Anesthesia and Drugs Real

Anesthesia and drugs
Dr. Bilal Tariq

What is Anesthesia?
Sedation /
Amnesia
Muscle
Analgesia
Relaxation
Stages of Anesthesia
Emergency Drugs
• Adrenaline
• Atropine
• Phenyl Ephrine
• GTN
• Metoprolol
• Nor Adrenaline
• Dobutamine
• Dopamine
Adrenaline
• Strong Beta agonist and alpha
agonist
• Increase heart rate, increase B.P
(vasoconstriction) ,
• Broncho dilation, Uterine
relaxation
• Used for Anaphylactic
Shock
• How to prepare?
• 1 mg in 1 ml = 1000 mics in 1 ml
• diluted in 10 cc = 1000 mics in 10 cc
• 100 mics per ml
• Take this 1 cc and further dilute in 10 cc
• 100 mics in 10 cc
• 10 mics per ml
• BOLUS: 5 to 20 mics (according to BP and response needed)

• 1:1000 means 1 mg per 1 mL (ie,
0.1%)
• 1:10,000 means 1 mg per 10 mL (ie,
0.01%)
• 0.1 mL of 1:1000 epinephrine added
to 9.9 mL of anesthetic solution =
1:100,000 dilution or 0.01 mg/mL
Atropine
• Anti Muscarinic (Anti cholinergic)
• Increase heart rate
• Decrease salivation
• Mydriasis (dilates Pupil)
• Dose = 0.4 to 1 mg can exceed up to 2 mg.

Phenyl Ephrine
• Alpha 1 agonist
• Vaso constriction
• Reflex brady cardia
Uses:
• Nasal decongestant
• Vasopressor
• Pupil dilation
• Bolus : 25 to 50 mics
Premedication / Stress response Blunting
• Dormicum (Midazolam)
• Mgso4 @ 15 to 20 mg / Kg.
• Xylocain Plain 2 % @1.5 mg / kg.
MIDAZOLAM(DORMICUM)
• It belongs to benzodiazepines.
• Rapid onset of effects and short duration of action.
• Midazolam is a hypnotic-sedative drug with anxiolytic, muscle
relaxant, anticonvulsant, sedative, hypnotic, and amnesic properties.
• Dose is 1-2mg for anxiolysis
• Toxicity : respiratory depression , reversed by Flumazenil .
Induction Phase
Drugs we use for Sedation
• Propofol
• Barbiturates (Thiopental Sodium)
• Benzodiazepines (Midazolam)
• Ketamine
• Dexmedetomidine
Inhalational:
• Sevoflurane
KETAMINE
• MOA :- NMDA receptor antagonist.
• Dosage: Induction: 1 mg/kg (5–10 mg/kg intramuscularly or per
rectum);
• sedation load: 200 to 1000 mcg/kg; then 30 to 80 mcg/kg/min for
maintenance.
• Side effects: Can cause direct myocardial depression and may lead to
decreased CO in sympathetic blockade, spinal cord transection, or
exhaustion of catecholamine stores (severe end-stage shock).
Relatively contraindicated in coronary artery disease, CHF,
uncontrolled hypertension, and aneurysms.
• TOXICITY : Inc. Intracranial pressure , inc intraocular pressure .
PROPOFOL
• MOA:-Facilitates GABA, increases binding affinity.
• 200mg / 1 Ampoule (Lipid preparation)
• Dosage: Induction: 2 mg/kg (2.5–3.5 mg/kg child);
• maintenance load, 100 to 150 mcg/kg/min until
• sedated; then 25 to 75 mcg/kg/min.
• Propofol should be administered within 6 hours
of opening the ampule.
• TOXICITY : Hypotension , CVS depression .
• Blunts Sympathetic response
• How to prevent pain by IV propofol?
Muscle relaxation
Suxamethonium
• Dose: 1.5 mg / kg
• Indication :
Rapid Sequence Induction (RSI)
Difficult intubation
Very Short procedure
• Contraindication:
Burns more than 12 hours.
Hyperkalemia
Muscular dystrophies
ATRACURIUM
• NON-Depolarizing Muscle Relaxant
• Dosage: 0.5mg/kg for Induction , 0.1mg/kg for Maintenance .
• Side effects: Histamine release (hypotension, tachycardia,
bronchospasm), laudanosine toxicity (breakdown product of
Hofmann elimination that can cause central nervous system excitation
and is metabolized by liver),prolonged action (at abnormal pH and
temperature).
Analgesia
• Opioids
• Ketamine
• Nsaids
• Pregabalin
• gabapentin
NALBUPHINE(NALBIN,KINZ)
• Opioid
• 10mg/1ampoule
• Dose: 0.1mg/kg
• Causes sedation at analgesic dose
• Mechanism of action:
nalbuphine is as a Competitive Opioid Antagonist, and Partial Opioid
Agonist. ... It appears to be an agonist at kappa opioid receptors and an
antagonist or partial agonist at mu opioid receptors.
• TOXICITY: Dizziness, sweating , nausea , anxiety , hallucinations ,
physical dependence.
• Over dose treatment?
PARACETAMOL(PROVAS)
• it acts by inhibition of cyclooxygenase (COX)-mediated production of
prostaglandins, unlike non-steroidal anti-inflammatory drugs
(NSAIDs),paracetamol has been demonstrated not to reduce tissue
inflammation.
• 1000mg/100ml
• Dose: 10-15mg/kg . In children 7.5mg/kg for first 10kg then same
dose for remaining weigh ..
• Used in GA after induction intraoperatively but for postoperative pain.
Maintenance
Sedation
• TIVA:
Propofol
Ketofol
• Inhalational
Isoflurane
Sevoflurane
Relaxation
• Non depolarizing Muscle relaxation
• Analgesia
• Nsaids
• blocks
Recovery
• Reversal
• Neopyrolate (neostigmine + glycopyrrolate)

Neostigmine
• Mechanism of action: Acetylcholinesterase inhibitor.
• Dosage: 0.04-0.08 mg/kg in children; 5 mg in adults.
• Clinical note: Typically administered with glycopyrrolate(0.2mg) to
prevent bradycardia.
• TOXICITY : salivation, increased mucus, muscle twitching, bowel
or abdominal cramps, nausea, Vomiting, diarrhea,
Aspiration prophylaxis
• Metoclopramide
• H2 receptor blockers
• Non particulate antacids
PONV
• Ondansetron
• Dexamethasone
ONDANSETRON
• MOA :-5-HT3 Receptor Antagonists
• Dosage : 0.1mg/kg
• Selectively block serotonin 5-HT3 receptors, which are located
peripherally (abdominal vagal afferents) and centrally (chemoreceptor
trigger zone of the area postrema and nucleus tractus solitaries) with
little or no effect on dopamine receptors
• They are effective antiemetics and are generally given at the end of
surgery.
• Side effects: Minimal; the most common side effect is headache. All
can slightly prolong the QT interval on the electrocardiogram (may
be more frequent with dolasetron).
Thankyou

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Anesthesia and drugs

Dr. Bilal Tariq

• BOLUS: 5 to 20 mics (according to BP and response needed)

• Dose = 0.4 to 1 mg can exceed up to 2 mg.

• Neopyrolate (neostigmine + glycopyrrolate)

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