Drugs Used in Anaesthesia

DRUGS USED IN ANAESTHESIA
Anaesthesia is defined as the absence of feelings, sensation or pain.
Anaesthetic drugs are agents that reduce or abolish feelings, sensation or pain;
affecting either the whole body (general anaesthesia) or a particular area or region of
the body (local anaesthesia). These drugs are used to produce anaesthesia especially
during surgery.
LOCAL ANAESTHETICS
Local anaesthetics have several clinical applications both topically and parenterally.
Examples of drugs used for local anaesthesia are;
 Lignocaine (lidocaine)
 Bupivacaine
 Mepivacaine
They reversibly block transmission of peripheral nerve impulses
LIGNOCAINE
This is the most commonly used local anaesthetic agent. It occurs in various strengths
for various uses.
Mode of action
It prevents initial depolarization and generation of nerve action potential
Pharmacokinetics
It is effectively absorbed from the mucous membranes, widely distributed throughout the
body, metabolized in the liver and excreted in urine.
Indications
 Infiltration anaesthesia before surgical procedures

 Surface anaesthesia of mucous membranes to relieve superficial pains
 Dental anaesthesia
 Relief of pain in haemorrhoids
 Anti-arrhythmic agent
Contra-indications
 Hypersensitivity
 Spinal anaesthesia
 Hypovolaemia
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 Heart block
 Adjacent skin infection
Dose
The dose varies with the indication and whether it has adrenaline or not.
Using 2% solution with epinephrine
Adult; 20-100mg (1-5mls)
Nerve blocks; max 4mg/kg and 7mg/kg with adrenaline
Side effects
 Dizziness
 Tremors
 Restlessness
 Unconsciousness
 Blurred vision
 Hypotension
 Cardiac arrest
 Convulsions
 Headache
 Urinary retention
Note;
1. Do not inject lignocaine which has adrenaline to organs with end arteries e.g. penis,
fingers. It can cause vascular constriction leading to gangrene of tissues
2. Lignocaine given by infiltration rarely causes side effects; unless given in high doses,
highly vascular area or if accidentally given into blood vessels
3. Lignocaine is sometimes combined with epinephrine (adrenaline), a powerful

vasoconstrictor, which decreases blood flow to the tissues where it has been injected
thereby controlling bleeding and also prolongs the anaesthetic action of lignocaine
GENERAL ANAESTHETICS
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Drugs classified as general anaesthetics are agents that are capable of producing;
 Analgesia
 Decreased muscle reflex activity
 Ultimate loss of consciousness and
 Loss of sensation
Consequently, no single drug represents an ideal general anaesthesia in terms of

potency, stability, safety and efficacy. Rather several drugs are used often in
combination to provide smooth induction, sufficient depth and duration of anaesthesia,
adequate muscle relaxation and minimal hazards to the vital systems. They are
classified as intravenous and inhalation general anaesthetics.
KETAMINE
It is a rapid acting general anaesthetic that selectively blocks afferent impulses
producing a state of dissociation characterized by profound analgesia, normal vascular
muscle tone and laryngeal reflexes, variable cardiovascular and respiratory stimulation.
It also causes bronchial muscle dilatation.
Pharmacokinetics
It is rapidly and well absorbed after intramuscular injection, rapidly enters the CNS,
metabolized in the liver and excreted in urine.
Indications
 Induction of anaesthesia before administration of other anaesthetics

 Diagnostic manoeuvres and short surgical procedures not involving intense pain
e.g. dressing burns, incision and drainage and examination under anaesthesia.
 Supplementation of low potency agents
 Pain relief
Contra-indications
 Hypertension
 History of stroke
 Raised intracranial pressure
 Severe cardiac disease
Dose
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Intravenous injection; 1-4.5mg/kg (duration lasts for 5-10minutes)
Intramuscular injection; 6.5-13mg/kg (duration lasts for up to 30minutes)
Side effects
 Elevated blood pressure

 Intensified muscle tone
 Pain on injection
 Increased salvation
 Raised intracranial pressure
 Hallucinations
 Redness of skin
 Post operative nausea and vomiting
Nursing concerns
1. Administer intravenous drug slowly
2. Recovery of patients that have under gone ketamine should take place in a quiet
environment
3. Always have resuscitative equipments at hand
THIOPENTONE
This is a short acting thiobarbiturate that is used during induction and maintenance of
anaesthesia.
Pharmacokinetics
It is rapidly and well absorbed following IV administration, widely distributed to body

tissues including the CNS highly bound to plasma proteins, metabolized in the liver and
excreted in urine.
Indications
 Induction of general anaesthesia

 Anticonvulsant as in status asthmaticus
 Reduction of intracranial pressure 2° to head injury
 Pain relief
Dose; 3-5mg/kg body weight
Side effects
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 Hypotension
 Respiratory depression
 Allergic reactions
 Thrombophlebitis
Others
1. Midazolam 2. Propofol
INHALATION ANAESTHETICS
The inhalation anaesthetics include gases and volatile liquids. Both types enter the
circulation rapidly upon inhalation and are transported through the blood stream to the
central nervous system.
The volatile liquid anaesthetics are administered by inhalation of the vapour given off by
the liquid along with adequate oxygen. They include; halothane, nitrous oxide and ether.
The depth of anaesthesia is controlled by the varying concentration since these agents
are short acting.
ETHER (DIETHYL ETHER)

This is one of the common clinically used volatile liquid anaesthetic agents in the
developing countries. It has good safety margin and produces excellent muscle
relaxation
Pharmacokinetics
Ether has relatively high blood gas solubility, 15% of ether is metabolized in the liver,
and it stimulates gluconeogesis and hence causes hyperglycaemia.
Indications
 Maintenance of anaesthesia usually in prolonged procedures
Dose
Induction; 5-7%, Maintenance; 3-5%
Side effects
 Hypersalvation
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 Post operative nausea and vomiting
 Hypotension
HALOTHANE
This is one of the best and widely used inhalation anaesthetic agents. It is four times as
potent as ether with rapid induction and recovery, little irritation and low incidence of
nausea and vomiting.
Pharmacokinetics
It produces smooth induction and rapid onset of anaesthesia. A small percentage (20%)
is metabolized in the liver and the remaining is excreted unchanged in urine.
Indications
 Induction of anaesthesia
 Maintenance of anaesthesia
Contra-indications
 Pregnancy
 porphyria
Dose
Induction; 2-4%, maintenance; 0.5-2%
Side effects
 Hypotension
 Rapid and shallow respiration
 Arrhythmias
 Vomiting
 Bradycardia
 Hypoxia
 Post operative shivering
 Possibility of liver

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DRUGS USED IN ANAESTHESIA

Anaesthesia is defined as the absence of feelings, sensation or pain.

They reversibly block transmission of peripheral nerve impulses

It prevents initial depolarization and generation of nerve action potential

 Infiltration anaesthesia before surgical procedures

Using 2% solution with epinephrine

Adult; 20-100mg (1-5mls)

Nerve blocks; max 4mg/kg and 7mg/kg with adrenaline

3. Lignocaine is sometimes combined with epinephrine (adrenaline), a powerful

Consequently, no single drug represents an ideal general anaesthesia in terms of

 Induction of anaesthesia before administration of other anaesthetics

Intramuscular injection; 6.5-13mg/kg (duration lasts for up to 30minutes)

 Elevated blood pressure

1. Administer intravenous drug slowly

3. Always have resuscitative equipments at hand

It is rapidly and well absorbed following IV administration, widely distributed to body

 Induction of general anaesthesia

Dose; 3-5mg/kg body weight

ETHER (DIETHYL ETHER)

 Maintenance of anaesthesia usually in prolonged procedures

Induction; 5-7%, Maintenance; 3-5%

Induction; 2-4%, maintenance; 0.5-2%

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