Beruflich Dokumente
Kultur Dokumente
30 Dec 2015
INTRAVENOUS
ANAESTHETIC
AGENTS
30 Dec 2015
OBJECTIVES
4- Propofol
4.1. Physical and chemical properties
4.2. Dosage
4.3. Effects on organ systems
4.4. Indication and contraindication
5. Ketamine
5.1. definition of dissociative anesthesia
5.2. Physical & chemical Properties
5.3. Pharmacokinetics (Route of administration and Dosage)
5.4. Metabolism
5.5. Mechanism of action
5.6. Pharmacodynamics (effect on organ systems)
5.7. Indications and contraindications
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OBJECTIVES
OBJECTIVES
6- Benzodiazepines
6.1. Features
6.2. Mode of action
6.3. Midazolam and Diazepam (Uses, differences between
them)
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INTRAVENOUS ANAESTHETIC
AGENTS
30 Dec 2015
Dr. Med. Khaled Radaideh
1- Barbiturate
1.1. sodium thiopental(used
for over 40 years)
2. Non barbiturate
2.1. propofol (newly
introduced)
2.2. ketamine (infrequently
used)
2.3. Etomidate
4. other adjuvant intravenous
anesthetic agents
(benzodiazepines,
midazolam, diazepam,)
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SODIUM THIOPENTAL
Definition:
(PENTOTHAL)
ph of 10.6 to10.8
-*when injected ,sodium bicarbonate
is neutralized and the thiopental is
converted to its lipid soluble non
ionazed form(40% ionized at
ph=7.4)
-its highly protien bound by
albumen(75%)
Which prevents precipition out of
solution in vivo
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SODIUM THIOPENTAL
-its
bacteriostatic in water and has a
(PENTOTHAL)
10
thiopental(yellow powder) is
dissolved in water& sodium carbonate to
make a 2.5% solution (25mg/ml)
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Supplied:
SODIUM THIOPENTAL
(PENTOTHAL)
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Pharmacokinetics
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Pharmacokinetics
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Pharmacokinetics
SODIUM THIOPENTAL
(PENTOTHAL)
CNS: barbiturates interact with chloride ion channels by
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pharmacodynamics
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SODIUM THIOPENTAL
(PENTOTHAL)
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pharmacodynamics
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SODIUM THIOPENTAL
(PENTOTHAL)
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Pharmacodynamics
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SODIUM THIOPENTAL
(PENTOTHAL)
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Pharmacodynamics
Respiratory:-induction of anesthesia with
thiopental may be associated with 2 or 3 large
breaths followed by apnea for less than 1min
-there is dose related depression of the
respiratory response to hypercarbia and
hypoxia
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SODIUM THIOPENTAL
(PENTOTHAL)
GI:
GU/pregnancy/fetus:
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Pharmacodynamics
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SODIUM THIOPENTAL
(PENTOTHAL)
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1- induction of anesthesia
2- maintenance of anesthesia
for short procedures
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SODIUM THIOPENTAL
(PENTOTHAL) INDICATIONS
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SODIUM THIOPENTAL
(PENTOTHAL)
1- airway obstruction
3- previous hypersensitivity
PRECUATIONS
2- porphyria
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Absolute contraindications
1- CVS disease
2- severe hepatic disease
3- renal diseases
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SODIUM THIOPENTAL
(PENTOTHAL)
1- hypotension :if thiopental is administered to
hypovolemic, shocked or previously hypertensive pt
used
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SIDE EFFECTS
asthmatics pts
SODIUM THIOPENTAL
(PENTOTHAL)
7- Rarely, intra-arterial injection can occur.
The consequences of accidental arterial injection may be severe.
Treatment consists of
1. dilution of the drug by the administration of saline into the
artery,
2. heparinization to prevent thrombosis, and
3. brachial plexus block.
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SIDE EFFECTS
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Intravenous
anaesthetic/hypnotic.
Akylphenol.
Propofol is a sweet drug
in the OR, but definitely
not for home use.
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PROPOFOL
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PROPOFOL
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1% propofol 10mg/ml
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PROPOFOL
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For
Elderly
Maintenance
For
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PROPOFOL
DOSAGE
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PROPOFOL
Cerebral:
Cardiovascular:
decrease in arterial blood pressure secondary to a
drop in systemic vascular resistance,
contractility, and preload. Hypotension is more
pronounced than with thiopental. Propofol
markedly impairs the normal arterial baroreflex
response to hypotension.
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PROPOFOL
Respiratory:
Venous irritation:
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indication
Initiation and maintenance of
Monitored Anesthesia Care
sedation
Combined sedation and regional
anesthesia
Induction of General Anesthesia
Mainenance of General Anesthesia
Intensive Care Unit (ICU) sedation
of intubated, mechanically
ventilated patients
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PROPOFOL
INDICATIONS
Adults only
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1.
2.
4.
3.
Egg allergy.
Lack of resuscitation equipment or
knowledge of the drug.
Inability to maintain a patent airway.
Conditions in which reduction in blood
pressure cant be tolerated. E.g. patients with
fixed cardiac output (severe aortic or mitral
stenosis, IHSS, pericardial tamponade) and
those in shock status.
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PROPOFOL
CONTRAINDICATIONS
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agent.
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KETAMINE
feel pain.
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KETAMINE
chemically
Water
pH=3.5
- 5.5
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KETAMINE
: 2mg/kg
IM.
Oral.
Rectal. Needs higher doze due to
extensive first pass metabolism and
decreased absorption.
I.V.
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PHARMACOKINETICS
ROUTE OF ADMINISTRATION
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KETAMINE
IV
IM
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PHARMACOKINETICS
DOSAGE
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KETMINE
METABOLISM
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KETMINE
MECHANISM OF ACTION
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CNS
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KETMINE
PHARMACODYNAMICS
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Respiratory
system:
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KETMINE
PHARMACODYNAMICS
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CVS:
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KETMINE
PHARMACODYNAMICS
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GI
Muscle system
GU
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KETMINE
PHARMACODYNAMICS
Endocrine Sys.
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2- induction of anesthesia
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KETMINE
INDICATIONS
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KETMINE
CONTRAINDICATIONS
6- cerebro-vascular disease
7- Patients. For whom hypertention is hazardous
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Features
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BENZODIAZEPINES
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BENZODIAZEPINES
MODE OF ACTION
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They
2- amnesia.
3- reducing anxiety.
1- IV sedation.
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BENZODIAZEPINES
MIDAZOLAM AND DIAZEPAM
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BENZODIAZEPINE ANTAGONISTS
(FLUMAZENIL)
Its an imidazobenzodiazepine.
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BENZODIAZEPINE ANTAGONISTS
(FLUMAZENIL)
Flumazenil is supplied as a colourless liquid in a
concentration of 0.1 mg/ml.
The usual initial dose is 0.2 mg over 15 seconds,
if the desired level of consiousness is not
obtained within one minute of administration we
can give repeated doses of 0.1 mg every minute
up to the maximum of 2 mg, and if sedation
recurs we can use infusions of 0.1-0.4 mg/hour.
Flumazenil is well tolerated.
The most common side is nausea (4% of
patients).
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NARCOTIC AGONISTS
derived
from dried juice of
poppy plant which
contains over 20
plant alkaloids.
including morphine
& codiene.
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Opium
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NARCOTIC AGONISTS
SITE OF ACTION
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Dr. Med. Khaled Radaideh
54
Rapid
Its
following IV injection.
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NARCOTIC AGONISTS
PHARMACOKINETICS
CNS:
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NARCOTIC AGONISTS
PHARMACODYNAMICS
56
Respiratory
result in dose related depression
of respiratory rate and minute
ventilation and increase the tidal
volume which will lead to a slow deep
respiration. Reversed by naloxone
administration.
They
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NARCOTIC AGONISTS
PHARMACODYNAMICS
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NARCOTIC AGONISTS
PHARMACODYNAMICS
Opioids
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CVS
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NARCOTIC AGONISTS
PHARMACODYNAMICS
Narcotics
Others
Increases
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GIT
retention.
Anaphylactic reactions, bronchospasm, chest
wall rigidity and pruritis.
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Fentanyl
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NARCOTIC AGONISTS
FENTANYL AND MORPHINE
Analgesic dose
Low dose
Morphine
mg 10
Fentanyl
100
mcg 100
Potency Ratio
30 Dec 2015
NARCOTIC AGONISTS
FENTANYL AND MORPHINE
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NARCOTIC ANTAGONISTS
(NALOXONE)
Naloxone competes with opioids at the mu, delta,
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Given
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ANAESTHESIA
THANK YOU
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Thank you
30 Dec 2015
INTRAVENOUS
ANAESTHETIC
AGENTS