Pharmacology

1. INTRAVENOUS ANESTHETICS
DR.FOUZIA

2. THIOPENTAL
1-Ultrashort acting Barbiturate
2-For induction
Pharmacological effects:
CNS depression (sedation to general anesthesia)
↓ Cerebral blood flow , ↓ICP
↓ in arterial BP
Respiratory depression

3. THIOPENTAL
Clinical uses:
1-Induction (less than 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

4. PROPOFOL
1-Induction and maintenance of anesthesia (30-40 sec)
2-Vasodilation
3-Bronchodilation
4-Hypnosis but no analgesic effect
5- ↓cerebral blood flow and ICP
6-Antiemetic effect

5. PROPOFOL
Clinical uses:
1-Induction and maintenance
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

6. KETAMINE
1-Analgesia
2-“dissociative anesthesia”
3-Blocks NMDA-R in 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

7. CLINICAL USES OF KETAMINE
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)

8. ADVERSE EFFECTS OF KETAMINE
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

9. BENZODIAZEPINES
1-Sedation and anterograde amnesia
2-Muscle relaxing and anticonvulsant property
Clinical uses:
1- Intraoperative sedation
2- Part of general anesthesia
3- Pre-anesthetic medication
4- Day care surgery

10. NEUROLEPT ANALGESIA/ANESTHESIA
Neurolept-Analgesia:
Droperidol + Fentanyl
Deep sedation and analgesia (endoscopy)
Neurolept-Anesthesia
N2O + Fentanyl + Droperidol
(Neuroleptanalgesia + Unconsciousness= Neurolept anesthesia)

11. PREANESTHETIC MEDICATIONS
It refers to 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

12. 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

13. 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

14. PREANESTHETIC MEDICATIONS
5-Anticholinergics
Atropine, Hyoscine
↓Salivary and 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