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    Preanaesthetic Medication Anaesthetic Agents PDF

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    Subhash Bera
    The document provides an overview of pre-anesthetic medication, general anesthetics, and their mechanisms of action and complications. It discusses the drugs used for pre-anesthetic medication including anti-anxiety drugs, sedatives, opioids, anticholinergics, antiemetics, and drugs that reduce acid secretion. It also describes general anesthetics like thiopental, propofol, ketamine, fentanyl and their pharmacokinetics. Finally, it discusses the complications of general anesthesia and the concept of balanced anesthesia.

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    Preanaesthetic Medication Anaesthetic Agents PDF

    Uploaded by

    Subhash Bera
    128 views35 pages
    The document provides an overview of pre-anesthetic medication, general anesthetics, and their mechanisms of action and complications. It discusses the drugs used for pre-anesthetic medication including anti-anxiety drugs, sedatives, opioids, anticholinergics, antiemetics, and drugs that reduce acid secretion. It also describes general anesthetics like thiopental, propofol, ketamine, fentanyl and their pharmacokinetics. Finally, it discusses the complications of general anesthesia and the concept of balanced anesthesia.

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    The document provides an overview of pre-anesthetic medication, general anesthetics, and their mechanisms of action and complications. It discusses the drugs used for pre-anesthetic medication including anti-anxiety drugs, sedatives, opioids, anticholinergics, antiemetics, and drugs that reduce acid secretion. It also describes general anesthetics like thiopental, propofol, ketamine, fentanyl and their pharmacokinetics. Finally, it discusses the complications of general anesthesia and the concept of balanced anesthesia.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    128 views35 pages

    Preanaesthetic Medication Anaesthetic Agents PDF

    Uploaded by

    Subhash Bera
    The document provides an overview of pre-anesthetic medication, general anesthetics, and their mechanisms of action and complications. It discusses the drugs used for pre-anesthetic medication including anti-anxiety drugs, sedatives, opioids, anticholinergics, antiemetics, and drugs that reduce acid secretion. It also describes general anesthetics like thiopental, propofol, ketamine, fentanyl and their pharmacokinetics. Finally, it discusses the complications of general anesthesia and the concept of balanced anesthesia.

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    of 35

    Dr.

    Shashi Bhushan
    Professor
    Dept. of Anaesthesiology
    KGMU, Lucknow
    Overview

    v Pre-anaesthetic Medication
    v Drugs used in pre-anaesthetic medication
    v General Anaesthetics
    v History
    v Stages of anaesthesia
    v Pharmacokinetics
    v Mechanism of action
    v Complications of general anaesthesia
    v Summary
    Preanaesthetic medication

    v“It is the term applied to the


    administration of drugs prior to
    general anaesthesia so as to make
    anaesthesia safer for the patient”

    vEnsures comfort to the patient & to


    minimize adverse effects of
    anaesthesia
    Aims

    — Relief of anxiety & apprehension


    preoperatively & facilitate smooth induction

    — Amnesia for pre- & post-operative events

    — Potentiate action of anaesthetics, so less


    dose is needed
    Aims(contd.)
    — Antiemetic effect extending to post-
    operative period

    — Decrease secretions & vagal stimulation


    caused by anaesthetics

    — Decrease acidity & volume of gastric juice to


    prevent reflux & aspiration pneumonia
    Drugs used for preanesthetic
    medication

    — Anti-anxiety drugs-

    - Provide relief from apprehension &


    anxiety

    - Post-operative amnesia
    e.g. Diazepam (5-10mg oral), Lorazepam
    (2mg i.m.) (avoided co-administration with
    morphine, pethidine)
    Sedatives-hypnotics-

    — e.g. Promethazine (25mg i.m.) has


    sedative, antiemetic & anticholinergic
    action

    — Causes negligible respiratory depression


    & suitable for children
    Opioid analgesics

    — Morphine (8-12mg i.m.) or Pethidine (50-


    100mg i.m.) used one hour before surgery

    — Provide sedation, pre-& post-operative


    analgesia, reduction in anaesthetic dose

    — Fentanyl (50-100μg i.m. or i.v.) preferred


    nowadays (just before induction of
    anaesthesia)
    Anticholinergics-

    — Atropine (0.5mg i.m.) or Hyoscine (0.5mg


    i.m.) or Glycopyrrolate (0.1-0.3mg i.m.) one
    hour before surgery(not used nowadays)

    — Reduces salivary & bronchial secretions,


    vagal bradycardia, hypotension

    — Glycopyrrolate(selective peripheral action)


    acts rapidly, longer acting, potent
    antisecretory agent, prevents vagal
    bradycardia effectively
    Antiemetics-

    — Metoclopramide (10mg i.m.) used as


    antiemetic & as prokinetic gastric emptying
    agent prior to emergency surgery

    — Domperidone (10mg oral) more preferred


    (does not produce extrapyramidal side
    effects)

    — Ondansetron (4-8mg i.v.), a 5HT3 receptor


    antagonist, found effective in preventing
    post-anaesthetic nausea & vomiting
    Drugs reducing acid secretion

    — Ranitidine (150-300mg oral) or Famotidine


    (20-40mg oral) given night before & in
    morning along with Metoclopramide reduces
    risk of gastric regurgitation & aspiration
    pneumonia

    — Proton pump inhibitors like Omeprazole


    (20mg) with Domperidone (10mg) is
    preferred nowadays
    GENERAL ANAESTHETICS
    — General Anaesthetics (GA) are drugs which
    produce reversible loss of all sensation &
    consciousness

    — Neurophysiologic state produced by


    general anaesthetics characterized by five
    primary effects:

    • Unconsciousness
    • Amnesia
    • Analgesia
    • Inhibition of autonomic reflexes
    • Skeletal muscle relaxation .
    Ideal anaesthetic-
    - Rapid induction
    - Smooth loss of consciousness
    - Rapidly reversible upon
    discontinuation
    - Possess a wide margin of safety

    — The cardinal features of general anaesthesia


    are:

    • Loss of all sensation, especially pain


    • Sleep (unconsciousness) & amnesia
    • Immobility & muscle relaxation
    • Abolition of somatic & autonomic reflexes
    — Development of intravenous anaesthetic
    agents such as Propofol

    Combined with Midazolam,


    Dexmedetomidine & Remifentanyl

    Led to the use of total intravenous


    anaesthesia (TIVA) as clinically useful tool
    in modern anaesthetic practice.
    Intravenous Anaesthetics

    a. Fast inducers –
    i.) Thiopental, Methohexital
    ii.) Propofol, Etomidate
    b. Slow inducers –
    i.) Benzodiazepines – Diazepam,
    Lorazepam & Midazolam

    c. Dissociative anaesthesia – Ketamine

    d. Opioid analgesia – Fentanyl


    Pharmacokinetics
    Procedure for producing anaesthesia
    involves smooth & rapid induction

    Maintenance

    Prompt recovery after discontinuation


    Induction –

    — “Time interval between the


    administration of anaesthetic drug &
    development of stage of surgical
    anaesthesia”

    — Fast & smooth induction desired to avoid


    dangerous excitatory phase
    — Thiopental or Propofol often used for
    rapid induction
    —
    — Unconsciousness results in few minutes
    after injection

    — Muscle relaxants(Pancuronium or
    Atracurium) co-administered to facilitate
    intubation

    — Lipophilicity is key factor governing


    pharmacokinetics of inducing agents
    Maintenance

    — Patient remains in sustained stage of


    surgical anaesthesia(stage 3 plane 2)

    — Depth of anaesthesia depends on


    concentration of anaesthetic in CNS

    — Usually maintained by administration of


    gases or volatile liquid anaesthetics (offer
    good control over depth of anaesthesia)
    Recovery

    — Recovery phase starts as anaesthetic drug


    is discontinued (reverse of induction)

    — In this phase, nitrous oxide moves out of


    blood into alveoli at faster rate (causes
    diffusion hypoxia)
    — Oxygen given in last few minutes of
    anaesthesia & early post-anaesthetic
    period

    — More common with gases relatively


    insoluble in blood
    Mechanism of Anaesthesia
    — Non-selective in action

    — At molecular level, anaesthetics interact


    with hydrophobic regions of neuronal
    membrane proteins

    — Inhaled anaesthetics, Barbiturates,


    Benzodiazepines, Etomidate & propofol
    facilitate GABA-mediated inhibition at
    GABAA receptor sites & increase Cl- flux

    — Ketamine blocks action of glutamate on


    NMDA receptor
    — General anaesthetics disrupt neuronal
    firing & sensory processing in thalamus,
    by affecting neuronal membrane
    proteins

    — Motor activity also reduced – GA inhibit


    neuronal output from internal pyramidal
    layer of cerebral cortex
    Intravenous anaesthetics
    Thiopentone sodium

    — Ultrashort acting thiobarbiturate,


    smooth induction within one
    circulation time
    — Crosses BBB rapidly
    — Diffuses rapidly out of brain,
    redistributed to body fats, muscles &
    other tissues
    — Typical induction dose is 3-5mg/kg
    — Metabolised in liver
    — Cerebral vasoconstriction, reducing
    cerebral blood flow & intracranial
    pressure(suitable for patients with cerebral
    oedema & brain tumours)

    — Laryngospasm on intubation

    — No muscle relaxant action

    — Barbiturates in general may precipitate


    Acute intermittent porphyria (hepatic ALA
    synthetase)

    — Reduces respiratory rate & tidal volume


    Propofol
    — Available as 1% or 2% emulsion in oil

    — Induction of anaesthesia with 1.5-2.5mg/kg


    within 30 sec & is smooth & pleasant

    — Low incidence of excitatory voluntary


    movements

    — Rapid recovery with low incidence of nausea &


    vomiting(antiemetic action)

    — Non-irritant to respiratory airways

    — No analgesic or muscle relaxant action


    — Anticonvulsant action

    — Preferred agent for day care surgery

    — Apnoea & pain at site of injection are common after


    bolus injection

    — Produces marked decrease in systemic blood


    pressure during induction(decreases peripheral
    resistance)

    — Bradycardia is frequent
    Ketamine
    — Phencyclidine derivative

    — Dissociative anaesthesia: a state characterized by


    immobility, amnesia and analgesia with light sleep
    and feeling of dissociation from surroundings

    — Primary site of action – cortex and limbic system –


    acts by blocking glutamate at NMDA receptors

    — Highly lipophilic drug

    — Dose: 1-2mg/kg i.v.


    — Only i.v. anaesthetic possessing significant
    analgesic properties & produces CNS stimulation

    — Increases heart rate, blood pressure & cardiac


    output

    — Markedly increases cerebral blood flow & ICP

    — Suitable for patients of hypovolaemic shock

    — Recovery associated with “emergence delirium”,


    more in adults than children

    — Use of diazepam or midazolam i.v. prior to


    administration of ketamine, minimises this effect
    Fentanyl
    — Potent, short acting (30-50min), opioid
    analgesic

    — Generally given i.v.

    — Reflex effects of painful stimuli are


    abolished

    — Respiratory depression is marked but


    predictable
    — Decrease in heart rate, slight fall in BP

    — Nausea, vomiting & itching often occurs


    during recovery

    — Also employed as adjunct to spinal & nerve


    block anaesthesia & to relieve postoperative
    pain
    Complications of Anaesthesia
    During anaesthesia: After anaesthesia:

    ØRespiratory depression ØNausea and vomiting


    ØSalivation, respiratory ØPersisting sedation
    secretions ØPneumonia
    ØCardiac arrhythmias ØOrgan damage – liver,
    ØFall in BP kidney
    ØAspiration ØNerve palsies
    ØLaryngospasm and ØEmergence delirium
    asphyxia ØCognitive defects
    ØAwareness
    ØDelirium and convulsion
    ØFire and explosion
    Balanced anaesthesia
    — General anaesthetics rarely given as sole agents

    — Anaesthetics adjuvants used to augment specific


    components of surgical anaesthesia, permitting lesser
    doses of GA

    — General anaesthetic drug regimen for balanced


    anaesthesia:

    Thiopental + Opioid analgesic(pethidine or fentanyl/


    benzodiazepine) + Skeletal muscle relaxant
    (pancuronium) & Nitrous oxide along with inhalation
    anaesthetic(Halothane/other newer agents )
    Summary
    Anaesthetics Characteristics
    Nitrous oxide Highest MAC, Second gas effect, Diffusion
    hypoxia
    Halothane Used in bronchial asthma, Malignant
    Hyperthermia
    Ether Safest in unskilled hands, highly inflammable
    Sevoflurane Agent of choice for induction in children
    Isoflurane Neurosurgery
    Ketamine Dissociative anaesthesia, used in CHF & shock
    Thiopentone Epilepsy, thyrotoxicosis
    Propofol Day care anaesthesia, i.v. Anaesthetic of choice
    in patients with Malignant Hyperthermia
    Etomidate Aneurysm surgeries & cardiac diseases
    References
    — Pharmacological Basis of Therapeutics, 12th
    Edition, Goodman & Gilman's

    — Medical Pharmacology, S.K. Srivastava

    — Principles of Pharmacology, 2nd edition K.K. Sharma

    — Review of Pharmacology, 8th edition Gobind Rai


    Garg

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