DRUGS USED IN PREMEDICATION

‫اﻷدوﯾﺔ اﻟﻤﺴﺘﺨﺪﻣﺔ ﻓﻲ اﻟﻤﻌﺎﻟﺠﺔ اﻷوﻟﯿﺔ‬

Dr: Ahmed saadoun

 PREMEDICATION‫اﻟﻤﻌﺎﻟﺠﺔ اﻷوﻟﯿﺔ‬
• Management of anaesthesia begins with preoperative psychological ‫• ﺗﺒﺪأ‬
‫إدارة اﻟﺘﺨﺪﯾﺮ ﺑﺎﻟﻨﻔﺴﯿﺔ ﻗﺒﻞ اﻟﺠﺮاﺣﺔ‬

Preparation of the patient and administration of a drug or drugs

selected to elicit specific pharmacologic responses. ‫ﺗﺤﻀﯿﺮ اﻟﻤﺮﯾﺾ‬
.‫وإﻋﻄﺎء اﻟﺪواء أو اﻷدوﯾﺔ اﻟﻤﺨﺘﺎرة ﻻﺳﺘﻨﺒﺎط اﺳﺘﺠﺎﺑﺎت دواﺋﯿﺔ ﻣﺤﺪدة‬

• This initial psychological and pharmacological component of

anaesthetic management is reffered to as (premedication).
.(‫• ﺗﻤﺖ اﻹﺷﺎرة إﻟﻰ ھﺬا اﻟﻤﻜﻮن اﻟﻨﻔﺴﻲ واﻟﺼﯿﺪﻻﻧﻲ اﻷوﻟﻲ ﻹدارة اﻟﺘﺨﺪﯾﺮ ﻋﻠﻰ أﻧﮫ )ﺗﻤﮭﯿﺪي‬
• Premedication:‫ﺗﺨﺪﯾﺮ‬

1. Psychological ‫ ﻧﻔﺴﯿﺔ‬.1

Pharmacological ‫ﻓﺎرﻣﺎﻛوﻟوﺟﻲ‬
• Psychological premedication: :‫• اﻟﺘﺨﺪﯾﺮ اﻟﻨﻔﺴﻲ‬

.is provided by the anaesthesiologists

preoperative and interview with the patient and
family members
.‫ﯾﺘﻢ ﺗﻮﻓﯿﺮه ﻣﻦ ﻗﺒﻞ أطﺒﺎء اﻟﺘﺨﺪﯾﺮ‬

.‫ﻗﺒﻞ اﻟﺠﺮاﺣﺔ وإﺟﺮاء ﻣﻘﺎﺑﻠﺔ ﻣﻊ اﻟﻤﺮﯾﺾ وأﻓﺮاد اﻷﺳﺮة‬

.pharmacological premedication::‫ﺗﺨﺪﯾﺮ دواﺋﻲ‬

 .administration of drugs to patient 1 to 3 hours before
induction of anaesthesia.
.‫ ﺳﺎﻋﺎت ﻣﻦ اﻟﺘﺨﺪﯾﺮ‬3 ‫ إﻟﻰ‬1 ‫إﻋﻄﺎء اﻷدوﯾﺔ ﻟﻠﻤﺮﯾﺾ ﻗﺒﻞ‬
 Goals of premedication‫أھﺪاف اﻟﺘﺨﺪﯾﺮ‬
• Sedation,
‫اﻟﺘﺨﺪﯾﺮ‬

• Anxiolytics ,
‫ﻣﺰﯾﻼت اﻟﻘﻠﻖ‬

• Amnesia,‫ﻓﻘﺪان اﻟﺬاﻛﺮة‬

• Analgesia ,
‫ﺗﺴﻜﯿﻦ‬

• Antisecretion, ‫ﻋﺪم اﻟﺘﻜﺘﻢ‬

• Hemodynamic stability ‫• اﺳﺘﻘﺮار اﻟﺪورة اﻟﺪﻣﻮﯾﺔ‬

• Prevent aspiration, ، ‫• ﻣﻨﻊ اﻟﻄﻤﻮح‬

• Decrease post_operative nausea and vomiting, ‫ﺗﻘﻠﯿﻞ اﻟﻐﺜﯿﺎن واﻟﻘﻲء ﺑﻌﺪ اﻟﺠﺮاﺣﺔ‬

• Allergic prophylaxis . ‫اﻟﻮﻗﺎﯾﺔ ﻣﻦ اﻟﺤﺴﺎﺳﯿﺔ‬

 Psychological premedication‫ﺗﺨﺪﯾﺮ ﻧﻔﺴﻲ‬
• Pre_operative visit must be conducted efficiently,but they must also
be informative and reassuring,answering all questions, ‫• ﯾﺠﺐ إﺟﺮاء زﯾﺎرة ﻣﺎ ﻗﺒﻞ اﻟﺠﺮاﺣﺔ ﺑﻜﻔﺎءة‬
، ‫ واﻹﺟﺎﺑﺔ ﻋﻠﻰ ﺟﻤﯿﻊ اﻷﺳﺌﻠﺔ‬، ‫ﻀﺎ وﻣﻄﻤﺌﻨﺔ‬
ً ‫ وﻟﻜﻦ ﯾﺠﺐ أن ﺗﻜﻮن ﻣﻔﯿﺪة أﯾ‬،

• Describe anaesthetic technique available and risk, ، ‫• وﺻﻒ ﺗﻘﻨﯿﺔ اﻟﺘﺨﺪﯾﺮ اﻟﻤﺘﺎﺣﺔ واﻟﻤﺨﺎطﺮ‬

• Describe what to expect in operation room, ، ‫• وﺻﻒ ﻣﺎ ﯾﻤﻜﻦ ﺗﻮﻗﻌﮫ ﻓﻲ ﻏﺮﻓﺔ اﻟﻌﻤﻠﯿﺎت‬

• Describe duration and time to return, ، ‫• وﺻﻒ اﻟﻤﺪة واﻟﻮﻗﺖ ﻟﻠﻌﻮدة‬

• Describe post_operative pain management, ، ‫• وﺻﻒ إدارة اﻷﻟﻢ ﺑﻌﺪ اﻟﺠﺮاﺣﺔ‬

• Psychological support, ،‫اﻟﺪﻋﻢ اﻟﻨﻔﺴﻲ‬ •

• Most patients are anxious before surgery,

‫ﯾﺸﻌﺮ ﻣﻌﻈﻢ اﻟﻤﺮﺿﻰ ﺑﺎﻟﻘﻠﻖ ﻗﺒﻞ اﻟﺠﺮاﺣﺔ‬
 • An informative and comforting pre_operative visit may replace many
milligrams of depressant medication, ، ‫• ﻗﺪ ﺗﺤﻞ اﻟﺰﯾﺎرة اﻟﻤﻔﯿﺪة واﻟﻤﺮﯾﺤﺔ ﻗﺒﻞ اﻟﺠﺮاﺣﺔ ﻣﺤﻞ اﻟﻌﺪﯾﺪ ﻣﻦ اﻟﻤﻠﯿﻐﺮاﻣﺎت ﻣﻦ أدوﯾﺔ اﻻﻛﺘﺌﺎب‬

• Psychological preparation cannot accomplish everything and will not

relieve all anxiety.
.‫• اﻻﺳﺘﻌﺪاد اﻟﻨﻔﺴﻲ ﻻ ﯾﻤﻜﻦ أن ﯾﻨﺠﺰ ﻛﻞ ﺷﻲء وﻟﻦ ﯾﺨﻔﻒ ﻛﻞ اﻟﻘﻠﻖ‬
 PHARMACOLOGICAL PREMEDICATION ‫اﻟﻤﻌﺎﻟﺠﺔ‬
‫اﻟﺼﯿﺪﻻﻧﯿﺔ‬
• Administration of medication before anaesthesia,usually 1_3 hours
Pre_operatively. .‫ ﺳﺎﻋﺔ ﻗﺒﻞ اﻟﺠﺮاﺣﺔ‬3_1 ‫ ﻋﺎدة‬، ‫• إﻋﻄﺎء اﻟﺪواء ﻗﺒﻞ اﻟﺘﺨﺪﯾﺮ‬

• Used to prepare the patient for anaesthesia and to help provide

optimal conditions for surgery ‫• ﺗﺴﺘﺨﺪم ﻹﻋﺪاد اﻟﻤﺮﯾﺾ ﻟﻠﺘﺨﺪﯾﺮ وﻟﻠﻤﺴﺎﻋﺪة ﻓﻲ ﺗﻮﻓﯿﺮ اﻟﻈﺮوف اﻟﻤﺜﻠﻰ ﻟﻠﺠﺮاﺣﺔ‬

• Premedication is traditionally given I.M but the oral route is preferred

especially in children, IM
‫• ﯾﺘﻢ إﻋﻄﺎء اﻟﺘﺨﺪﯾﺮ ﺑﺸﻜﻞ ﺗﻘﻠﯿﺪي‬ ، ‫وﻟﻜﻦ اﻟﻄﺮﯾﻖ اﻟﻔﻤﻮي ﻣﻔﻀﻞ ﺧﺎﺻﺔ ﻋﻨﺪ اﻷطﻔﺎل‬

• No best drug for pre_operative medication . .‫• ﻻ ﯾﻮﺟﺪ أﻓﻀﻞ دواء ﻷدوﯾﺔ ﻣﺎ ﻗﺒﻞ اﻟﺠﺮاﺣﺔ‬
THE CHOICE OF DRUG(S) USED FOR
PREMEDICATION ‫اﺧﺘﯿﺎر اﻟﺪواء )اﻷدوﯾﺔ( اﻟﻤﺴﺘﺨﺪﻣﺔ‬

‫اﻟﻤﻌﺎﻟﺠﺔ اﻷوﻟﯿﺔ‬

Depends on: v :‫ﯾﻌﺘﻤﺪ ﻋﻠﻰ‬

Patient age and weight, .‫ ﻋﻤﺮ اﻟﻤﺮﯾﺾ ووزﻧﮫ‬-

• Physical status, ‫اﻟﻮﺿﻊ اﻟﻤﺎدي‬

• Levels of anxiety and pain, ‫ﻣﺴﺘﻮﯾﺎت اﻟﻘﻠﻖ واﻷﻟﻢ‬

• Previous history of drug use or abuse, ، ‫• اﻟﺘﺎرﯾﺦ اﻟﺴﺎﺑﻖ ﻟﺘﻌﺎطﻲ اﻟﻤﺨﺪرات أو إﺳﺎءة اﺳﺘﺨﺪاﻣﮭﺎ‬

• History of post_operative nausea,vomiting or motion sickness ‫• ﺗﺎرﯾﺦ ﻣﻦ اﻟﻐﺜﯿﺎن واﻟﻘﻲء‬

‫أو دوار اﻟﺤﺮﻛﺔ ﺑﻌﺪ اﻟﺠﺮاﺣﺔ‬

• Drug allergies, ‫ﺣﺴﺎﺳﯿﺔ اﻟﺪواء‬

 • Elective or emergency surgery, ، ‫• ﺟﺮاﺣﺔ اﺧﺘﯿﺎرﯾﺔ أو طﺎرﺋﺔ‬

• Inpatient or outpatient status.

.‫• ﺣﺎﻟﺔ اﻟﻤﺮﺿﻰ اﻟﺪاﺧﻠﯿﯿﻦ أو اﻟﺨﺎرﺟﯿﯿﻦ‬
• Benzodiazepine: diazepam,midazolam,lorazepam. .‫ ﻟﻮرازﯾﺒﺎم‬، ‫ ﻣﯿﺪازوﻻم‬، ‫ دﯾﺎزﯾﺒﺎم‬:‫• اﻟﺒﻨﺰودﯾﺎزﯾﺒﯿﻦ‬

• Opioid:morphine,pethidine,fentanyl. .‫ اﻟﻔﻨﺘﺎﻧﯿﻞ‬، ‫ اﻟﺒﯿﺜﯿﺪﯾﻦ‬، ‫ اﻟﻤﻮرﻓﯿﻦ‬:‫• اﻟﻤﻮاد اﻷﻓﯿﻮﻧﯿﺔ‬

• Anticholinergic:atropine,glycopyrrolate,scopolamine. ، ‫ ﺟﻠﯿﻜﻮﺑﯿﺮوﻻت‬، ‫ أﺗﺮوﺑﯿﻦ‬:‫• ﻣﻀﺎدات اﻟﻜﻮﻟﯿﻦ‬

.‫ﺳﻜﻮﺑﻮﻻﻣﯿﻦ‬

• H2_receptor antagonist:cimetidine,ranitidine,famotidine. ‫• ﻣﻀﺎدات ﻣﺴﺘﻘﺒﻼت‬

H2_receptor: .‫ ﻓﺎﻣﻮﺗﯿﺪﯾﻦ‬، ‫ راﻧﯿﺘﯿﺪﯾﻦ‬، ‫ﺳﯿﻤﯿﺘﯿﺪﯾﻦ‬

• Proton pump inhibitor:omeprazole. .‫ أوﻣﯿﺒﺮازول‬:‫• ﻣﺜﺒﻂ ﻣﻀﺨﺔ اﻟﺒﺮوﺗﻮن‬

• Gastrokinetic:metoclopramide. .‫ ﻣﯿﺘﻮﻛﻠﻮﺑﺮاﻣﯿﺪ‬:‫• ﺣﺮﻛﯿﺔ اﻟﻤﻌﺪة‬

• Butyrophenone:droperidol. .‫ دروﺑﯿﺮﯾﺪول‬:‫• ﺑﻮﺗﯿﺮوﻓﯿﻨﻮن‬

• Alpha2_adrenergic agonist:clonidine,dexmedetomidine.
‫• ﻧﺎھﺾ‬ ‫‪Alpha2_adrenergic:‬‬ ‫ﻛﻠﻮﻧﯿﺪﯾﻦ ‪ ،‬دﯾﻜﺴﻤﯿﺪﯾﺘﻮﻣﯿﺪﯾﻦ‪.‬‬
 Benzodiazepines‫اﻟﺒﻨﺰودﯾﺎزﯾﺒﯿﻨﺎت‬
• Most popular drugs used for pre_operative medication. ‫ﻋﺎ اﻟﻤﺴﺘﺨﺪﻣﺔ ﻓﻲ اﻷدوﯾﺔ‬
ً ‫• اﻷدوﯾﺔ اﻷﻛﺜﺮ ﺷﯿﻮ‬
.‫اﻟﺴﺎﺑﻘﺔ ﻟﻠﺠﺮاﺣﺔ‬

• Reduce anxiety,amnesia,and sedation. ‫ﺗﻘﻠﯿﻞ اﻟﻘﻠﻖ وﻓﻘﺪان اﻟﺬاﻛﺮة واﻟﺘﺨﺪﯾﺮ‬

• Little depression of the respiratory or cardiovascular systems with

premedicant doses. .‫• اﻧﺨﻔﺎض ﺑﺴﯿﻂ ﻓﻲ اﻟﺠﮭﺎز اﻟﺘﻨﻔﺴﻲ أو اﻟﻘﻠﺐ واﻷوﻋﯿﺔ اﻟﺪﻣﻮﯾﺔ ﻣﻊ اﻟﺠﺮﻋﺎت اﻟﻤﺴﺒﻘﺔ‬

• Have a wide therapeutic index and low incidence of toxicity. ‫ﻟﺪﯾﮭﺎ ﻣﺆﺷﺮ ﻋﻼﺟﻲ واﺳﻊ وﻧﺴﺒﺔ‬
‫ﻣﻨﺨﻔﻀﺔ ﻣﻦ اﻟﺴﻤﯿﺔ‬

• No analgesic effect.
‫ﻻ ﯾﻮﺟﺪ ﺗﺄﺛﯿﺮ ﻣﺴﻜﻦ‬
 Mechanism of action of Benzodiazepin
‫آﻟﯿﺔ ﻋﻤﻞ اﻟﺒﻨﺰودﯾﺎزﯾﺒﯿﻦ‬

• Benzodiazepine bind to the gamma sub_unit of the GABA_A receptor. •

GABA_A.
‫ﯾﺮﺗﺒﻂ اﻟﺒﻨﺰودﯾﺎزﯾﺒﯿﻦ ﺑﻮﺣﺪة ﺟﺎﻣﺎ اﻟﻔﺮﻋﯿﺔ ﻟﻤﺴﺘﻘﺒﻞ‬

• Their binding causes an allosteric (structural) modification of the

receptors. .‫• ﯾﺆدي ارﺗﺒﺎطﮭﺎ إﻟﻰ ﺗﻌﺪﯾﻞ ﺧﯿﻔﻲ )ﺑﻨﯿﻮي( ﻟﻠﻤﺴﺘﻘﺒﻼت‬

• Increase the frequency of channel opening events which leads to an

Increase in chloride ion conductance and inhibition of the action
potential.
.‫• زﯾﺎدة وﺗﯿﺮة أﺣﺪاث ﻓﺘﺢ اﻟﻘﻨﺎة ﻣﻤﺎ ﯾﺆدي إﻟﻰ زﯾﺎدة ﺗﻮﺻﯿﻞ أﯾﻮن اﻟﻜﻠﻮرﯾﺪ وﺗﺜﺒﯿﻂ ﺟﮭﺪ اﻟﻔﻌﻞ‬
 ‫‪• Midazolam:water soluble,not painful on injection,rapid onset‬‬
‫‪(1_2 min.),short duration, 2 to 3 times as potent as diazepam,‬‬
‫‪stable hemodynamic.‬‬ ‫اﻟﻤﯿﺪازوﻻم‪ :‬ﻗﺎﺑﻞ ﻟﻠﺬوﺑﺎن ﻓﻲ اﻟﻤﺎء ‪ ،‬ﻏﯿﺮ ﻣﺆﻟﻢ ﻋﻨﺪ اﻟﺤﻘﻦ ‪ ،‬ﺑﺪاﯾﺔ ﺳﺮﯾﻌﺔ )‪ 2_1‬دﻗﯿﻘﺔ( ‪ ،‬ﻣﺪة ﻗﺼﯿﺮة ‪ 2 ،‬إﻟﻰ ‪ 3‬ﻣﺮات أﻗﻮى ﻣﻦ‬

‫اﻟﺪﯾﺎزﯾﺒﺎم ‪ ،‬دﯾﻨﺎﻣﯿﺎت اﻟﺪم اﻟﻤﺴﺘﻘﺮة‬

‫‪.dose: usually 0.5_1 mg IV,given over 2min.(not to exceed‬‬

‫‪2.5 mg/dose),wait 2_3 min. to evaluate sedative effect after each‬‬
‫‪dose adjustment,use 30% less midazolam if patient premedicated‬‬
‫‪with narcotic or other CNS depressant.‬‬
‫اﻟﺠﺮﻋﺔ‪ :‬ﻋﺎدة ‪ 1_0.5‬ﻣﺠﻢ ﻓﻲ اﻟﻮرﯾﺪ ‪ ،‬ﺗﻌﻄﻰ أﻛﺜﺮ ﻣﻦ دﻗﯿﻘﺘﯿﻦ )ﻻ ﺗﺘﺠﺎوز‬

‫ﺼﺎ ﻣﺴﺒﻘًﺎ ﻟﻠﻤﺨﺪرات أو ﻣﺜﺒﻄﺎت أﺧﺮى ﻟﻠﺠﮭﺎز اﻟﻌﺼﺒﻲ اﻟﻤﺮﻛﺰي‪.‬‬

‫ﻟﺘﻘﯿﯿﻢ اﻟﺘﺄﺛﯿﺮ اﻟﻤﮭﺪئ ﺑﻌﺪ ﻛﻞ ﺗﻌﺪﯾﻞ ﻟﻠﺠﺮﻋﺔ ‪ ،‬اﺳﺘﺨﺪم ‪ ٪30‬أﻗﻞ ﻣﻦ اﻟﻤﯿﺪازوﻻم إذا ﻛﺎن اﻟﻤﺮﯾﺾ ﻣﺨﺼ ً‬ ‫‪ 2.5‬ﻣﺠﻢ ‪ /‬ﺟﺮﻋﺔ( ‪ ،‬اﻧﺘﻈﺮ ‪ 3_2‬دﻗﯿﻘﺔ‪.‬‬
 • Lorazepam:5_10 times as potant as diazepam,more amnesia 4 times
than diazepam,slow acting,long duration. ، ‫ ﻣﺮات أﻗﻮى ﻣﻦ اﻟﺪﯾﺎزﯾﺒﺎم‬10_5 :‫• ﻟﻮرازﯾﺒﺎم‬

.‫ طﻮﯾﻞ اﻷﻣﺪ‬، ‫ ﺑﻄﻲء اﻟﻤﻔﻌﻮل‬، ‫ ﻣﺮات أﻛﺜﺮ ﻣﻦ اﻟﺪﯾﺎزﯾﺒﺎم‬4 ‫ﻓﻘﺪان اﻟﺬاﻛﺮة‬

insoluble in water,not associated with pain on injection.

not appropriates for premedication in outpatient
anaesthesia.
dose: 1_4 mg orally.
.‫ ﻻ ﯾﺼﻠﺢ ﻟﻠﺘﺨﺪﯾﺮ ﻓﻲ اﻟﻌﯿﺎدات اﻟﺨﺎرﺟﯿﺔ‬.‫ وﻻ ﯾﺮﺗﺒﻂ ﺑﺄﻟﻢ ﻋﻨﺪ اﻟﺤﻘﻦ‬، ‫ﻏﯿﺮ ﻗﺎﺑﻞ ﻟﻠﺬوﺑﺎن ﻓﻲ اﻟﻤﺎء‬

.‫ ﻣﻠﻎ ﻋﻦ طﺮﯾﻖ اﻟﻔﻢ‬4_1 :‫اﻟﺠﺮﻋﺔ‬

 • Diazepam:anxiolytic,sedative,anticonvulsant,
pain on injection (IM,IV). ‫ أﻟﻢ ﻋﻨﺪ اﻟﺤﻘﻦ‬، ‫ ﻣﻀﺎد ﻟﻼﺧﺘﻼج‬، ‫ ﻣﮭﺪئ‬، ‫ ﻣﺰﯾﻞ ﻟﻠﻘﻠﻖ‬:‫• دﯾﺎزﯾﺒﺎم‬

IM ، IV).
)

peak effect 30 min, oral, lasting for 20 hr

dose:10 mg IM before surgery.
.‫ ﻣﻠﻎ ﻓﻲ اﻟﻌﻀﻞ ﻗﺒﻞ اﻟﺠﺮاﺣﺔ‬10 :‫ ﺳﺎﻋﺔ ﺟﺮﻋﺔ‬20 ‫ ﯾﺴﺘﻤﺮ ﻟﻤﺪة‬، ‫ ﻋﻦ طﺮﯾﻖ اﻟﻔﻢ‬، ‫ دﻗﯿﻘﺔ‬30 ‫ﺗﺄﺛﯿﺮ اﻟﺬروة‬
 Opioids‫أﻓﯿﻮﻧﯿﺎت اﻟﻤﻔﻌﻮل‬
• The opioid given in premedication doses do not produce sedation or
amnesia and are often combined with a benzodiazepine for these
effects. .‫• اﻟﻤﻮاد اﻷﻓﯿﻮﻧﯿﺔ اﻟﺘﻲ ﺗ ُﻌﻄﻰ ﺑﺠﺮﻋﺎت ﺗﻤﮭﯿﺪﯾﺔ ﻻ ﺗﺆدي إﻟﻰ اﻟﺘﺨﺪﯾﺮ أو ﻓﻘﺪان اﻟﺬاﻛﺮة وﻏﺎﻟﺒًﺎ ﻣﺎ ﯾﺘﻢ دﻣﺠﮭﺎ ﻣﻊ اﻟﺒﻨﺰودﯾﺎزﯾﺒﯿﻦ ﻟﮭﺬه اﻟﺘﺄﺛﯿﺮات‬

• Morphine and pethidine were historically the most frequently used

opioids for intramuscular pre_operative medication. ‫• ﻛﺎن اﻟﻤﻮرﻓﯿﻦ واﻟﺒﯿﺜﯿﺪﯾﻦ ﺗﺎرﯾﺨﯿًﺎ أﻛﺜﺮ اﻟﻤﻮاد‬
.‫اﻷﻓﯿﻮﻧﯿﺔ اﺳﺘﺨﺪاًﻣﺎ ﻟﻸدوﯾﺔ اﻟﻌﻀﻠﯿﺔ ﻗﺒﻞ اﻟﺠﺮاﺣﺔ‬

• Currently the administration of intravenous fentanyl with its rapid

onset and shorter duration has become much more common.
.‫ﻋﺎ‬
ً ‫ أﺻﺒﺢ اﺳﺘﺨﺪام اﻟﻔﻨﺘﺎﻧﯿﻞ ﻓﻲ اﻟﻮرﯾﺪ ﻣﻊ ﺑﺪاﯾﺘﮫ اﻟﺴﺮﯾﻌﺔ وﻗﺼﺮ ﻣﺪﺗﮫ أﻛﺜﺮ ﺷﯿﻮ‬، ‫• ﻓﻲ اﻟﻮﻗﺖ اﻟﺤﺎﻟﻲ‬
Mechanism of action of opioid ‫آﻟﯿﺔ ﻋﻤﻞ اﻟﻤﻮاد‬
‫اﻷﻓﯿﻮﻧﯿﺔ‬
• Produce analgesia by binding to the specific G_protein coupled
receptors in brain and spinal cord. G
‫• إﻧﺘﺎج اﻟﺘﺴﻜﯿﻦ ﻋﻦ طﺮﯾﻖ اﻻرﺗﺒﺎط ﺑﻤﺴﺘﻘﺒﻼت ﻣﺤﺪدة ﻣﻘﺘﺮﻧﺔ ﺑﺎﻟﺒﺮوﺗﯿﻦ‬ ‫ﻓﻲ اﻟﺪﻣﺎغ‬
.‫واﻟﺤﺒﻞ اﻟﺸﻮﻛﻲ‬

• Receptors: ‫ﻣﺴﺘﻘﺒﻼت‬

.mu,delta,kappa receptors: all 3 sub_types are involved in analgesic

mechanisms at both spinal and supraspinal levels.. ‫ ﻣﺴﺘﻘﺒﻼت‬mu ‫و‬delta ‫و‬
kappa: ‫ﺟﻤﯿﻊ اﻷﻧﻮاع اﻟﻔﺮﻋﯿﺔ اﻟﺜﻼﺛﺔ ﻣﺘﻮرطﺔ ﻓﻲ آﻟﯿﺎت اﻟﻤﺴﻜﻨﺎت ﻋﻠﻰ اﻟﻤﺴﺘﻮﯾﯿﻦ اﻟﺸﻮﻛﻲ‬
.‫وﻓﻮق اﻟﻨﺨﺎع‬
.mu receptors respiratory depressant and GIT symptoms. ‫ﻣﺴﺘﻘﺒﻼت ﻣﻮ‬
.‫ﻣﺜﺒﻄﺎت اﻟﺠﮭﺎز اﻟﺘﻨﻔﺴﻲ وأﻋﺮاض اﻟﺠﮭﺎز اﻟﮭﻀﻤﻲ‬
.delta receptors development of tolerance. .delta .‫ﻣﺴﺘﻘﺒﻼت ﺗﻄﻮﯾﺮ اﻟﺘﺴﺎﻣﺢ‬
.kappa receptors involved in sedation and GIT symptoms. ‫ﻣﺴﺘﻘﺒﻼت‬
.kappa .‫ﺗﺸﺎرك ﻓﻲ اﻟﺘﺨﺪﯾﺮ وأﻋﺮاض اﻟﺠﮭﺎز اﻟﮭﻀﻤﻲ‬
MECHANISM OF ACTION(CONT.)
MECHANISM OF ACTION(CONT.)
 Classification of opioid
‫ﺗﺼﻨﯿﻒ اﻟﻤﻮاد اﻷﻓﯿﻮﻧﯿﺔ‬

• 1.hydrophilic: propoxyphene,codeine,morphine,
oxycodone/hydrocodone,hydromorphone;
methadone (mixed mu/NMDA). :‫• ﻣﺎء‬
، ‫ ﻣﻮرﻓﯿﻦ‬، ‫ ﻛﻮدﯾﻦ‬، ‫ﺑﺮوﺑﻮﻛﺴﯿﻔﯿﻦ‬
 ‫ﻛﺴﯿﻜﻮدون ‪ /‬ھﯿﺪروﻛﻮدون ‪ ،‬ھﯿﺪروﻣﻮرﻓﻮن ؛‬
‫اﻟﻤﯿﺜﺎدون )ﻣﺨﺘﻠﻂ ﻣﻮ ‪ /‬ﻧﻤﺪا(‪.‬‬

‫‪• 2.lipophilic: fentanyle,sufentanil,carfentanil,lofentanil.‬‬

‫ﻣﺤﺒﺔ ﻟﻠﺪھﻮن‪ :‬ﻓﻨﺘﺎﻧﯿﻞ ‪ ،‬ﺳﻮﻓﻨﺘﺎﻧﯿﻞ ‪ ،‬ﻛﺮﻓﻨﺘﺎﻧﯿﻞ ‪ ،‬ﻟﻮﻓﻨﺘﺎﻧﯿﻞ‬
 Side effects of opioid ‫اﻵﺛﺎر اﻟﺠﺎﻧﺒﯿﺔ ﻟﻠﻤﻮاد‬
‫اﻷﻓﯿﻮﻧﯿﺔ‬
• Pruritus, ‫ﺣﻜﺔ‬

• Histamine release, ‫إطﻼق اﻟﮭﺴﺘﺎﻣﯿﻦ‬

• Flushing,dizziness,miosis, ، ‫ ﺗﻘﺒﺾ اﻟﺤﺪﻗﺔ‬، ‫ دوﺧﺔ‬، ‫• اﺣﻤﺮار‬

• Nausea and vomiting, ،‫اﺳﺘﻔﺮاغ و ﻏﺜﯿﺎن‬ •

• Delay gastric emptying, .‫• ﺗﺄﺧﯿﺮ إﻓﺮاغ اﻟﻤﻌﺪة‬

• Respiratory depression, ‫ﺗﺜﺒﯿﻂ اﻟﺠﮭﺎز اﻟﺘﻨﻔﺴﻲ‬

• Orthostatic hypotention, ‫ھﺒﻮط ﺿﻐﻂ اﻟﺪم اﻻﻧﺘﺼﺎﺑﻲ‬

• Sphincter of Oddi spasm.

‫ﺗﺸﻨﺞ اﻟﻌﻀﻠﺔ اﻟﻌﺎﺻﺮة‬
 • synthetic opioid
agonist
OPIOID
Fentanyl • No histamine
release nor
myocardial
Morphine depression
• ventilatory
meperidine depression and
profound
bradycardia
• Analgesia
• Rapid onset
• Respiratory depression
• Short duration
• Myocardial depression
30 mins
• Nausea and vomiting
• Potency 1/10 of Morphine • More potency
• Histamine release
• Less histamine release and than Morphine
• Caution with asthma patient,
respiratory depression 100 times
spasm of sphincter of oddi
• Dose : 1-2 mg/kg IM or IV • Dose : 1-2
• onset 15 to 30 minutes, peak in
ug/kg IV or IM
45 to 90 minutes and lasts as
or oral trans
long as 4 hours
mucosal
• Dose: 0.1-0.2 mg/kg IM or IV
 Anticholinergic‫ﻣﻀﺎدات اﻟﻜﻮﻟﯿﻦ‬
• Old inhalation anaesthetic produced copious respiratory tract
secretions and intraoperative bradycardia was a frequent danger.
.ً ‫• ﺗﺴﺒﺐ ﻣﺨﺪر اﻻﺳﺘﻨﺸﺎق اﻟﻘﺪﯾﻢ ﻓﻲ إﻓﺮازات ﻏﺰﯾﺮة ﻓﻲ اﻟﺠﮭﺎز اﻟﺘﻨﻔﺴﻲ وﻛﺎن ﺑﻂء اﻟﻘﻠﺐ أﺛﻨﺎء اﻟﻌﻤﻠﯿﺔ ﺧﻄﺮا ً ﻣﺘﻜﺮرا‬

• Were widely used pre_operative medication,newer inhalational

agents reduced the routine use of anticholinergic drugs for
pre_operative medication.
.‫ ﺣﯿﺚ ﻗﻠﻠﺖ ﻋﻮاﻣﻞ اﻻﺳﺘﻨﺸﺎق اﻷﺣﺪث ﻣﻦ اﻻﺳﺘﺨﺪام اﻟﺮوﺗﯿﻨﻲ ﻟﻌﻘﺎﻗﯿﺮ ﻣﻀﺎدات اﻟﻜﻮﻟﯿﻦ ﻟﻸدوﯾﺔ ﻗﺒﻞ اﻟﺠﺮاﺣﺔ‬، ‫• ﺗﻢ اﺳﺘﺨﺪام اﻷدوﯾﺔ ﻗﺒﻞ اﻟﺠﺮاﺣﺔ ﻋﻠﻰ ﻧﻄﺎق واﺳﻊ‬
 Specific indications for an anticholinergic
before surgery ‫ﻣﺆﺷﺮات ﻣﺤﺪدة ﻟﻤﻀﺎدات اﻟﻜﻮﻟﯿﻦ‬

‫ﻗﺒﻞ اﻟﺠﺮاﺣﺔ‬

• 1.decrease secretion (antisialogogue), ، (‫اﻧﺨﻔﺎض إﻓﺮاز )ﻣﻀﺎد ﻟﻼﻟﺘﮭﺎب‬

• 2.dry airway ‫ﻣﺟرى اﻟﮭواء اﻟﺟﺎف‬

• 3.sedation, ‫ﺗﺴﻜﯿﻦ اﻻﻟﻢ‬

• 4.amnesia, ‫ﻓﻘﺪان اﻟﺬاﻛﺮة‬

• 5.vagolytic.
‫ﻣﺒﮭﻢ‬
 Side effects of anticholinergic medicatio ‫اﻵﺛﺎر‬
‫اﻟﺠﺎﻧﺒﯿﺔ ﻟﻸدوﯾﺔ اﻟﻤﻀﺎدة ﻟﻠﻜﻮﻟﯿﻦ‬
• Drying and thickening of airway secretion, ، ‫• ﺗﺠﻔﯿﻒ وﺗﻜﺜﯿﻒ إﻓﺮاز ﻣﺠﺮى اﻟﮭﻮاء‬

• Decrease in lower esophageal sphincter tone, ‫اﻧﺨﻔﺎض ﻓﻲ ﻧﻐﻤﺔ اﻟﻤﺼﺮة اﻟﻤﺮﯾﺌﯿﺔ اﻟﺴﻔﻠﯿﺔ‬

• Mydriasis and cycloplegia, ، ‫• ﺗﻮﺳﻊ ﺣﺪﻗﺔ اﻟﻌﯿﻦ وﺷﻠﻞ ﻋﻀﻠﻲ‬

• Central nervous system toxicity, ‫ﺳﻤﯿﺔ اﻟﺠﮭﺎز اﻟﻌﺼﺒﻲ اﻟﻤﺮﻛﺰي‬

• Prevention of sweating, ‫ﻣﻨﻊ اﻟﺘﻌﺮق‬

• Hyperthemia ‫ارﺗﻔﺎع اﻟﺤﺮارة‬ •

• Constipation ‫إﻣﺴﺎك‬ •

• Urinary retention
‫اﺣﺘﺒﺎس اﻟﺒﻮل‬ •
 HISTAMINE 2 RECEPTOR ANTAGONIST
‫ ﻣﺴﺘﻘﺒﻞ اﻧﺘﺎﻏﻮﻧﯿﺴﺖ‬2 ‫اﻟﮭﯿﺴﺘﺎﻣﯿﻦ‬
• Blocks H2_receptors of gastric parietal cells,leading to inhibition of
gastric secretions. H2 ‫• ﯾﺤﺠﺐ ﻣﺴﺘﻘﺒﻼت‬ .‫ﻟﻠﺨﻼﯾﺎ اﻟﺠﺪارﯾﺔ ﻓﻲ اﻟﻤﻌﺪة ﻣﻤﺎ ﯾﺆدي إﻟﻰ ﺗﺜﺒﯿﻂ إﻓﺮازات اﻟﻤﻌﺪة‬

• Antagonism of the histamine receptors occurs in a selective and

competitive manner. .‫• ﯾﺤﺪث ﻋﺪاء ﻣﺴﺘﻘﺒﻼت اﻟﮭﯿﺴﺘﺎﻣﯿﻦ ﺑﻄﺮﯾﻘﺔ اﻧﺘﻘﺎﺋﯿﺔ وﺗﻨﺎﻓﺴﯿﺔ‬

• Not affect gastric fluid volume or gastric emptying time.

.‫• ﻻ ﯾﺆﺛﺮ ﻋﻠﻰ ﺣﺠﻢ اﻟﺴﺎﺋﻞ اﻟﻤﻌﺪي أو وﻗﺖ إﻓﺮاغ اﻟﻤﻌﺪة‬
H2 ANTAGONIST
• Cimetidine:increase the gastric fluid PH above 2.5 in 80% of patients. •
.‫ ﻣﻦ اﻟﻤﺮﺿﻰ‬٪80 ‫ ﻓﻲ‬2.5 ‫ ﯾﺰﯾﺪ ﻣﻦ درﺟﺔ اﻟﺤﻤﻮﺿﺔ ﻓﻲ ﺳﻮاﺋﻞ اﻟﻤﻌﺪة ﻓﻮق‬:‫ﺳﯿﻤﯿﺘﯿﺪﯾﻦ‬

.gastric effect of cimetidine last as long as 3_4 hr.

.inhibits the hepatic mixed function oxidase ‫ﯾﺴﺘﻤﺮ اﻟﺘﺄﺛﯿﺮ‬
.‫ ﺳﺎﻋﺎت‬4_3 ‫اﻟﻤﻌﺪي ﻟﻠﺴﯿﻤﯿﺘﯿﺪﯾﻦ ﻟﻤﺪة‬

‫ ﯾﻤﻨﻊ أوﻛﺴﯿﺪﯾﺰ اﻟﻜﺒﺪ اﻟﻤﺨﺘﻠﻂ‬.

enzyme system,therefore,it can prolong the half_life of
many drugs
 ‫‪(diazepam,propranolol,lidocaine,theophylline).‬‬
‫‪.dose:150_300 mg orally or parenterally 1 to 1.5 hr before‬‬
‫‪surgery.‬‬
‫ﻧﻈﺎم اﻹﻧﺰﯾﻢ ‪ ،‬ﻟﺬﻟﻚ ‪ ،‬ﯾﻤﻜﻦ أن ﯾﻄﯿﻞ ﻋﻤﺮ اﻟﻨﺼﻒ ﻟﻠﻌﺪﯾﺪ ﻣﻦ اﻷدوﯾﺔ )دﯾﺎزﯾﺒﺎم ‪ ،‬ﺑﺮوﺑﺮاﻧﻮﻟﻮل ‪ ،‬ﻟﯿﺪوﻛﺎﺋﯿﻦ ‪ ،‬ﺛﯿﻮﻓﯿﻠﯿﻦ(‪ . .‬اﻟﺠﺮﻋﺔ‪ 300_150 :‬ﻣﺠﻢ ﻋﻦ طﺮﯾﻖ اﻟﻔﻢ أو ﺑﺎﻟﺤﻘﻦ ﻣﻦ ‪ 1‬إﻟﻰ ‪ 1.5‬ﺳﺎﻋﺔ ﻗﺒﻞ اﻟﺠﺮاﺣﺔ‪.‬‬
 • Ranitidine:more potent and longer acting than cimetidine.
.usual oral dose is 50_200 mg..parenterally 50_100mg
given within 1hr.
.last up to 9 hr. .‫ أﻗﻮى وأطﻮل ﻣﻔﻌﻮﻻً ﻣﻦ اﻟﺴﯿﻤﯿﺘﯿﺪﯾﻦ‬:‫• راﻧﯿﺘﯿﺪﯾﻦ‬
‫ ﻣﺠﻢ ﺑﺎﻟﺤﻘﻦ‬100_50 .. ‫ ﻣﺠﻢ‬200_50 ‫اﻟﺠﺮﻋﺔ اﻟﻤﻌﺘﺎدة ﻋﻦ طﺮﯾﻖ اﻟﻔﻢ ھﻲ‬
.‫ ﺳﺎﻋﺎت‬9 ‫ آﺧﺮ ﻣﺎ ﯾﺼﻞ إﻟﻰ‬. .‫ﺗﻌﻄﻰ ﺧﻼل ﺳﺎﻋﺔ واﺣﺪة‬

• Others:famotidine,nizatidine.
.‫ ﻧﯿﺰاﺗﯿﺪﯾﻦ‬، ‫ ﻓﺎﻣﻮﺗﯿﺪﯾﻦ‬:‫• آﺧﺮون‬
PROTON PUMP INHIBITORS
‫ﻣﺜﺒﻄﺎت ﻣﻀﺨﺔ اﻟﺒﺮوﺗﻮن‬
• Omeprazole:binds to H/K exchanging ATPase (proton pump) in gastric
parietal cells,suppresses gastric acid secretion. H ‫ ﯾﺮﺗﺒﻂ ﺑـ‬:‫• أوﻣﯿﺒﺮازول‬

/ K ATPase
‫ﻣﺒﺎدﻟﺔ‬ .‫ وﯾﺜﺒﻂ إﻓﺮاز ﺣﻤﺾ اﻟﻤﻌﺪة‬، ‫)ﻣﻀﺨﺔ اﻟﺒﺮوﺗﻮن( ﻓﻲ اﻟﺨﻼﯾﺎ اﻟﺠﺪارﯾﺔ ﻓﻲ اﻟﻤﻌﺪة‬

.intravenous dose of 40 mg 30 min before induction. ‫ﺟﺮﻋﺔ‬

.‫ دﻗﯿﻘﺔ ﻗﺒﻞ اﻟﺘﺤﺮﯾﺾ‬30 ‫ ﻣﻠﻎ‬40 ‫ﻓﻲ اﻟﻮرﯾﺪ‬
.oral doses of 40 _80 mg must be given 2_4 hrs before
surgery, last as long as 24 hr. 40 ‫ﯾﺠﺐ إﻋﻄﺎء ﺟﺮﻋﺎت ﻓﻤﻮﯾﺔ ﻣﻦ‬
.‫ ﺳﺎﻋﺔ‬24 ‫ وﺗﺴﺘﻤﺮ ﻟﻤﺪة‬، ‫ ﺳﺎﻋﺎت ﻣﻦ اﻟﺠﺮاﺣﺔ‬4_2 ‫ ﻣﺠﻢ ﻗﺒﻞ‬80_
• Others: lansoprazole,esomeprazole,pantoprazole.
‫آﺧﺮون‪ :‬ﻻﻧﺴﻮﺑﺮازول ‪ ،‬إﯾﺰوﻣﯿﺒﺮازول ‪ ،‬ﺑﺎﻧﺘﻮﺑﺮازول‬
 Gastrokinetic‫ﺣﺮﻛﯿﺔ اﻟﻤﻌﺪة‬
• A prokinetic agents: a type of drugs which enhances gastrointestinal
motility by increasing the frequency or strength
contractions.it helps to control acid reflux. ‫• اﻟﻌﻮاﻣﻞ اﻟﻤﺴﺒﺒﺔ‬
.‫ وھﻲ ﺗﺴﺎﻋﺪ ﻋﻠﻰ اﻟﺘﺤﻜﻢ ﻓﻲ ارﺗﺪاد اﻟﺤﻤﺾ‬.‫ ﻧﻮع ﻣﻦ اﻷدوﯾﺔ اﻟﺘﻲ ﺗﻌﺰز ﺣﺮﻛﯿﺔ اﻟﺠﮭﺎز اﻟﮭﻀﻤﻲ ﻋﻦ طﺮﯾﻖ زﯾﺎدة ﺗﻮاﺗﺮ ﺗﻘﻠﺼﺎت اﻟﻘﻮة‬:‫ﻟﻠﺤﺮﻛﺔ‬

• Metoclopramide (plasile):blocks dopamine receptors (at high dose)

and serotonine receptors in chemoreceptors trigger
zone of CNS,and sensitizes tissues to acetylcholine,
increases upper GI motility but not secretion,
increases lower esophageal sphincter tone.
‫ وﯾﺰﯾﺪ ﻣﻦ ﺣﺮﻛﯿﺔ اﻟﺠﮭﺎز اﻟﮭﻀﻤﻲ‬، ‫ وﺗﺤﺴﺲ اﻷﻧﺴﺠﺔ ﻟﻸﺳﺘﯿﻞ ﻛﻮﻟﯿﻦ‬، ‫ ﯾﺤﺠﺐ ﻣﺴﺘﻘﺒﻼت اﻟﺪوﺑﺎﻣﯿﻦ )ﺑﺠﺮﻋﺎت ﻋﺎﻟﯿﺔ( وﻣﺴﺘﻘﺒﻼت اﻟﺴﯿﺮوﺗﻮﻧﯿﻦ ﻓﻲ اﻟﻤﺴﺘﻘﺒﻼت اﻟﻜﯿﻤﯿﺎﺋﯿﺔ اﻟﺘﻲ ﺗﺤﻔﺰ ﻣﻨﻄﻘﺔ اﻟﺠﮭﺎز اﻟﻌﺼﺒﻲ اﻟﻤﺮﻛﺰي‬:(‫• ﻣﯿﺘﻮﻛﻠﻮﺑﺮاﻣﯿﺪ )ﺑﻼزﯾﻞ‬
.‫ وﯾﺰﯾﺪ ﻣﻦ ﺣﺪة اﻟﻌﻀﻠﺔ اﻟﻌﺎﺻﺮة ﻟﻠﻤﺮيء‬، ‫اﻟﻌﻠﻮي وﻟﻜﻦ ﻟﯿﺲ اﻹﻓﺮاز‬
 ‫‪• Dose of metoclopramide: 5_10 mg IV or IM 1hr before surgery.‬‬ ‫• ﺟﺮﻋﺔ ﻣﯿﺘﻮﻛﻠﻮﺑﺮاﻣﯿﺪ‪:‬‬
‫‪ 10_5‬ﻣﺠﻢ ﻓﻲ اﻟﻮرﯾﺪ أو اﻟﻌﻀﻞ ‪ 1‬ﺳﺎﻋﺔ ﻗﺒﻞ اﻟﺠﺮاﺣﺔ‪.‬‬

‫دﻗﯿﻘﺔ ‪.onset: 1_3 min IV, 10_15‬ﺑﺪاﯾﺔ‬

‫ﯾﻌﻄﻰ ‪min IM30_60 min‬‬
‫‪oral.‬ﻋﻦ طﺮﯾﻖ اﻟﻔﻢ‬
‫اﻟﻤﺪة‪.duration: 1_2 hr regardless of route. :‬‬
‫‪ 2_1‬ﺳﺎﻋﺔ ﺑﻐﺾ اﻟﻨﻈﺮ ﻋﻦ اﻟﻤﺴﺎر‬
‫‪ .‬ﻻ ﺗﺴﺘﺨﺪم ﻣﻊ ﻣﺮﯾﺾ اﻧﺴﺪاد اﻟﻘﻨﺎة ‪.do not use with gut obstruction patient.‬‬
‫اﻟﮭﻀﻤﯿﺔ‪.‬‬
‫‪.it can cause extrapyramidal symptoms.‬‬
‫ﯾﻤﻜﻦ أن ﯾﺴﺒﺐ أﻋﺮاض ﺧﺎرج اﻟﺴﺒﯿﻞ اﻟﮭﺮﻣﻲ‪.‬‬
 BUTYROPHENONE‫ﺑﯿﻮﺗﯿﺮوﻓﯿﻨﻮن‬
• Is a chemical compound,some of its dreviatives (called commonly
butyrophenone) are used to treat various psychiatric disorders such
as schizophrenia,as well as acting as antiemetics. ‫ ﺑﻌﺾ ﻣﺸﺘﻘﺎﺗﮫ )ﺗﺴﻤﻰ ﻋﺎدة‬، ‫• ھﻮ ﻣﺮﻛﺐ ﻛﯿﻤﯿﺎﺋﻲ‬
.‫ وﻛﺬﻟﻚ ﺗﻌﻤﻞ ﻛﻤﻀﺎدات ﻟﻠﻘﻰء‬، ‫ﺑﯿﻮﺗﯿﺮوﻓﯿﻨﻮن( ﺗﺴﺘﺨﺪم ﻟﻌﻼج اﻻﺿﻄﺮاﺑﺎت اﻟﻨﻔﺴﯿﺔ اﻟﻤﺨﺘﻠﻔﺔ ﻣﺜﻞ اﻟﻔﺼﺎم‬

• Droperidol: dopamine receptor antagonist,predominantly

Dopamine 2_receptors antagonist,reduced motor activity,anexiety and
causes sedation,also possesses adrenergic-blocking,antifibrillatory,
antihistaminic,and anticonvulsive properties. ‫ ﻣﻀﺎدات‬:‫• دروﺑﯿﺮﯾﺪول‬
‫ ﻓﻲ اﻟﻐﺎﻟﺐ‬، ‫ﻣﺴﺘﻘﺒﻼت اﻟﺪوﺑﺎﻣﯿﻦ‬

‫ وﯾﻤﺘﻠﻚ‬، ‫ واﻟﻘﻠﻖ وﯾﺴﺒﺐ اﻟﺘﺨﺪﯾﺮ‬، ‫ واﻧﺨﻔﺎض اﻟﻨﺸﺎط اﻟﺤﺮﻛﻲ‬، 2 ‫ﻣﻨﺎھﺾ ﻟﻤﺴﺘﻘﺒﻼت اﻟﺪوﺑﺎﻣﯿﻦ‬
، ‫ وﻣﻀﺎد اﻟﺮﺟﻔﺎن‬، ‫ﻀﺎ ﻣﻨﻊ اﻷدرﯾﻨﺎﻟﯿﺔ‬
ً ‫أﯾ‬
‫ﺧﺼﺎﺋﺺ ﻣﻀﺎدات اﻟﮭﯿﺴﺘﺎﻣﯿﻦ وﻣﻀﺎدات اﻻﺧﺘﻼج‪.‬‬
‫‪• Onset: 3_10 min.‬‬ ‫• اﻟﺒﺪاﯾﺔ‪ 10_3 :‬دﻗﺎﺋﻖ‪.‬‬

‫‪• Duration:2_4 hr,may persist up to 12 hr.‬‬ ‫• اﻟﻤﺪة‪ 4_2 :‬ﺳﺎﻋﺔ ‪ ،‬ﻗﺪ ﺗﺴﺘﻤﺮ ﺣﺘﻰ ‪ 12‬ﺳﺎﻋﺔ‪.‬‬

‫‪• Dose:initially not more than 2.5 mg IV/IM.‬‬

‫‪IV / IM.‬‬
‫• اﻟﺠﺮﻋﺔ‪ :‬ﻓﻲ اﻟﺒﺪاﯾﺔ ﻻ ﺗﺰﯾﺪ ﻋﻦ ‪ 2.5‬ﻣﻠﻎ‬
ALPHA 2_ADRENERGIC AGONIST
‫ أدرﯾﻨﯿﺮﺟﯿﻚ‬2 ‫ﻧﺎھﺾ أﻟﻔﺎ‬
• Centrally acting alpha 2_agonist ,stimulate alpha 2_ adrenoceptor
receptors in the central nervous system (brain and spinal cord).
alpha 2_receptors are found on cells in the sympathetic nervous
system. ‫_ ﻣﺴﺘﻘﺒﻼت اﻷدرﯾﻨﺎﻟﯿﺔ ﻓﻲ اﻟﺠﮭﺎز‬2 ‫ ﯾﺤﻔﺰ ﻣﺴﺘﻘﺒﻼت أﻟﻔﺎ‬، ‫ ﻣﺮﻛﺰﯾﺎ‬2 ‫• ﻧﺎھﺾ أﻟﻔﺎ‬
.(‫اﻟﻌﺼﺒﻲ اﻟﻤﺮﻛﺰي )اﻟﺪﻣﺎغ واﻟﻨﺨﺎع اﻟﺸﻮﻛﻲ‬

‫ ﺗﻢ اﻟﻌﺜﻮر ﻋﻠﻰ ﻣﺴﺘﻘﺒﻼت‬alpha 2_receptors .‫ﻓﻲ اﻟﺨﻼﯾﺎ ﻓﻲ اﻟﺠﮭﺎز اﻟﻌﺼﺒﻲ اﻟﻮدي‬

• Clonidine:central sympatholytic via stimulation of central alpha
receptors,result in reduced sympathetic outflow causing decrease
pulmonary vascular resistance,heart rate and blood pressure. :‫• اﻟﻜﻠﻮﻧﯿﺪﯾﻦ‬
.‫ ﻣﻤﺎ ﯾﺆدي إﻟﻰ ﺗﻘﻠﯿﻞ اﻟﺘﺪﻓﻖ اﻟﻮدي ﻣﻤﺎ ﯾﺆدي إﻟﻰ ﺗﻘﻠﯿﻞ ﻣﻘﺎوﻣﺔ اﻷوﻋﯿﺔ اﻟﺪﻣﻮﯾﺔ اﻟﺮﺋﻮﯾﺔ وﻣﻌﺪل ﺿﺮﺑﺎت اﻟﻘﻠﺐ وﺿﻐﻂ اﻟﺪم‬، ‫ﯾﺤﻠﻞ اﻟﻮدي اﻟﻤﺮﻛﺰي ﻋﻦ طﺮﯾﻖ ﺗﺤﻔﯿﺰ ﻣﺴﺘﻘﺒﻼت أﻟﻔﺎ اﻟﻤﺮﻛﺰﯾﺔ‬
 • Its believed to have some useful effects such as pain ‫ﯾﻌﺘﻘﺪ أن ﻟﮭﺎ ﺑﻌﺾ اﻵﺛﺎر اﻟﻤﻔﯿﺪة ﻣﺜﻞ اﻷﻟﻢ‬

• relief,sedation,and reducing anxiety. .‫• اﻟﺮاﺣﺔ واﻟﺘﺨﺪﯾﺮ وﺗﻘﻠﯿﻞ اﻟﻘﻠﻖ‬

• Decrease anaesthetic and opioid requirement.

.‫• ﺗﻘﻠﯿﻞ ﻣﺘﻄﻠﺒﺎت اﻟﺘﺨﺪﯾﺮ واﻟﻤﻮاد اﻷﻓﯿﻮﻧﯿﺔ‬
 • Onset: less than 1hr (2_4 peak effect )(‫ ﺗﺄﺛﯿﺮ اﻟﺬروة‬4_2) ‫ أﻗﻞ ﻣﻦ ﺳﺎﻋﺔ واﺣﺪة‬:‫• اﻟﺒﺪاﯾﺔ‬
• Duration:6_10 hr‫ ﺳﺎﻋﺎت‬10_6 :‫• اﻟﻤﺪة‬
• Dose:5_20 mcg/kg.orally..‫ ﻛﺠﻢ ﺷﻔﻮﯾﺎ‬/ ‫ ﻣﯿﻜﺮوﺟﺮام‬20_5 :‫• اﻟﺠﺮﻋﺔ‬
• Dexmedetomidine:centrally acting alpha 2_receptor agonist that has
sedative and anaesthetic properties possibly by activating G-proteins in the
brain stem,which result in the inhibition of norepinephrine release. ‫ • ﻧﺎھﺾ ﻣﺴﺘﻘﺒﻼت‬.
‫ ذو اﻟﺘﺄﺛﯿﺮ اﻟﻤﺮﻛﺰي اﻟﺬي ﻟﮫ ﺧﺼﺎﺋﺺ ﻣﮭﺪﺋﺔ وﻣﺨﺪرة رﺑﻤﺎ ﻋﻦ طﺮﯾﻖ ﺗﻨﺸﯿﻂ ﺑﺮوﺗﯿﻨﺎت‬2 ‫أﻟﻔﺎ‬G . .‫ ﻣﻤﺎ ﯾﺆدي إﻟﻰ ﺗﺜﺒﯿﻂ إﻓﺮاز اﻟﻨﻮرإﺑﯿﻨﻔﺮﯾﻦ‬، ‫ﻓﻲ ﺟﺬع اﻟﺪﻣﺎغ‬

• Indicated for sedation of non_intubated pateints before and/or during

surgical and other procedures..‫ أو أﺛﻨﺎء اﻟﻌﻤﻠﯿﺎت اﻟﺠﺮاﺣﯿﺔ وﻏﯿﺮھﺎ‬/ ‫• ﯾﺸﺎر إﻟﯿﮫ ﻟﺘﺴﻜﯿﻦ اﻟﻤﺮﺿﻰ ﻏﯿﺮ ﺗﺤﺖ اﻟﺘﻨﺒﯿﺐ ﻗﺒﻞ و‬
• Loading dose:1 mcg/kg IV over 10 min.‫ دﻗﺎﺋﻖ‬10 ‫ ﻛﻎ ﻋﻦ طﺮﯾﻖ اﻟﻮرﯾﺪ ﻟﻤﺪة‬/ ‫ ﻣﯿﻜﺮوﻏﺮام‬1 :‫ﺟﺮﻋﺔ اﻟﺘﺤﻤﯿﻞ‬
• Maintenance 0.6 mcg/kg/hr IV titrate to effect (usually 0.2_1mcg/kg/hr).
.(‫ ﺳﺎﻋﺔ‬/ ‫ ﻛﺠﻢ‬/ ‫ ﻣﯿﻜﺮوﺟﺮام‬1 _0.2 ‫ ﺳﺎﻋﺔ ﻋﻦ طﺮﯾﻖ اﻟﻤﻌﺎﯾﺮة اﻟﻮرﯾﺪﯾﺔ ﻟﻠﺘﺄﺛﯿﺮ )ﻋﺎدة‬/ ‫ ﻛﺠﻢ‬/ ‫ ﻣﯿﻜﺮوﺟﺮام‬0.6 ‫• اﻟﺼﯿﺎﻧﺔ‬
 • Onset:less than 5 min. and the peak effect occur within 15 min. 5 ‫ أﻗﻞ ﻣﻦ‬:‫• اﻟﺒﺪاﯾﺔ‬
.‫ دﻗﯿﻘﺔ‬15 ‫ وﯾﺤﺪث ﺗﺄﺛﯿﺮ اﻟﺬروة ﻓﻲ ﻏﻀﻮن‬.‫دﻗﺎﺋﻖ‬

• Following IV administration,it shows rapid distribution phase with a

distribution half life of six min. and terminal elimination half life of
approximately 2 hrs.
.‫ وﻧﺼﻒ ﻋﻤﺮ اﻟﻘﻀﺎء اﻟﻨﮭﺎﺋﻲ ﺣﻮاﻟﻲ ﺳﺎﻋﺘﯿﻦ‬.‫ ﯾُﻈﮭﺮ ﻣﺮﺣﻠﺔ اﻟﺘﻮزﯾﻊ اﻟﺴﺮﯾﻊ ﻣﻊ ﻧﺼﻒ ﻋﻤﺮ ﻟﻠﺘﻮزﯾﻊ ﯾﺒﻠﻎ ﺳﺘﺔ دﻗﺎﺋﻖ‬، ‫• ﺑﻌﺪ اﻹﻋﻄﺎء اﻟﺮاﺑﻊ‬
other pre_medicated drugs ‫اﻷدوﯾﺔ اﻷﺧﺮى‬
‫اﻟﻤﻌﺎﻟﺠﺔ ﻣﺴﺒﻘًﺎ‬
• Antacide:.non_particulate antacid,0.3 M sodium citrate, ، ‫ ﻏﯿﺮ ﻣﻀﺎد ﻟﻠﺠﺴﯿﻤﺎت‬:‫• ﻣﻀﺎد ﻟﻠﺤﻤﻮﺿﺔ‬
، ‫ ﻣﻮﻻر ﻣﻦ ﺳﺘﺮات اﻟﺼﻮدﯾﻮم‬0.3

.neutralize gastric PH > 3.5,

.30 ml oral 30 min. before induction, ‫ ﺗﺤﯿﯿﺪ‬PH ، 3.5 <‫اﻟﻤﻌﺪة‬

، ‫ ﻗﺒﻞ اﻟﺤﺚ‬.‫ دﻗﯿﻘﺔ‬30 ‫ ﻣﻞ ﻋﻦ طﺮﯾﻖ اﻟﻔﻢ‬30

.colloid antacid suspension may be more effective
than the non-particulate antacid in increasing gastric
fluid PH.
‫‪.antacid are effective on the fluid already present in the‬‬
‫‪stomach.‬‬
‫ﻗﺪ ﯾﻜﻮن اﻟﺘﻌﻠﯿﻖ اﻟﻐﺮواﻧﻲ اﻟﻤﻀﺎد ﻟﻠﺤﻤﻮﺿﺔ أﻛﺜﺮ ﻓﻌﺎﻟﯿﺔ ﻣﻦ ﻣﻀﺎد اﻟﺤﻤﻮﺿﺔ‬
‫ﻏﯿﺮ اﻟﺠﺴﯿﻤﻲ ﻓﻲ زﯾﺎدة درﺟﺔ اﻟﺤﻤﻮﺿﺔ ﻓﻲ ﺳﺎﺋﻞ اﻟﻤﻌﺪة‪.‬‬

‫ﻓﻌﺎل ﻋﻠﻰ اﻟﺴﻮاﺋﻞ اﻟﻤﻮﺟﻮدة ﺑﺎﻟﻔﻌﻞ ﻓﻲ اﻟﻤﻌﺪة‪.antacid .‬‬

• Phenothiazine: is a class of agents exhibiting antiemetic,antipsychotic
antihistaminic and anticholinergic activities.it antagonize the
dopamine 2_receptor in the chemoreceptor trigger zone of
the brain,potentially preventing chemotherapy induced
emesis. ‫ ﻓﻲ ﻣﻨﻄﻘﺔ ﺗﺤﻔﯿﺰ‬2 ‫ وھﻮ ﯾﻌﺎﻛﺲ ﻣﺴﺘﻘﺒﻞ اﻟﺪوﺑﺎﻣﯿﻦ‬.‫ ﻓﺌﺔ ﻣﻦ اﻟﻌﻮاﻣﻞ اﻟﺘﻲ ﺗﻌﺮض ﻧﺸﺎًطﺎ ﻣﻀﺎدًا ﻟﻠﻘﻰء وﻣﻀﺎدًا ﻟﻠﺬھﺎن وﻣﻀﺎدًا ﻟﻠﮭﯿﺴﺘﺎﻣﯿﻦ وﻣﻀﺎدًا ﻟﻠﻜﻮﻟﯿﻦ‬:‫• اﻟﻔﯿﻨﻮﺛﯿﺎزﯾﻦ‬
.‫ ﻣﻤﺎ ﯾﺤﺘﻤﻞ أن ﯾﻤﻨﻊ اﻟﺘﻘﯿﺆ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﻌﻼج اﻟﻜﯿﻤﯿﺎﺋﻲ‬، ‫اﻟﻤﺴﺘﻘﺒﻼت اﻟﻜﯿﻤﯿﺎﺋﯿﺔ ﺑﺎﻟﺪﻣﺎغ‬

.it include prochlorperazine,chlorpromazine and promethazine

commonly employed in the ER to treat severe nausea and
vomiting accompanying migraine.
.common side effects are ‫ ﺑﺮوﻛﻠﻮرﺑﯿﺮازﯾﻦ‬.
‫اﻵﺛﺎر اﻟﺠﺎﻧﺒﯿﺔ ھﻲ اﻟﺘﺨﺪﯾﺮ واﻟﻨﻌﺎس واﻻﻛﺎﺛﯿﺴﯿﺎ وﺧﻠﻞ اﻟﺘﻮﺗﺮ اﻟﻌﻀﻠﻲ‪common .‬‬
• Steroids: are man made version of chemicals,known as hormones,
thar are made naturally in the human body. steroids are
designed to act like these hormones to reduce inflammation.
they are also known as corticosteroids,and are different to
anabolic steroids used by body builders and athletes.
• ً ‫ ﺗ ُﻌﺮف أﯾ‬.‫ اﻟﻤﻨﺸﻄﺎت ﻣﺼﻤﻤﺔ ﻟﻠﻌﻤﻞ ﻣﺜﻞ ھﺬه اﻟﮭﺮﻣﻮﻧﺎت ﻟﺘﻘﻠﯿﻞ اﻻﻟﺘﮭﺎب‬.‫ ﺗﺼﻨﻊ ﺑﺸﻜﻞ طﺒﯿﻌﻲ ﻓﻲ ﺟﺴﻢ اﻹﻧﺴﺎن‬، ‫ ﺗﻌﺮف ﺑﺎﻟﮭﺮﻣﻮﻧﺎت‬، ‫ ھﻲ ﻧﺴﺨﺔ ﻣﻦ اﻟﻤﻮاد اﻟﻜﯿﻤﯿﺎﺋﯿﺔ اﻟﺘﻲ ﯾﺼﻨﻌﮭﺎ اﻹﻧﺴﺎن‬:‫• اﻟﻤﻨﺸﻄﺎت‬
، ‫ﻀﺎ ﺑﺎﺳﻢ اﻟﻜﻮرﺗﯿﻜﻮﺳﺘﯿﺮوﯾﺪات‬
.‫وﺗﺨﺘﻠﻒ ﻋﻦ اﻟﺴﺘﯿﺮوﯾﺪات اﻻﺑﺘﻨﺎﺋﯿﺔ اﻟﺘﻲ ﯾﺴﺘﺨﺪﻣﮭﺎ ﺑﻨﺎة اﻟﺠﺴﻢ واﻟﺮﯾﺎﺿﯿﻮن‬

.onset: between a few min. and several hrs, dependent on

indication and route of administration. .‫ ﺑﯿﻦ ﺑﻀﻊ دﻗﺎﺋﻖ‬:‫اﻟﺒﺪاﯾﺔ‬
.‫ ﺣﺴﺐ اﻹﺷﺎرة وطﺮﯾﻘﺔ اﻹﻋﻄﺎء‬، ‫وﻋﺪة ﺳﺎﻋﺎت‬
.dose: according to the case.‫ ﺣﺴﺐ اﻟﺤﺎﻟﺔ‬:‫ اﻟﺠﺮﻋﺔ‬.
• 5-Hydroxytryptamine: a hormone found in the brain,platelets,
digestive tract and pineal gland. it acts both as
neurotransmitter and vasoconstrictors. ‫ ھﺮﻣﻮن‬:‫• ھﯿﺪروﻛﺴﻲ ﺗﺮﯾﺒﺘﺎﻣﯿﻦ‬

.‫ إﻧﮫ ﯾﻌﻤﻞ ﻛﻨﺎﻗﻞ ﻋﺼﺒﻲ وﻣﻀﯿﻖ ﻟﻸوﻋﯿﺔ‬.‫ﻣﻮﺟﻮد ﻓﻲ اﻟﻤﺦ واﻟﺼﻔﺎﺋﺢ اﻟﺪﻣﻮﯾﺔ واﻟﺠﮭﺎز اﻟﮭﻀﻤﻲ واﻟﻐﺪة اﻟﺼﻨﻮﺑﺮﯾﺔ‬

5-HT3: selective serotonine receptor antagonist block serotonine

both peripherally on gastrointestinal vagal nerve terminals,
and centrally in the chemoreceptor trigger zone.this blockade
result in powerful antiemetic effects HT3: ‫ﯾﻤﻨﻊ ﻣﻨﺎھﺾ ﻣﺴﺘﻘﺒﻼت‬
‫اﻟﺴﯿﺮوﺗﻮﻧﯿﻦ اﻻﻧﺘﻘﺎﺋﻲ اﻟﺴﯿﺮوﺗﻮﻧﯿﻦ ﻋﻠﻰ ﺣﺪ ﺳﻮاء ﻣﺤﯿﻄﯿًﺎ ﻋﻠﻰ أطﺮاف اﻟﻌﺼﺐ‬
‫ ﯾﻨﺘﺞ ﻋﻦ ھﺬا‬، ‫ وﻣﺮﻛﺰﯾﺎ ﻓﻲ ﻣﻨﻄﻘﺔ اﻟﺰﻧﺎد اﻟﻜﯿﻤﯿﺎﺋﻲ‬، ‫اﻟﻤﮭﺒﻠﻲ اﻟﻤﻌﺪي اﻟﻤﻌﻮي‬
‫‪.‬اﻟﺤﺼﺎر ﺗﺄﺛﯿﺮات ﻗﻮﯾﺔ ﻣﻀﺎدة ﻟﻠﻘﻰء‪.‬‬
• Ondansetron (Zofran): the first commonly used 5HT3 antagonist,has
been followed by granisetron,dolasetron,tropisetron.
• HT3
5 ‫ أول ﻣﻧﺎھض‬:(‫• أوﻧداﻧﺳﯾﺗرون )زوﻓران‬ .‫ ﺗروﺑﯾﺳﺗرون‬، ‫ دوﻻﺳﯾﺗرون‬، ‫ ﺗﻼه ﺟراﻧﯾﺳﯾﺗرون‬، ‫ﺷﺎﺋﻊ اﻻﺳﺗﺧدام‬

• Indications:prevention of chemotherapy induced nausea&vomiting,

•.‫ اﻟﻮﻗﺎﯾﺔ ﻣﻦ اﻟﻐﺜﯿﺎن واﻟﻘﻲء اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﻌﻼج اﻟﻜﯿﻤﺎوى‬:‫• دواﻋﻰ اﻹﺳﺘﻌﻤﺎل‬

.prevention of radiation therapy induced nausea&vomiting

‫اﻟﻮﻗﺎﯾﺔ ﻣﻦ‬
‫اﻟﻌﻼج اﻹﺷﻌﺎﻋﻲ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﻐﺜﯿﺎن واﻟﻘﻲء‬
.prevention of post_operative nausea &vomiting ‫اﻟﻮﻗﺎﯾﺔ ﻣﻦ‬
‫اﻟﻐﺜﯿﺎن واﻟﻘﻲء ﺑﻌﺪ اﻟﺠﺮاﺣﺔ‬
 .treatment of post_operative nausea& vomiting.
.‫ﻋﻼج اﻟﻐﺜﯿﺎن واﻟﻘﻲء ﺑﻌﺪ اﻟﻌﻤﻠﯿﺔ اﻟﺠﺮاﺣﯿﺔ‬
Psychological factors in pediatric patients
‫اﻟﻌﻮاﻣﻞ اﻟﻨﻔﺴﯿﺔ ﻓﻲ ﻣﺮﺿﻰ اﻷطﻔﺎل‬
• The hospital stay is stressful and full of apprehension,

•، ‫• اﻹﻗﺎﻣﺔ ﻓﻲ اﻟﻤﺴﺘﺸﻔﻰ ﻣﺮھﻘﺔ وﻣﻠﯿﺌﺔ ﺑﺎﻟﺨﻮف‬

• Age is probably the most important aspect, ، ‫• رﺑﻤﺎ ﯾﻜﻮن اﻟﻌﻤﺮ ھﻮ اﻟﺠﺎﻧﺐ اﻷﻛﺜﺮ أھﻤﯿﺔ‬

• A baby younger than 6_8 months of age is not emotionally upset

when separated from his or her mother, ‫ أﺷﮭﺮ ﻻ ﯾﺸﻌﺮ ﺑﺎﻟﻀﯿﻖ ﻋﺎطﻔﯿﺎ ً ﻋﻨﺪ اﻧﻔﺼﺎﻟﮫ‬8_6 ‫• اﻟﻄﻔﻞ اﻟﺬي ﯾﻘﻞ ﻋﻤﺮه ﻋﻦ‬
، ‫ﻋﻦ واﻟﺪﺗﮫ‬

• Preschool children are upset when separated from their mothers and
fear the operating room, ، ‫• أطﻔﺎل ﻣﺎ ﻗﺒﻞ اﻟﻤﺪرﺳﺔ ﯾﻨﺰﻋﺠﻮن ﻋﻨﺪ ﻓﺼﻠﮭﻢ ﻋﻦ أﻣﮭﺎﺗﮭﻢ وﯾﺨﺎﻓﻮن ﻣﻦ ﻏﺮﻓﺔ اﻟﻌﻤﻠﯿﺎت‬

• It is easier to communicate with patient from age 5 years to

adolescence. .‫ ﺳﻨﻮات ﺣﺘﻰ اﻟﻤﺮاھﻘﺔ‬5 ‫• ﯾﺴﮭﻞ اﻟﺘﻮاﺻﻞ ﻣﻊ اﻟﻤﺮﯾﺾ ﻣﻦ ﺳﻦ‬
 • Good preoperative visit and proper psychological preparation may be
more important,
، ‫• ﻗﺪ ﺗﻜﻮن اﻟﺰﯾﺎرة اﻟﺠﯿﺪة ﻗﺒﻞ اﻟﺠﺮاﺣﺔ واﻹﻋﺪاد اﻟﻨﻔﺴﻲ اﻟﻤﻨﺎﺳﺐ أﻛﺜﺮ أھﻤﯿﺔ‬
 • Reassurance and explanation,gain the childs trust, ، ‫ وﻛﺴﺐ ﺛﻘﺔ اﻟﻄﻔﻞ‬، ‫• اﻻطﻤﺌﻨﺎن واﻟﺸﺮح‬

• Most anaesthesiologist will want to involve the parents, ‫• ﺳﯿﺮﻏﺐ ﻣﻌﻈﻢ أطﺒﺎء اﻟﺘﺨﺪﯾﺮ ﻓﻲ إﺷﺮاك‬
، ‫اﻟﻮاﻟﺪﯾﻦ‬

• Motion pictures,and slide shows to be helpful, ، ‫• اﻟﺼﻮر اﻟﻤﺘﺤﺮﻛﺔ وﻋﺮوض اﻟﺸﺮاﺋﺢ ﻟﺘﻜﻮن ﻣﻔﯿﺪة‬

• Bring a personal belonging (stuffed animal or blanket), (‫• إﺣﻀﺎر ﻣﻤﺘﻠﻜﺎت ﺷﺨﺼﯿﺔ )ﺣﯿﻮان ﻣﺤﺸﻮ أو ﺑﻄﺎﻧﯿﺔ‬
،

• Allow to baby to taken an active role (holding the face mask).

.(‫• اﺳﻤﺢ ﻟﻠﻄﻔﻞ ﺑﺄﺧﺬ دور ﻧﺸﻂ )إﻣﺴﺎك ﻗﻨﺎع اﻟﻮﺟﮫ‬
Differences in pharmacologic preparation
‫اﻻﺧﺘﻼﻓﺎت ﻓﻲ اﻟﺘﺤﻀﯿﺮ اﻟﺪواﺋﻲ‬
v Sedative_hypnotics: :‫اﻟﻤﮭﺪﺋﺎت‬

• The oral rout is often used,، ‫• ﻏﺎﻟﺒًﺎ ﻣﺎ ﯾﺘﻢ اﺳﺘﺨﺪام اﻟﻄﺮﯾﻖ اﻟﻔﻤﻮي‬
• In preschool children drugs may also be given rectally ‫• ﻓﻲ اﻷطﻔﺎل ﻓﻲ ﺳﻦ ﻣﺎ ﻗﺒﻞ اﻟﻤﺪرﺳﺔ ﯾﻤﻜﻦ أﯾًﻀﺎ إﻋﻄﺎء‬
‫اﻷدوﯾﺔ ﻋﻦ طﺮﯾﻖ اﻟﻤﺴﺘﻘﯿﻢ‬

• Midazolam by the oral route,achieved by mixing 0.5_0.75 mg/kg with

flavored syrup, .‫ ﻛﺠﻢ ﻣﻊ ﺷﺮاب ﻣﻨﻜﮫ‬/ ‫ ﻣﺠﻢ‬0.75_0.5 ‫ وﯾﺘﻢ ﺗﺤﻘﯿﻘﮫ ﺑﺨﻠﻂ‬، ‫• اﻟﻤﯿﺪازوﻻم ﻋﻦ طﺮﯾﻖ اﻟﻔﻢ‬

• Oral ketamine 5_10 mg/kg has been prescribed 20 to 30 min. before

induction. .‫ ﻗﺒﻞ اﻟﺤﺚ‬.‫ دﻗﯿﻘﺔ‬30 ‫ إﻟﻰ‬20 ‫ ﻛﺠﻢ ﺗﻢ وﺻﻔﮫ ﻣﻦ‬/ ‫ ﻣﺠﻢ‬10_5 ‫• اﻟﻜﯿﺘﺎﻣﯿﻦ ﻋﻦ طﺮﯾﻖ اﻟﻔﻢ‬

• Ketamine IM (5_10 mg/kg) in older or handicap,

‫اﻟﻜﯿﺘﺎﻣﯿﻦ ﻋﻦ طﺮﯾﻖ اﻟﻌﻀﻠﺔ‬
‫) ‪٥_1٠‬ﻣﺠﻢ‪/‬ﻛﺠﻢ(‬
‫ﻓﻲ ﻛﺒﺎر اﻟﺴﻦ أو ذوي اﻻﻋﺎﻗﺔ‬

‫‪• Both ketamine (3_8 mg/kg) and midazolam (0.2 mg/kg) can be given‬‬
‫‪using a nasal atomizer,‬‬ ‫• ﯾﻤﻜﻦ إﻋﻄﺎء ﻛﻞ ﻣﻦ اﻟﻜﯿﺘﺎﻣﯿﻦ )‪ 8_3‬ﻣﺠﻢ ‪ /‬ﻛﺠﻢ( واﻟﻤﯿﺪازوﻻم )‪ 0.2‬ﻣﺠﻢ ‪ /‬ﻛﺠﻢ( ﺑﺎﺳﺘﺨﺪام رذاذ اﻷﻧﻒ‪.‬‬

‫‪• Ketamine (5mg/kg) and midazolam (0.3 to 1mg/kg) have also been‬‬
‫‪given rectally (rare),‬‬ ‫• اﻟﻜﯿﺘﺎﻣﯿﻦ )‪ 5‬ﻣﺠﻢ ‪ /‬ﻛﺠﻢ( واﻟﻤﯿﺪازوﻻم )‪ 0.3‬إﻟﻰ ‪ 1‬ﻣﺠﻢ ‪ /‬ﻛﺠﻢ( ﺗﻢ إﻋﻄﺎؤھﻢ ﻋﻦ طﺮﯾﻖ اﻟﻤﺴﺘﻘﯿﻢ )ﻧﺎدر(‪.‬‬

‫‪• Methohexital rectally (20_30 mg/kg) may be given immediately‬‬

‫‪before operation (rare).‬‬
‫• ﯾﻤﻜﻦ إﻋﻄﺎء اﻟﻤﯿﺜﻮھﻜﺴﯿﺘﺎل ﻋﻦ طﺮﯾﻖ اﻟﻤﺴﺘﻘﯿﻢ )‪ 30_20‬ﻣﺠﻢ ‪ /‬ﻛﺠﻢ( ﻣﺒﺎﺷﺮة ﻗﺒﻞ اﻟﻌﻤﻠﯿﺔ )ﻧﺎدًرا(‪.‬‬
v Opioids:‫أﻓﯿﻮﻧﯿﺎت اﻟﻤﻔﻌﻮل‬
• Occasional need,، ‫• اﻟﺤﺎﺟﺔ اﻟﻌﺮﺿﯿﺔ‬
• Methadone oral 0.1_0.2 mg/kg dose,، ‫ ﻛﺠﻢ‬/ ‫ ﻣﺠﻢ‬0.2_0.1 ‫• ﺟﺮﻋﺔ اﻟﻤﯿﺜﺎدون ﻋﻦ طﺮﯾﻖ اﻟﻔﻢ‬
• Intramuscular morphine and pethidine are used,، ‫• ﯾﺘﻢ اﺳﺘﺨﺪام اﻟﻤﻮرﻓﯿﻦ اﻟﻌﻀﻠﻲ واﻟﺒﯿﺜﯿﺪﯾﻦ‬
• Opioid+sedative_hypnotic+anticholinergic drugs (cocktail) given orally
• ‫ ﻣﻀﺎدات اﻟﻜﻮﻟﯿﻦ )ﻛﻮﻛﺘﯿﻞ( ﺗﻌﻄﻰ ﻋﻦ طﺮﯾﻖ اﻟﻔﻢ‬+ ‫ اﻟﻤﮭﺪﺋﺔ_ اﻟﻤﻨﻮﻣﺔ‬+ ‫• اﻷدوﯾﺔ اﻷﻓﯿﻮﻧﯿﺔ‬

• Transmucosal administration of fentanyl (5_20 mcg/kg), ‫• اﻹﻋﻄﺎء ﻋﺒﺮ اﻟﻐﺸﺎء اﻟﻤﺨﺎطﻲ ﻟﻠﻔﻨﺘﺎﻧﯿﻞ‬
، (‫ ﻛﻎ‬/ ‫ ﻣﯿﻜﺮوﻏﺮام‬20_5)

• fentanyl (2mcg/kg) and sufentanil (3 mcg/kg) given by the intranasal

route.
‫• اﻟﻔﻨﺘﺎﻧﯿﻞ )‪ 2‬ﻣﯿﻜﺮوﺟﺮام ‪ /‬ﻛﺠﻢ( واﻟﺴﻮﻓﯿﻨﺘﺎﻧﯿﻞ )‪ 3‬ﻣﯿﻜﺮوﺟﺮام ‪ /‬ﻛﺠﻢ( ﯾﻌﻄﻰ ﻋﻦ طﺮﯾﻖ اﻷﻧﻒ‪.‬‬
v Anticholinergics:‫ﻣﻀﺎدات ﻣﻔﻌﻮل اﻟﻜﻮﻟﯿﻦ‬
• Child easily induced vagal reflexes,، ‫• ﺣﺪوث ردود ﻓﻌﻞ ﻣﺒﮭﻢ ﻟﺪى اﻟﻄﻔﻞ ﺑﺴﮭﻮﻟﺔ‬
• Bradycardia may result from:airway manipulation,surgical
manipulation,or succinylcholine,
• ، ‫ اﻟﺘﻼﻋﺐ ﻓﻲ ﻣﺠﺮى اﻟﮭﻮاء أو اﻟﻤﻌﺎﻟﺠﺔ اﻟﺠﺮاﺣﯿﺔ أو اﻟﺴﻜﺴﯿﻨﯿﻞ ﻛﻮﻟﯿﻦ‬:‫• ﻗﺪ ﯾﻨﺘﺞ ﺑﻂء اﻟﻘﻠﺐ ﻋﻦ‬

• Childs cardiac output is more dependent on heart rate,

• ، ‫• اﻟﻨﺘﺎج اﻟﻘﻠﺒﻲ ﻟﺪى اﻷطﻔﺎل أﻛﺜﺮ اﻋﺘﻤﺎدًا ﻋﻠﻰ ﻣﻌﺪل ﺿﺮﺑﺎت اﻟﻘﻠﺐ‬

• Atropine IM/IV, glycopyrrolate,scopolamine (sedation,amnesia and

drying of the airways),
• IM / IV ،
‫اﻷﺗﺮوﺑﯿﻦ‬ ، (‫ ﻓﻘﺪان اﻟﺬاﻛﺮة وﺗﺠﻔﯿﻒ اﻟﻤﻤﺮات اﻟﮭﻮاﺋﯿﺔ‬، ‫ ﺳﻜﻮﺑﻮﻻﻣﯿﻦ )اﻟﺘﺨﺪﯾﺮ‬، ‫ﺟﻠﯿﻜﻮﺑﯿﺮوﻻت‬
 ‫‪• One must be aware (fever,down syndrome).‬‬
‫• ﯾﺠﺐ أن ﯾﻜﻮن اﻟﻤﺮء ﻋﻠﻰ ﻋﻠﻢ )اﻟﺤﻤﻰ ‪ ،‬ﻣﺘﻼزﻣﺔ داون(‪.‬‬
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