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anaesthetic drugs - PowerPoint PPT Presentation


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James Holding. Green for Danger - Rank Films 1946. 2009 Anaesthesia. Intravenous induction Short acting opiate - e.g. fentanyl ‘anaesthetic’ - e.g. propofol Set up of anaesthetic maintenance - e.g. sevoflurane vapour in oxygen and air Specific muscle paralysis may be needed

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2009 anaesthesia
2009 Anaesthesia
  • Intravenous induction
  • Short acting opiate - e.g. fentanyl
  • ‘anaesthetic’ - e.g. propofol
  • Set up of anaesthetic maintenance - e.g. sevoflurane vapour in oxygen and air
  • Specific muscle paralysis may be needed
  • Definitive analgesia
  • Anti-emetic
maintenance12
Maintenance

Concepts of partial pressure and MAC

  • Isoflurane (ISO) – MAC = 1.1
  • Desflurane (DES) – MAC = 6
    • The most insoluble – so the fastest to equilibrate – but a respiratory irritant, so unsuitable for gaseous induction.
  • Sevoflurane (SEVO) – MAC = 2.2
    • Used for gaseous induction.
  • Nitrous Oxide – a gas. MAC = 105
  • Propofol and Remifentanil
neuromuscular blockers
Neuromuscular blockers
  • Depolarising
    • Suxamethonium
  • Non-depolarising
    • Atracurium
    • Vecuronium
    • Rocuronium
reversal of paralysis
Reversal of Paralysis
  • Neostigmine
    • Blocks cholinesterase
    • Stimulates nicotinic and muscarinic
    • Given with an anticholinergic
  • Sugammadex
uppers
Uppers
  • Anticholinergics
    • Atropine
    • Glycopyrulate
  • Symatheto-mimetics
    •  agonists
      • Phenylepherine
      • Metaraminol
    • Ephidrine
      • A mixed  and  adreno agonist
downers
Downers

More anaesthetic or opiate

Short acting -blockers (labetalol, esmolol)

GTN

Clonidine - 2 agonist clonidine

slide21

Opiates

Morphine

Fentanyl

Alfentanil

Remifentanil

antiemetics23
Antiemetics
  • Cyclizine – an anti-histamine (SE – tachycardia and other anti-cholinergic effects)
  • Granisetron and ondansatron – 5-HT3 receptor antagonists (SE – constipation)
  • Prochlorperazine (stematil) – a dopamine and mACh receptor antagonist (SE – extrapyramidal)
  • Dexamethasone – a glucocorticoid (SE – deranged glucose control)
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