SURG 703 (Anesthesiology

and Intensive Care)

Lecture 2

Dr. Muhammad Ali Tariq

Objectives
• Groups of General Anesthetics
Groups of Anesthesia
At Macroscopic level
❑ When drug acts on Thalamus and Reticular activating system it will
produce loss of consciousness
❑ When drug acts on Hippocampus, Amygdala and Prefrontal cortex it
will produce amnesia
❑ When drug acts on spinal cord it will produce Analgesia and
Immobility.
At microscopic level there are basically three Groups of General
Anesthesia
1. Induction Group
2. Maintenance Group
3. Halogenated Gaseous Anesthetics Group
Group 1 (Induction Group)
❑ Induction is mainly achieved by I/V administration of Propofol,
Barbiturates and etomidate. The drugs of this group exert their
effects that is mediated via GABA A receptor present on CNS pre-
synaptically and post-synaptically in majority of neurons. It has
pentameric arrangements of sub-units. Binding of these drugs with
GABA A can cause the conformational changes in the pentameric
shape of GABA A receptor that allows chloride ions channels to
open up and results in the influx of chloride ions by which
hyperpolarization of neurons occurs that cause a resting potential
that will finally cause patient to loose its senses (LOC).
❑ The primary effect of these drugs is to cause loss of consciousness
Drugs side effects

• Respiratory Depression
• Hypotension
Propophol • Bradycardia

• Adrenal supression
• Transient skeletal muscle
movement (myoclonus)
Etomidate • Reduce Blood Pressure

• Vomiting
• Apnea, Cough, Bronchospasm
• Respiratory depressions
Barbiturates
Group 2 (Maintenance Group)
This group consists of one IV/IM agent Ketamine and other inhalation
agents like Nitrous oxide, Xenon and cyclopropane. In contrast to group
1 and group 3 these drugs produces significant analgesia unlike Group
1 their ability to produce unconsciousness is not present however their
ability to produce immobility is relatively weak than group 3. Their
effects are appear to be mediated through NMDA receptor. These
receptors are located in spinal cord and are crucial in pain modulation
and processing. When neurotransmitter glutamate bind to the NMDA
receptor it causes influx of extracellular Ca++ into the postsynaptic
neurons which then activate a series of molecules causing the pain
signals to increase and fire more frequently. The drugs of these groups
inhibits NMDA receptor by replacing glutamate which automatically
inhibits neurotransmission of pain. The members of this group also
effect 2 pore domain K+ ion channel which regulate resting membrane
potential of neurons. Specifically these drugs open up K+ ion channels
that contributes to efflux of K+ ions that further contributes to the
reduction of neuronal excitibility and by this these drugs cause
immobility in patients.
Drugs side effects

(Ketamine)
Hypertension
Tachycardia (cyclopropaine)
Hyper salivation Dizziness
Vivid dreams, Nausea
hallusination and Vomiting
delirium even after
recovery upto 24
hrs

(Nitrus oxide) (Xenon)

Dizziness No side effects
Nausea Vomiting
Group 3 (Halogenated Gaseous Anesthetics)

• Members of this group are Halothane, Isoflurane, Desflurane,

Sevoflurane and Enflurane.

Can be used for induction or maintenance

Effect on the GABA- Effect on 2-pore-

A will cause loss of domain potassium Effect on NMDA will
consciousness ion cannels will produce Analgesia
cause Immobility
Drugs Used for Induction/ Maintenance and Side effects
(Halothane) (Isoflurane)
Due to Pungent smell and being
Irritant it can’t be used for Due to Pungent smell and being
induction Irritant it can’t be used for induction
Side effects: Reduction in blood Side effects: Reduction in blood
pressure and cardiac out put. pressure and cardiac out put.
Cardiac Arrhythmias and hepato-
toxicity
(Enflurane)
Due to Pungent smell and being
Irritant it can’t be used for
induction
Side effects: Reduction in blood
pressure and cardiac out put.
(Sevoflurane)
Due to non Pungent smell (Desflurane)
and being non Irritant it can Due to Pungent smell and being
be used for induction Irritant it can’t be used for
Side effects: Reduction in induction
blood pressure and cardiac Side effects: Reduction in blood
out put. pressure and cardiac out put.
Renal Toxicity