and spinal contusion, and in prevention of brain damage following a
severe hypoxic episode. The chief factor limiting its use alone in heart
surgery is the danger of hypoxic brain damage.
• For this reason, older patients and those with cardiac defects requiring
extensive repair should be managed with heart lung bypass.
• Hypothermia has also been used in dogs to remove heartworms and to
repair cardiac anomalies, but its use is not widespread.
• To produce hypothermia in dogs, a phenothiazine tranquilizer may be given IV
as a preanesthetic agent.
• A thiobarbiturate is injected for general anesthesia, following which an
endotracheal catheter is inserted and an inhalant anesthetic is used for
maintenance
• A slow intravenous drip of Ringer’s lactate solution or 5% dextrose is started,
and a muscle relaxant is given in the drip tubing to abolish respirations.
• Controlled ventilation is then initiated. Unless a cooling mattress is available,
the animal is positioned in a sink, bathtub, or other container, with its head
above water.
• Electronic thermometer probes are placed in the esophagus at heart level and
in the rectum, and electrodes of an electrocardiograph are attached to the feet.
• From this point, constant monitoring of the electrocardiogram on
an oscilloscope is desirable, because cardiac fibrillation may
occur at any time during the cooling period and requires
immediate corrective measures.
• Ice water is used for rapid cooling. It should be constantly
agitated by hand or with a pump.
• The dog should be removed from the bath before the desired
body temperature is reached, because temperature will
continue to decline even after the dog’s removal from the water.
• Remove dog
• Rewarm
• If the operation is short, rewarming in a water bath may be
necessary, along with administration of atropine and
neostigmine to reverse the effects of the muscle relaxant.
Electronarcosis and Immobilization
• Electric stimulation of the brain can activate either opioid or
nonopioid pain-control pathways or both
• needle electrodes applied to the head.
• Direct, pulsating direct, and alternating current have been used
to produce electronarcosis
• Continuous electrode contact is important to maintain
electronarcosis anesthesia.
• Individual variation among animals requires that the current be
adjusted for each according to the response observed.
Acupuncture
• This technique has been advocated for providing analgesia
during the operative and postoperative periods, to treat chronic
pain, and even to treat selected disease states.
• Charts for people and farm animals (horses, cattle, and pigs)
can be commonly found in the Oriental literature.
• Acupuncture points can be stimulated in many different ways,
including needling, injection of saline, electric stimulation, and
metal implantation.
• It has been shown that electroacupuncture minimally decreases
halothane MAC in dogs
• Three reasons why acupuncture should not be solely relied upon for surgical
anesthesia:
1. lack of restraint,
2. inadequate analgesia, and
3. lack of adequate information on acupuncture points to be used for specific surgical
sites.
• These factors—along with the disadvantages of
• unfamiliarity, time-consuming methods of application, and inconsistent effects—have
made acupuncture an unreliable and nonviable method of producing general
anesthesia.
• Acupuncture may be best used for treatment of chronic pain in animals.
• Treatment of laminitis and chronic back pain in horses has reportedly been effective.
Physiological Hypnosis
• Certain species of animals are highly susceptible to hypnosis
• (immobility reflex). These include arthropods, amphibians,
reptiles, birds, guinea pigs, and rabbits.
• This modality is seldom used in animal anesthesia because of a
lack of analgesia associated with the state of physiological
hypnosis.
• Hypnosis should be viewed as a legitimate method of producing
immobilization, not anesthesia.
• Calm environment
• Gentle touch
• Soothing sounds
• Holding position
• Tonic State(immobility)