Drugs used in Anaesthesia

Dr. Vasanthi Pinto

(MD, FRCA, FRACSI)

Consultant Anaesthetist

Components of Anaesthetics
LOC

Muscle relaxation

Analgesia

Each of these can be varied without affecting the other two by using selective drugs

Core Drugs in Anaesthetic Practice

Intravenous Anaesthetics Inhaled Anaesthetics and O2 Analgesics Local Anaesthetics Muscle relaxants and its reversal Anticholinesterase Other Drugs

Intravenous Anaesthetics
Agents that induce loss of consciousness in one arm brain circulation time Induce Anaesthesia reliably and pleasantly

IV Induction Agents

Barbiturates
Eg:Thiopentone Sodium

Non Barbiturates
Etomidate Propofol

Benzodiazepinemidazolam
Ketamine

Thiopentone Na
Induce in one arm brain circulation time No analgesic activity Rapid recovery Complete metabolism and excretion take 24 hrs Intra arterial injection causes severe vasospasm and gangrene

Mechanism of Action
Act through GABA dependant Cl Channel Opening in the

Hyperpolarization

neuronal inhibition

Pharmacological Properties
Rapid onset High lipid solubility Rapid recovery

Adverse reactions
Histamine

release Anaphylactic reaction

TPS
CVS BP CO HR R/S ICP Dose RR

Propofol Ketamine Mida

3-5 2mg/kg mg/kg

2mg/kg

Propofol
Onset and recovery is rapid and predictable Rapid clearance Can use as infusion or as TIVA( Total Intravenous Anaesthesia)

Inhaled Anaesthetics

N2O Volatile Anaesthetics

Halothane Isoflourane Enflourane Sevoflourane Desflourane

Chloroform, Ether, Trichloroethylene, Cyclopropane

 Like

dose in IV agents = Inhalation agents -MAC

(Minimal Alveolar Concentration) Eg. MAC of Halothane 0.75

Common Features
High oil gas permeability Not metabolized or least metabolized Non toxic Pleasant order Atmospheric friendly non flammable Cheap

Effects All are myocardial depressants

Halothane Isoflorane BP Sevoflorane

Contractility
SVR HR Cardiac Output Preserved Nil

Important Points
N2O Megaloblastic changes in the bone marrow, reduce DNA synthesis

Halothane Cardiac irritability

Liver toxicity with hepatic damage

Isoflorane Maintains cardiac out put

Sevoflourane Ideal for children

minimal side effects New agent - Xenon

Oxygen
Part of all Anaesthetic techniques Minimum during anaesthesia 33% High risk patients and children needs higher %

Analgesics
Opioids and related drugs
Morphine 0.1mg/kg Pethidine 1mg/kg Fentanyl - 1g/kg Alfentanil ,Sufentanyl & Remifentanil Tramadol

Act on opioid receptor

Problems - Respiratory depression - Histamine release - Bradycardia - Pruritus - Nausea & vomiting - Urinary retention

- CNS - sedation

Non steroidal Anti inflammatory drugs

NSAIDS - Inhibit PG synthesis Bad effects - Gastric irritation - NSAIDS sensitive asthma - Renal function - reduced - platelet function - reduced

Muscle relaxants

Neuro muscular junction

Action potential

Ach release

Opening of Na/K+ channel

muscle contraction

Muscle relaxants

Depolarising Eg. Suxamethonium short acting

Non depolarizing

Eg. Atracurium
Vecuronium Pancuronium long acting

Depolarizing mechanism
-Suxamethonium mimic action of Ach

-Binds to Ach receptor

-But no enzyme to metabolize quickly

-Therefore prolong opening of channels

Muscular relaxed Uses: relax the vocal cord muscle for intubation Action lasts 5-10 minutes

Non depolarising
Binds competitively to Ach receptor

Ach cannot bind to its receptor and cause muscle contraction

Eg. Atracurium,Vecurorium

Uses: prolonged surgeries which needs muscle relaxation Eg. Laparotomy

End of surgery

needs to reverse the muscle relaxation

Anticholinesterases

Reversal of muscle relaxation

Normally Ach metabolized by Ach Esterase enzyme

If block Ach Esterase enzyme

more Ach available

Can compete with the muscle relaxant and displace the muscle relaxant and initiate contraction Eg. Neostigmine

LOC

IV Inhaled

Analgesia
Opiates

Muscle relaxation

NSAIDS
LA

Depolarise Short

Non Depolarise
Long Reverse by anticholinesterases

Local Anaesthetics
Reversible inhibition of transmission of nerve impulses Impede inward flow of Na+ ions and prevent propagation of nerve impulse Drug in the vicinity of pain receptors, nerves, nerve plexuses, ganglia, spinal cord and roots in the subarachnoid space or extramural space

Procaine Cocaine Lignocaine Prilocaine Bupivacaine Ropivacaine

Toxicity of Local Anaesthetic agents

Due to Overdose, Rapid absorption from a vascular site, Inadvertent IV injection, Anaphylaxis Effects are seen in CNS and CVS

CNS -Restlessness, numbness of tongue, dizziness,tinnitus,convulsions CVS Tachycardia,Hypotention,cardiac arrest Respiratory arrest Anaphylaxis Dermal urticaria Angioneurotic oedema Bronchoconstriction

QUESTIONS ?