All In One Series | 2021

Anesthesia
[Definition:
Reversible pharmacologically-induced blocking of pain in whole body or in a part of it during surgical, diagnostic or therapeutic procedures

Q: Enumerate 3 drugs used in Intravenous/Inhalational Q: Enumerate 4 drugs used for pre-anesthetic medications:
anesthesia:
Drug Aim
Intravenous anesthesia Inhalational anesthesia 1- Anxiolytic (e.g. Benzodiazepines) Anxiolysis, sedation & amnesia
° Thiopentone sodium ° Halothane 2- Analgesics (e.g. Opioids) || sympatho-adrenal response

° Propofol ° Isoflurane 4- Antiemetics (e.g. Metoclopramide) Prevent aspiration - || postoperative vomiting

° Ketamine ° Sevoflurane 3- Anticholinergics (e.g. Atropine) || vagal reflexes - || secretions

5- Antihistaminics Hl blockers —> prevent allergic reaction

(Hl & H2 blockers) H2 blockers —> || gastric secretions
6- Antibiotics - Anticoagulant

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 All In One Series | 2021
Intravenous anesthesia

1 Thiopentone sodium I Propofol 1 Ketamine 1

I Indications
1- Induction of anesthesia
2-Maintance of anesthesia for short procedures
3- Treatment of status epilepticus 3- Safe in porphyria 3- Analgesics
4- intracranial pressure (ICP) 4- Safe in hepatic disease
I Contraindications
1- Airway obstruction
2- Pervious hypersensitivity reaction
1- Porphyria 1- Porphyria
2- Poor hepatic function 2- High ICP

3- Bronchial asthma 3- HTN & IHD

Side effects (Disadvantages)
1- Drowsiness 1- Excitatory phenomenon
2- Allergic reactions 2- Postoperative nausea & vomiting
3- Pain & thrombophlebitis “if injected in small veins” 3- cerebral metabolic rate & ICP

4- CVS depression 4- Delirium & psychomotor activity

5- Resp. depression 5- Diplopia & nystagmus
6- Dreams — unpleasant
*

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 UI In One Series

11 ! Thiopentone sodium Propofol 1 Ketamine 1

Pharmacological action
° CNS 1- CNS depression 1- CNS depression 1- Dissociative anesthesia
2- Potent anticonvulsant 2- No anticonvulsant effect
3- No excitatory phenomenon 3- Excitatory phenomenon
4- Poor analgesic effect 4- Potent analgesic effect
5-|| cerebral metabolic rate & ICP 5- a cerebral metabolic rate & ICP
6- No postoperative nausea & vomiting 6- Postoperative nausea & vomiting
° CVS
-ABP
-HR
u a
No effect TT
-COP No effect IT
° Resp. 1- Respiratory depression 1- Respiration —> normal
system 2- Bronchospasm 2- Bronchodilatation
3- Laryngeal spasm 3- Larynx —* normal
a Neuromuscular
|| muscle tone muscle tone
effect
° Renal
blood flow
n
° Hepatic
blood flow
u ““

a Others || intraocular pressure a intraocular pressure

|| plasma concentration of cortisol

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 All In One Series
! Thiopentone sodium
1 Advantages “Less important”
1- Rapid & pleasant induction with rapid
recover}7
2- No HICP
3- No postoperative nausea & vomiting
4- No apparatus needed
5- Diathermy can be used
[ 2021
i Propofol ' Ketamine ’
1- Rapid & complete recovery 1- Potent analgesia & amnesia
2- Safe in porphyria 2- No respiratory depression
3- Safe in hepatic disease 3- Potent bronchodilator
4- Drug, of choice. in: 4- Drug of choice in:
Malignant hyperthermia patient Shocked patient
COPD patient Pediatric
Ambulatory surgery Bronchial asthma
ICU sedation “by infusion”

5- Antiemetic
6- Antipruritic
7- Antioxidant

8- Neuroprotective

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All In One Series j 2021
Inhalational anesthesia

Halothane Sevoflurane Isoflurane

MAC ‘minimum alveolar cone.” 1 0.75% 2% 1.15%
Contraindications
1- f f TCP 1- Severe hypovolemic patient
2- Malignant hyperthermia 2- Ischemic heart disease
3- Severe hypovolemic patient
4- Pheochromocytoma 4- With Sod lime
5- Liver impairment
1 Pharmacological action
° CNS 1- CNS depression
2- Cerebral VD —> ft cerebral blood flow
—* moderate ff ICP Slight ft ICP — moderate f f ICP
3- More emergence agitation
° CVS
• ABP a a a
-HR a No effect a
-COP
Other
a
Arrhythmia
a a
Coronary steal phenomena
° Resp. 1- Not irritant to respiratory tract 1- Irritant to respiratory tract —» cough
system 2- Potent bronchodilator & breath holding

° Neuromuscular 1- Moderate a
muscle tone 1- Strongly a muscle tone
effect 2- Triggering agent for malignant hyperthermia

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All In One Series | 2021
Halothane Sevoflurane Isoflurane
° Renal
blood flow II
° Hepatic
blood flow
U 1 tt 1 ll
Advantages 1
1- Not inflammable & Not explosive 1- Minimal & less pungent odor 1- Not inflammable & Not explosive
2- Rapid induction & recovery 2- Useful in mask induction 2- Rapid induction & recovery
3- Potent 3- Potent
4- Safe in children & in BA
Respiratory system Respiratory system Neuromuscular effects
1- Not irritant 1- Not irritant 1- Strong muscle tone
2- Potent bronchodilator 2- Potent bronchodilator
CVS
1- No IT HR
2- No coronary steal phenomena
Disadvantages (Side effects) 1
1- Malignant hyperthermia 1- Malignant hyperthermia 1- Pungent odor
2- renal & hepatic blood flow 2- || renal & ft hepatic blood flow 2- Not used in mask induction
3- Hepatotoxicity 3- Less soluble in blood & tissue CNS
1- CNS depression 2- Slight ff ICP
4- Potent uterine relaxant 4- Less potent
CNS CVS
1- CNS depression 1- tt HR
2- Moderate ff ICP 2- Coronary steal phenomenon /z
‘In One;
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 1- Hypnosis “loss of consciousness”
2- Amnesia “loss of memory”
3- Analgesia “loss of pain sensation”
4- Relaxation “loss of muscle tone & activity’

|lnduction:|
1- Intravenous induction
2- Inhalational induction
3- Intramuscular induction

iMaintenance:
1- Inhalational anesthesia with spontaneous ventilation
2- Relaxant anesthesia

CComplication:
° CNS 1- Awareness during anesthesia
2- Delayed recovery ||
3- Postoperative pain
° CVS 1- Hypotension & hypovolemia ff & f J
2- Hypertension & Hypervolemia II & ||
3- Arrhythmia
4- Myocardial ischemia
° Resp. 1- Hypoventilation ||
2- Hypoxemia ||
3- Hypercapnia ft
4- Aspiration pneumonia
3- Pneumothorax
GIT 1- Nausea & vomiting
2- Regurgitation
° Temp 1- Hypothermia ||
2- Hyperthermia & malignant hyperthermia ff
° Drugs 1- Adverse effect
2- Hypersensitivity

Anesthesia (7)
 All In One Series 12021
| Spinal (Intrathecal or Subarachnoid) anesthesia
Indications:' ?sia & anesthesia nerves & dorsal ganglia1
° Preoperative Pre-emptive analgesia
° Intraoperative Surgeries below the umbilicus
D
Postoperative Pain control

|Contraindications:|
r~"1 1- Shock
(hypovolemic)
i si
i ! 2- Stenosis (Aortic - Mitral)
i i
3- Patient refuse
!P!
i ! 4- Psychosis or dementia
i !
jin j 5- Skin infection at the site of injection
i i
i Al! 6- Allergy
i.—! 7- Anticoagulant therapy

[Complications:!
Early Late
1- Pain on injection 1- Backache
2- Vasovagal attack 2- Urine retention
3- Hypotension 3- Infection (meningitis)
4- Total spinal anesthesia 4- Postdural puncture headache
5- Vascular injury —> Epidural hematoma
|6- Nerve injury

[Advantages & Disadvantages:

Advantages
1- Cheap
2- Simple & effective
3- ||surgical blood loss
4- ||venous thromboembolic complications
5- Not affect patient mental status
6- Not interfere with resp. functions &
Not require endotracheal intubation
Disadvantages
1- Below the umbilicus surgeries only
2- Requires patient cooperation
“C.L in uncooperative , psychosis & dementia”
3- Causes vasodilatation & hypotension
“C.I. in shock & stenotic valvular lesions”

Anesthesia (8)
 Advantages Disadvantages
1- Bronchodilatation 1- Mydriasis
2- 1| salivary & bronchial secretion 2- Dryness of all secretions
3- 1| incidence of bradycardia & cardiac arrest 3- Urine retention & constipation
4- 1| postoperative nausea & vomiting 4- Glaucoma
5- Tachycardia
6- Atropine fever
7- Atropine flush

Enumerate advantages & disadvantages of inhalational anesthesia:

Advantages Disadvantages
1- Rapid & instant 1- Volatile or gaseous
2- Local action can be obtained 2- Difficult dose calculation
3- Lower doses compared to other routes 3- Inflammatory drugs can’t taken
4- Can bypass liver

Pre-anesthetic assessment
History 1- Allergies
“AMPLE” 2- Medication
3- Past medical history
4- Last meal or other intake
5- Events leading to presentation
Physical 1- Vital signs
examination 2- Airway
3- Heart & lung
4- Nervous system
Investigations “Routine investigations”
1- CBC
2- Liver & kidney fun. test
3- Serum glucose
4- ECG

Anesthesia (9)