Anaesthetic Agents

Anaesthetic Agents
General anaesthesia is an altered
physiological state with reversible loss of
consciousness (anaesthesia), analgesia,
amnesia & some muscle relaxation.
Drugs used:
1) Inhalational agents (volatiles)
2) Nonvolatile anaesthetic agents
3) Neuromuscular blocking agents
General Anaesthesia
3 phases:
1) Induction
2) Maintenance
3) Emergence
IV Induction Agents
Sodium Thiopentone
Propofol
Etomidate
Ketamine
Sodium Thiopental
Barbiturate
Cerebral protection
Also indicated for Status Epilepticus
Hang over (long half life)
Powder to mix
Smells like garlic
Dose 4-6mg/Kg
Caution
Caution in hypovolaemia
Less drop in BP d/t compensatory
tachycardia
Caution in elderly
Avoid in patients with Porphyria
Necrosis if intra-arterial (pH 11)
Propofol
An emulsion of a soya oil/propofol
mixture in water
Anti emetic
Anti pruritus
Anticonvulsant
TIVA / TCI / sedation (infusion)
Dose 2-2.5mg/Kg
Caution

HYPOVOLAEMIA
Reduce dose in elderly
Pain on injection (Lignocaine10mg)
Allergy eggs, peanuts, soya, soyabean
DECREASES BP AND HR
Etomidate
Cardiostable in therapeutic dose
Pain on injection
Will cause myoclonus
Causes severe PONV
Short half life
Dose 0.2-0.3mg/Kg
Caution

Burns
Adrenal Suppression
 Expensive
Epileptics- lowers seizure threshold
Ketamine
Dose 1-2mg/Kg
Dissociative anaesthesia
Sympathetic stimulation but myocardial
suppressant
Pain dose: 0.3mg/kg
Bronchodilation
Caution

Emergence delirium reduced by benzo’s

Caution in hypertension
Excess Salivation (give Antimuscarinic drug)
Increase ICP
Depress Respiration only if given rapidly
Long term psychiatric effect
Avoid in psychiatric patients
Analgesic agents:
Opioids
Paracetamol
NSAIDS
Opioids
Morphine
Only give IV with supplemental O2 under
SpO2 and BP monitoring with
resuscitation equipment available
Full effect only after 20 min
Lasts 4 to 6 hours in healthy adults
Caution

Respiratory Depression – prolonged

when given via spinal / epidural
Nausea, vomiting
Dysphoria
Histamine release: Pruritus, hypotension,
bronchospasm
Constipation, Urine retention
Kidney Failure
Fentanyl/Sufentanil
Cardiostability
Highly fat soluble
Onset of action: 5min
Duration 30-60min
Sufentanil does not accumulate with
continuous infusion TIVA
Can use Fentanyl intrathecally/epidurally
Caution
Bradycardia
Respiratory depression
High dose: Muscle Rigidity!! Only to be
used in theatre
Reduce MAC
Also used as a co-induction agent
Alfentanil
Onset 90 sec
Duration 10min
Obtunds intubation response in
hypertensives or PIH/eclamptic pts
Caution: Causes bradycardia and
hypotension
Remifentanil
Ultra-short acting opioid metabolised by
plasma esterases
Used as an infusion as an adjunct to
anaesthesia either for haemodynamic
reasons or TIVA/TCI
Need to give morphine 20mins prior to
wake-up.
Caution: Severe bradycardia and
hypotension
Paracetemol
Vitalcomponent of multi-modal analgesia
Used ivi, pr and po
Opiate sparing
Minimal side effects and safe to use in
most patients
Caution in patients with hepatic
impairment and neonates/prems
NSAIDS
Also important in analgesia
COX inhibitors
Caution in elderly, hypertensives,
children<1yr, PUD, orthopaedics, plastics
Used ivi, pr, po, imi
Eg. Diclofenac, Ketorolac, Ibuprofen
Neuromuscular Blocking Drugs
Depolarizing
◦ Suxamethonium
Non Depolarizing
◦ Atracurium
◦ Cisatracurium
◦ Vecuronium
◦ Rocuronium
◦ Pancuronium
Reversal
How to choose a NMBA
Pt factors: Full stomach, renal failure,
liver failure, allergy, porphyria, scoline
apneoa, burns, spinal cord injury, asthma
Surgical factors: Duration of surgery,
neurosurgery
Suxamethonium
Onset 30-60 sec
Offset 5-10min
(plasma cholinesterase dependant)
Use in Classic RSI
Dose 1-2 mg/kg
Caution

• Fasciculations
• Muscle pain
• Hyperkalaemia
• Autonomic effects- Bradycardia NB
paeds
• Masseter Rigidity and Malignant
Hyperthermia
• Intracranial Pressure Elevation
• Intraocular Pressure Elevation
• Intragastric Pressure Elevation
• Histamine release – Anaphylaxis
• Burns and Spinal cord injuries
• NB in paeds risk of undx’d myopathy
Atracurium
Temperature and pH dependant Hoffmann
elimination (non-specific enzymes)
Dose 0.5mg/kg
Onset 3min
Duration 20-30min
Mild Histamine release
◦ Rash
◦ Hypotension
◦ Bronchospasm
Cisatracurium
Isomer of Atracurium
Temperature and pH dependant Hoffmann
elimination (non-specific enzymes)
Dose 0.15mg/kg
Onset 5 min
Duration 30-45min
No Histamine release
Vecuronium
Steroid – Liver metabolism + renal
excretion
Onset 3min
Action 20 to 30min
No cardiovascular effect
Dose 0.1mg/kg
Rocuronium
Dose Onset Offset
0.3mg/kg 3min 25min
0.6mg/kg 2min 45min
1.2mg.kg <1min >60min
Neostigmine- 40μg/kg
Reversal of non-depolarising muscle
relaxants
Full Onset 5-10min
Duration 60min
Administer with Antimuscarinic agent
Atropine 20μg/kg or
Glycopyrrolate 10μg/kg
Caution

Bradycardia
Nausea and Vomiting
Excessive salivation
Thank you