Review of Pharmacology - 9E (2015)

Review of Pharmacology
Agent
Thiopentone
Summary of systemic effects of intravenous anaesthetics
Cardiovascular
system
Heart
rate
↑
(reflex)
Mean
arterial
Central nervous system
O 2
of
consumption
brain
ICT
Cerebral
blood
flow
Respiratory system
Ventilation
Bronchial
muscles
↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓ Constriction
(tachycardia)
Methohexital ↑ ↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓ Constriction
Ketamine ↑↑ ↑↑ ↑↑ ↑↑ ↓↓↓ ↑ Dilatation
Propofol 0 ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓ 0
Etomidate 0 ↓ ↓↓ ↓↓ ↓↓ ↓ 0
2. Slow Acting Agents
A. Benzodiazepines
• Important benzodiazepines are diazepam, lorazepam and midazolam.
• These are not analgesic agents.
• However, these possess muscle relaxing and anticonvulsant property.
• Lorazepam is the most commonly used benzodiazepine in pre-anaesthetic
medication.
• Midazolam is used for day care surgery.
• These agents may cause sedation and anterograde amnesia.
Anaesthesia
Drugs Useful for Day Care
Surgery
Dr
Manmohan
Singh
Is
A
Prime
Minister
Desflurane
Midazolam
(Benzodiazepine)
Sevoflurane
Isoflurane
Alfentanil
Propofol
Mivacurium
(Muscle relaxant)
B. Opioids
• Fentanyl, alfentanil, sufentanil and remifentanil are the opioids used in anaesthesia.
• These are 100 times more potent than morphine. Sufentanil is the most potent
opioid.
• These drugs possess very strong analgesic activity.
• Fentanyl is used along with droperidol for neurolept analgesia.
• If nitrous oxide is also added, the combination can be used as neurolept anaesthesia
(N 2
O + fentanyl + droperidol).
• These agents can lead to post operative muscle rigidity (SCh causes post operative
muscle pain and fasciculations).
• Alfentanil is used for day care surgery and for total intravenous anaesthesia.
• Remifentanil is the shortest acting opioid (due to its metabolism by esterases).
C. Neuroleptic agent
• Droperidol is a D 2
receptor blocker.
• It is used along with fentanyl to produce neurolept analgesia and neurolept
anaesthesia.
• It can produce extrapyramidal symptoms.
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