Fixed Anesthetic Agents

Dr. Anil Dutt

Reader, Deptt of Shalya Tantra
Section of Sangyaharan
R.G.G.P.G Ay College, Paprola
 Thiopentone sodium
• Type: Ultra-short acting thiobarbiturate
• Dose and administration: 3-5mg/kg of
2.5% conc.i.v. prepared in Normal
saline/distilled water
 SYSTEMIC EFFECTS
• C.N.S : Produces effects in <30sec after i.v inj.
There is progressive depression of CNS,
including spinal cord reflexes.
Central effects: sedation, anesthesia,
resp depression, anti-convulsant,retrograde
amnesia and depression of VMC.
• CVS :Decreased Myocardial contractility
Peripheral vasodilatation
This leads to
Hypotension
Tachycardia
 Systemic effects contd…
• Respiratory system
• Respiratory depressant
Centrally mediated resp depression & decreased
sensitivity to Carbon dioxide
Transient Apnoea

Laryngeal reflex intact

Coughing, laryngeal spasm and bronchoconstriction
may occur, particularly in asthmatics
• Eyes – IOP decreased by 40%
light reflex lost
corneal, conjunctival,eyelids,eyelash
reflex lost.
• Hepatorenal functions: Impaired
transiently
• Uterus and placenta: uterine tone
unaffected
Lipid solubility allows passage across
placenta.
 Adverse effects
• Hypotension
• Respiratory depression
• Tissue necrosis-(periveinous injection)
• Laryngospasm- results from(a) direct local
stimulation(airway,blood,saliva) (b)stimulation of
remote area(anal sphincter,cervix uteri)
• Allergic reactions – ranges from cutaneous
rashes to severe anaphylaxis
• Thrombophlebitis
 Intra-arterial inj
• Follows arterial cannulation
• Clinical features:
complain of intense burning pain
forearm and hand may be blanched and blisters
may appear distally.
• Cause: change in the pH of thoipentone when
mixing with blood > ppt of solid crystal>cause
NAd realese> vasocostriction, thrombosis
formed by endarteritis,aggregation of platelets
emboli ischemia or gangrene.
 Management
Leave cannula in place
• Vasodilator (e.g papaverine 40-80mg in
10-20ml of N.S i.v., phenoxybenzamine
0.5mg i.v)
• Stellate ganglion and brachial plexus block
• i.v heparin 500 units, reverses alkalinity
and prevents thrombosis.
• Oral anticoagulants
 Absolute contraindications
• Airway obstruction- in epiglottitis,oral or
pharyngeal tumors.
• Porphyria- LMN paralysis & severe CVS
collapse. Induction of gamma
aminolivulinic acid> production of
porphyrin.
• Previous hypersensitivity reaction
• Bronchial asthma
 Ketamine
• Phenylcyclidine derivative.
• Dose: 1-2mg/kg i.v for induction
4-6 mg/kg i.m.
25-100µg/kg/min i.v infusion.
 Systemic effects
• CNS: increases cerebral blood flow,
metabolism,and ICP.
• Respiratory system: resp depression
less than other anesthetic agents.
Pharyngeal reflexes are preserved.
• Powerful bronchodilator due to direct
sympathomimetic effect.
• Increased salivation leads to chances of
upper airway obstruction.
• CVS: heart rate. B.P., C.O., myocardial
Oxygen consumption increased.
Sensitizes heart to small doses of
epinephrinecan precipitate arrythmia.
• Pain: Central sensitization is reduced
after tissue injury.
Prevents growth of new pain pathways .
Phonation,nystagmus,eye movements and
limb movements are common.
 Adverse effects
• Emergence Phenomenon
Can occur upto 24hrs & includes
hallucinations. May be reduced by
premedication with benzodiazepines.
• may produce psychosis
 Contra-indication
• Raised ICP
• I.H.D., Vascular aneurysm: Ketamine
causes hypertension and tachycardia.
• Psychiatric disease
• Subrachnoid use: preservative
chlorobutanol is neurotoxic.
 Precautions
• Stomach and bladder should be empty.
• Following should be in hand
• Laryngoscope
• Tracheal tubes
• Oxygen
• Mask and reservior bag
• Tilting table
• Suction apparatus
• Suitable syringes and needles
• Normal resuscitation equipments.
 Recovery from anesthesia
• Nurse the patient in lateral position.
• Oxygen should be administered.
• Watch airway and tidal exchange
carefully.
• Day cases should always be accompanied
• Pts should be asked not to drive or
engage in responsible activity for 24 hrs.
The return of normal mental faculties
does not accompany apparent return of
full consciousness.
Thanks