KETAMINE

INDICATIONS AND USAGE Ketamine hydrochloride injection is indicated as the sole anesthetic agent for diagnostic and surgical procedures that do not require skeletal muscle relaxation. Ketamine hydrochloride injection is best suited for short procedures but it can be used, with additional doses, for longer procedures. Ketamine hydrochloride injection is indicated for the induction of anesthesia prior to the administration of other general anesthetic agents. Ketamine hydrochloride injection is indicated to supplement lowpotency agents, such as nitrous oxide. DOSAGE AND ADMINISTRATION Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Note: Barbiturates and ketamine, being chemically incompatible because of precipitate formation, should not be injected from the same syringe. If the ketamine dose is augmented with diazepam, the two drugs must be given separately. Do not mix ketamine hydrochloride and diazepam in syringe or infusion flask. Dosage As with other general anesthetic agents, the individual response to ketamine is somewhat varied depending on the dose, route of administration, and age of patient, so that dosage recommendation cannot be absolutely fixed. The drug should be titrated against the patient s requirements.

SUCCINYLCHOLINE CHLORIDE
Succinylcholine Chloride is a sterile, nonpyrogenic solution to be used as a short-acting, depolarizing, skeletal muscle relaxant. The solutions are for I. M. or I. V. use. Succinylcholine chloride is indicated as an adjunct to general anesthesia, to facilitate tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation. INDICATIONS AND USAGE Succinylcholine chloride is indicated as an adjunct to general anesthesia, to facilitate tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation.

ATROPINE SULFATE
Drug classes of Atropine Sulfate  Anticholinergic  Antimuscarinic  Parasympatholytic  Antiparkinsonian  Antidote  Diagnostic agent (ophthalmic preparations)  Belladonna alkaloid Therapeutic actions of Atropine Sulfate  Competitively blocks the effects of acetylcholine at muscarinic cholinergic receptors that mediate the effects of parasympathetic postganglionic impulses, depressing salivary and bronchial secretions, dilating the bronchi, inhibiting vagal influences on

the heart, relaxing the GI and GU tracts, inhibiting gastric acid secretion (high doses), relaxing the pupil of the eye (mydriatic effect), and preventing accommodation for near vision (cycloplegic effect); also blocks the effects of acetylcholine in the CNS. Indications of Atrophine Systemic administration  Antisialagogue for preanesthetic medication to prevent or reduce respiratory tract secretions  Treatment of parkinsonism; relieves tremor and rigidity  Restoration of cardiac rate and arterial pressure during anesthesia when vagal stimulation produced by intraabdominal traction causes a decrease in pulse rate, lessening the degree of AV block when increased vagal tone is a factor (eg, some cases due to digitalis)  Relief of bradycardia and syncope due to hyperactive carotid sinus reflex  Relief of pylorospasm, hypertonicity of the small intestine, and hypermotility of the colon  Relaxation of the spasm of biliary and ureteral colic and bronchospasm  Relaxation of the tone of the detrusor muscle of the urinary bladder in the treatment of urinary tract disorders  Control of crying and laughing episodes in patients with brain lesions  Treatment of closed head injuries that cause acetylcholine release into CSF, EEG abnormalities, stupor, neurologic signs  Relaxation of uterine hypertonicity  Management of peptic ulcer  Control of rhinorrhea of acute rhinitis or hay fever

Antidote (with external cardiac massage) for CV collapse from overdose of parasympathomimetic (cholinergic) drugs (choline esters, pilocarpine), or cholinesterase inhibitors (eg, physostigmine, isoflurophate, organophosphorus insecticides)  Antidote for poisoning by certain species of mushroom (eg, Amanita muscaria) Ophthalmic preparations  Diagnostically to produce mydriasis and cycloplegia-pupillary dilation in acute inflammatory conditions of the iris and uveal tract


Adverse

effects

of

Atrophine

Systemic administration  CNS: Blurred vision, mydriasis, cycloplegia, photophobia, increased IOP, headache, flushing, nervousness, weakness, dizziness, insomnia, mental confusion or excitement (after even small doses in the elderly), nasal congestion  CV: Palpitations, bradycardia (low doses), tachycardia (higher doses)  GI: Dry mouth, altered taste perception, nausea, vomiting, dysphagia, heartburn, constipation, bloated feeling, paralytic ileus, gastroesophageal reflux  GU: Urinary hesitancy and retention; impotence  Other: Decreased sweating and predisposition to heat prostration, suppression of lactation

PROPOFOL
Propofol is a drug that reduces anxiety and tension, and promotes relaxation and sleep or loss of consciousness. Propofol provides loss of awareness for short diagnostic tests and surgical procedures, sleep at the beginning of surgery, and supplements other types of general anesthetics. What should my health care professional know before I receive propofol? They need to know if you have any of these conditions: y arrhythmia (rapid, slow, or irregular heart beat) y blood vessel disease y head injury y heart disease y high cholesterol y pancreatitis y seizures (convulsions) y an unusual or allergic reaction to propofol, anesthetics, other medicines, foods, dyes, or preservatives y pregnant or trying to get pregnant y breast-feeding How should I use propofol? Propofol is for injection into a vein. It is given by trained anesthesia professionals in a controlled environment. Contact your pediatrician or health care professional regarding the use of this medicine in children. Special care may be needed. What drug(s) may interact with propofol? y alcohol y barbiturate medicines for inducing sleep or treating seizures (convulsions) y herbal products, including St. John's wort

medicines for anxiety or sleeping problems, such as diazepam or temazepam y medicines for colds, breathing difficulties, or weight loss y medicines for mental problems and psychotic disturbances y medicines for pain Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines. Propofol side effects. Side effects that you should report to your prescriber or health care professional as soon as possible: y difficulty breathing, wheezing, swelling of the throat y fast heartbeat, palpitations y lightheadedness or fainting spells y numbness or tingling in the hands or feet y seizure (convulsion) y skin rash, flushing (redness), or itching y swelling or extreme pain at the injection site y uncontrollable muscle spasm Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome): y dizziness y pain or irritation at the injection site
y

EPINEPHRINE (ADRENALINE)
Brand Name: epinephrine bitartrate Pregnancy Category C Drug classes: Sympathomimetic drug, Alpha-adrenergic agonist, Beta1 and beta2adrenergic agonist, Cardiac stimulant, Vasopressor, Bronchodilator,Anti asthmatic drug, Nasal decongestant, Mydriatic, Antiglaucoma drug Therapeutic actions Naturally occurring neurotransmitter, the effects of which are mediated by alpha or beta receptors in target organs. Effects on alpha receptors include vasoconstriction, contraction of dilator muscles of iris. Effects on beta receptors include positive chronotropic and inotropic effects on the heart (beta1 receptors); bronchodilation, vasodila tion, and uterine relaxation (beta2receptors); decreased production of aqueous humor. Indications Intravenous: In ventricular standstill after other measures have failed to restore circulation, given by trained personnel byintracardiac puncture and intramyocardial injection; treatment and prophylaxis of cardiac arrest and attacks of transitory AV heart block with syncopal seizures (Stokes-Adams syndrome); syncope due to carotid sinus syndrome; acute hypersensitivity (anaphylactoid) reactions, serum sickness, urticaria, angioneurotic edema; in acute asthmatic attacks to relieve bronchospasm not controlled by inhalation or SC injection; relaxation of uterine musculature; additive to local

anesthetic solutions for injection to prolong their duration of action and limit systemic absorption Injection: Relief from respiratory distress of bronchial asthma, chronic bronchitis, emphysema, other COPDs Aerosols and solutions for nebulization: Temporary relief from acute attacks of bronchial asthma, COPD Topical nasal solution: Temporary relief from nasal and nasopharyngeal mucosal congestion due to a cold, sinusitis, hay fever, or other upper respiratory allergies; adjunctive therapy in middle ear infections by decreasing congestion around eustachianostia Contraindications Contraindicated with allergy or hypersensitivity to epinephrine or components of preparation (many of the inhalant and ophthalmic products contain sulfites: sodium bisulfite, sodium or potassiummetabisulfite; check label before using any of these products in a sulfitesensitive patient); narrow-angle glaucoma; shock other than anaphylactic shock; hypovolemia; general anesthesia with halogenated hydrocarbons or cyclopropane; organic brain damage, cerebral arteriosclerosis; cardiac dilation and coronary insufficiency;tachyarrhythmias; ischemic heart disease; hypertension; renal dysfunction (drug may initially decrease renal blood flow); COPD patients who have developed degenerative heart disease; diabetes mellitus; hyperthyroidism; lactation. Adverse effects Fear, anxiety, tenseness, restlessness, headache, light-headedness, dizziness, drowsiness, tremor, insomnia, hallucinations, psychological disturbances,

convulsions, CNS depression, weakness, blurred vision, ocular irritation, tearing, photophobia, symptoms of paranoid schizophrenia Arrhythmias, hypertension resulting in intracranial hemorrhage, cardiovascular collapse with hypotension, palpitations, tachycardia,precordial pain in patients with ischemic heart disease Nausea, vomiting, anorexia Constriction of renal blood vessels and decreased urine formation (initialparenteral administration), dysuria, vesical sphincter spasm resulting in difficult and painful urination, urinary retention in males with prostatism Pallor, respiratory difficulty, orofacial dystonia, sweating Headache, browache, blurred vision, photophobia, difficulty with night vision, pigmentary (adrenochrome) deposits in the cornea, conjunctiva, or lids with prolonged use Transitory stinging on initial instillation, eye pain or ache, conjunctivalhyperemia

contraction. In myasthenia gravis the body's immune system destroys many of the muscarinic receptors, so that the muscle becomes less responsive to nervous stimulation. Neostigmine bromide increases the amount of acetylcholine at the nerve endings. Increased levels of acetyl choline allow the remaining receptors to function more efficiently. This medicine usually restores mucle function to near-normal levels. What is it used for? Abnormal muscle weakness (myasthenia gravis) Difficulty in passing urine (urinary retention) Failure of function of part of the gut causing an obstruction (paralytic ileus) Use with caution in Asthma Decreased kidney function Epilepsy Low blood pressure (hypotension) Parkinson's disease People who have recently had a heart attack Peptic ulcer Slow heart rate of less than 50 beats per minute (bradycardia) Not to be used in Blockage of the gut (intestinal obstruction) Known sensitivity or allergy to any ingredient Obstruction of the urinary tract (urethra) This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and

y y y

y y y y y y y y

NEOSTIGMINE
How does it work? Neostigmine belongs to the group of medicines called anticholinesterases. It works by prolonging the action acetylcholine, which is found naturally in the body. It does this by inhibiting the action of the enzyme acetylcholinesterase. Acetylcholine stimulates a type of receptor called muscarinic receptors. When stimulated, these receptors have a range of effects. Muscarinic receptors are found throughout the body, especially on muscle. Stimulation of these receptors causes to muscle

y y y

inform your doctor or pharmacist immediately. Pregnancy and Breastfeeding Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine. y This medicine should be used with caution during pregnancy. Seek medical advice from your doctor. y This medicine should be used with caution by breastfeeding mothers, and only if the expected benefit to the mother is greater than any possible risk to the baby. Seek medical advice from your doctor.

Side effects Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect. Abdominal cramps Diarrhea Nausea and vomiting Increased salivation The side effects listed above may not include all of the side effects reported by the drug's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

y y y y

GENERAL ANESTHETIC DRUGS

Submitted by: Dalawampu, Allan Jayson P. Fajura, Kathy L. Maralit, Reschell F. Mendoza , Maricris B. Ramos, Angelica

Submitted to: Mrs. Loui Hernandez, RN, MAN (Clinical Instructor)

December 19, 2011