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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 Definitive analgesia Anti-emetic

Propofol

Maintenance

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. Used for gaseous induction.

Sevoflurane (SEVO) MAC = 2.2

Nitrous Oxide a gas. MAC = 105 Propofol and Remifentanil

MAC = minimum alveolar concentration

Muscle Paralysis

Neuromuscular blockers

Depolarising

Suxamethonium Atracurium Vecuronium Rocuronium

Non-depolarising

Nicotinic ACh Receptor

Reversal of Paralysis

Neostigmine

Blocks cholinesterase Stimulates nicotinic and muscarinic Given with an anticholinergic

Sugammadex

Uppers

Anticholinergics

Atropine Glycopyrulate

Symatheto-mimetics

agonists

Phenylepherine Metaraminol

Ephidrine

A mixed and adreno agonist

Downers
More anaesthetic or opiate
Short acting -blockers (labetalol, esmolol) GTN Clonidine - 2 agonist clonidine

Opiates

Morphine Fentanyl Alfentanil Remifentanil

Antiemetics

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)